Is therapy a series of commands or a process?

Alpert tells people what to do, rather than helping them with their thought processes, so they can make their own decisions.  Many people begin treatment wanting the therapist to tell them what to do, but if a therapist does that, patients will never learn to think through things and take responsibility for their own decisions.  I often make a feeble joke, saying that I forgot to buy batteries for my magic wand, before explaining that I wouldn’t dream of telling someone what to do.  My job is to help them explore the things that get in the way of satisfaction in their daily lives, so they can decide what they want to do, based on rational thought, instead of impulse, emotion, or an unconscious motivation that  drives their decision-making process.  The treatment approach Alpert embraces fosters childish dependency, with patients waiting for the therapist to “feed” them, rather than the therapist helping them look at the dependency and blame that often motivate this insistence on being told what to do.  Remember:  Dependency is the idea that I need you to do something so I can feel okay, and I get to blame you when you don’t do it right.  Alpert’s approach is the “give a man a fish and he eats for a day” method, instead of teaching him to fish, so he can eat for a lifetime.

Short-term therapy has its place…

Short-term, goal-focused counseling has its place in dealing with situational problems that are right on the surface:  How can I set limits with my clients or boss?  How can I help my teenager learn to accept more responsibility?  I just moved here and need support to adjust and integrate myself into a new community.

…as does long-term therapy

But major depressive disorder, bipolar disorder, alcoholism, drug addiction, narcissistic personality disorder, borderline personality disorder, anxiety disorder, long-term dissatisfaction in a relationship, or a pattern of unsatisfactory personal or professional relationships?  Even the example he uses of a woman who’s been unhappy with her boyfriend for the past year is fatally flawed in his formulation of the case.  He says that he would ask what could be missing from her relationship and how she could take care of the missing elements or end it.  He leaves out a few basic important points:  1) Was she happy before she was in the relationship, i.e., is this a woman who knows how to be happy?; 2) Is she looking for her boyfriend to make her happy and give her happily-ever-after in life, i.e., are her dependency issues getting in the way?; 3) What are her contributions to the lack of satisfaction in the relationship?  No one person holds all the good or all the bad in the relationship.  It’s a dynamic; 4) Did she grow up with a model of parents who enjoyed each other and were satisfied in their relationship, or did she grow up with a parent who was disappointed in his or her partner, who subtly or obviously passed along the idea that men are disappointing?  Those questions are just a first pass look at what Alpert has left out in his simplistic, I’ll-just-tell-her-what-to-do approach.

The long and short of it is…

There is effective and ineffective short-term therapy and effective and ineffective long-term therapy.  As a therapist in private practice 17 years, I’ve done lots of short-term and long-term treatment of patients.  New patients frequently want me to tell them how long treatment lasts.  I make a treatment recommendation about session frequency, based on clinical assessment, but the duration of the treatment is something that evolves, as I learn more about them and their issues, and as they learn more about themselves and their issues.  It’s not a one-size-fits-all process, despite what Jonathan Alpert says.  Bob Newhart’s character in the following sketch beat Alpert’s quick-fix record by a mile.  He could do it in just two words.  Watch it, have a laugh, and feel free to leave a comment below.  If you want change that takes more than two words, read up on the differences between short-term counseling and therapy here.  As always, I ask you to excuse the repetition of a word or phrase, in this case “therapy”; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a basic rule of good writing.

For all those times you stood by me
For all the truth that you made me see
For all the joy you brought to my life
For all the wrong that you made right
For every dream you made come true
For all the love I found in you
I’ll be forever thankful, baby
You’re the one who held me up
Never let me fall
You’re the one who saw me through through it all

You were my strength when I was weak
You were my voice when I couldn’t speak
You were my eyes when I couldn’t see
You saw the best there was in me
Lifted me up when I couldn’t reach
You gave me faith ’cause you believed
I’m everything I am
Because you loved me

You gave me wings and made me fly
You touched my hand I could touch the sky
I lost my faith, you gave it back to me
You said no star was out of reach
You stood by me and I stood tall
I had your love I had it all
I’m grateful for each day you gave me
Maybe I don’t know that much
But I know this much is true
I was blessed because I was loved by you

You were my strength when I was weak
You were my voice when I couldn’t speak
You were my eyes when I couldn’t see
You saw the best there was in me
Lifted me up when I couldn’t reach
You gave me faith ’cause you believed
I’m everything I am
Because you loved me

You were always there for me
The tender wind that carried me
A light in the dark shining your love into my life
You’ve been my inspiration
Through the lies you were the truth
My world is a better place because of you

You were my strength when I was weak
You were my voice when I couldn’t speak
You were my eyes when I couldn’t see
You saw the best there was in me
Lifted me up when I couldn’t reach
You gave me faith ’cause you believed
I’m everything I am
Because you loved me

You were my strength when I was weak
You were my voice when I couldn’t speak
You were my eyes when I couldn’t see
You saw the best there was in me
Lifted me up when I couldn’t reach
You gave me faith ’cause you believed
I’m everything I am
Because you loved me

I’m everything I am
Because you loved me.

I kept listening and applied the words to a different scenario, that of a child to a speaking to a parent.  The words fit, except for the “baby” in the first verse.  The second scenario allowed me to enjoy the song as a description of the impact of a parent’s love in a child’s life.

Parenting is key

Every day I treat patients who didn’t get the love they needed as children, or at least not in the way they needed it as children.  Some parents meant well, but didn’t understand their children’s needs.  Some parents were too depressed or preoccupied with tragic events in their own lives to meet their children’s needs properly.  Some parents were so self-involved they believed their children should accommodate them.
Some of these patients have children of their own now and are coming to terms with the fact that they have unintentionally injured their children’s self-esteem and shaped their personalities in the negative ways they experienced as children.  Painful stuff!

Conscious parenting helps you heal and gives your child a great start!

But this insight and the things they learn as we work together in therapy can help them turn things around in their lives and for their children.  For patients who begin therapy before starting a family, parenthood becomes a chance to further heal psychologically by loving their children in healthier ways than their parents were able to do.  Developing empathy and understanding, warming up emotionally to another person:  These are true gifts to your child, and to yourself.

Therapy can help you turn around your parenting values and style!

If you find yourself saying things to your child that you swore you would never say to your child, therapy can help you learn to control your impulses and understand the thoughts and behaviors you want to change, so that you can actually become the parent you want to be.

*Note:  Apologies for the repetition of “parenting” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a basic rule of good writing.

What makes these TV characters so unwatchable is their narcissism, one aspect of which is their stunning lack of capacity to put themselves in anyone else’s shoes.  Have you known people in real life whose narcissism affects you like the sound of fingernails on a chalkboard?  Narcissism, defined on Dictionary.com as “inordinate fascination with oneself; excessive self-love; vanity,” is a defense against feeling insignificant and humiliated.  And it’s not such a stretch to see the fear of humiliation in these TV characters.  If you can remember that narcissism is a defense against potential humiliation, it can help you tolerate the narcissistic people you have to deal with in everyday life.

Narcissism starts in childhood

I didn’t watch “The Comeback” or “Curb Your Enthusiasm” enough to know the specific childhood origins of the Valerie Cherish and Larry David characters’ narcissism.  However, it doesn’t take even a minute of watching the interaction between “Enlightened”’s Amy Jellicoe and her mother Helen to see that the apple doesn’t fall far from the tree.  The two of them are constantly fending off humiliation by various narcissistic methods:  belief that they have a monopoly on the truth, an emphasis on looking good over feeling good, trying to get other people to recognize their superiority, etc.

Am I saying that narcissism is hereditary, like eye color or other physical characteristics?  Not at all!  I’m saying that narcissism is passed along from generation to generation through the parents’ inability to meet a child’s psychological and physical needs in age-appropriate, warm, and loving ways.

My narcissism ate my satisfaction!

Leading with narcissism doesn’t work any better for people in the real world than it does for these television characters.  Narcissism destroys satisfaction on a daily basis.  These characters are having rather miserable lives, with their self-esteem going up and down.  If your self-esteem fluctuates in ways that make the stock market seem stable by comparison, your narcissism may be running the show.

Therapy is incredibly helpful in dealing with narcissism—your own and that of the people you encounter on a daily basis.  A good therapist can help you understand the origins and consequences of your narcissism, see it in real time, and find more satisfying ways to live everyday life.

* Note:  Apologies for the repetition of “narcissism” in the post; search engine optimization requires choosing a keyword (narcissism) for each post and using it repeatedly, thereby breaking a basic rule of good writing.

While flipping through the channels recently, I landed on HBO’s new series “Enlightened,” and stayed to watch because I admire actress Laura Dern’s work.  She plays Amy Jellicoe, a corporate executive who has a dramatic flame-out, goes to a spiritual retreat center, and returns to her life as a new-and-improved Amy, she believes.  While she gets on her feet, she lives with her mother, played by Diane Ladd, Laura Dern’s real-life mother.  We get to see how Amy got to be such a mess, through seeing how cold, mean, and superior her mother is.  And when new-and-improved Amy confronts stresses in her life, she reverts to mimicking Mom, without even realizing it.  Mom has a pampered little dog she dotes on, but doesn’t miss an opportunity to criticize Amy.  The dog can do no wrong; Amy can do no right.

Superiority vs. humiliation

Amy reads a self-help book she got at the retreat center, and wants to reach and enlighten the people around her, starting with her mom (who asks how long she has to listen) and ex-husband (who cuts lines of coke while she’s talking with him).  She wants to “have closure” with the married boss with whom she’d had an affair.  Surprise:  he’s not interested.  Amy can’t even get her old job back.  After Amy threatens the corporation with a lawsuit when HR says there’s no job for her, she’s given a menial job in the basement, a corporate version of the land of misfit toys, clearly an attempt to bore and humiliate her into quitting.  There she unknowingly mimics her mother’s superiority and contempt toward her co-workers.  She walks the edge of superiority, with the quick fall to abject humiliation always a threat.  That’s how it goes:  when a person feels small, they try to make themselves feel better by feeling superior to someone else—all to try to fend off the humiliation that’s lurking in the background.  If the person didn’t have to be perfect, they wouldn’t have to feel so humiliated by making mistakes—i.e., being human—like the rest of us.

As a viewer I want to say, “Amy, move out of your mom’s house when you get your first paycheck!”  As a therapist, I know that moving out of her mom’s house won’t take her mom out of Amy’s head and stop her mom from driving the bus of Amy’s life right off the peak of superiority into the abyss of humiliation.  It’s a wreck from which we can’t avert our eyes.

Amy’s mom isn’t all bad; she is letting her stay at her house.  It seems she provided custodial care during Amy’s childhood, which is enough to get Amy to chronological adulthood, but not enough to make Amy function as adults should.  Amy’s mom did the best she could, but probably didn’t have her emotional needs met as a child.

Superiority:  a learned behavior

Amy’s predicament is common; most of us find ourselves saying something from time to time just like our parents used to say.  If the parents were warm and loving, made conscious decisions, and functioned like responsible adults, learning from what they modeled will turn out well.  The problem is that if description doesn’t fit the parents, what comes out of our mouths sometimes isn’t so kind and the thoughts we have aren’t so rational.  If you find yourself mimicking some parental attributes that don’t lead to satisfaction, that are not ones you want to live by, there’s help.  Therapy helps you look at what you learned from your parents that you like and want to build on, and what you learned that isn’t so useful in life.  Therapy won’t make those problematic things go away, whether superiority or masochism, but through lots of hard work in treatment you’ll learn to see them before you act out on them and make a spectacular mess of things.

* Note:  Apologies for the repetition of “superiority” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a basic rule of good writing.

Poor decisions, or chronic lack of satisfaction?

It’s an expression of a lack of satisfaction with what is.  People who often feel that way experience many situations and choices as disappointing or unsatisfying.  Is it a case of making poor decisions, or is it a default orientation toward life?  Are things chronically lacking in your experiences, or did you learn this “glass half-empty” stance somewhere?

One of my patients used to refer to this mindset as GIPped, which he defined as “Gippy, Icky, Pissy.”  You can see it in a TV commercial that’s currently in rotation, in which a guy informs his wife that he just signed up the family for unlimited texting.  She berates him for this, and says something like, “My mom was right:  I should’ve married _______.”  She is clearly having a GIPped–or V-8–moment, and feels so screwed over that even when her husband tells her that it was free, she still looks sour!  Clearly this has gone on a long time in their marriage, because she doesn’t seem the least bit horrified by her behavior and the guy looks beaten down.  What a miserable way to go through life!

Therapy improves decision-making and satisfaction

Therapy can be helpful in sorting out whether it’s a problem of judgement or of how you think about and interpret your life experiences, or a combination of the two.  And along with figuring out which it is, therapy can help you improve your decision-making process—and how you think about and experience your life.

In other words, satisfaction can be learned, which is pretty magnificent, if you ask me!  Let me know what you think about satisfaction and V-8 moments in the comments below.

*Note:  Apologies for the repetition of “satisfaction” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a basic rule of good writing.

You’re already networking!

Another truth is that you probably already do natural networking in your daily life without realizing it!  Parents, how have you found babysitters?  Often it’s through a friend or friend of a friend, right?  How did you find the person who cuts your hair or walks your dog?  How about your accountant, primary-care doctor?  Many of the folks in your life probably came through people with whom you have trusting relationships—or their trusted relationships.

Networking doesn’t have to be a huge crowd scene with people papering each other with business cards.  It can be as easy as getting together with people you already know to do things you enjoy doing.  How?  Well, you talk about what’s going on in your personal and professional lives.  You listen as well as talk.  And you listen for the ways in which you can help, through introductions to friends and others you trust who may also be able to make useful introductions.  And you let the person you’re with know whom you’d like to meet.  It’s easy and fun.  And it’s how successful people in all walks of life help build their businesses and populate their lives.  It’s a win-win!

Networking still intimidating?

If you have trouble doing this or even imagining yourself networking, you may want to take a look at what’s getting in the way.  You may be concerned about what other people will think of you.  Or your anxiety may inhibit you in networking or social situations.  Or it feels like too much work.  Or it seems humiliating to ask for help.  There may be any number of reasons.  Therapy can help you determine and explore your reasons and get to the underlying issues, so that you can get out of your own way.  Then networking can be a natural and comfortable part of your everyday life, and you can start to enjoy the resulting success.

*Note:  Apologies for the repetition of “networking” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a basic rule of good writing.

Reframing is the opposite.  It’s thinking about the same situation from a different perspective, rather than feeding the perspective that makes you feel sad, angry, or wronged.  Whatever you feed gets bigger!  This quote of unknown origin provides a great description of reframing:  “The happiest people don’t necessarily have the best of everything; they just make the best of everything they have.”

Reframing 101

Let’s take it from the abstract to the concrete, to more easily understand reframing.  If someone cuts you off driving, you may replay how close you were to an accident.  You may even construct a revenge fantasy in which you flip off the other driver, honk, flash your lights, and run the person off the road.  If you want to reframe the situation, you may decide to focus instead on the quick reflexes that got you through the close call, how calm you stayed at the time, though you were scared.  You may entertain the possibility that the other driver  misjudged the distance.  The first option is going with your righteous indignation, which leaves you all revved up and right.  The second choice involves taking a positive view of yourself in the situation—so that instead of feeling wronged and resentful, you feel proud of how you handled yourself—and giving the other person the benefit of the doubt.

Maybe you’re a freelancer who can’t afford to take time off for vacation because business was slow earlier in the year.  You can feel resentful about the situation, and even angry at the clients you’re working with during the summer.  By reframing, you can feel good about having the good health to work, about successfully networking and marketing your business in order to have these clients, about being expert in this field (or being paid to further develop your skills), and being able to work in your chosen field when so many people have to take jobs that are unrelated to their training and interests.

Or, if you have to work outside your field of interest during these challenging economic times, you can feel victimized by your circumstances, or proud of yourself for doing what’s necessary to support yourself and/or your family.  Reframing can be the difference between feeling horrible about your life, and enjoying it on a daily basis.

Therapy helps with reframing and other life skills

If you didn’t learn to reframe situations when you were growing up, this mindset can feel absolutely impossible now that you’re an adult.  Therapy can be a great help in developing this and other important life skills, so that you can find the joy in everyday life!

*Note:  Apologies for the repetition of “reframing” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a cardinal rule of good writing.

Try to make the flight and give the cabbie an 8-hour head start selling my info, if he’s so inclined?  Or skip the trip and try to recover my stuff? I opted for a compromise:  as my husband held down the traveling fort (daughter, bags, security line, gate directions), I started making calls.  The operator from the NYC report-a-problem line stayed on with me, even as my phone went through the x-ray machine, and we resumed the reporting process as I slipped on my shoes, grabbed my jacket, and sprinted toward the gate to join my family.  Since our departure was delayed due to weather conditions, I even had time to call the bank to stop payment on the checks, and contact three police precincts before boarding.  During the layover in Chicago I called the credit card companies to report loss of the cards.

Panic is optional

The real choice was this:  panic, or deal.  In other words, panic and then deal, or just begin dealing.  In any situation, if you panic, you’ll still have to deal with the situation at hand.  But you will have worn yourself out and exhausted your inner resources before tackling the problem.  Not the greatest conditions for trying to function at your best!

The call I didn’t think to make till dinner that evening:  my home phone to check my messages.  There was only one—from the cabbie.  He had found my bag, called the number on the business cards, and wanted to make arrangements to return everything.  When I got back the next week, he brought my bag to me.  Everything was there, including $637 in cash.  He refused my $200 reward, stating that he was a practicing Muslim and he was just doing the right thing, that it was my money and my bag, and he wasn’t looking for a reward.  I insisted, and he finally accepted.  Perfect ending. What if it hadn’t gone so well, if he had taken the opportunity to steal my identity and rack up enormous charges on my cards before I reported them as lost.  Would panicking at the airport have changed the outcome?  No, but it sure would have made the situation harder to deal with!

If you have trouble skipping the panic to deal with the situations of everyday life, counseling can help you learn to cope more effectively.

Note:  Apologies for the repetition of “panic” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a cardinal rule of good writing.

A caterer friend was baking pastries for a large event and had grated three cups of lemon zest when her young son came in and bumped the measuring cup, breaking the glass and spilling the lemon zest.  Another friend who was there at the time held his breath, waiting for the inevitable huffing and puffing.  Instead the caterer burst out laughing.  When she stopped, she said, “That was pretty funny, Chris!”  She knew he didn’t do it to mess up her timetable.  It was an accident.  She has an uncanny ability to find the humor in a situation most of us would find incredibly frustrating.  Rather than waste time on something that couldn’t be undone, she understood where he was coming from (it was an accident), had a good laugh, and started zesting more lemons.  That’s a healthy response that allows her to enjoy life much more than many people do.

Humor at your own expense is also your own reward!

And laughing at oneself is one of the best things going.  I’m not talking about laughter as a defense, where everything is a joke, but about lightening up overall.  Life is too short to collect your injustices—and what would you do with them anyway?!  It’s not like you can trade them in like frequent flyer miles.

I know someone who was depressed and went to a neighborhood workshop on laughter and healing.  She thought even a chuckle would be good for her.  Alas, it was the 1980s and lots of strange things went on!  Each participant was asked to name the saddest event of his or her childhood.  Sexual abuse.  Death of a sibling.  The list continued.  Each person was then instructed to talk about the event in detail while everyone else would laugh.  The depressed person, rather than walking out—which would have been the smart thing to do!—talked about the death of her father when she was a teenager, and began to cry.  She was scolded by the workshop leader.  On the walk home, she thought about her experience and realized she was doing better:  thinking about crying her way out of the laughter workshop cracked her up!

Carol Burnett says that humor is tragedy plus time, a statement I disagree with.  Nothing funny about tsunamis and tornadoes.  But I think humor can be annoyance and inconvenience coupled with a good attitude—and it will probably make a good story later.

*Note:  Apologies for the repetition of “humor” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a cardinal rule of good writing.

How urgent is that impulse?

“Why now?”, to me, seems about a feeling of urgency, which speaks to impulse control.  I need that brownie, or new pair of pants, or fourth martini, you say to yourself, when it’s just a want that will eventually pass.  Confusing wants with needs is a common problem in people’s lives and it comes up frequently in therapy.

One of the most destructive impulses that I try to help people control is a sense of urgency to talk with someone, especially a partner, about something that seems really important.  These topics include doubts about the relationship, concerns about one’s own biological clock and how the partner’s timetable meshes or doesn’t, quitting a job, setting a friend straight, etc.

That’s not to say you should never have these conversations, because they are important topics, but don’t take on the big discussions in the heat of the moment.  Better to think things through in a calm, rational way and have a conversation, rather than a confrontation.  I suggest to patients that when they feel a sense of urgency, they should take that as a clear clue to “zip it” and wait till that urgent feeling passes.

If you believe that there is a “Seinfeld” episode for every occasion, this would be the one where George decides that the best action in every situation is the exact opposite of what he would normally do.  While I don’t advocate a default opposite position for every impulse, I do stress making conscious decisions.  And a good place to start when feeling an urgent impulse is to ask yourself, “Why now?”.

If lack of impulse control is interfering in your daily life—whether it’s overspending, ripping into your partner, or substance abuse—treatment can be a tremendous help.

Note:  Apologies for the repetition of “impulse” in the post; search engine optimization requires choosing a keyword for each post and using it repeatedly, thereby breaking a cardinal rule of good writing.