Wednesday, November 17, 2010

In Appreciation of Duets

In Honor of SD & BS - Mazel Tov!

I’ve been re-reading parts of Carl’s writing about marriage (He’d be nearly 100 by now so it’s probably safe to now say “committed-long-term relationship”. From here forward, when I say “marriage“ feel free to paste in CLTR; to me, they are nearly synonymous.) Carl viewed marriage as the most natural venue where emotional growth could blossom. Granted, things were so much different even 40 years ago but in many ways we are so much the same in our psychological makeup.

Like Carl, I’ve long been an advocate of marriage. I’m certain there’s much to be said about the merits of singleness and even serial monogamy but that is not my focus in this column.

The thesis of this column is the idea that “maturity” is only half accomplished when we are physically and intellectually mature – the rest is a process that happens in the context of a marriage. Perhaps an apt metaphor is the event of two compatible DNA strands meeting and the explosive proliferation of Life that comes from it. One strand is insufficient (unless we dare venture into the world of cloning). While we are initially attracted by preliminary dynamics, we soon find ourselves on the launching pad for the ride of our life – and like a rocket launch, the ascent is not a cushy ride, but bone shaking. The ride will test our fortitude and endurance. Here, we discover if we are still in an adolescent stage of insisting that Life conform to what “I” say, or have we matured enough to accept that our partner is different and often sees things differently – not wrongly.

Carl likened marriage to the tennis player who decides that playing doubles is more enjoyable because of the creative interplay that develops. Learning when one should  hit the ball for the other and admiring the other’s abilities. Playing as a twosome is entirely different than being the staring monad. “… the simple joy of teaming becomes more important than whether we win or lose”.

I’ve talked with many couples who seem to be under the impression that marriage is about winning. The partner is seen as an opponent. The couple is playing singles against each other. When they are in my office it sometimes seems I should be wearing a black robe as I listen to attorneys for the prosecution and the defense. I often wonder, “Where is the jury?”

If we successfully graduate from our family of origin, we might be ready for the challenge of marriage. Successfully graduating helps to make it more likely that we won’t have to re-enact old unfinished familial battles with our mate – somehow again proclaiming our independence and worth, but this time, to the wrong ears. If we have successfully matriculated, we won’t be forced to complete our adolescence in our marriage.

Often couples present the bi-lateral pseudo-therapy model. In this set-up (pun intended), there is a covert awareness that HE isn’t quite right in his current form but SHE will subtly shape him into the man SHE knows he can be. HE temporarily tolerates HER inconsistencies with the intent of “helping” her become the woman HE thinks she should be. This is an idea that borrows the dubious notion that a therapist is going to change another.

Marriage is not a long-term remodel job on your partner. Marriage is teaming.

For certain, there will, in marriage, be trying moments, there will be moments of “blah” and there will be moments of great joy. Carl spoke of “…[a] whole-person to whole-person relationship…” It is a more mature love that hopefully develops. Of that stage of relational development he commented, “It is independent of sexual stimulation or sexual attraction [do not infer sexual abstinence].”

A marriage, like a swinging pendulum, increases one’s capacity for being part of a WE.  A thriving marriage allows for the increasing ability to express each party’s individuality and reflexively, each increases their capacity for togetherness.

This increasing back and forth arc describes the growing development of the WE co-created by the He and SHE.  

(Please forgive the limitations of my sexist language. I do not intend to exclude those too often marginalized. Specifically, I mean to include the wide spectrum of gender preferences) 

In this way, a marriage naturally has the movement of Life. The tides come in and go out; the heart contracts, and relaxes. In this manner we develop our personhood. Too often, this natural movement provokes anxiety for a couple:

“Oh no, they’re moving away!” or the opposite “Ugh, I’m feeling smothered.”

When we fearfully resist (or escape) this natural and reflexive dialectical process, anxiety and the resulting impulse to control the other can soon follow. Being able to relax - rising and falling with the swells of Life is freeing for both in the marriage. It is similar to what is taught in meditation – “follow the breath” – inhale… exhale. Would someone argue that it is more RIGHT to inhale than exhale? (Probably, some would.) Together there is Life, when one stops the other does too – it’s called death. 

The idea of WE, as something distinct from HE and SHE, is an idea too often unappreciated by a couple. I have always enjoyed the following poem which expresses this ephemeral idea:

The Third Body

A man and a woman sit near each other, and they do not long
at this moment to be older, or younger, nor born
in any other nation, or time, or place.
They are content to be where they are, talking or not talking.
Their breaths together feed someone whom we do not know.
The man sees the way his fingers move;
he sees her hands close around a book she hands to him.
They obey a third body they have in common.
They have made a promise to love that body.
Age may come, parting may come, death will come.
A man and woman sit near each other;
as they breathe they feed someone we do not know,
someone we know of, whom we have never seen.

Robert Bly

To me, a compelling question is: How does the couple move from the “bilateral pseudo-therapy stage” of relationship with its assorted games and maneuvers to the more mature, enjoyable, less controlling and anxious, “whole-person to whole-person stage”?

In my personal and clinical experience, it seems that, like other forms of evolution, it is a process borne of necessity, not choice. Either we adapt and evolve a more expansive and flexible style of relating (my Analytic friends might call it sublimation) or the relationship will fail like a root-bound plant. The plant’s previously useful pot (older ideas about the relationship) must expand to allow for new growth. For those with green thumbs, the concept is familiar – sometimes the pot needs to be discarded in the interest of the plant’s health – but the important element is the plant, not the pot. Too often, a couple fears discarding their earlier definitions of the relationship because redefining the relationship carries a risk – a risk of change – and who among us welcomes change when we have become accustomed to what is familiar – even if that familiarity is the very thing that is killing the relationship.

I remember with great fondness (before the constraining “pot” of today’s health insurance), my colleague Tomaso and I practiced co-therapy for more than a decade, a sort of professional marriage. We saw hundreds of families, couples and individuals as a professional team. His therapeutic style encouraged me to see things differently, we sometimes openly disagreed in front of our patient(s) but we were not vying to be RIGHT. Musicians, probably, (I’m not a musician so if I’m wrong, my brother or others will correct me) will agree that playing with others is more fun than… (Dare I say it?) playing with yourself. (Another intended pun.)

There is room for solos, but in this brief commentary I have addressed duets.

A commentator from an earlier column chastised me for not being more encouraging and so I end this column with my prayer for couples:

Look for what is different in the other, strive to appreciate the differentness. Resist the impulse to make others more like you. Look and listen for the rhythms created by the WE.

Perhaps this is what musicians would describe as the “unplayed notes” or playing “in the pocket”. 

Thank you to JB, TH and Bill for your help.

Friday, November 5, 2010

An apology...

I know I’ve recently made various allusions to a former teacher, Carl. Here is another of Carl’s stories. (If anyone knows the facts of this to be different, I hope you’ll correct me.) Earlier, in Carl’s career, he was appointed to a much coveted position as the Chairman of Psychiatry at a famous medical school. Almost immediately, he established a policy that all first and second year medical students must participate in regular group therapy. Probably, this was a great idea but it ended up entirely alienating him from the rest of the faculty. So, soon thereafter, he was fired. It was a terrible blow to his career. From that incident, Carl learned that while it’s important to do what is morally and ethically right, one must also consider the repercussions – particularly if one has a family.

I must apologize to those who read my comments here. Earlier this week, I posted information which I believe is important information to consumers of health-care services. It is possible that there would be repercussions which would impact others. Because of that, I have removed those postings.

If you want to view the information, feel free to email me and I’ll try to help you find it yourself.

Thursday, November 4, 2010

How to Quickly (and Easily) Ruin a Relationship.

So much as been written by so many about how to make relationships (with mates – family – coworkers) better; I thought I’d try it the other way – since there are shelves after shelves of books about improving relationships and the reasons for relationship failure continue to grow.

One might think that (logically) it would be reasonably easy to keep a relationship together; just pay attention to what’s happening in the relationships that go bad… and do the opposite!

To get you started with your own list, I’ll start you off with some of the most common blunders I encounter as I work with families and couples.

[11/15/2010  Warning: the following is irony, see the below comments.]

  • Believe fervently and insist that your perceptions, judgment and recollections are “RIGHT”. For variety, you can try the reverse – insist that the other person’s recollection of events are distorted or outright lies. Try gently insinuating that the other person is perhaps demented or lacking in integrity. (Just consider how effective this has been for Israel and Palestine.)
  • When you’ve been thinking for days about something the other has done that bothers you – wait until the other party is unprepared and ambush them with your carefully thought-out and rehearsed verbal attack. During WW II this was known as the “Pincer” attack and was successful in defeating the other side.
  • Tell others that you know what they are secretly thinking – this is almost guaranteed to make the other person apoplectic and will damage the relationship.
  • Secretly keep score of who is winning or losing points when there is a disagreement. If you think the other person “won” the last contest, provoke another argument so you have an opportunity to even the score.
  • Make up tests that will determine if the other person REALLY cares about you, is honest, finds you desirable – anything you feel insecure about; design a test (also known as a trap) that will somehow prove that your insecurities are caused by the other person which also means it is THEIR responsibility to behave differently so that you won’t have to deal with your own issues.
  • During a disagreement, be sarcastic and pretend to agree with the other person but paraphrase what they’ve said stating it in the extreme, absurd and hyperbolic manner. For example, if the other says, “I didn’t understand what you were saying.” You could try saying, “Oh, that’s right, I’m the one who doesn’t know how to communicate and you’re the one who never miscommunicates.” (If you can say it in a snide tone it’s even more destructive.) This will often create a no-win situation that will surely damage the relationship.
  • At all costs, avoid stating things in a provisional way. Stating anything provisionally only leads to solving problems. To insure problems, state things in the extreme. (i.e., I never… You always…) Stating things in the extreme will make sure that a disagreement is perpetual. (Isn't this fun?)
  • Whenever possible over-reach your boundaries and encroach on another's boundaries. This should be easy because there are a variety of ways to do it. Here, are but a few you could try tonight. Tell the other person how to drive or where to park. Tell the other they use too much salt. Make social plans without informing others – then “spring it on them” with little or no notice. Tell the other how to dress. When you engage in any of these, reframe the boundary violation as an innocent attempt to be “helpful”. (This way when the other person objects; you can make it sound like you were only trying to help and THEY are unappreciative.) SCORE.
  • Never fall into the trap of accepting personal responsibility for contributing to the misunderstanding. Proclaim your sainthood at even the smallest of opportunities.
  • Only talk about negatives. Never tell the other person about all the nice things they do. This nearly always makes the other person feel like a failure and they’ll quickly stop trying to be helpful giving you another opportunity to criticize them (cool).
  • Remember all the things you used to do early in the relationship that was fun? Don’t do any of them. If you really want to poison the relationship, only do things that are drudgery. Make sure that everything else is more important than your relationship. Work, kids, laundry, softball, lawn-work should all take priority.
  • To spice things up, try blindsiding the other with an ultimatum. Ultimatums will always set you at odds and will surely stimulate resistance from the recipient.
  • Expect others to read your mind so that they would do better than Kreskin (I guess that dates me.) when it comes to reading your body language and silence.  
  • Treat your relationships with others as if they were made of iron and able to tolerate abuse and neglect.
  • Take your relationships for granted. Perhaps this is a little redundant since many of the above are examples of how you can behave as if your relationships are a birthright. Behave as if you are entitled to use awful language. Act like an impudent adolescent and NEVER share in household responsibilities.
These are but a few ideas just to get you started. Remember, improving a relationship takes time and work but tearing one apart can be done easily and quickly without too much effort.

Tuesday, November 2, 2010

Your Beliefs versus a Therapist's Beliefs

As some know, one of my pet peeves is the fact that so many people have unquestioningly accepted the various beliefs and theories put forth by a century of therapists.

James Hillman and Michael Ventura authored a book some years ago – “We’ve Had a Hundred Years of Psychotherapy – and the World’s Getting Worse".

I’m not sure their assertion is accurate but I don’t think the influence on the culture is always benign or helpful. Psychotherapy is in the company of other “healing arts” – they too are not always benign. Who has not heard frightening stories of surgeries gone awry or adverse reactions to medicine; and these are usually the result of well-meaning practitioners using approved treatments. Add to these the quacks using untested methods or phony treatments.

Many, if not most, naively present themselves for treatment, assuming that the treatment provided will help. I am a bit surprised that many of my own patients scheduled preliminary appointments with me without interviewing me first. It is worrisome that some will accept the referral of AN INSURANCE COMPANY employee whom they’ve never met. When I’m on the phone with a potential patient scheduling a first appointment, I’ll usually ask, “Is there anything you’d like to ask me about – my therapeutic approach, how long I’ve practiced, my credentials, what my thoughts are about specific concerns." Some just want to schedule the appointment (I hope if they find me unhelpful they won’t continue seeing me.) A recent patient was candid enough to tell me she just wanted to talk with me for a while to see if I sounded crazy.

Allow me to mention a few of the ideas and practices that I believe are unhelpful. (In previous columns, I’ve discussed what I think IS helpful.)

Talking more is always helpful.

This commonly held belief has prevailed in the Western culture for probably the last 50 years. Rooted in the heyday of anything-goes sensitivity groups (originally, “T-groups”) unedited stream-of consciousness talking was thought to be “healthy”, it theoretically was an expression of an uninhibited mind.

The truth is that more talking is SOMETIMES helpful and it is sometimes unhelpful. Perhaps you’re familiar with the axiom: “You cannot unring the bell.” It is also true that what is said CANNOT be taken back regardless of some people who strongly assert that they take back a comment. Once said, it will exist forever in the mind of the one hearing it.

I have told many patients that when I speak to my boss, I am careful (i.e., full of care). It seems to me that when I speak to someone I care about, my words should reflect my care. If I spoke carelessly to my boss, I imagine I would not have remained employed for more than 20 years. Presumably, I care more about my mate than my boss – I believe my words should reflect that I care. Context is an important (though not sole) determinant of our tone of voice and our words. Some believe that they are not responsible for their words and tone of voice. I assume the most people are (for the most-part) neurologically intact. That leads me to believe that most (99.5%?) do have control of their behavior – despite the insistence by some that they don’t. A gross example would be the battering spouse who would have us believe they were not in control of the hands that strangled their spouse.

A variant of this idea, that we must “say what is on our mind” is an apparent belief that we must express our thoughts and feelings (particularly if they are negative) because if not expressed, we will somehow build-up psychic pressure (as if people are pressure cookers or steam engines) and explode. This belief has no foundation in fact. It does bear striking resemblance to the old but still used ploy told to women (forgive me for the following vulgarity) that unless men can have sexual release with women that the man will develop “blue balls” (an entirely fictional condition). Just as men will not explode without sexual release – people will not explode if they don’t express to ones they care about, complaints or other hurtful comments. (If this principle were true, wouldn't there be a pandemic people - particularly teenage boys, spontaneously exploding?)

It’s OK to say (if it’s true.)
Another falsehood – again I suggest the guiding principle should be “Is this the most caring thing to say and way to say it.” Using the rationalization that “it’s true so it’s OK” is an excuse to be uncaring and hurtful in our communicating.

Most of us have heard the cliché: A woman asks her mate, “Honey, do these jeans make my butt look big?” One can very lamely try to hide behind the rationalization that the jeans are unflattering to say, “Yes, they make your butt look really big.” With just a little thought, one can answer in a more caring way, “Those jeans are OK but I really like the way you look in the other outfit.” The guiding principle is caring.

You should use communication the way I do.
For me, it’s annoying when people seem to believe that others should communicate in a way that essentially is similar to their own. Previously, I reported a saying from my old mentor: “The fact that we both speak English only augments the delusion that we are speaking the same language.” Clearly each of us uses language differently, some more effectively - others… not so much.

Problems develop proportionally to how much we expect others to believe and communicate as we do. I can personally attest to this. Not everyone appreciates my sense of humor. In the not-too-distant past, I was careless about my sense of humor. In recent years, I have become more careful. I used to believe that everyone could, with only brief notice, express how they think and feel (copiously) about almost anything. I’ve learned that others are not like me – some people prefer to be more deliberate (i.e., think before they speak). I’m unaware of any word that has a unitary definition and if there were, we would still moderate the word by the tone and inflection we use. Others will not (ever) communicate the same way we do. You might wonder, “How then do we ever communicate?” The answer is the same as the punch-line to the old joke: “How do two porcupines mate?” The answer is, “Very CAREfully.” Effective communication acknowledges that we are all different and so we communicate most effectively when we try as much as we can to avoid assumptions that the other has understood what we intended with our comments – we intermittently confirm that we have communicated effectively - when we detect miscommunication, we correct it.

I was perfectly clear in my statement – YOU misinterpreted.
An axiom of communication theory states: “The meaning of a communication is its effect.” (not its intent) This is a very difficult notion to understand. I too have trouble accepting it, particularly if I’m the one that feels that I was totally clear about what I’ve said. If I am trying to communicate a thought or idea to another, it is my responsibility to express it in a manner in which it is most likely to be understood by the other party. If their reaction to my communication suggests they may have misunderstood, it is my responsibility to restate the communication more effectively. It is not the receiving party’s responsibility to understand me (particularly if I am using expressions that are not commonly understood). Believing that “I communicated clearly” is very similar to the delusion “I am right and you are wrong.” (see my earlier post.) Anyone who does public speaking will appreciate that choosing the right words and tone is their obligation. Again, in homage to my teacher, Carl, “If during a play of a comedy, the audience doesn’t laugh, it’s not the fault of the audience.”

Feelings reign supreme.
Psychotherapy has encouraged the idea that feelings and emotions are more important that thoughts and behavior. Truthfully, all are important but the relative importance of each merits greater reflection because they each are differing categories of experience.
Feelings are emotional facts like the doctrine of The Trinity is a religious fact. It is a disservice to try to justify these as concrete facts – this doesn’t however diminish their importance. Feelings can be very ephemeral; I may experience an emotion for a moment and then it fades. An emotion is not bound by appropriateness or consistency. I’ve often heard a patient say of their mate, “I love him but at times I could just strangle him.” Emotions don’t have to be reasoned, they just are. Emotions can shift from one moment to the next. Thinking is more deliberative; we have considered a variety of factors and have come to a tentative position.

Think of behavior as sign-language. I remember that for years, I expected my father to express himself the way I do. For years, I believed that because he didn’t communicate and believe as I do, he was in “denial”. When I became a bit more open-minded, I saw that his behavior communicated what he couldn’t verbally express. Too often, behavior is under-appreciated. When a man changes the oil in his wife’s car, it is an act of caring. When a wife makes dinner (please excuse my sexism), it is an act of caring.
At least twice monthly a patient tells me, “I love my mate, but I’m not “in love” with him/her.” To me, this reflects that my patient is expecting the exhilarating feeling of infatuation that is often experienced in the first stage of a relationship. Some of my patients have told me love is a verb. Love is what you do or what another does for you. Being “in love” is an experience – the experience is not a constant; it is a variable phenomena that ebbs and flows. Reflect on other feelings such as fear, joy, anger or suspense. These are not constant, they come and go depending on context.

Feelings are not more important – they are feelings, nothing more and nothing less.

My last comments before ending this rant; please consider carefully anything a therapist says. Remember, unlike physicians who have x-rays and lab tests all we have is beliefs. A therapist's job is to help you be more clear about what you think and feel – not to indoctrinate you into what they think and feel.