Saturday, November 19, 2011

Viewing Families as a System

When I was in graduate school, we learned that families are systems that affect each other.  When one “piece” of the family changes, the others adjust to accommodate those changes so that the family maintains a balance and its needs are met.  All of this is fine when read in a text book and heard in a lecture, but it’s amazing how true it also is in practice.

I am going to tell you the story of the first client I ever saw, with details changed, of course, to protect their confidentiality.
                Eleanor was a mother of 3, who came into my office with her young children, aged 6, 4, and 1.  She was coming in for Amanda, her oldest child, who had been having significant behavioral problems in her kindergarten class and at home.  She had been throwing temper tantrums at least 3 times a day, was inattentive and hyperactive at school, and picked fights almost daily with her siblings. 
                I radiated inexperience, but I went over office policies and then gave Eleanor the floor to explain this to me while Amanda and her sister wreaked havoc in the office, pulling anything that looked like a toy off the shelf and her brother cried for attention on his mother’s lap.  Eleanor tried to control her children, but truthfully, she was too anguished to tend sufficiently to their chaotic actions.
                As Eleanor’s words told me she was worried about Amanda, her tears told me another story.  Sitting before me was a multistressed woman who was not happy at home.  She told me about how things had been hard at home because her husband was never around anymore, and she explained to me, still crying, that this was something she believed greatly affected her children.
                Towards the end of the session, I made a gentle suggestion: it seemed to me that she could use a place to talk, and that she was frustrated in her marriage.  Sometimes, I told her, remembering my text books and lectures with mild skepticism, when children are acting up, it’s a reflection of the other problems in the family.  The way to fix the children’s behavior is to fix the tension among the adults.  Eleanor agreed to bring her husband, Frank, in for couples therapy.
               
Through couples therapy, Eleanor and Frank began to work on their problems.  After several sessions, they were both much happier in their marriage and in their family.  I was amazed and humbled at this couple’s ability to use therapy so effectively under my guidance to fix the problems in their relationship. 
I saw Frank and Eleanor for about 10 weeks.  At their final session, they were no longer crying, yelling, fighting.  Instead, they were a loving couple, holding hands.  They acknowledged that maintaining their newfound happiness would require some ongoing work, but felt they had learned a lot about themselves and each other through their therapy.
And Amanda?  As soon as her parents started getting along and being loving to one another again, her negative behaviors all but disappeared.

And that’s the magic of how family systems work.

Monday, October 17, 2011

Bibliotherapy: A Complaint Free World

I complain a lot.  I would have said I “used to” complain a lot, but it has become abundantly clear through a new project I have undertaken that this is not entirely the truth.  Let me explain how this realization came to pass.

The last several months of my life have been full of transition and new developments.  Some of these things have been good, and there have definitely been rough spots, but as with any change, it has been stressful.  And in speaking to my therapist (yes, I have my own therapist – I firmly believe that it’s important for therapists to process their own stuff in order to be more effective with their clients), I marveled at the stability of my closest friendships throughout these trying times. 

“The thing is,” I told her, “if someone came over to my house every day and complained about money and complained about work and complained about this and complained about that, I’m pretty sure I would quickly tire of that person.”

“I think you have,” she said.

Wow, what a revelation!  I was tired of hearing myself complain!

Coincidentally, I had just bought a book a few weeks prior at a Borders going-out-of-business sale called A Complaint Free World by Will Bowen.  The book urges readers to try to stop complaining entirely for 21 consecutive days.  You do this through a basic behavioral therapy technique, in which you wear a purple wristband (initially available through their website for free, though they have since started charging a small amount of money), and every time you complain, you switch it to the other wrist.  This action raises your awareness of how much you complain, causes you to attempt to decrease the behavior, and, in effect, causes you to complain less.

When I first started doing this, someone asked me if I would have any clients left if everyone were to stop complaining.  This point is a valid one and one that I wondered about myself.  While I feel that a large portion of my job is to get people to talk about the positive things in their life in order to strive for more of the same, isn’t one of the lessons of therapy that talking about things is better than bottling them up?  Doesn’t complete cessation of complaints simply produce a phony and unhealthy façade?

In short, yes and no.

The book does an excellent job defining what, exactly a complaint is, and even makes the point that processing feelings is different from regurgitating a series of annoying events just to gain sympathy from others.  It also talks a lot about the energy behind a negative comment.  This was something, as I began the book, that actually concerned me about the theory.  I wondered:

If I order chicken, and the waiter brings me fish, am I supposed to just eat the fish?  Is saying that I ordered chicken and received the wrong food item a complaint? 

According to the book, no.  If I say, “Excuse me, but I think there’s been a mistake… I ordered the chicken,” that is not a complaint.  On the other hand, if I exasperatedly storm over to the waiter, call him a jerk, and demand that my meal be rectified, that’s a complaint.

While A Complaint Free World has parallels with the Law of Attraction (the theory that if you think about good things, they will magically manifest in your life), a theory whose New Age-iness leaves me feeling ambivalent, I agree with the basic sentiment of both of these theories, which is that it never hurts to try to put more positive energy in the world.  Personally, I’d rather live in a happy place with happy, positive people… wouldn’t you?

I haven’t made it through a full day yet without switching my purple bracelet.  But I’m working on it, and by being more mindful of it, I’m finding that there are more positive things coming out of my mouth.  And for a start, that’s not half bad.

A shortlist of lessons from this book

1.       1. Complaining is reinforced with sympathy.  Children learn at a very young age that if they complain, it will be rewarded.  A child who scrapes his knee and complains three hours later that it hurts is given reassuring hugs and pats on the head.  This is not to say one shouldn’t sympathize with and give attention to children in pain, but rather it makes the point that the reason we complain so much goes far back into childhood.  We learn very early that if we want people to show they care about us, complaining is the way to go about achieving that.  Think of it as deep-rooted fishing for compliments.

2.      2. A direct quotation from the book: ”When we complain, often we live in a state of ‘something is wrong’ and this increases stress in our lives.”  It’s so true.  One of the stressful events in my life was an aversive job that I got into the habit of complaining about on a daily basis.  When I left that job for another much more favorable job, I found myself searching for things about it that merited complaining.  When complaining is a way of life, you will seek it out even when things are good. 

3.      3. You can say the same words with different intentions, and it ceases to be a complaint.  “There was a lot of traffic on the highway” as an explanation for why you’re running behind is not, in itself a complaint.  “There was a lot of traffic on the highway” as a conversation starter intended to stir up sympathy for your plight of sitting in an air conditioned car for an hour is.

Wednesday, October 5, 2011

What’s in Store for a Gryffindor?: The Nature of Bravery


I have a story to tell you with a great moral.  Allow me, please, to be a little bit of a nerd for a moment, and then I’ll get to the psychology of it all.  I promise.

Anyone familiar with the Harry Potter universe can tell you about the four houses of Hogwarts.  Ravenclaw is for those whose primary quality is their intelligence.  Slytherin is for those who are ambitious.  Hufflepuff contains those who are most loyal.  And Gryffindor, the lens through which we hear the entire story, is for the bravest of the brave. 

For over a decade, rabid fans of the book series have identified with a specific house.  There have been “Which house are you” facebook quizzes and lengthy questionnaires on a plethora of websites, all of which seek to emulate the “Sorting Hat” that first-year Hogwarts students wear in order to learn where they will spend their seven years at the school.

But just recently, J.K. Rowling, the book’s author, has released a website called Pottermore.  Pottermore contains new information about the characters, the places, the spells, and the magical world.  It also provides an interactive experience, where users can shop at Diagon Alley for their school supplies, brew potions, and, of course, get sorted into their house.  This sorting is done through a random sampling of about 50-100 questions.  Each participant answers seven of those questions, and the Sorting Hat makes its declaration.  Its ruling is considered somewhat definitive, and those who are big fans of the series take it seriously.  As one tongue-in-cheek online support group for those who have been “improperly sorted” says, “Queen Rowling has spoken and told us where we belong.”

Last night, a friend and I were exploring the new website.  After much anticipation, we reached the Sorting Hat.  I have often fancied myself a Gryffindor, though I have strong qualities of Ravenclaw and Hufflepuff too and, at times, even a little bit of Slytherin.

However, my friend considers herself a Ravenclaw – the “smart” house.  And we all consider her a Ravenclaw too.  Highly educated, full of knowledge and information, her intelligence is the first thing nearly anyone would notice when they meet her.  Secondarily, she could be a Hufflepuff – the “loyal” house.  She nearly always considers others before herself, and is an intensely loyal friend. 

My friend, smart and loyal as she is, has many fears.  She is afraid of heights, the dark, rollercoasters, bugs, confrontation, and uncomfortable social situations.  When asked, in the course of the quiz, “What do you fear most?,” I immediately clicked “Isolation,” but she sat there deliberating over the seven choices for five whole minutes before choosing one.

When we finished our seven questions, we sat there, on separate laptops, our cursor hovering over the button that would reveal our House.  “Ok,” I said, “on three.”

We clicked.

And as I held my breath, my screen turned bright red.  Gryffindor!!  I grinned.  I had been nervous that I would have to exchange my fan paraphernalia upon discovering that I was pretty brave, but really more smart or loyal. 

I looked at my friend’s screen, expecting to see a deep Ravenclaw blue.  But hers was red too!

I felt confused.  She felt confused.  We started making hypotheses – maybe my presence had influenced her choices.  Maybe she should have gone with her gut and her first impulse instead of choosing her answers so carefully.  At least, I told her, it was only the house I would have expected her to be in SECOND least.  Never has there been a person who was less of a Slytherin.

“I love you,” I told her, “but you really aren’t a Gryffindor.”

She left for the evening, looking confused and feeling, I think, quite annoyed.  And I was confused too – clearly, the questions were broken.

But after sleeping on it, I have a different thought: My friend is incredibly brave.

I remembered the time we were at the theatre and someone started yelling aggressively at me, and she came to my aid to try to back me up and diffuse the situation.

I thought about her social anxiety, measured next to all of the Meetup groups she attends and parties she goes to.

I considered her strong feelings of right and wrong, her tendency to vocally and actively support the causes she believes in.

And I had a revelation.  Bravery is not about a lack of fear.  It’s about a willingness to do things that scare the pants off you or are outside your comfort zone in order to strive for the world you want to live in.  It’s about standing up for what you believe, even if you’re afraid.  It’s about being afraid when it’s okay to be afraid, but swallowing those fears and doing what you need to do if it needs to be done.

And I’m pretty sure my friend, while terrified of a laundry list of different things, would climb to the roof of a skyscraper and decapitate a giant spider in order to confront a villain if it meant saving the world in which we live.

Wednesday, September 21, 2011

Wear Your Happy on Your Sleeve!


“You do an eclectic celebration of the dance!  You do Fosse Fosse Fosse Fosse Fosse!  You do Martha Graham Martha Graham, or Twyla, Twyla, Twyla, or Michael Kidde Michael Kidde Michael Kidde Michael Kidde, or Madonna, Madonna, Madonna, Madonna… but you keep it all inside.”
-Robin Williams in The Birdcage

…but why keep it all inside?  What’s the danger in singing out loud, in dancing through the streets, in telling your friends and family you love them?  It’s a sitcom staple for the quirkly, slightly socially inept to be “caught” doing a happy dance, for which he (as the character is most often male) is either relentlessly teased or cautioned against.  (“Don’t do the happy dance,” a female character often cautions her significant other, pre-empting his physical expression of his emotion.)

To be clear, I am not advocating for the open and unbridled expression of all emotions on a day-to-day, id-powered, feel-it-so-express-it kind of a basis.  Even if you’re having the kind of day that makes you very angry, or very sad, or very fearful or apprehensive, you need to be able to function.  You need to be able to go to work, and when a client or coworker asks how you’re doing, to answer with a functional, “fine, and you?”  If instead you respond that you’re livid because your boss just treated you unfairly and sometimes she pisses you off so much that you just want to set the building on fire while screaming unpleasant things about her family and upbringing… well, you may quickly find yourself out of a job.
Don’t get me wrong – it’s important to express these feelings.  It’s important to be able to talk about the very sad or infuriating things in your life, and to be able to discuss your worries about the future with your nearest and dearest.  Whether it’s a therapist or a friend you confide in, you have to get that stuff out too. 
But to function in the world, you can’t just let that stuff out in full force to whoever happens to be around you.  You can’t just walk around like an emotional autopsy in progress, all your anger and sadness and fear and frustration and bitterness hanging out of you like the liver of a murder suspect.  As a respected supervisor is fond of saying, you have to let those things out in appropriate ways and at appropriate times, and then when you go back out into the world, you have to “zip yourself up” so that you can be a functional member of society.

And I get that.  That makes sense.  But why happiness?  If you just found out you were approved for a loan and can buy your first house, or that you’re about to be a parent, or if you’re just in a great mood because your favorite song was on the radio, what’s the harm in telling the world?  Society tells us to “play it cool,” but I disagree.  I think happiness, positive thinking, and general goodwill are contagious.  I think if you’re so happy that you can’t contain it inside your body, do your happy dance.  Belt out a few notes.  Grin like your cheeks are trying to escape your face.  Look on the bright side without reservation or hesitation.
And if people look at you like you’re crazy… encourage them to give it a try too.  “The world,” inform them, “could use a little more happiness.”

Down with the Tyranny of the Shoulds!


                Karen Horney, a disciple of Sigmund Freud’s, referred to a concept called “The Tyranny of the Shoulds.”  Although she lived about a century ago, that concept is still quite relevant today, and in my perception, responsible for a lot of the sadness, frustration, anger, and anxiety that people feel.
                Many people go through their lives talking about what others should and should not do.  Even those of us who refrain from criticizing others have many “Shoulds,” conscious and unconscious, that dictate our daily actions.  A lot of these thoughts stem all the way from our childhoods, from messages we were given, deliberately or otherwise, by the people in our lives.
                Some Shoulds have very good reasons for existing in our lives.  “You should refrain from doing bodily harm to others” is an obvious example.  Also, “you should stop to make sure there’s no one coming the other direction when approaching a red octagon” and “you should brush your teeth”.  If you ignore these rules, you are likely to end up injuring someone, getting in a car accident, or losing your teeth to cavities and decay.
                Other Shoulds, however, are things we carry around with us as learned behaviors – things we never really question, and do simply because we should.  Many of these are smaller things.  For example, when I was growing up my father was fond of telling me I should put my socks on before my pants, or that I should shower and dress for the day before doing anything else.  While these are sound pieces of advice, and while he meant well, the real question is… why?
                Why does it matter if I put on my pants first?  Who will it hurt if I watch a Tivo’ed episode of The Simpsons before I change out of my pajamas on a Saturday with no plans or obligations?
                But there are deeper Shoulds too – things that don’t have to do with daily upkeep or habits.  There are Shoulds about who we should spend our time with, what we should aspire to, how we should whittle away our spare time.  Shoulds dictate appropriate conversational topics, career choices, the extent to which we express our thoughts and feelings to others, the ways in which we limit ourselves.
                Alex is told he should aspire to be a doctor, but he prefers English class to biology.
                Sara loves math, but has been told by her family that as a girl, she should be better at the humanities.
                Billy loves to sing, but has been discouraged from doing so by his parents, who think he should spend his time on something more “useful”.
                Joe is having strong feelings towards other men, but has been told that he should ignore them and try to be “normal”.
                All of these Shoulds are far more damaging than the order in which one puts on clothing, or even whether one stops when a sign indicates one should.
                If you are feeling depressed or angry in regards to a strong belief, I urge you to ask yourself some questions:

1.       What is the belief or “should” that I have that is being contradicted by what I feel is right?
2.       What is the purpose of this “should”?  Where did it come from?
3.       What would the consequence be if I chose to ignore this “should”?
4.       If there are no major consequences, how can I begin to take steps to overcome this “should”?

As a friend of mine astutely observed, “should” is a tricky word.  If you can overcome the Tyranny of the Shoulds, you may find that you feel much more at ease.

How I Became the Therapist I Am

                The vast majority of the issues on this blog are going to focus on the things I learn that I want to share with any readers who happen to stumble across my page.  But to set the stage, so to speak, I want to first address who I am and how I came to do what I do.

When I was seven years old, my friend Elise’s parents got divorced.  This affected Elise in a number of ways, so her parents made a mutual decision to send her to a therapist. 
My friendship with Elise was not one of deep confidence.  It was, instead, a friendship that involved playing the kinds of games typical to young girls – games that involved swing sets, Barbie dolls, and brightly-boxed board games.  Elise would choose the activity, set the parameters, and we would play accordingly.  Thus, you may not find it surprising that Elise did not confide deeply to me about her sessions with her therapist.
One day, however, I had a play date with Elise that coincided with her therapy appointment.  I went to the office with her and her mother, and was told to sit in the waiting room.  For about half an hour, I sat there, playing with toys and thumbing through old issues of Highlights Magazine.  Then Elise’s therapist came to the waiting room and asked if I would like to join them for the second half of the session.  I shrugged and obliged.
Once in the therapy office, we were given art supplies and encouraged to draw, play, and engage with each other and the therapist.  After a few minutes, the therapist asked us who made the rules in our friendship, and we quickly agreed that Elise did.  “What if,” the therapist suggested, “Jennifer got to make the rules one time?”
An electricity ran through me at the suggestion.  This was a whole new perspective I had never considered!  That night, I went home and told my mother that I wanted to see a therapist.  For the next several years, I insisted on this.  At about age 12, the request, no longer made to my mother, but rather to myself, shifted: “I want to become a therapist.” 

                This planted the seed, and as I grew older, I found that I was the kind of person people felt they could talk to.  I was decidedly nonjudgmental about the things people shared with me, and very good at remaining neutral and making people feel safe.  Because of this, I had a lot of very one-sided friendships.  People would talk to me, tell me their problems, and I would offer an ear, a lack of judgment, and, on occasion if solicited, advice or feedback. 
This became addicting – this being needed in that way – but much of the time, it wasn’t reciprocated.  If I needed someone to talk to, I often found I had nowhere to turn.
When my family suggested I see a therapist to deal with some of the “I’m an angsty adolescent and I’m a little bit maladjusted and need someone to talk to because I’m hormonal and crazy and everything makes me angry and I don’t know why” issues I was dealing with, I was strongly resistant.  I wasn’t crazy.  I didn’t need to talk to anyone. 
But I loved my therapist.  I loved that I could talk to her, and she wouldn’t judge me and she wouldn’t criticize me.  Once we got to know each other, she would occasionally challenge me.  But it seemed there were no bounds to what I could share with her.  I could tell her about my fears, my concerns, my feelings.  If I wanted to bring in a photo album and show her my friends, “sure, no problem.”  If I wanted to bring in my guitar and play her the new song I’d written, “absolutely, I’d love to hear it.” 
It wasn’t about receiving advice.  It wasn’t about quipping in the other 6 days and 23 hours of my week, “my therapist suggested I try…”  It was about having a safe space and unconditional positive regard.

Around the time I started seeing my therapist, I got a call from one of my fair-weather friends, Joel.  He lived across the country, in Florida, and he was a deeply troubled person.  When I answered the phone, Joel told me that he was planning to tie a plastic bag over his head before he went to sleep and commit suicide by asphyxiation.  I asked if he’d spoken to his parents about this, and he said he had and they didn’t care.  He said he just wanted to let me know he was planning to do this, and to say goodbye.
I paced back and forth.  I hyperventilated.  Finally, I confided in my mother.  She told me – no argument allowed – that I needed to call a suicide hotline and tell them what Joel had just told me. 
“But what if he’s angry?” I asked.  “What if he hates me for it?”
“You have to do it,” she said.  She was very rarely this insistent about anything.  “If you do, he might hate you.  But if you don’t, he might kill himself.”
I called the hotline.  They sent a psychiatric intervention team to Joel’s home.  In California, they call it a 5150.  In Massachusetts, they call it a Section 12.  I have no idea what they call it in Florida, but I do know that Joel was involuntarily hospitalized for 72 hours.  His parents were furious, and they called threatening me and my parents.
Two weeks later, Joel called and thanked me.  He sounded humbled and tired, and maybe a little bit medicated.  But he was alive, and he was grateful.
I relay this story not because I think I did anything particularly heroic, but because it was my first taste of a number of things – of helping someone in a serious, long-lasting way; of the idea that just because someone wants something doesn’t mean it’s what’s right for them; of how one person really can make a difference in another person’s life, just by caring enough to be attentive and proactive.

When I finished college, I said I was sick of school, that I was never going back.  But something in me needed to be a therapist.  I needed to follow this dream and this helping instinct that I’d had ever since being dragged into Elise’s session.  So I applied to graduate school and was admitted to California State University, Northridge’s school of Educational Psychology and Counseling with an emphasis on Marriage and Family Therapy.

So that’s the story of how and why I became a therapist.  But it doesn’t explain how I became strength-based and so focused on empowerment.  It doesn’t explain why I’m the kind of therapist I am.
                My graduate school advisor and thesis chair, Stan Charnofsky, had this theory that we become the kind of therapist that reflects our childhood.  Often, sitting in my classes and listening to the other therapists-to-be telling the tales of their broken families, their tragic childhoods, I had the impression that I was not “broken” enough to become a therapist. 
                But I sat in my classes, and I listened to what my classmates had to say.
                “I grew up around gang violence, so I really want to work with an underprivileged population to empower the youth in those neighborhoods to have bright futures.”
                “I was 7 when my mother died.  It’s hard growing up with just one parent.  I want to reach out to grief-afflicted clients.”
                “When my brother had his first manic episode, none of us knew what it was.  I always looked up to him, and suddenly he was erratic and wild and unpredictable.  When his mania ended in his hospitalization, our family learned a lot about bipolar disorder.  So I want to help families afflicted by severe mental illness.”

I had no trauma.  I grew up in a functional nuclear upper-middle-class family with a mother and father who loved each other.  I had one younger sister.  We both went to private school.  Neither of us really wanted for anything. 
Sure, my adolescence was an angsty one, and I had some social problems, but my upbringing was right out of a right-wing “save the traditional family” ad.  (Not that I believe in the “traditional” family.  I absolutely don’t.  Did you know that only 25% of households with children under 18 consist of a woman, a man, and their biological child or children?  So much for that being the “norm”!  But I digress.)
I tell you this not to garner sympathy of the “oh, poor Jennie, she had a great childhood” variety, but to explain where I come from in my work and in my writing.  I believe in empowerment because my parents taught me to believe in myself.  I believe that no matter where people come from, they’re worth something, because my family taught me about the inherent “goodness” in me, even if I made choices that were not the best.  I believe in focusing on a client’s positive qualities, because I learned, as my family pressed me to make the most of my strengths, that that’s where positive change comes from.
It’s like Dr. Charnofsky said: I’m the therapist I am due largely to the kind of upbringing I had.  I like it because it’s positive, and because I think it works.
I hope that now you have a better understanding of how I got here and where my ideas and philosophies come from throughout the rest of this blog.