Waiting Room Therapy III


waiting-room-DS9_0928-bw

“You’re back. It’s been a while.”

“I was scheduled to come with my husband. I told him I cancelled and came alone.”

“You got married!”

“It’s not that exciting, you know.”

“Well, I was wondering when it would happen for you.”

“Gee, thanks!”

“Do I smell trouble already?”

“No. Everything is wonderful. Why, can’t I come to therapy alone? I give him everything else.”

“Hmm. Yeah. OK.”

“Fine. I am just…grieving.”

“You are always griving.”

“It’s not my fault I get attached to people. It’s just my nature.”

“You have choice. There would be no sense of loss without a sense of ownership.”

“Sounds like you know the feeling.”

“If I can quit drinking, you can quit anyone.”

“I know. I have done it a million times.”

 

 


I Don’t Want To Talk About It.


not-talking

Often times people will come to therapy knowing exactly what the issues are but not really wanting to talk about them. They will hint at those issues, tip toe around them to see if it’s even safe to bring those things up. If the therapist gets the hint and probes deeper, the person may shut down, back away, deny and often get frustrated with the therapist. If the therapist doesn’t get the hint, the person may shut down, back away, deny (in silence) and get angry and frustrated with the therapist.

So, why would then someone come to therapy in the first place?

Because therapists ARE supposed to hear what’s not being said, unfold the story that’s not being told.

Here are some of the “don’t want to talk about it” issues people are secretly dying to talk about:

1. Addictions (alcohol, drugs, food, gambling, overspending, sex)

2. Social anxiety & Introversion

3. Unrecognized grief (you don’t get a sympathy card for this one)

4. Money problems

5. Sexual problems

6. Failures/mistakes

7. Depression (mostly in men)

8. Love (or lack there of)

9. Parents

10. Trauma

If you can relate to any of this, you probably have learned that talking about these issues is not safe. Safety is one of the most important basic needs we have as humans. And I’m not just talking about physical safety. We need emotional safety to thrive. Many people in our lives are unsafe for us, often this includes loved ones, parents, partners, etc. This makes it hard to go to them for help when you really need it. Safety is established when you know you will be loved and accepted even after you disclose intimate things about yourself. Safety means you will not be rejected, shunned, criticized and punished for who you are. The need for safety is a powerful driving force. So pay attention to it. Get better at identifying unsafe people or unsafe topics to discuss with particular people.

Because the only thing worse than not talking about it, is talking about it with an unsafe person.

OK, but even if I find a safe person to talk to about my issues, does that mean I will feel better?

Good question. I believe that real change and transformation often can not even be conceived without the talking part. This is particularly true for addictions especially in the early stages of change which are characterized by ambivalence (conflict between the desire to continue behavior/drug and necessity/desire to stop). Talking is also very beneficial for processing certain emotions such as sadness and can significantly alleviate depression and feelings of loneliness. Talking can greatly help in the cases of trauma or childhood wounding. On the other hand,  I think some things you just have to do and not talk too much about. Talking sometimes can be a form of  rumination which is a symptom of depression and anxiety. I like to call that unproductive talking. Talking is not particularly helpful for emotions like anger, anxiety or fears. People who worry love to talk about what worries them. That does not mean they feel better afterwards. In fact, they may even feel worse. In these cases therapy needs to be more contained, oriented and structured. Also, in these cases the real “therapy” happens between sessions so homework is essential.

It’s always rewarding to see that my clients are making progress and feeling better. It’s wonderful to hear praise from them, to know that the work we’re doing has had a significant, long-lasting impact on their lives. I always joke around and say “I’m THAT good.” The truth is, I can’t possibly take all the credit. They are getting better because they are TALKING about something they did not want to talk about. They are getting better because they are DOING their homework.


How To Approach Realtionships Like a Job Interview.


I’m back in therapy. After 4 years of doing relatively well, I felt I had come to a point where I needed to explore some patterns that keep creeping up in my life. Patterns are telling. Pay attention to them. They are desperately trying to tell you something about yourself.

My therapist gave me an assignment. I can’t believe I have never done this before. A list of non-negotiable and negotiable characteristics I would like to see in a partner. This was to be completely separate from actual relationships, past or present. Purely focused on me. Relationships are a very important aspect of one’s life. So why is it that we typically do not go about them in a systematic way? The same way we go about finding a job or buying a house or grocery shopping? We often base relationships on how they FEEL in the beginning, and go with the flow without thinking about things too much.

I have to confess. I have a tendency to be impulsive. I have done things in the past purely based on how they feel. I also thought I wasn’t very clear about what I wanted since I change my mind a lot but as I set down for this assignment things were clearer to me than they have ever been. Truthfully, these thoughts have been dominating my wants and needs historically. I just never wrote them down. Of course, they are subject to change. We are subject to change. Relationships also change with time. But I had to focus on the here-and-now.

Here’s my list.

Not negotiable                                                                                   

Independent (work/career)

Emotionally independent/not needy

Safe (emotionally – I can be myself)

Reliable/trustworthy

Experience seeker/traveler

Smart

Secure/healthy self-esteem

Good sense of humor

Affectionate/loving/caring

Generous

Preferences/Negotiable

Outdoorsy/adventurous

Non-traditional (beliefs)/quirky

A good sense of style

Good cook

Into movies/music/art/photography (similar interests)

Spontaneous

Happy/playful

Good listener

 

I don’t think my list is unreasonable. Also because I am able to offer pretty much everything I’m asking for.

So whether you’re in a relationship or not, what’s your list?


More on Marital Games


From Eric Berne’s Games People Play

If it Weren’t For You. This is a typical marital game. Mrs. White complained that her husband severely restricted her social activities so that she had never learned to dance. At some point the husband became less sure of himself and more indulgent. Mrs. White at that point is free to enlarge the scope of her activities. She signs up for dancing classes but then discovers to her despair that she had a morbid fear of dance floors and ends up abandoning the project. This unfortunate adventure, along with similar ones, exposed some important aspect of the structure of her marriage. Out of many suitors she had picked a domineering man for her husband. She was then in a position to complain that she could do all sorts of things ‘if it weren’t for you”. Many of her women friends also had domineering husbands and would often get together for a game of “if it wasn’t for him”. As it turns out, however, her husband is performing a very real service for her by forbidding her to do something she is deeply afraid of and by preventing her from becoming aware of her fears. But to the woman, marriage has proven one thing “all men are mean and tyrannical”

As long as the husband is prohibitive the game can proceed. If instead of saying “Don’t you dare!” he says “Go ahead!” the underlying phobias are unmasked and the wife can no longer turn on him. In other words, game over.

Harried. This is a typical housewife game. Her life requires her to be ten or twelve different things, often at once: mistress, mother, housemaid, nurse, etc. Now if the wife is able to find satisfaction in this while doing her best, she may be able to enjoy her 25 years and see her youngest child go off to college with a pang of loneliness. But if, on the other hand, she is driven by her inner Parent (the part of our Ego that represents our parents) and called to account by a critical husband, she may grow more and more unhappy. What to do? Let’s play Harried. In this game the wife takes on everything that comes and even asks for more. She agrees with her husband’s criticism and accepts all her children’s demands. If she has to entertain at dinner, she not only feels she must function impeccably as conversationalist, interior decorator, caterer, glamour girl, virgin queen and diplomat, she will also volunteer that morning to bake a cake a take the children to the dentist. Then in the middle of the afternoon she justifiably collapses and nothing gets done. Her self-reproaches adds to her misery. After this happens two or three times, her marriage is in jeopardy, the children are confused, she loses weight, her hair is untidy, her face is drawn and her shoes are scuffed.

How not to play the game: ask for help and be able to accept it. If the wife is playing Harried, it will be hard for her to stick to this principal. It is important to mention here, that the culprit is more likely the wife’s parent and not the husband. Harried, can quicly progress to divorce.

Look how hard I’ve tried. This is a game played with three characters, husband wife and the therapist. The couple is having trouble in their marriage and have come to therapy. The husband (usually) is bucking for a divorce while the wife genuinely wants to work things out. The husband comes to therapy under protest and talks just enough to demonstrates to the wife that he’s cooperating; usually he plays a mild game of Courtroom. As times passes he exhibits either resentful pseudo-compliance or belligerent argumentativeness towards the therapist. After 5 or 6 visits, he refuses to come any longer and goes hunting or fishing instead. The wife is then “forced” to file for divorce. The husband is now blameless since the wife has taken the initiative. He is in a good position to say to any attorney, judge or friend: Look how hard I’ve tried”

Once the therapist realizes the husband is playing this game, the wife should be seen alone, on the valid ground that the husband is not ready for therapy. He can still get a divorce but only at the expense of abandoning his position that he’s really trying.

In everyday form this is observed in children as a two-handed game with one parent. It is played from two positions: “I’m helpless”-child tries but is unsuccessful so the parent has to do it for him. “I’m blameless”-the parent has no reasonable ground for punishing him.

Sweetheart. Mr. White makes a subtly derogatory remark about Mrs. White, disguised as an anecdote, and ends: “Isn’t that right, sweetheart?” Mrs. White tends to agree for two reasons: a) because the anecdote itself, in the main, is accurately reported and b) because it would seem rude to disagree with a man who calls her sweetheart in public. The psychological reason for her agreement however is her depression position: Mr. White would expose her flaws thus saving her from having to do it herself. Her parents may have “accommodated” her in the same way perhaps.

The anti-sweetheart, or refusal to play would sound like this: “you can tell derogatory anecdotes about me, but please don’t call me sweetheart”. A more sophisticated and less dangerous antithesis is to reply “yes honey”. In another form, the wife instead of agreeing, responds with a similar sweetheart type anecdote about the husband “you have an ugly face too, dear”. Sometimes, the endearments are not actually pronounced but a careful listener can hear them. This is the “Sweetheart” silent type.


The Online Disinhibition Effect


What causes online disinhibition? What is it about cyberspace that loosens the psychological barriers that block the release of  inner feelings and needs?

You Don’t Know Me (dissociative anonymity): anonymity works wonders for the disinhibition effect. When people have the opportunity to separate their actions from their real world and identity, they feel less vulnerable about opening up

You Can’t See Me (invisibility): Invisibility gives people the courage to go places and do things that they otherwise wouldn’t. Not only that, but online you can’t see or hear the other person or their reaction to you. This can be quite therapeutic, but impersonal at the same time. In psychoanalysis, the analyst sits behind the patient in order remain a physically ambiguous figure, without revealing any body language or facial expression, so that the patient has free range to discuss whatever he or she wants, without feeling inhibited by how the analyst is physically reacting.

See You Later (asynchronicity): In email and message boards people don’t interact with each other in real time. Others may take minutes, hours, days, or even months to reply to something you say. Not having to deal with someone’s immediate reaction can be disinhibiting. In real life, it would be like saying something to someone, magically suspending time before that person can reply, and then returning to the conversation when you’re willing and able to hear the response. On the other hand, that response does not come quickly enough. This may contribute to what I like to call compulsive email checking. This is based on the principal of variable ratio schedule of reinforcement (a reinforcement schedule in which the number of responses necessary to produce reinforcement varies from trial to trial) . I will use my dogs to explain this. I let them out in the backyard to play and when I call them they don’t want to listen. They are having too much fun. So I shake a box of their favorite treats to get their attention. They come running back into the house expecting a treat. But I don’t always give them one. It works every time. Why? Because they can not predict whether or not they will get a treat so they produce the desired behavior “thinking” they will. This is the same mechanism slot machines use and it’s precisely why gambling is so addictive.

It’s All in My Head (solipsistic introjection): With online communication there is a “blending” of the minds that happens meaning your mind has merged with the mind of the online companion. The online companion now becomes a character within our intrapsychic world, a character that is shaped partly by how the person actually presents him or herself via text communication, but also by our expectations, wishes, and needs. It appears that our social interactions are more distorted than ever with the help of social media and the internet.

It’s Just a Game (dissociative imagination) Emily Finch, an author and criminal lawyer studying identity theft in cyberspace, has suggested that some people see their online life as a kind of game with rules and norms that don’t apply to everyday living (pers. comm., 2002). Once they turn off the computer and return to their daily routine, they believe they can leave that game and their game-identity behind. Why should they be held responsible for what happens in that make-believe play world that has nothing to do with reality?

Given these factors, it is easy to see how online chat rooms, gaming and role play has become so addictive. And who’s to say that’s necessarily a bad thing?

References

John Suler @ The Zur Institute The Online Disinhibition effect


NIMH · Obsessive-Compulsive Disorder


Since I believe that addictive behaviors have a obsessive-compulsive nature I thought this info would be useful. This was taken from the National Institute of Mental Health publication on Anxiety Disorders @ http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-index.shtml

NIMH · Obsessive-Compulsive Disorder.

“I couldn’t do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn’t. It took me longer to read because I’d count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn’t add up to a ’bad’ number.”

“I knew the rituals didn’t make sense, and I was deeply ashamed of them, but I couldn’t seem to overcome them until I had therapy.”

“Getting dressed in the morning was tough, because I had a routine, and if I didn’t follow the routine, I’d get anxious and would have to get dressed again. I always worried that if I didn’t do something, my parents were going to die. I’d have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.”

People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.

For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

OCD affects about 2.2 million American adults, and the problem can be accompanied by eating disorders, other anxiety disorders, or depression. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.

The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. NIMH is supporting research into new treatment approaches for people whose OCD does not respond well to the usual therapies. These approaches include combination and augmentation (add-on) treatments, as well as modern techniques such as deep brain stimulation.


Love


For someone who is addicted to alcohol or drugs, that pill or joint or line of cocaine, that glass of wine, beer is the object of one’s desire. When you’re addicted you LOVE that glass of wine, that glass of wine is your best friend, you miss it when it’s not there, you panic when its Sunday morning and you can’t buy it till noon. You have a love relationship with the object of your addiction. If you have ever been in romantic love with someone this is very similar. More specifically, it’s very much like an abusive relationship, a love that hurts, a love you can’t break free from. Your friends don’t understand how you can still love vodka after 3 DUIs and countless court appearances and fines. Your friends just don’t get it. Vodka is your lover. And I’m not joking. Vodka is the lover and you are misunderstood. Same principal applies to that pint of ice cream in your freezer, bacon or a big Mac, that fabulous pair of Prada shoes or Gucci handbag, the feel of the green felt on the black jack table, sex, porn, World of Warcraft, and the list goes on. Now, there is a normal degree of eating fast food, splurging on a Gucci purse, buying scratch off tickets or getting really good at Guitar Hero. What I’m talking about here is pure love. Love that takes over everything else in you life and makes you feel more wonderful than any lover has eve been able to make you feel. Love you would lie, steal, kill for, sell you soul to the devil for, love that gives you butterflies in your stomach, excites you beyond ecstasy, makes you forget you haven’t showered or eaten,  love that consumes you so much you can’t really focus on anything else, and you can no longer remember what your life was like before it. Love that finds you, sees you, deep in you and makes you feel alive. Love that completes you.

After a while though it’s not so great anymore. And to make matters worse most addictions have significant consequences which are negative, destructive and often irreversible. You were found and now you’re lost. And now its even worse because you know what you are missing. But you also know there is only one way out. Quit . And when you do, this is one of the greatest losses you’ll ever experience in your life.

But you make that commitment and do all the hard work and you’re clean and sober for a while. Maybe a year goes by and you have finally discovered a way to feel excited, happy and complete again. And then you meet an old friend you used to drink with and they have no idea how great you’re doing, they invite you for a beer and you think “heck I deserve it, only one”. Before you know it, you are on your 12th and have started doing shots and now you really want some coke. Yeah, that would be fantastic right about now! And then…well, long story short, you wake up next to a transvestite prostitute, your wallet has disappeared, you  can’t find your car and have no idea where you are or how you got there.

There is a point to this I promise. And this is my newest theory about addictions. Ready?

Addictive behaviors are human’s way of cheating death. And not just because they satisfy our innermost primitive pleasure instinct (also known as the life instinct) but also because every time we pick up after we quit we exercise a superhuman power of reviving our love from the dead. And isn’t that the oldest, most universal fantasy of our species? When we lose someone in our life to death we know they are not coming back. Death is irreversible and leaves us powerless in despair. A lot of our behaviors go back to our attempts to deal with the permanency of our mortality and addiction can be a very effective cheating system for a while. But this system is faulty. The truth is, no one can have a permanent or even long-term relationship with their drug. There is typically no such thing as married till death do us part. Unless you overdose, which sadly happens a lot. And every time one “revives” their drug they are setting themselves up for another loss, another burial and the pain that comes with it, feeling it all, all over again. And you may be cheating death but you’re also wasting your life doing it.

So before I ask you to attend AA or work on your triggers, do you mind if we talk about death?