Emotionally Focused Therapy: a modality for couples

Last weekend, I posted about all of the wonderful people I met and all of the exciting things I learned, and I included a few teasers about two subjects which were broad enough that they required posts of their own.  One of those was Emotionally-Focused Therapy.

Emotionally-Focused Therapy is the latest "craze" in couples counseling.  I've been curious about it for awhile, because it's one of those buzz words that keeps popping up in therapist circles, and I finally had the opportunity to learn a little bit about it at a networking event through The Massachusetts Association of Marriage and Family Therapy.  A woman named Suzanne Marcus spoke about the subject for half an hour and I finally learned a little bit about this wonderful modality!

Basically, EFT is about patterns and ways of interacting.  Consider an argument between two people in a couple.  One person says something, the other does not respond, the first person gets angry at the lack of response and escalates, the second person flees.

This dynamic is called pursuer/withdrawer, and is the most common dichotomy in troubled relationships.  The pursuer (the first person) is seeking attention because he or she feels invisible, disconnected, and abandoned, and the message behind words and actions is, "I can't count on you!"  The withdrawer (second person) feels rejected, inadequate, numb, and overwhelmed, and his or her underlying sentiment is, "I can't do anything right, and if I'm wrong you might leave me."  The pursuer pursues because s/he is seeking a reaction, validation, and connection, and the withdrawer withdraws for fear of doing or saying the wrong thing.  This leads a couple to feel trapped and have spontaneous arguments.

The result of all of this is really negative circular feedback loops.  In other words, someone says something, which causes the other person to respond, which causes the first person to react, and so on.  So what happens is that person 1 is seeking validation, person 2 reacts from a fearful place, person 1 then tries to maintain contact, person 2 becomes even less certain of how to respond "correctly," and it escalates from there.  What both people have in common is that they are being driven by their emotions, and when they can hone in on and identify their emotions, they can become softer (if a pursuer) or more communicative (if a withdrawer).

This is just the very beginning of this theory and modality, which I learned from a half-hour lecture.  I plan to pursue more information, eventually by taking workshops, but my next step is to read Hold Me Tight by Sue Johnson.  If you're interested in learning more about these patterns, I recommend the same for you.

Professional Organizations, Couples Therapy, and the DSM-5

Wow, what a three days I have had!  This weekend and today, I have immersed myself in a different professional activity each day, and each has been completely invigorating in its own way.  I've learned so much, and am so enthusiastic for the future of my career and my profession, and I want to share these experiences with you.

I started my weekend with the Massachusetts Mental Health Counselors Association's annual planning meeting.  I've been wanting to get involved in MAMHCA for quite some time, so when I was invited to attend this meeting, I leaped at the opportunity!  What I learned is that the people who are involved in MAMHCA are an eclectic mix of enthusiastic, young clinicians and more experienced, seasoned, older professionals.  I was very impressed by the strengths each of these groups brought to the table, and how everyone worked together so well.

The meeting focused on a lot of different subjects, including membership, networking, scholarships and awards, and advocacy, as well as administrative matters like solidifying an annual budget for the organization.  I was nervous when I got there, wondering if I had anything to offer these experienced people who are so actively involved, but I quickly felt embraced and comfortable enough to bring up some thoughts I have about the importance of networking among counselors and mental health professionals on a whole.  I was asked to be the secretary on their Board of Directors, and may also be taking charge of an additional project with other members.

Sunday evening, I attended a networking event through the Massachusetts Association of Marriage and Family Therapy (MAMFT).  I felt like a bit of an interloper, since I'm not a Marriage and Family Therapist - I'm a Mental Health Counselor (though my educational background is as an MFT since that's the license that is most regularly granted in California where I went to grad school)... but I was readily accepted by them and met a number of wonderful people.  The group was very emphatic that they are the Massachusetts Association of Marriage and Family Therapy, not Marriage and Family Therapists, and that having an interest in a systemic perspective and in working with couples is sufficient to partake in the event and the organization.  I met a number of people with shared professional and personal interests, and had the privilege to sit in on a member's introductory overview of Emotionally Focused Therapy for Couples - a topic that is so rich and fascinating that I will be posting a separate blog entry about it in the next few days.

And today I went to a workshop about the DSM-5.  For those of you who are not familiar with the DSM, it stands for Diagnostic and Statistical Manual, it's a publication of the American Psychiatric Association, and it is the Big Book of Diagnosis for mental health professionals of all disciplines.  Currently, we are using the DSM-IV-TR, but the next edition is coming out in May 2013 and everyone is anxious to know how the way we do diagnosis will change. 

I have some very mixed feelings about the upcoming changes.  I'll post more fully about this later, because I think it's an important subject that therapy clients as well as therapists would benefit from learning about.  (After all, if someone is diagnosing you with something, don't you want to know what it means?)  But as a teaser, I'm pleased with some of the changes made in areas of addiction, mood disorders, and transgender issues.  I'm very upset at the elimination of Asperger's Disorder.  And I can't quite wrap my head around the new diagnosis guidelines for Personality Disorders.  Ok, now I'm disintegrating into genuine psychobabble, and I think I need to save the rest of this issue for its own post at some later date. 

But the point is that I don't think I've had such a great professional development weekend since my last 3-day annual conference a few years ago... and I hope for many more to follow.

Transgender Issues 101

Happy Independence Day!  Today, we celebrate the independence of our country from Britain, which includes, among other things, the assertion that all people are created equal!  Well, ok, the Constitution says it’s all men, which was definitely the initial intention of the Founding Fathers at the time, but thanks to suffragists, the Supreme Court, and the passage of time, women are considered (in theory, if often not in practice) to be equal as well.  

But what about transgendered people?  As of two days ago, Governor Deval Patrick signed a legislative act declaring that in Massachusetts, transgendered people are subject to all of the same rights and protections as cisgender (the opposite of transgender) people when it comes to employment, housing, education, and lending.  It also takes transgender status into consideration when deciding whether to rule an attack as a hate crime.  For more information on the ruling, see this article.

In celebration of this ruling - of Massachusetts recognizing all men, women, and transgender people as being equal - I think it’s time to write about what all of this gender stuff means.

Sex v Gender

The first thing you need to know in order to understand transgender issues is that there is a difference between sex and gender.  Sex is the biological component of being male or female, and gender is the sociological component of defining oneself as male or female.  What this means is that if you are cisgender (you were born with male parts and chromosomes and you now identify readily with a male identity, or you were born with female parts and chromosomes and you now identify readily with a female identity), your sex and gender are the same.  Conversely, if you are transgender (you were born with male parts and chromosomes and you now identify with a female identity, or vice versa), your sex is different from your gender.

Because gender is sociological, it is also a construct, which means that it is cultural.  Other cultures view the notion of femininity and masculinity very differently than we do here in the United States.  Some cultures have three or four genders, rather than just two, or assign a position of prestige to people who are transgendered.  For this reason, it is important to question ideas about what is “girly,” or telling a person to “man up.”  All of these things are relative to the environment in which they exist.

People often use the words sex and gender interchangeably, but this is inaccurate.  Often, this happens because people are afraid to use the word “sex,” since it’s a “dirty word.”  Whenever a pregnant woman tells me she is going to find out the gender of her baby, I want to ask her how technology has advanced so far as to be able to know such a thing!  The more accurate statement for her to make would be that she is going to find out the sex of her baby, and that if she fosters a positive, open, and nonjudgmental relationship with her child and maintains a healthy attachment with him or her, she may be fortunate enough to know the baby’s gender in anywhere from five to forty years.

The Definition of Transgender

Once upon a time, there were transsexual people and transvestites.  The former were people whose sex and gender did not match (male sex, female gender, or vice versa) and who therefore sought out surgeries to correct the situation.  Transvestites were people who simply enjoyed wearing the clothing of the opposite sex.  

While the latter term is still used (most famously by comedian Eddie Izzard.), it was decided that these terms are limited and do not adequately sum up everyone’s experience.  There are people whose sex and gender differ, but who do not have any interest in undergoing a surgical procedure to have their bodies match their gender.  Those who do choose to have corrective surgery may not completely physically transition.  For example, many female to male (FtM or transmen) people get “top surgery,” which involves a double mastectomy, but do not undergo a surgery to obtain male genitals.  Furthermore, some people are “third gender”, and do not feel their gender fits into either the male or female categories.  

Transgender is an umbrella term that was coined to resolve this, and to simply mean anyone whose gender differs from their sex. 

The Definition of Intersex

Transgender is often confused by laypeople as being the same thing as intersex.  Someone who is intersex is a person whose biological sex is more complicated than being simply male or female.  There are many ways in which this can occur, the most well-known of which is ambiguous genitalia, which used to be called hermaphroditism.  However, there are many other ways in which a person can be intersex.  These include over a dozen conditions, including Klinefelter Syndrome, where a person has an XXY chromosomal makeup, guevedoces, a condition common in the Dominican Republic in which a person appears to be female until puberty, at which point he develops a masculine appearance, and androgen insensitivity syndrome, in which a person’s body does not respond to testosterone, which in males creates a feminine appearance.

Often, it is not readily apparent that someone is intersex because their external genitalia appears male or female, but when a baby is born with obviously ambiguous genitals, the parents are often tasked with the decision of which gender they want their child to be and “corrective” surgery is done on the infant.  This is very controversial, and a lot of intersex people, as well as the Intersex Society of North America, are staunchly against it.    

Some, but not all, intersex people identify as transgendered.  As with any sexual or gender minority, it is important to ask individuals how they identify themselves, rather than relegating them into a category to which they may or may not relate.  It is equally important to understand that being intersex has to do with biological sex, whereas being transgendered has to do with gender identity.

Transgender People and Sexual Orientation

As much as being transgender is independent from being intersex, it is also independent from one’s sexual orientation.  Some transmen and transwomen are attracted to men, others to women, and others are bisexual, asexual, or pansexual.  The biggest similarity between someone who is “transgendered” and someone who is “gay” is that they are part of a minority.  However, the former is part of a gender minority, and the latter is part of a sexual minority.  Many people in the GLBTQQIAA (gay, lesbian, bisexual, transgendered, questioning, queer, intersex, asexual, ally - or as I call it, "gay alphabet soup") community choose to simplify the question of identity by identifying as “queer,” which is an all-encompassing term for a person in a gender or sexual minority.

“Gender Identity Disorder” in Mental Health

The Diagnostic and Statistical Manual, 4th edition Revised (DSM-IV-TR) is the current bible of the mental health world.  That means that anything a person is diagnosed with is in that book.  The third edition of the DSM eliminated the diagnosis of homosexuality as a mental disorder in 1980.  However, transgender people are still seeking recognition that their gender identity is not a “disorder.”

Currently, in the DSM-IV-TR, Gender Identity Disorder is a diagnosable mental health condition.  This name is very offensive to many people because it implies that someone who is transgendered is mentally ill.  In the 5th edition of the DSM (DSM-V), which is due to come out next year, there is a proposed revision to the diagnosis, and it has been renamed “Gender Dysphoria,” which is a much less offensive term.  However, many advocates want the diagnosis removed from the manual completely so that it the stigma and the idea of “pathology” are separated from the idea of being transgendered.

It should also be noted that gender identity is often considered differently in children than in adults, and is a different diagnosis (GID or Gender Dysphoria in Children).  This is because there is a much higher incidence of gender dysphoria in children than in adults, and some prepubescent children “grow out of it.”  However, although transgendered children do not always grow up to be transgendered adults, there is a strong correlation between childhood gender dysphoria and adult homosexuality.

Transitioning

The process of transitioning can be difficult for everyone involved.  For the friends and family of the person “coming out,” it can mirror a grief process.  If Billy tells his friends and family that he is transgendered and would like people to call her Suzy, Suzy’s friends and family are grieving Billy while they are learning to understand Suzy.  At best, this is done compassionately, and at worst, the transitioning individual can lose some important people in his or her life.

Transitioning can also be difficult for the individual, whether or not he or she chooses to have surgical procedures.  Reactions to the news that a person is transgendered can range from well-meaning but ignorant questions to outright cruelty, transphobia, and hatefulness.  As a person begins to live as his or her true gender, there is peacefulness to that, but society responds differently to men than to women.  My friend Tom wrote a beautiful article about how he was treated differently after transitioning.

If you know someone who is transitioning, or who has just come out as transgendered, the best thing you can do is take a learning stance.  Ask the person about his or her own individual experience, and how he or she identifies.  Don’t assume you know what it means when a person tells you he or she is transgendered - it is a very personal event that each person experiences differently - and don’t make assumptions about the person’s sexual identity or intersex status.  Additionally, don’t “out” people.  Before discussing a transgender’s person transition with a third party, ask who he or she is “out” to.  Be respectful of a person’s right to go through this process at his or her own pace.

Talking to Transgendered People

I’m now going to seemingly contradict what I just said: Think before asking questions.  Allow me to clarify.  If a question would be rude to ask someone cisgendered, assume it is rude to ask someone who is transgendered.  Someone who is transgendered is also a human being, and deserves the same respect, consideration, and right of privacy you would give to other human beings.

When faced with an anomaly, we have normal human curiosity and we want to know everything… but some questions are invasive and very personal, and some are invalidating of an individual’s gender identity.  An FtM transgender friend of mine is often asked whether he has a penis, and he usually responds by asking the questioner to describe his or her own genitalia in detail.  If a question is rude to ask someone who is cisgendered, it is probably also rude to ask someone who is transgendered.  Another offensive question people get asked is what their “real” name is.  This is negative not only because it invalidates their current identity, but also because it may be something they are trying to move beyond.  One person told me, “I don’t usually tell people my birth name, because then the person I’ve told tries to see me as that person.”  Honor the person’s identity by accepting the name and gender identity they have been introduced as.

Lastly, the question of pronouns can be tricky.  When unsure about a person’s gender, “it” and “he-she” are very offensive unless a person has told you that they are his or her preference.  The former objectifies the person, and the latter implies something “freakish.”  The best thing to do is ask a person what his or her preferred pronoun is and to honor this to the best of your ability.  For a primer about gender-neutral pronouns, here is a great article, put out by Transcending Boundaries, an annual gender and sexuality convention.

In Conclusion

For anyone interested in learning more about all of this, there are many great resources.  The collected works of Kate Bornstein is a great place to start.

It is also worth noting that I identify as a cisgendered ally.  If you are reading this and find that you disagree with anything I’ve written, or that something is factually inaccurate, I’d love for you to leave that feedback.  You can put it in the comments, or send me an email.

Change for the New Year

                “How do people change?”

                I was at my group interview for graduate school, and my interviewer, Dr. Stan Charnofsky, the head of the department to which I was hoping to gain admission, had just asked us this question.  The eight of us sat there, looking like deer in the headlights.  We hadn’t studied any of this yet – how were we supposed to know?  Always assertive, I ventured a guess.

                “Well…” I said, tentatively, “I think you’re probably not going to change something about your life or yourself unless it’s causing you discomfort.  Change – real change – takes a lot of work.  So unless you feel that something is really wrong, you’re not going to make the effort.”

                Stan, as he asked us to call him, nodded in agreement.  “And awareness,” he added.  “The first step is for a person to become aware that there’s a problem.”

                As we approach the New Year, a lot of people are hoping to make changes.  Many people make resolutions.  They recognize their shortcomings and say, “I can be better, and I want to make a change.”

                If you’re making a resolution, chances are you’ve already reached the point of awareness and discomfort.  For example, if your goal is to lose weight, you are aware that you weigh more than you would like to, and you are uncomfortable with this notion.  So you resolve to do something about it.  Excellent.

                But really, that’s step 1.  Where do you go from there?  Because every year, thousands of people get to the point of awareness and discomfort, make a resolution on January 1^st, and return to their pie-eating, sedentary lifestyles by January 4^th. 

                The subject of change was also later addressed at a workshop I attended while in graduate school.  The process was presented in 3 simple steps:

1. Start immediately
2. No exceptions
3. Tell the world

Start Immediately

                You’ve probably heard the adage, “never put off until tomorrow what you can do today.”  Equally relevant is, “no time like the present.”  People often designate a date to start their desired change.  New Years is a popular one.  “Starting in 2012, I’m not going to smoke anymore.”  Or people find times when they believe it will be difficult to stick to their guns.  “I can’t start my diet today, because I’m throwing my friend a birthday party next week.  But I’ll eat better after that.”

                The problem with this is that there is always an excuse.  “I was going to quit smoking, but work is so stressful at the beginning of a new year.”  Or, “I was planning to start my diet after the party, but all the guests brought junk food and now it’s all over my house.”

                When you’re really, seriously ready to make a change, don’t pick a date in the future - start now.

No exceptions

                There is a method of persuasion called the foot-in-the-door theory.  A friend asks for a dollar.  Sure, why not?  What’s a dollar?  “Oh actually, do you have a five?”  Studies show that you’re much more likely to give them the five than if they had just asked for it upfront.  You already have your wallet out.  You’re already in the mindset of giving your friend money.

                You persuade yourself of things with the foot-in-the-door theory all the time.  “Ok, just this one piece of cake,” you tell yourself.  But then the diet is shot for the day, so why not have Burger King for dinner, and what’s one more piece of cake?  And then the next day, well, you didn’t eat right yesterday, and nothing catastrophic happened as far as you can tell, so why not go back to your old ways?

                It’s like the old ad for Lay’s potato chips - you can’t have just one.  Real change means no exceptions.

Tell the World

                This is all about accountability.  I’ve been on “secret diets” before, because I’m by no means a large person - I just know I could eat better and be healthier, and it couldn’t hurt my long-term health to lose about 10 or 20 pounds.  So the diets have been secret because I don’t want to defend myself when people tell me I’m being ridiculous and I don’t need to lose weight.

                But is that really my motive?  Or do I just not want to be questioned when I have a moment of weakness and decide to order dessert?  If I’m with a friend who knows I’m trying to eat more healthfully (or read more, or drink less, or improve myself in any way) and they notice that I’m lapsing, I feel embarrassed.  If you’re making a change, it’s helpful to have the people in your life who love and care about you keeping tabs, even if it’s a little bit annoying.

                The flip side of that is that your friends and family can reinforce your changes.  If you’re trying to go to sleep earlier, they might observe that you seem more energized.  If you’re trying to be more direct, they might tell you that they really appreciate the way you’ve started to be more straightforward.  And those compliments - let’s face it - are really nice to hear.

                If you’re trying to change something about your life, don’t hide it - tell the world.

                One final note about change before I go watch the ball drop: make sure that whatever you’ve resolved to do better in 2012 is something you’re doing for yourself.  Personal growth is something I want to actively encourage, but it needs to be in the direction you think you need to grow.  Take a moment for introspection and make sure that this is something that you, not someone else, feel would be beneficial to you. 

Even if you’re Aware that your friend thinks you should go to the gym, and it causes you Discomfort when she remarks on it, you’re not going to make ANY change that you don’t want to make yourself.  This is not to say that something that has been suggested to you may not be valid, but make sure it’s something that you want too.

That said, have a happy New Year, and I wish you happiness and success with your resolutions in 2012! 

Tis the season for…

A friend of mine made a facebook post a few weeks ago about how therapists get a “holiday bonus” every year because the holidays are so stressful for people.  And while he’s very much correct in this observation, it got me thinking… why?

Regardless of denomination, it seems that in a season when people are supposed to be feeling jolly, joyful, charitable, loving, and spirited, guilt and stress are the feelings that run rampant.  I look around me, and I see Christmas trees, Menorahs, the last vestiges of autumn fading away, and cheerful lights on scattered houses.  But when I look at people, I see telltale signs of anxiety: wide eyes, disheveled hairdos, and frenzied, restless body language.

People are stressed out about gifts.  They wonder:

Do I get Allison a gift?  I don’t know her that well.  But what if she gets me a gift, and then I don’t have anything to reciprocate?  Then I’ll feel awful and guilty.  Or what if I get her something and she doesn’t have anything for me?  Then she’ll feel awful and guilty, and I’ll feel awkward.  Or what if I get her a calendar and she gets me something expensive?  Or if she gets me something expensive and I don’t get her anything at all?

It’s a downward spiral.  As society tells us tis the season to give gifts, there’s an unintended consequence of making people feel that they need to designate which people in their lives get gifts, and which people in their life are unworthy.  It’s no wonder people go into shopping frenzies, ripping their hair out over who to buy for, making their list and checking it twice, three times, four times. 

And then there’s the financial aspect of gift-giving.  The December holidays are an especially stressful time of year for people who are in a tight financial situation.  This is something that I’ve found to be especially true for parents in low-income families who celebrate Christmas.  (While all gift-giving denominations feel stress in regards to this, Christmas seems to carry a larger amount of pressure than other holidays… perhaps this is because parents tell their children that their gifts come from Santa Claus, and they worry that their children will believe they were “naughty” if they don’t get everything on their list.  Or maybe it’s because there’s such a gift-giving culture to Christmas.)  Parents fear that their children will feel deprived if there isn’t a formidable pile of gifts under the Christmas tree.  I have known some people who have taken out large loans in order to give their families a spectacular Christmas, and then spent the rest of the year paying for their generosity.  I have known others who have spent all of November and most of December crying daily at their lack of ability to give their young children the Christmas or other holiday they would like to.

So how does one alleviate this gift-giving anxiety?

1.       When it comes to concerns about reciprocity, communication is key.  It may seem crass, but the people in your life who love you don’t want you to feel stressed out.  Call people, and ask what the gift-giving expectation is in that relationship.  Ask people, “are we doing the gift thing this year?”  They may be having the same worries, and it’s possible they will even feel relieved you’ve asked. 

2.       If your worries are of a financial nature, investigate programs in your area that help people in low-income families.  In Boston, the local newspaper does “Globe Santa,” where you can sign up to have gifts delivered to your home.  Many towns also have “toy banks,” which are like food banks, except they provide toys to give as gifts, especially around the holidays.

3.       For 2012, plan ahead.  A friend of mine mentioned that what he likes to do is buy things that remind him of the people in his life and hold onto them until an appropriate gift-giving occasion.  If you’re able to organize yourself well enough, this can help to alleviate the need to dump all your money into the economy in the span of a single month.  If you see something on December 27^th that your friend Bill would really like, don’t wait until next Black Friday (or Small Business Saturday or Cyber Monday) to get it – if you have the cash flow available, buy it then and hold onto it until next December (or Bill’s birthday).

The second major source of stress around the holidays is family issues.  Some people have families that, try as they might, simply cannot get along.  But Christmas, Chanukah, and December in general is billed as a “time for family.”  Everyone gets together for dinner, and in the Norman Rockwell painting in your mind, Mom smiles joyfully and Dad carves the turkey, while you, your younger brother, and your older sister harmonize a gleeful rendition of Jingle Bells or I Have a Little Dreidel.  The embers burn in the fireplace, and the room and everyone’s hearts are warm. 

For some people, this may be a reality, but for a lot of families it’s far from it.  According to Froma Walsh’s book Normal Family Processes (2002), only 25% of American families with children under age 18 consist of a mother, a father, and their biological children.  This is not to say that there are no happy families that don’t meet that definition: certainly many happy holidays are had by Daddy 1, Daddy 2, and the two children they have adopted, or Single Mom or Dad and her or his 3 children, or, for that matter, Mom, Dad, Stepmom, Stepdad, brother, sister, half-brother, and stepsister.  But nontraditional families may feel that something is lacking during the holidays.

And, even more importantly, not all families are happy.  Some families have sibling rivalry, or an alcoholic mother, or a hypercritical father, or a child with developmental disabilities or severe mental health issues.  And when all of these people get together to try to create the holiday spirit they’re “supposed” to have, everyone just feels disappointed and distressed.  And after a few years of feeling disappointed and distressed, a lot of people come to dread the holidays with their family more than they look forward to it.  And this, of course, causes a month of anxiety in anticipation of that horrible, chaotic dinner.

How to mitigate family stressors around the holidays:

1.       Accept your family for who they are.  You’re not going to change them, but you can adjust your expectations.  Your parents, siblings, and extended family are who they are.  If you go in with false expectations that your critical parent or needy sibling will be a different person just because it’s a holiday, you will be disappointed.  Hope for the best, of course, but if you can take your family’s imperfections as they are, the day, and the month leading up to it, will be a lot less stressful.

2.       If your family is a huge stressor for you, consider asking them to join you in therapy.  As you grow up, your family determines who you become, and if you blame them for the unhappiness in your life, it can be helpful to open up to them and discuss that with them in a safe space, moderated by a trained and qualified family therapist.

3.       If your family is excessively dysfunctional, especially if you have a history of trauma or abuse related to them, consider allowing yourself to skip the family holiday celebration.  Spend the holidays with close friends or a significant other, and for the sake of your own mental health and wellbeing, politely decline the invitation.

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.

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.