Wednesday, June 30, 2010

Here's brain-twister...

Why would a neurologist decide she wants to go back to school and become a teacher? Well it's a great question and one that's explained in some of the links below. In Santa Barbara, Judy Willis, M.D., M.Ed has done just that!

I heartily recommend you visit her site!

Here are some links:

Tuesday, June 29, 2010

Parenting and Step-parenting

When I began to write this column, I didn’t expect it to be this long. I thought about splitting it into two parts but decided to leave it one L-O-N-G column. I hope it’s not too boring.

Before I plunge into this topic of parenting and step-parenting, I wanted to first give thanks to my best teachers – my patients. I’m glad I have my academic background and my post-graduate training was invaluable but really, I am most indebted to my patients who have trusted me with concerns that are deeply personal and important to them. It is humbling beyond words that my patients trust me enough to share their dilemmas – their failings – their frustrations. More than they know, I have walked in their moccasins.

Sometimes it may seem that my role is easy; to sit in the chair of wisdom/authority while they bare their insecurities – shame or confusion. I’ve been there myself. It is my patients who have really shown me what works and what doesn’t work. I am and always will be grateful to my patient-teachers.

Many have heard me say that I believe that probably the two most difficult and perilous journeys one ever takes is committing to a long term relationship and committing to parenting. I believe it would be easier to climb Mount Everest or to swim the English Channel. There are many reasons for the belief I’ve just stated; one reason is that a long committed relationship and parenting may last well more than 20 years. Another reason is that a relationship and parenting will find and expose aspects of your personality that you wish were not true, perhaps that you abhor.

Relationships and parenting are day after day, year after year events regardless if you’re sick or are in the mood. I believe these are the toughest tasks we will ever encounter. These are also endeavors that while more precious than gold are parts of our life that others frequently feel free to criticize. A relationship and parenting are not for the faint-hearted. An old saying tells us, “Life is hard; get a helmet.” If that is true, then one should get a helmet, shoulder pads, shin pads, body armor and eat your Wheaties if you plan on being in a relationship or parenting. Those who are emotionally anemic or aren’t ready for hard work, don’t yet have the resume needed. If you still believe there’s a “right way” to parent or that children should do what they’re told “just because you’re older”, you should postpone the challenge of parenting/step-parenting until you’ve got more understanding. (See the earlier posting “Are you ready to get pregnant and be a parent?”)

My initial comments on the subject apply both to parenting and step-parenting. Later, I’ll add further comments aimed at the delicate and tough task of step-parenting.

Power and Control (See the earlier post on power and control)
Many have heard me say that I believe that all of us from birth until death want to have more power and control in our environment. I believe this drive is entirely normal. This idea is perhaps most apparent in dealing with children. Childhood is a nearly endless period of learning about how to gain more power and control. Much, if not most of what a child does may be viewed as an experiment in gaining and shaping power and control. Some people make (in my opinion) a mistake in their thinking when they say a child is manipulative. All of us manipulate. I manipulated my time, money and effort to gain an education which I manipulated into a career which provides an income for me. When one prepares a meal, they manipulate ingredients to create the meal they want. Manipulating is normal and natural – the key is to learn what kinds of manipulation are appropriate. As parents (or step-parents), it is our responsibility to help children learn what is appropriate and what are inappropriate ways to manipulate. It is also our responsibility as parents to teach (mostly by example) how much power and control is reasonable. I often ask my patients, “How much control (in life) do you think you have – and is it realistic or appropriate." One of our most important tasks is to help our children come to terms with the fact that they have limited control.

When a child is an infant, they have almost no control. As the child matures, they learn to have control over some bodily functions, they learn that Life (initially embodied by their parents) has expectations of them and they are expected to learn to control whether their bedroom is messy or clean, they learn that they are expected to control whether or not their schoolwork is completed (a further manifestation of Life). In their later teens, they will learn to have control of a car. All of these tasks and their ability to control certain elements of their own life need to be synchronized with their developmental ability. Asking a child to do something that is beyond their ability will quickly become an exercise in frustration for the parent and if the demand for competence is beyond their ability, it will become a source of failure and low self esteem for the child. I hope none of us would expect a five year-old girl to begin her menstrual cycle – it would be developmentally preposterous. Neither should we expect children to succeed at tasks that are beyond their ability. Another saying tells us that one shouldn’t try to teach a pig to sing – because it will be frustrating for the farmer and annoying to the pig. Our control in this Life is tenuous, we need to learn the limits of our control and we must teach our children that their control in Life is limited and linked to their DEMONSTRATED exercise of responsibility.

Intentionally and unintentionally reinforcing behavior.
Continuing from the above idea that children are small learning organisms, we might ask, “How do they learn to manipulate or control their environment?” AN EXCELLENT QUESTION! Have you ever watched a small child play a video game? I have. They don’t read any instruction book and adults don’t explain the myriad shortcuts and tricks – but within a month or so, the child has amazingly learned the most arcane aspects of the game. If you ask them to explain the game they get into a detailed but hard to follow explanation. It’s like listening to a 4 year-old physicist – except they aren’t explaining physics. The important point is that they’ve learned and they’ve learned quickly. I defy most adults to play a video game against a six year-old and win, I’m not expert in education but here’s what I’ve observed. The child RANDOMLY pushes buttons on the controller and they pay attention to the reaction. Through almost-endless repetitions of this, the child learns. This same pattern is enacted again and again with a child and their parent. (Now the parent replaces the video game.) The child RANDOMLY pushes our buttons. Some of our buttons are connected to our unresolved emotional issues – when those buttons get pushed, we “light up” with an interesting response. Perhaps we blanch, perhaps we blush, perhaps we react verbally or perhaps we react with alarm. Allow me to illustrate this process: Let’s imagine a seven year-old Alison comes home from school where they’ve just had a day with Child Welfare Services learning about “good touch and bad touch”. Alison naively but proudly announces, “I know what a penis is!” Probably, if Alison’s mom experienced some kind of sexual abuse as a child, she’ll have a strong reaction to Alison’s announcement. Perhaps she’ll blanch, her pupils might dilate and she’ll ask with a tone of alarm, “What did you say?” (She lights up.) With all of these interesting reactions, Alison has inadvertently been strongly reinforced. She has learned that when she says, “penis”, she will get an interesting, strong emotional reaction from mom. Perhaps, if mom has strong unresolved issues about her own past abuse, she might even take Alison to a therapist to make sure nothing bad has happened. Being taken out of school and being asked about where she heard about a penis will further reinforce that talking about a penis will reliably elicit a strong reaction. Children are incredible learning machines – they notice the reactions that follow their actions; an effective parent will know this. An effective parent tries to control their reactions because they know how influential their reactions are in shaping their child’s behavior. (Remember: as a parent, you can’t get an “A”, the best you can achieve is a “B+”. At times we’ll “blow it” but we need to always try to be in control of our reactions.)

A child’s behavior can be reinforced inadvertently but their behavior can also be reinforced intentionally as well. Remember, children are strongly reinforced by the quality of our reactions. If a child does something we want to encourage, we should react in a manner that reinforces the behavior. Most of us know that we should praise desirable behavior, but praising can have a paradoxical effect. I remember when my son, then eight years old drew a stunningly good copy of a famous piece of art. I generously praised him for his efforts but that gave him information about how he could have power by refusing to produce more art; power is also obtained by defying the desire of parents. Remember our rule of thumb: DO WHAT WORKS. We can react in a manner that suggests we are amazed and puzzled by the child’s behavior. “I don’t understand… how did you learn to take out the trash? Usually kids can’t take out the trash until they’re seven or eight!” Another way to intentionally reinforce behavior is to wait until the child is within earshot and then make a phone-call to someone and tell them how surprised you are with your child’s behavior. The only consistent guideline we can use is DO WHAT WORKS. Different kids will respond to different parental reactions. To be an effective parent we must be keen observers of what works and what doesn’t work.

Stop talking!
Probably, therapists are to blame for the fact that parents (particularly mothers and step-mothers, as a generalization, because women are more verbal than men) try to utilize verbal communication as a way of providing positive and negative consequences for children. Again, think about what is developmentally appropriate. A, three - five year-old child roughly has the intellectual abilities of a smart dog. If a dog kept their sleeping area messy how long would you talk to the dog about it? Hopefully, not too long. Hopefully, most of your praise and corrections of a dog are primarily behavioral and hopefully they are relatively brief (1-2 minutes) and hopefully your response to a dog’s behavior is “closely paired” time-wise. If your reaction to a dog’s behavior occurs four to five hours after the event, it is wasted because the dog doesn’t have the capacity to link what they did to your reaction. The same is true of children. Generally, we expects far too much of children when we talk to them. Children have little capacity to comprehend and utilize a conversation lasting more than four – five minutes. Our rewards and punishments should be closely paired time-wise with the child’s behavior and we should try to make the reward or punishment non-verbal (i.e., standing in the corner, taking away a favored toy, going to bed early). With adolescents, we should also limit our talking. At all costs, avoid protracted arguments with kids. If kids can engage you in an argument wherein you’re intent on “winning” – they’ve already won major power points. If you’ve ever had a debate with an adolescent, you know that a ten year-old’s mind-numbing arguments can quickly take an adult from bemusement to sputtering frustration in a matter of five minutes. I advise parents to avoid longish debates with their adolescents. If an adolescent can bring you to the point of frustration – they have won that power-game round. Any conversation with kids should be kept short (five – six minutes) if the issue will necessitate more time, break-up the talk into segments. When I see children in therapy, I don’t expect them to sit and discuss an issue with me for 45 – 50 minutes as I would with an adult. With a child, I will often have a parent come in and I direct much of my comments to the adult; the child is allowed to draw or play with toys and they interject what they are thinking as they have the inclination and then when their attention span is exhausted they go back to their play activity. If I’m alone with the child, typically, well discuss the issue for a while, detour to an entirely unrelated topic, and then come back to the problem in ten minutes. It’s important to keep it brief.

Time is of the essence.
As I mentioned earlier, time is crucial. In order for a reward or punishment to be effective it must be tightly paired time-wise to the child’s behavior. Suggesting that a child will be rewarded with a day at Disneyland if they bring up their grades during the next report period will not be an effective incentive because the trip to Disneyland is temporally too distant from the desired behavior. It would be more effective to offer a reward if they show you their homework each day. (This goal is more incremental and the reward/punishment e.g., staying up an extra 90 minutes vs. going to bed 90 minutes earlier is more tightly paired.) The more time that intercedes between the child’s behavior and the consequence, the more the effectiveness of the consequence will be diminished.

Learn to pick your battles.
This axiom is important in Life, but very important in parenting. An error some parents (and step-parents) make is that they try to correct everything they see a child doing that the parent deems to be “wrong”. “Sit up straight. Don’t chew with your mouth open. Say hello. Say excuse me. Don’t fidget. Don’t interrupt. Clean your room. Eat your dinner. Wash your hands. Don’t pick your nose. Stop making that noise. Wake up. Go to sleep. Do your homework. Ad infinitum. When will it ever end? This is a mistake for a few reasons; first, if we jump on everything a child does that we view as “wrong”; it will dissipate our own energies. Beyond that it communicates to the child, “Everything you do is wrong”. Remember the first point about control – one way a child gains control is if they do some behavior which will trigger a reaction from a parent. I can’t tell you how many times a parent has been in my office with a child. The child is slouched in the chair (what could be more normal?). The parent snaps, “Sit up straight!” – and the child sits up A LITTLE. Again the parent demands, “Sit up!” – the child pretends not to hear. The child is winning “control points” by defying the parent.

Usually, I suggest that parents write out a prioritized list of ten concrete/behavioral target behaviors they want the child to change. Then, we will initially only focus on the top three items of the list. We intentionally turn a blind-eye to the others. Once we have controlled the three behaviors, we move on to the others – three at a time. If we react to everything a child does it implies that everything they do is wrong and we’ll find ourselves becoming more and more frustrated. We need to learn to pick our battles.

If you want respect – demonstrate respect.
Really, need I say more about this? Children are not slaves to be ordered around. It’s true that you are the parent but a child’s personhood should always be respected. Of course your decisions will usually prevail but their positions should be heard and valued even if you ultimately disagree.

Positive and negative consequences.
I often relate to parents that some time ago I saw a television program wherein a man had trained house-cats to do circus tricks. After the performance the man was asked how he’d trained the cats since it was thought it was at best difficult to train cats. The man explained that these were ordinary cats he’d obtained from the Humane Society. He went on to explain that when he first brings the cats home (this usually makes people wince), he doesn’t feed them for four days! He explained, “After four days of not eating the cats are extremely smart (I.e., motivated). The man then places a morsel of food on the other side of a hoop. “The cats go right through the hoop without reading instructions or explanations from him. The keys are that the cats must be motivated and when rewarded, the cats should not be completely satisfied; they should remain somewhat hungry. The same principle holds for dealing with children. If we’ve given the child everything they want and more – they will lack motivation. If our children do the behavior we desire we should only reward them a bit so as to not rob them of their motivation
Being a good parent includes the effective and judicious use of consequences, both positive and negative. In order for consequences to be effective there are some basic guidelines a parent should keep in mind. Parents (and step-parents) often make the mistake of believing explanations should lead to changed behavior. I encourage parents (and step-parents) to create a prioritized list of five positive consequences (rewards) and five negative consequences (punishments). As stated above, these consequences should ideally be available for utilization immediately after a child’s behavior. The consequences should primarily be non-verbal whenever possible. The consequences should be tightly-paired, the more tight the pairing the more effective the consequence, whether positive or negative. Remember my earlier comment that children are naturally driven by a desire to have more power and control in their life. Invest some of your time figuring out what your child values most; this will provide important information in deciding on rewards. Your child may like video games, skateboard riding and watching TV. Your child may find deprivation of the foregoing most annoying. I encourage parents to create prioritized lists of rewards and punishments. Explain these to your child before implementation is needed. Once equipped with the positive and negative consequences, I advise that parents rehearse the punishments and rewards. (Remember that emergency first responders rehearse or drill for events.) As an example, after explaining what the consequences will be for good and bad behavior at a super market, plan for a drill journey to the market. Plan the drill for a day and time when you don’t need to do anything else. (Attempting initial trials when you have a pressing appointment will likely result in a failure. The drill should be planned so that if a negative consequence is called for, you won’t be inconvenienced.) It might resemble this: Explain that you’re going to the store – remind them what the positive and negative consequences will be for good or bad behavior. Go to the store fully prepared to walk out the instant bad behavior occurs and once home, commence a time-out in the corner for 20 minutes. If there’s been good behavior, administer a significant though not overwhelming positive consequence. This type of rehearsal should be done several times so that your child fully knows what to expect.

Teach by modeling.
Whenever there is a moment to use yourself as an example – seize it! If you get irate with other drivers when your child is in the car with you – use that moment (assuming you can catch yourself in the act) to say something like, “There I go… I need to learn to react more appropriately because I can’t control other’s driving behavior.” Modeling like this is powerful. We all know the saying, “Do what I say – not what I do.” And we all know that our kids pay far more attention to what we do. YOUR KIDS WILL LEARN PRIMARILY FROM THE BEHAVIOR YOU DEMONSTRATE.

Avoid Criticizing.
In personal relationships, criticism RARELY is effective in accomplishing the goal. I often explain to patients that I have a boss that is the medical director of the Clinic where I work. He often makes decisions that I think are unwise; despite this, I have never told him he’s wrong or that he hasn’t thought through a decision. Why – because I value my job. I’m CAREFUL in the manner I speak to him (i.e., full of care). Let me confess that I have failed to follow this advice and the result is the same you’ll experience. It doesn’t help; actually it makes things worse.

At the beginning of this column, I said parenting is extraordinarily difficult. If you’re a step-parent, you also need to be a consummate diplomat.

In a remarried family with kids, there are subtle and not-so-subtle politics involved. Often the biological parent will feel trapped in their loyalty to their kids and their loyalty to their new mate. How can the biological parent choose one without alienating the other? Often, step-parents will be ambivalent about “forcing” their agenda, the kids are confused and quite naturally (i.e., instinctively – not consciously) will exploit any difference of opinion between adults.

Start Small and go slow.
Repeat this to yourself 500 times per day. When a step-parent enters a family, it’s important to remember that you’re the newcomer. Politically, you carry little if any authority or leverage. Your status will grow over time if the child learns that your behavior is reasonable, fair and trustworthy. I always suggest that for the first SEVERAL YEARS, just hang around and observe the child and their interaction with their biological parent. Avoid making judgmental comments about the child’s or parent’s behavior. Your first goal is to gain the child’s trust.

This can’t be stated strongly enough. Any perception that you are competing with the other same gender parent will become a likely opportunity for a power struggle. You’ll have enough power struggles without inviting another – and this is one you can’t win. Find a way to complement the other same gender parent. Nearly always, criticizing the other parents will be viewed as you not respecting them (most often, your mate). You should expect significant differences in your views – this nearly axiomatic. Avoid right/wrong and good/bad characterizations, instead talk about “differences in perspective.

Support the role of the biological parent.
Be a neutral sounding board for the child and be supportive of your partner’s role as parent. DO NOT offer advice UNLESS it is asked for and then offer it in a very tentative way. Avoid “You should…” comments, instead you might say if asked (or you can ask if your opinion is welcome) that, “Here’s another way…” Don’t insist that your way is right and their way is wrong. As I said earlier, labeling parenting styles as right or wrong leads to problems. Think in terms of what is effective – what works. If you must be in a position of authority it is better if you obtain the biological parent’s approval in the child’s presence. (e.g., “Since I can’t go to the zoo today, Jean will be in charge.”)

Be careful of the pitfall of interjecting prematurely. Interjecting in the middle of the biological parent’s interaction with the child is nearly guaranteed to become an emotional hand-grenade.

Develop your mate’s confidence.
One of the most important family-tasks is to gain the trust of the biological parents. This is a slow process – it may take years. With the child, the age of the child plays an important role. The younger the child the more quickly trust is developed.

Allow your role to show your strengths.
As a stepparent, you will have opportunities to bring your talents and strengths to the life of the family and to the child, BUT DON’T RUSH IT. Find your sweet-spot. Maybe your role will be as someone who helps the child to read or brings a sense of art to the child’s life. There will be a role for you but you’ll have to wait for it to become clear to you. (Remember - it's about TIMING – start small.)

This may be one of the most touchy topics in step parenting. For the first several years, the biological parents should be the sole administrator of discipline. Avoid being an obvious tattle-tale. Your primary allegiance is with your mate and some of the child’s behavior should be reported but it is the biological parent’s decision regarding how infractions are handled. There are few “black & white” issues in this Life so avoid too many rigid black & white rules in the home; too many rigid rules often leads to the development of a “false-self”.

The intimate outsider
Your role is unique and extremely valuable to the child. Any child would benefit from having a relationship with an adult who is trusted but is not a parent. Protect your role from being contaminated with resentment because you were viewed as competing with a biological parent. You are there to help in character building – not judging or disciplining.

What is developmentally appropriate?
Particularly if you haven’t had children of your own (and even if you have) do some reading to find out what is developmentally appropriate and realistic for your stepchild. Just as we would not (I hope) expect a seven year old girl to have a menstrual cycle (in case some don’t know – it’s not developmentally appropriate) – we shouldn’t expect children to exhibit behavior that is beyond their developmental ability. Expect kids to test, retest and retest family rules. Testing and retesting is their job. Kids are neurologically hard-wired to push the envelope. The parent’s (and step-parent’s) job is to maintain clear boundaries. If you maintain CLEAR BOUNDARIES THAT ARE REASONABLE (not excessive and not too rigid), the child will develop a sense of security and safety. If you don’t have children of your own take classes that are offered in most schools. (P.E.T. and S.T.E.P. are excellent.)

Above all - GOOD LUCK! It's a difficult task which at times may seem impossible. Give yourself breaks. Training for a triathalon, being a motorcycle stuntman or special-ops commando would be easier than being a pretty-good parent. There should be a National holiday week for parents and step-parents. If you're getting a C+ or B- you deserve a medal!

Monday, June 14, 2010


As I begin writing this column, I have a sense of foreboding. An affair after all is one of the more if not the most volatile subjects a therapist can tackle. The opinions about affairs are legion and so the reader should be forewarned that what follows is only my opinion based on my own personal values combined with my clinical experience, (i.e., I’m biased.). Also, like many other behaviors, affairs are discussed by innumerable therapists all offering their own theories. I am not suggesting that I am “right”; I am only expressing some of my thoughts.

Let me begin by stating some basic beliefs/opinions I have about affairs.

  • They are virtually always exceptionally destructive – they are never good for marriages.
  • There is virtually never a “good excuse” for an affair.
  • I accept that while affairs are destructive – they are very common.
  • No one is immune from having an affair.
  • If one has had or is having an affair – it is not the end of the world or the marriage.
  • I do not believe it is necessary to always tell your mate of an affair you’ve had or are having.
  • If you are having an affair, you should end it immediately.
  • People having affairs often believe their circumstances are unique; they’re not.
  • I define “affair” pretty broadly – it includes secretive emails – sexually-charged chat-rooms – “emotional affairs” – I even consider alcoholism, compulsive gambling and other addictions as an affair. These behaviors involve deceit and take your energy away from your mate.

Often, a patient wants to know “why” they are having or have been involved in an affair. The “why” is not nearly as important as, what to do about it.

I’ve been very impressed by how much an affair resembles an addiction – and like an addiction, why someone is an addict is not nearly as important as what to do about it. Like an addiction the first thing to do is to stop the behavior. After the behavior has ceased one should begin a journey of recovery.

When considering what recovery means we might consider a dictionary definition: “The act or an instance of recovering; a regaining of something lost or stolen, a return to health, consciousness, etc., a regaining of balance, control, composure, etc, a process of attempting to change dysfunctional behavior, as by abstaining from an addictive substance: an alcoholic in recovery. I also think of physical therapy as one recovering use of a limb that was injured. In the context of recovering from an affair it might include doing whatever is necessary to repair damaged trust. Once the behavior has ended and one has made every effort to repair the damage, one can then begin to speculate about “why”.

Again, like an addiction the “why” is found in an element sometimes hard to describe. Initially I’ll express it simply but go on to define it in some of it’s various expressions.

The problem is that an import element is missing – the shorthand way to say it is, “spirituality”. Some people have a near-automatic gag reflex to hearing that word – so if you’re one of those people – stick with me for a few more minutes. Some find profound spirituality in surfing, some in music, art, poetry or wood-working. Some will find great spirituality in serving others; others will experience the numinous in nature while still others may find traditional spiritual practices important beyond words.

In a previous column, I sang the praises of Steven Pressfield and his book, “The War of Art”. In that book, he does a great job of giving a kick-start to anyone wishing to pursue their own spirituality.

Some have said to me, “I don’t know what form or shape my spirituality would be – so how do I pursue it?” If one doesn’t have an aversion to traditional spiritual practices, I’ll suggest that as a starting point. I’ll ask about dreams one may have harbored in youth. I’ll ask about one’s heroes or role models. Sometimes one’s nocturnal dreams will give a clue. “What turns you on?” (not sexually but in a more spiritual sense) Affairs and addictions are forgeries for the REAL THING. One of my patients was working in a civil service capacity but had a childhood wish to become a pilot. (Believe it or not, she is now a pilot flying cargo – and SHE LOVES IT.) If you’re not engaged in pursuing what you care about – what you love – if you’ve ignored your muse, you’re at risk for falling for a counterfeit of genuine spirituality. Addictions and affairs are attempts to achieve a spiritual state; the problem is that it’s fraudulent. Sometimes, (not always), therapy can be useful.

Now, let’s get pragmatic. What if YOU are the one having the affair? END IT! And begin the process described above.

What if your mate discovers the affair?
  • Fall on you sword. Accept 100% responsibility – NEVER suggest your mate shares any blame.
  • Make a genuine apology. An affair is so egregious, it may require many sincere apologies.
  • I am not an advocate of unburdening yourself of the feelings of guilt and remorse by giving details. As the saying goes, “You can’t unring the bell.” Once it’s been said you can’t take it back and your mate will never get it out of their memory.
  • Be ready to hear about it from your spouse for a while. (I can’t say how long – probably more than two weeks and probably less than six months.)
  • Be ready to be on a very short leash for a long time.
  • Despite all of your attempts to salvage the marriage; your spouse may find the damage too much to be fixed.

What if you discover your mate has had an affair?
  • Initially you might be in shock – the breach of trust is enormous.
  • Probably your feelings will fluctuate for weeks. Its important not to make any major decisions for a month or two.
  • Take plenty of time for yourself and surround yourself with those who love you and have good judgment.
  • It’s normal to “go ballistic” for a while (Maybe a couple weeks – maybe a few months.)
  • If your mate is making a genuine apology and willing to go to any length to repair the damaged trust; I recommend giving it a try – remember this is very personal. For you, the damage may be too great, but in a long term relationship, there’s more to consider than just your feelings. (There’s a shared history, frequently there are children and it may sound outrageous to say it but, money is a consideration.)
  • You will never “forget”, but you can forgive. Forgiving means that at some point, you decide to not bring it up any more. (With some couples, an ended affair is brought up like a trump card during every argument.)
  • Therapy can help – with the right therapist.

Parting words: If you are in this terrible situation the very best book I can suggest is:
Divorce Busting: A Step-by-Step Approach to Making Your Marriage Loving Again
By Michele Weiner-Davis

Every couple – whether or not there’s an affair, should read this book.

Thursday, June 10, 2010

The drama game... (let's stop playing it)

Many, many times have I been talking with a patient and they will describe a pattern of behavior between themselves and another person – spouses, parent-offspring, coworkers, siblings, you name it. Most of us fall into this pattern, sometimes it’s chronic, sometimes it’s brief, sometimes disastrous and sometimes not. Regardless of its various expressions in a relationship, it is nearly always counter-productive if not destructive.

I’m referring to the pattern of interaction when two people enact the role of “Rescuer”, “Victim”, or “Persecutor”. The process is perhaps best illustrated by what is now called the “drama triangle” first described by Stephen Karpman in an article he authored in 1968.

Many of us react to Life as a Victim. Some do it habitually. Whenever we refuse to take responsibility for ourselves, we play the starring role as Victim. Here are a few questions that might help you decide if you’re playing Victim.

  • Do you feel that others often take unfair advantage of you?
  • Does it seem your efforts are often unappreciated?
  • Do you often say (or think), “It’s not my fault.”
  • Does it seem that you have to carry more than your fair share?
  • Do you feel you seldom get a fair opportunity?
  • Does it seem you’re just unlucky and have received a raw deal from Life?
  • Do you often feel that if you could just “get a fair break” that your life would improve?

The above are frequent indicators of those who play Victim. Victims ask to be taken care of, bailed out or cut slack. Sometimes it’s subtle and sometimes it’s outrageously blatant.

Frequently, (particularly when I’m not on top of my game) when I encounter the Victim, my heart wants to go out and help them. I get sucked into the vortex of the drama triangle. It’s happened many times to me both personally and sometimes professionally. When I succumb to Victim bait, I reflexively enact the “Rescuer” role. When playing the Rescuer role, I initially feel good about myself because I believe I’m helping. In the role of Rescuer, one feels competent, beneficent, compassionate or morally elevated. Apparently, my belief (at that moment) is that the Victim is incapable, not as smart or insightful as I am or will perhaps sink further into an abyss without my intervention. I act as if I’m saving them from a fate which they haven’t had a hand in engineering, (intentional or unintentional).

Before going further with the dynamics involved, I’d like to comment on a few aspects so far.

While a Rescuer will nearly always insist that they are Rescuing (i.e., enabling) for the sake of the Victim, but, the hard truth is they are not. The Rescuer engages in rescuing behavior to reduce their own anxiety. The greater motivation for Rescuing is one’s own need to feel better about ONE’S OWN SELF. Our true motivation is not so altruistic as we may wish to believe.

When we see someone doing a good job of playing the Victim role, it is normal that our level of anxiety escalates; when we bail-out the Victim, our anxiety drops and we feel more comfortable. The problems that accompany this “duet” are (a) the Victim will, if the pattern becomes chronic, eventually resent the Rescuer because (b) The Rescuer nearly always expects “something” in return – gratitude, acknowledgment – some sort of pay-back.

After repeated enactments of the Rescuer/Victim drama, the Victim will “run the bases” on the triangle and take on the role of Persecutor and the heretofore Rescuer will now take the role of the Victim of the Persecutor. This base-running is the drama – just like the drama of baseball when players are running the bases

Confused? Allow me to present a simplified but increasingly common example:
In this vignette, we will assume an interaction between a Rescuer-parent and the parent’s 30 year-old Victim-“child”.

  • The 30 year old has free room and board – has no job. “Nobody’s hiring. All the employers drug-test applicants.” The Victim wants to continue smoking pot, ostensibly because he gets too angry when he can’t have his pot. He plays video games most of the day. He complains there no food in the house that suits his palate. He up half the night playing on the computer. He sleeps during the day. He does few if any chores and the lets everyone know he’s put-upon. He says he’s also depressed. He’s surly and entitled.
  • The Rescuer-mom doesn’t give her son the boot because she falls for the Victim- bait that he’s depressed; so he can’t help it. The Rescuer-mom doesn’t object to the pot because she thinks she’s just doing what it takes to keep him happy. She doesn’t boot him out because, “the economy is terrible – no one is hiring – it’s not his fault." She buys the food he likes to keep peace in the family. She doesn’t impose boundaries because he might get upset.

In the above example there is a tacit acceptance of the idea that the son is incapable, incompetent or disabled; he is playing the role of Victim.

The Rescuer-mom’s anxiety escalates rapidly if her son seems angry. She tries to pacify him instead of (a) tolerating her anxiety and (b) allowing her son to take responsibility for his own behavior. Taken to an extreme for the sake of illustration it is as if the mother is picking up a colicky infant believing that that baby must be comforted. Regardless of the mother’s protestations, the primary reason for picking up the baby and trying to sooth him is to reduce her anxiety.

Eventually, the Victim will “run the bases” becoming the Persecutor. Instead of being grateful, he’ll resent the Rescuer who now “runs the bases” to play the role of the Persecutor’s Victim. (Isn’t this dramatic?) Probably she’ll sing the refrain that’s common for many Rescuers who have been converted to Victims. “Why does this always happen to me? I was only trying to help. I do everything for him and look at how I’m treated. It’s not my fault.” Sometimes the Victim-mom will appear in my office – but by now she’s reverted back to Rescuer. She says, “What can I do to help my son?” When I tell her to boot him out, she won’t; it would escalate her anxiety to an intolerable degree. “Where will he live, what will he eat?” Again this exhibits the tacit assumption that the son is incompetent to fend for himself.

  • The Persecutor is resentful, angry and suggests the Rescuer has helped them only to gain leverage over them.
  • The Persecutor chronically feels misunderstood
  • The Persecutor feels righteous in their anger.
  • The Persecutor frequently has out-bursts of “uncontrollable anger”.
  • Occasionally, the Persecutor is assaultive.
  • The Persecutor often resorts to intimidating name-calling

Unless someone is genuinely injured or has been officially determined to have an inadequate IQ, they will either learn to survive in the world on their own – or they will find another Rescuer to take care of them.

I think most understand that generalizations are limited. Stereotypes can sometimes be useful for the sake of illustration but they are never always true – nevertheless – allow me to point out some typical arrangements where the drama triangle is often found.

  • Parents and adult offspring
  • Therapists and patients
  • Co-dependents and addicts

How does one stop enacting the drama? It’s difficult but the key is that the Rescuer has to be able to tolerate their feelings – feeling of guilt, fear, rejection –feelings can be uncomfortable but feelings don’t kill us. Allowing the drama to continue is far worse for everyone.

Wednesday, June 9, 2010

Are you ready to get pregnant (AND BE A PARENT)?

DISCLAIMER: I did not write this and I'm sorry that I don't have the information to give the author credit. If the author reads this and objects to showing it here, I'll delete it - but I thought it was quite good. I suggest you copy it and give it to every post-puberty child you know. (You may have to read it to them.)

Preparation for parenthood is not just a matter of reading books and decorating the nursery. Here are 12 simple test questions for expectant parents to take to prepare themselves for the real life experience of being a mother or father.

  1. (Women) To prepare for maternity, put on a dressing gown and stick a beanbag chair down the front. Leave it there for nine months. After nine months, remove 10% of the beans. Now try-on all the clothes you love -oh well.
  2. (Men) To prepare for paternity, go to the local drug store, tip the contents of your wallet on the counter, and tell the pharmacist to help himself. Then go to the supermarket. Arrange to have your salary paid directly to their head office. Go home. Pick up the paper and read it for the last time.
  3. Before you finally go ahead and have children, find a couple who are already parents and berate them about their methods of discipline, lack of patience, appallingly low tolerance levels, and how they have allowed their children to run riot. Suggest ways in which they might improve their child's sleeping habits, toilet training, table manners, and overall behavior. Enjoy it--it's the last time in your life that you will have all of the answers.
  4. To discover how the nights feel, walk around the living room from 5pm till 10pm carrying a wet bag weighing approximately 8-12 pounds. At 10pm put the bag down, set the alarm for midnight, and go to sleep. Get up at 12am and walk around the living room again with the bag, until 1am. Put the alarm on for 3am. As you can't go back to sleep, get up at 2am and make a drink. Go to bed at 2:45am. Get up again at 3am when the alarm goes off. Sing songs in the dark till 4am. Put the alarm on for 5am. Get up. Make breakfast. Keep this up for 5 years. Look cheerful.
  5. Can you stand the mess children make? To find out, smear peanut butter onto the sofa and jam onto the curtains. Hide a fish stick behind the stereo and leave it there all summer. Stick your fingers in the flower beds then rub them on the clean walls. Cover the stains with crayons. There, how does that look?
  6. Dressing small children is not as easy as it seems. First buy an octopus and a string bag. Attempt to put the octopus into the string bag so that none of the arms hang out. Time allowed for this: all morning.
  7. Take an egg carton. Using a pair of scissors and a can of paint, turn it into an alligator. Now take a toilet paper tube. Using only scotch tape and a piece of foil, turn it into a Christmas tree. Last, take a milk container, a ping pong ball, and an empty packet of COCO Puffs and make an exact replica of the Eiffel Tower. Congratulations, you have just qualified for a place on the play group committee.
  8. Forget the Sports car and buy the minivan. And don't think you can leave it out in the driveway spotless and shining. Family cars don't look like that. Buy a chocolate ice cream bar and put it in the glove compartment. Leave it there. Get a quarter. Stick it in the cassette player. Take a family-size bag of chocolate cookies. Mash them down the back seats. Run a garden rake along both sides of the car. There! Perfect!
  9. Get ready to go out. Wait outside the toilet for half an hour. Go out the front door. Come in again. Go out. Come back in. Go out again. Walk down the front path. Walk back up it again. Walk down it again. Walk very slowly down the road for 5 minutes. Stop to inspect minutely every cigarette butt, piece of used chewing gum, dirty tissue, and dead insect along the way. Retrace your steps. Scream that you've had as much as you can stand until all of the neighbors come out and stare at you. Give up and go back in the house. You are now just about ready to try taking a small child for a walk.
  10. Always repeat everything you say at least five times. Go to your local supermarket. Take with you the nearest thing you can find to a pre-school child. A fully grown goat is excellent. If you intend to have more than one child, take more than one goat. Buy your week's groceries without letting the goats out of your sight. Pay for everything the goats eat or destroy. Until you can easily accomplish this do not even contemplate having children.
  11. Hollow out a melon. Make a small hole in the side. Suspend it from the ceiling and swing it from side to side. Now get a bowl of soggy Froot Loops and attempt to spoon it into the hole of the swaying melon by pretending to be an airplane. Continue until half of the Froot Loops are gone. Tip the rest into your lap, making sure that a lot of it falls on the floor. You are now ready to feed a 12-month-old child.
  12. Learn the names of every character from Barney, Sesame Street, and Power Rangers. When you find yourself singing, "I love you, you love me" at work, now you finally qualify as a parent!

Wednesday, June 2, 2010


What are our expectations of Life?
What forms our expectations? How does it happen?

I recall some time ago a patient came to my office – I forget if the patient was male or female, it doesn’t matter because the questions aren’t gender-specific.

I asked one of my typical openers, “So, who or what prompted you to make today’s appointment?”

The patient replied, “I don’t know… it just shouldn’t be this hard.”

The patient’s statement is not uncommon. When I hear it I begin thinking of a variety of things. Firstly, (because I really do want to be a good therapist) I pause because I’m going to wait for the patient to (hopefully) expand their answer – to put some flesh on these few bones. It’s possible the patient is horribly depressed. Maybe he/she truly doesn’t know. It is true that major depression is characterized by diminished concentration and neurasthenia.

On the other hand, perhaps my patient suffers from a condition that sometimes seems pandemic. For lack of a better word, I’ll call it entitlementism.

It sometimes seems that too often, people who otherwise seem richly blessed, believe that “happiness” is the “normal” emotional steady-state and that achieving it shouldn’t be difficult. Entitlementism is to me, a very curious condition. As I survey the condition of the world, I find very little that suggests that happiness is the de fact0 human condition, to the contrary, it seems that the world is “hard”. Famine seems more common than abundance. War seems to be a chronic plague to humans.

How then did people develop the notion that they should be happy most of the time – if not constantly – and if they aren’t “happy” then they are (almost by definition) “depressed”? I don’t know about you, but I don’t wake-up with the giggles and I don’t spend the bulk of my day with a self-contented grin on my face. Don’t get me wrong, I do have moments of happiness and much of my day is filled with gratitude and I find a sense of purpose and meaning in my life. I am able to see beauty in the world… maybe 10% of my day is “happy”.

What do you believe you’re entitled to?

The same dynamic attaches to people in relationships (any relationship). Some people seem to believe that a relationship should be “easy”. I sometimes wonder, “On what planet do these people live?”

To me, is seems that even under the most favorable conditions, relationships are not easy. Two individuals with different perspectives, different beliefs, different life-experiences are going to make different choices in life. It seems that two individuals must be fairly mature, flexible and forgiving to make a long-lasting relationship.

Does anyone really believe that relationships should be “easy”?

To me, it seems self-evident that anything of great value requires ongoing effort to maintain the condition of the valued thing. Think for a moment of owning a car; if I care about my car, I keep it clean (that takes money time and effort), I change the oil regularly (that takes time, money and effort). I replace the tires when needed (MT&E) and I keep it licensed (MT&E). The same applies if I own a home. Maybe I missed it, if so, can someone point out where the “easy” is.

A while ago, a patient brought me an “easy button”. When pushed, a mechanical voice says, “That was easy.” - but it doesn’t change my car’s tires or pay any bills that came addressed to me.

Perhaps entitlementism is the result of generations that were encouraged (often by therapists) to believe that somehow struggle, suffering or not getting everything we want, suggests that there is something out of alignment. That something is broken and needs fixing.

If one owns a house should it be expected that weeds will never be a problem? Is it “wrong” to find termites? Should a roof last for eternity?

Where did we get these ideas?

Does this all sound like too much gloomy news?

Maybe people would rather hear the lyrics to that Broadway song, “The Sun Will Come Out Tomorrow.”

It seems to me if we recover from entitlementism, perhaps then we can begin to accept that the goal is not persistent happiness but meaningful work, appreciating small moments of Grace and gratitude for the smallest brief moments of serenity.