Tag Archives: Therapy

When Progress Falls Short


New York State is passing new gun regulations. They are the first to do so after the 2012 Newtown (Connecticut) school shooting. The legislation will be lauded for its expanded ban on assault weapons and a broader definition of those weapons. The part of the legislation that will probably get the least attention the mention of mental illness. We seem to agree (subconsciously at least) that massacring innocent people is not the work of a sane individual. We also collectively agree that there are many many people struggling with their thoughts and feelings every single day. Most of us would agree that if we have a mental health system in this country to speak of, it is filled with holes and dead ends. So any legislation that even begins to address the mentally ill is a good thing, no?

Not when the legislation is a directive to mental health practitioners to report patients who are going to harm themselves and others, allowing the authorities to then remove guns from that patient’s home. Talk about your paper tigers! If people struggling with mental illness had access to a practitioner we’d have reason to celebrate! If mental health practitioners could predict who will cause harm we would be living in a very safe world indeed. A person is determined to be a danger to him/herself or others when the patient says that he or she is a danger to him/herself or others. So this ‘dangerous’ group is now a minute percentage of the actual group of potentially dangerous people. Now compound that with the fact that this new legislation might deter someone with any hint of paranoia or delusion from seeking mental health support. Add to that mess the fact that the shooting that prompted this legislation was done with weapons belonging to the murderer’s mother, not the man himself. You see how this might be more smoke than substance?

This could and should be the opportunity to decree that people haunted by their thoughts and impulses should not have to work so hard to get care. This is our chance to say that mental illnesses are complex and challenging to treat, but so is cancer and like cancer we need to go at it with everything we’ve got. Right now before the voices or the rage or the hopelessness cause a person to lash out on a subway platform, or slash someone on the street or shoot a toddler with a handgun or burn down a home; is when we should say that decent people do not allow this to continue. Decent people know that when we choose to not fight for those that need us most we forever must bear some responsibility for the consequences. Decency doesn’t allow for empty gestures or placating. There is no doubt that any restriction on guns is good for our country, and this legislation makes an impact on that goal. The public may very well applaud the creators of this legislation. There may be pats on the back and a nice sense of achievement. But at the end of the day the authors of this legislation know that they missed a golden opportunity to make real, humane and lasting change and may have stalled whatever building momentum there was to do so.

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Posted by on January 15, 2013 in Cultural Critique, Well-Being


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An Illness In The Family



Periodically, most often prompted by crisis, mental health pops up in our cultural conversation. Pundits point out the obvious flaws in our care system, medical professionals speak of conflicting and vague diagnostics, and some families share heart wrenching personal tales. This flurry of post-crisis activity is actually a microcosm of the complex issues of mental health care: People state the obvious, others admit to the complexity and the people in need are suffering.

Family members (and by ‘family’ we mean everyone who shares love) are often in the direct line of fire of mental illness. Their lives can be upended by the illness of a loved one and their every moment consumed with pursuing effective care. It is those closest to someone ill who will witness and be subjected to troubling behaviors. And unless the ill person is a minor or the behaviors so blatantly outrageous, it is difficult to judge when it’s appropriate to intervene and to what extent. We are a culture that holds personal freedom and autonomy in the highest regard. And while we like to tell people what to do with their lives in the abstract, we shrink from doing so in reality. We don’t want to unnecessarily offend and even if we did, it’s difficult to know what to say or do. It might be helpful to think of behaviors and approaches categorically.

Danger to self or others – There’s no wiggle room here. Our society has agreed that impending physical harm trumps personal freedom. While the “danger to self or others” definition is meant to be applied in crisis, the philosophy applies more universally. When asking ourselves; “Is it time to seriously intervene?” we can use this statement as a guide. It is time to move on from nagging and/or cajoling a family member to eat when you see/feel that their weight loss is dangerous. If someone is driving when drinking, passing out and/or injuring themselves when drinking, they are a danger. If someone cannot get out of bed and has vulnerable people in his/her care he/she is a danger. The question to ask when making this judgment is; “Is someone going to get hurt?”

In crisis is probably the most common presenting challenge. There is no immediate danger but instead a person who is simply not well. For the most challenging mental illnesses (i.e., schizophrenia, bi-polar, personality disorders) a state of crisis is a common occurrence. For people faced with depression or anxiety, crises can be one-offs or few and far between. Depression is a real and debilitating illness, it should not be confused with sadness. Being sad is prompted by incident: a death, a world event, a hormonal event all can trigger sadness. Of course these events can also trigger depression. The key is how long is the darkness lasting and has it changed the very nature of the individual? The same is true for anxiety. When a response to real and present danger morphs into sustained hyper-vigilance it is not serving the individual well.

Intervention – Erase any image you might have of corralled family members confronting someone while shakily holding index cards. It’s a powerful scene for television and movies but is flat out surreal in real life. If there are other caring people who can assist in getting the person in need appropriate care, so be it. But folding chairs and prepared statements are not necessary. If the person is in crisis (danger to self or others) they need immediate professional assistance. If someone has demonstrated a desire to hurt themselves or others they can and should be hospitalized and treated until they are stable. If the person in crisis is compliant you can take them to an emergency room yourself. If they are violent the police will help them to the hospital. *Note: It is best to assume that each and every threat of harm is valid. There is nothing to gain from assuming someone is crying wolf. If nothing else the emergency room staff will become more familiar with the person in crisis and be able to provide more specific care with each return trip.

For people not in crisis, intervention can be a hairy and anxiety provoking business. Every situation, relationship and individual is different. There are no universal guidelines on what to do, but there are some pretty clear guidelines on what not to do. Do not make it easy for someone to not get help. Do not take on the role of amateur therapist. Do some research and find a therapist in the right price-range (any doctor’s office, school, women’s health clinic, or divorce attorney will have referrals.) When the individual seeks to emote or purge have a contact number on hand and take full responsibility; “I want to help in a meaningful way, I’m your friend/family but not a therapist.” If an individual refuses professional help do not abandon them but do not engage in the fiction (i.e., “it’s just a phase, the season, pesticides, politics, etc.) Keep in mind that they are not entirely themselves and may not be the most reliable narrator. Bring them into the world (perhaps kicking and screaming.) Do not sit by their side and watch television. Go for a walk; remind them of the world they’re missing out on. Do not lose sight of the goal of professional help. Do not give up until you’ve exhausted every argument and yourself.

Someday we will treat mental health as we do dental or physical health. Blame and shame will dissipate and systemic effective care will be available to all. Family (in all its definitions) will always be at the front, but in time they will have proper support. There simply is no sane alternative.


Posted by on January 7, 2013 in Cultural Critique, Well-Being


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And You Too, Can Be A Star

review of the new film Sessions refers to one character as a ‘sex therapist.’ The therapist’s job, as described in the review, is to have sex with a client. Sex can be therapeutic, but a ‘sex therapist’ is an actual therapist. Psychiatrists and psychologists specialize in sex therapy (the study and treatment of sexual dysfunction.) Treatment involves talk therapy and homework assignments (homework not tutorials!) Are there sex therapists (or scout leaders, coaches, pediatricians, dentists) who have engaged in unethical and criminal behavior while on the job? Sure. But a sex therapist does not by definition engage in sex for pay. The review goes on to describe this character as a sex surrogate (how did such a straightforward career end up with so many titles?)

What ever happened to good old-fashioned prostitutes? When is the last time you even heard that word? Everyone’s and escort or a call girl, or I suppose a sex surrogate. I’m not sure the working conditions change much with a new title. Director of correspondence control is still a mailroom clerk. But everyone likes a fancy title. Personally, I find the title; “stripper” far more attractive than that of dancer. Stripper conjures up an act or at least a gimmick. Dancer is a bored practically nude women swinging from a pole. And if that girl leaves the stage to squirm on a drunken businessman in a back room, she’s not just a dancer she’s a surrogate. And what of all men and women in the corps de ballet? Does every introduction now have to be followed with; “no, really, an actual dancer”?

Who doesn’t enjoy a little spin? We like to put the best face on things. Our children are all doing incredibly well and everyone that’s remotely related to us is gifted. But when did we decide that being a prostitute is somehow undesirable but being an escort was understandable? Do we really think that all those dancers are making their way through law school, but strippers are simply down on their luck? (And for the record these professions and terms are not gender-specific.) For some reason the sex professions enjoy more than their fair share of spin (there’s a burlesque joke in there somewhere.) Nobody acts in pornographic movies; they are porn STARS. Nobody poses naked for pornographic magazines; they are CENTERFOLDS. There must be bold-faced terminology for internet pornography as well (feel free to leave me in the dark.)

In the end a rose is a rose is a rose I suppose. But it’s not a help to the therapeutic community to call a person who has sex with clients for money a “sex therapist.” It’s strangely apt, but not all that helpful to that other profession.

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Posted by on October 19, 2012 in Cultural Critique


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Nobody’s Watching You

A therapist friend recently asked me for advice.  (No this isn’t the opening remark at the American Psychiatric Association convention.)  She was feeling remiss about starting, and not keeping up with, a blog.  What with her practice and her actual life, her energies didn’t seem to be directed into blogging.  I actively listened (until she took a long breath, I’m only human after all) and asked her “why do you want a blog?”  “I guess I don’t, I just thought I should” she replied.  I assured her that no one is watching.

Doing things that have no (positive or negative) impact on anyone else because you feel you should is exhausting.  Time and energy is in fact finite, and to habitually spend any of it on activities that simply don’t resonate for us seems rather self-sabotaging.

Of course I don’t mean to suggest the key to a self-actualized life is to only do what one wants.  Not at all.  There will always be things we must do (i.e., teeth cleanings, insurance wranglings, tax filings, etc.)  There will always be things we do because doing so means something to someone we love.  We will attend partner’s high school reunions (and duck out frequently to text friends back home) we will be by the bedside of a sick and frightened loved one, we will babysit a “I have a permanent marker and I’m not afraid to use it” toddler so his mother can get her hair cut.  Relationships by definition are two-way streets, and no doubt people similarly treat us with generosity.

There is a difference between engaging in the world and with our loved ones and reacting to trends or external pressure.  The tricky part is that the only way to detect what actions resonate for us personally is to listen very closely.  There are some people who love nothing more than staying up until midnight making 60 homemade cupcakes frosted with each classmates’ initials.  These people no doubt love the sense of creativity and accomplishment that comes from such an activity.  But the person next door might be doing the same thing because he/she thinks it is expected.

By whom this activity is expected is an interesting question of course.  No one is watching.  Do we project an exacting parent’s expectations onto strangers?  Maybe.  Do we really think that the world cares that much about what we do or don’t do?  Maybe.  Do we look at the world in a very critical manner ourselves and therefore assume everyone else does as well.  Perhaps.

Not much good can come from living one’s life as if on stage.  Humanity is far too wrapped up in their own lives than to sit and watch ours.  If you find yourself dragging your feet or having a gastrointestinal disturbance when faced with an activity; take a moment.  Are you going to book club or yoga because you love the experience, or because you feel ‘this is what I should do?”  There are enough built-in “should do”s in grown-up life.  Read whatever book you want.  Find a physical activity that makes your heart soar (literally) and blog only if all the words in your head desperately need to get out.

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Posted by on June 19, 2012 in Well-Being


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Put Me In Coach

The first time I heard the expression “life coach” I assumed it was a play on words.  However this was twenty years ago or so, and since then I have heard of “breastfeeding” and “marriage proposal” coaches.  Evidently, if there is a life stage to be navigated, there is a complementing coach.  People of every age and walk of life can hang out a “life coach” shingle in the same way we can all (legally) call ourselves “therapists.”  For the record, I would suggest there is far less room for tragic endings with the untrained calling oneself a life coach than a therapist.

In the grand, or even not so grand scheme of things, who really cares what people do with their money.  If there’s an extra couple of hundred dollars hanging around, why not spend it on someone who will tell you what to do next?  I do however find it more than just a bit bizarre that universities (of renown) now offer life coach certification.  Maybe I just need to catch up.  There was a time before “stylists” too.  (You hear that design schools?  There’s a certificate program just waiting to be created.)

I enjoy picturing the expressions on the faces of our 1960s ancestors, if we tried to explain these professions.  “Life coach?” the real life manifestation of Betty Draper would repeat while exhaling a plume of unfiltered cigarette smoke.  She would drop her chin an inch or two, raise her eyebrows and lower her voice; “Really? Is that a thing?”  As we tried to explain, she would drop a saccharin into her dainty cup of coffee, shake her head ever so forlornly and declare; “That is so sad, to not have friends.”

In the spirit of universal friendship might I offer the following (gratis) coaching:

  • Relationships: Does she or he cause you unhappiness?
    • If yes, reconsider your commitment
    • If no, proceed to: Am I the best possible version of myself in this relationship?
      • If yes, stay, if no, go
  • Work: Am I happy on Sunday night thinking of the week ahead?
    • If yes, don’t change a thing
    • If no, proceed to: If I won the lottery today, how would I spend my days?
  • Relocation: Should I stay or should I go?
    • If you are considering moving for the sake of moving, keep in mind that wherever you go, there you are.  Geography is not destiny and will not change who you are.
  • Behaviors: Whether it’s smoking, fitness or carbs, once you do anything for six (long hard) weeks, it becomes a learned behavior.  Begin now.

I’m afraid our time is up.  Thank you, now go out there and live!


Posted by on January 29, 2012 in Cultural Critique


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