Worthy of repeat - Boundaries!!!!

Having practiced psychotherapy for more than two decades, I’ve noticed that certain themes or topics seem to be perennial. I infer that these themes are reflective of certain common human foibles.

The theme that has come up again is in the top-ten “golden oldies”, maybe in the top five. Can you guess what it is? If you guessed BOUNDARIES, you’re right!

Before I wrote this column, I checked in past blogs thinking I’d probably written before about this and sure enough I had. Almost one year ago I wrote a small commentary called, “Uhhh…. Can You Say No?”. I’ll try to not be redundant in this commentary but if you find this of some interest then you may want to click the link to read that posting also.

Some of you know too well that I apparently enjoy using shocking analogies and metaphors. I always say I do it because it creates a more enduring impression. It’s probably equally if not more true that I do it for the reason my mother always suggested – I just like getting others’ attention. With that admission out of the way, let’s begin.

Recently, I’ve talked with people upset about feeling violated because others (family and friends) either don’t notice boundaries or their boundaries are too permeable – too diffuse.

This morning, Jane (not her real name) tells me that a sibling feels free to make “constructive criticism” about Jane’s parenting methods.

I can’t think of anyone I know who kindly receives such unsolicited critiques. Why does the sibling feel free to poke their nose – especially uninvited, into concerns that are Jane’s?

The answer is _______________________ .

1. wanting to be helpful 
2. wanting to appear superior 
3. diffuse interpersonal boundaries.

If you said 1, you may be correct – but I doubt it. If you said 2, you may be right and if true, the person is a jerk. If you said 3, I think you’ve won the brass ring!

(WARNING – shocking analogy follows.)

Let’s take the above situation and change one quality about it to see how it might change your answer.

This morning, Jane (not her real name) tells me that a sibling feels free to make “constructive criticism” about Jane’s sexual behaviors with her husband.

Why does the sibling feel free to comment on Jane’s sexual activities with her husband?


The answer is _______________________ .

1. wanting to be helpful 
2. wanting to appear superior 
3. diffuse interpersonal boundaries.

In the latter example, I think most would recognize that opining about another’s intimate activities is violation of normal boundaries. It’s a no-brainer.

In this morning’s conversation, Jane was quite understandably insulted and justifiably angry. These are normal and healthy responses after being violated.

It was interesting that soon after Jane related her sister’s major misstep, she went on to tell me about how she (Jane) sometimes calls her mother to k’vetch about her (Jane’s) husband.

I asked Jane if she would ever consider discussing with her mother the dimensions of her husband’s (Dick – excuse the pun) reproductive anatomy. Jane appropriately said she wouldn’t dream of disclosing such personal and inappropriate information.

In my comments referred to earlier, I quoted Robert Frost’s familiar maxim, “Good fences make good neighbors.” But it is true that all good fences don’t look the same. Like so much in life, boundaries are described as being a spectrum from too permeable and flexible on one extreme to too rigid and completely impermeable on the other extreme. Usually, neither extreme is good (perhaps there are some exceptions). At times, my own boundaries have been too permeable. Other therapists (usually those more psychoanalytically inclined) have chastised me because they believe I disclose too much of a personal nature during the course of therapy with my own patients. I believe that patients should have unrestricted access to their own medical records. HIPAA laws dictate otherwise. If I want to maintain my employment at the Clinic and retain my license, I have to put HIPAA laws above my personal opinions.

My patients/teachers who are members of Alcoholics Anonymous remind me of the danger of being too private. They tell me that one is as sick as their secrets. (A variant of this says, “You’re as sick as you are secret.”)

How do we know if our boundaries are too much one way or the other? The simplistic but very true answer is, if it causes a problem it is a problem.

In my example cited at the beginning, Jane’s sibling’s sense of boundaries is too diffuse, too permeable. The result is Jan is angry, hence it is a problem. Jane’s complaints about her husband put too much burden on Jane’s mother, hence it’s a problem.

The permeability of ones boundaries should be adjusted based on communicating clearly with the parties involved. Instead of giving unasked for advice, ask first if it is wanted. Consider the “Golden Rule”; how would you want to be treated.

I conclude this short reminder about boundaries with a book recommendation. The book is written for women but is equally applicable to men. The book title is:

“My Answer is No . . . If That's Okay with You: How Women Can Say No with Confidence" by Nanette Gartrell, MD

Why – How –What

No, this is not an essay on important aspects of journalism. Rather, this is a brief essay about “change”. Some may say it is an essay about “psychotherapy”. Arguments can be made that the two are different or similar.

Historically, psychotherapy has focused almost exclusively on the “why”; the personal, emotional archaeology; a sort of psycho-Darwinism that suggests that what we do (presently) is largely informed, if not dictated, by past experiences.

I decided to write about this after a conversation with one of my patient/teachers today. He, like many others I’ve talked with, has an important task he wants to accomplish. The task is personally important to him. The task is not odious; it is not difficult, but for reasons which elude us, he does not perform the task. Like many therapists might, I have discussed with him, “why” the task is not done. Let me emphasize that many (myself included), have experienced a similar phenomenon. Almost reflexively, we pursue the answer to “why”.

I’ll offer one of my own experiences as an example:

For probably thirty years, I have been over-weight. As a therapist-in-training, I completed perhaps ten years of psychotherapy as the patient. You might well imagine that many years were spent therapizing “why” I am over-weight. I suppose the theory was (and is still popular today) that if I understood, “why”, that would lead to the “cure”, (i.e., I would lose weight.) Well, guess what; I’m still overweight, perhaps more so. I do have several interesting theories (we therapists do love our theories) about “why” I am over-weight.
 

• I have a protracted adolescent rebellion against my father who, as a restaurant owner, made sure everything was the correct portion size.
• I’m afraid of intimacy.
• I’m trying to fill some deep psychic void with food.

While all of these why-theories have their germ of truth, none of it has helped me to lose weight.

Steve de Shazer, a former teacher wrote a book, “Words Were Originally Magic”. One chapter of the book was entitled “Getting to the Surface of the Problem”. Steve was a proponent of finding a solution to a problem; he was not particularly interested in finding a cause or a “why”.

Here’s another example of my quirky behavior:

Years ago, I despised the voicemail on my office phone. I had absolutely no problem with the voicemail at my private practice. For years I forwarded all my Clinic calls to my receptionist. “Why?” one might ask.
Honestly, I haven’t a clue. I can’t even make up a reason which, for a therapist, is remarkable. Then, about two years ago, a memo was issued from HQ stating unequivocally, that all providers were REQUIRED to respond to voicemail messages within 24 hours.

My “voicemail phobia” was instantly “cured”. No insight or introspection was needed. I did not seek help from a therapist. I now regularly and without hesitation respond to all voicemail messages.

Other patients have complained of cluttered homes, unpaid bills and derelict lawns. Without exception they have told me they don’t “understand” (i.e., have insight) about “why” the various activities remain untouched in their “in” box. Often it may be suggested they are “avoiding” the activity for some hidden reason. It is sometimes conjectured that the reason for not completing the task is due to an unresolved fear that almost always originates in early adulthood or childhood. These are attempted explanations to satisfy the "why" question.

It seems that while understanding “why” may take the patient on an interesting psycho/archeology dig and may yield interesting theories, it will probably not result in the expressed desire for changed behavior.

Let’s shift the focus from “why” to “how and what”. How can change be induced? What is associated with behavioral change?

Frequently, I consult with couples who explain that they frequently have “stupid and hurtful arguments”. Sometimes, one blames the other – sometimes they want to know “why”.
Sorting through the possible “whys” and trying to educate a couple that blaming is never useful, may go on for months. If however, I can convince them to audio record arguments – almost magically, the terrible arguments cease. I’ve listened to some recorded arguments – what I hear are two adults with mildly raised volume respectfully disagreeing. There is no name-calling, no cursing, no door-slamming. The “whys” can be various but more important was “how” the arguing changed or “what” changed the arguing. Alternatively, I may ask the couple to continue the arguing but I ask them to solemnly agree that one will begin the argument on even-numbered days and the other will begin arguments on odd-numbered days. 99% of the time, the couple stops arguing. Some will tell me that my suggestion was so absurd, they refused to do it… and didn’t argue.

Again we can generate numerous “whys” that attempt to explain but the truth is, explaining, understanding and insight have little or nothing to do with the change. More important was “what” and “how”.

The patient/teacher I initially referred to had, months earlier, done the needed task. I asked him to do it in my office. (It involved a brief computer task.) He immediately performed the task without a moment’s hesitation. Though the patient/teacher was equipped with at least four “whys” (involving his insecurity, childhood traumas and past failures) – he did the benign task. Those “whys”, regardless of their validity, did not stop him. Again, we may speculate a dozen “whys” but the how and what changed the behavior.

What then, is the “take away” from this brief essay? 

“Why” may be interesting (and be alluring to one's intellect) but it doesn’t lead to change – if you want change, think about “what” will change the behavior.

Concerning power and "therapy"

[Note: In these comments, I have offset some words with quotation marks. I do this to denote that the word, so marked, has meanings that deserve careful questioning. The meanings of these words are sometimes undeserved and frequently driven by the politics of the culture. If the quoting seems excessive, then it only further illustrates how virulent the effects of "professionalized languaging" has infiltrated and influenced the culture.]

Today, I spoke to a "patient", a very nice, bright woman. A year or two ago she was very upset by a variety of events. As she sat in my office, she was clearly very distressed. Because I work in a traditional medicalized system, I did what is expected and required of me in this context. I referred her to a psychiatrist. If I did not make the referral, I could be found guilty of malpractice due to the system of health-care (the context in which I work). Not surprisingly, the psychiatrist arranged for hospitalization and the patient remained in the hospital for over a week. When she was "released", not surprisingly, she had been “diagnosed” with a “mental disorder” and the treating psychiatrist had prescribed several medications. The patient was “released” from the hospital with an entirely inadequate understanding of the “diagnosis” and much less of the medicines prescribed. Because she was a "compliant" patient, she took the medicine as prescribed.

I’m commenting on this because, as I have opined previously, I am troubled by the inherent problems that accompany power discrepancies found in many professions between the “professional” and the “nonprofessional”. Particularly, I think of the medical profession and more so, psychology and psychiatry. The psychological/psychiatric “profession” has appropriated the “authority” to "diagnose" and treat “mental disorders”. It is almost unknown that descriptions of unusual behaviors and experiences that a person may have (other than those in the domain of “health-care professions”) exist. The dominant belief is that only psychiatrists/psychologists/therapists can appropriately "diagnose" and treat these "conditions" or dis-eases.

“The Diagnostic and Statistical Manual of Mental Disorders” (DSM-IV) allows only five of its more than 800 pages to acknowledge that there are “culturally-bound syndromes” that are briefly described. The implication is that these culturally-bound syndromes are quaint descriptions originating from less progressive (i.e., less educated) cultures. A patient’s descriptions and explanations of their experience are expected to yield to the more learned (and ostensibly, more accurate) “professional” descriptions. Descriptions that are indigenous to the one experiencing the unusual or troubling feelings/experience often become quickly converted to an alien medicalized idiom. Automatically deferring to the “professionals” is not always a good idea. Monthly, I receive journals that report legal/ethical violations by “professionals”. I am flabbergasted by some of the deplorable behaviors of some in the “profession”.

My concerns are not original and hopefully shared by many others. Perhaps the first to discuss the problems of power discrepancies was the highly controversial French philosopher, Michel Foucault (1926 – 1984). While Foucault probably would have objected to my use of parts-only of his thinking while excluding other portions – I’ll do so anyhow.

A significant portion of Foucault’s work focused on how power is virtually inseparable from knowledge. In fact, in much of his writing he would often speak of a hyphenated power-knowledge, thus acknowledging the reflexive nature of the two, or as some might say, “two sides of the same coin.” I’ll try to briefly sketch the basics of the Foucault’s concept and show its significance in medicine and psychology/psychiatry.

As any type of specialized knowledge develops, so too “experts” emerge. The “experts” develop special (typically unusual) language and concepts that are familiar only to the “experts”. The specialized language, perhaps intended to help “experts” better understand, has the effect of creating a widening disparity between the individual’s experience and the “professional”. (Consider the influence of the Roman Catholic Mass when it was said only in Latin and the separating effects it had on the laity.) Power and control are natural attributes of specialized knowledge. One can easily see how this dynamic lends itself to many professions and disciplines. Let’s look at how this is expressed in today’s culture.

• In medicine, physicians invest much time to learn and become “expert” in “curing” “illness”. In the process of their education, physicians learn a language that is specialized and unfamiliar to the layman. Physicians are generally held in high esteem. They wear a mantle of god-like authority and power symbolized by their white frocks. Is it only coincidence that these garments share common qualities as the vestments of the clergy? They have the authority to diagnose and prescribe powerful drugs. If the laity (the unordained) question a physician they may well be rebuked, “And what medical school did YOU attend?” If a psychiatrist decides (Remember, there are no tests to diagnose mental illness; no x-rays, no blood tests, no brain imaging.) one is alcoholic and dictates that into a patient’s medical record, it is in the record virtually forever. It is illegal to remove it. It doesn’t matter if the psychiatrist is misinformed. Now, the patient will be labeled and other ordained experts will read that assessment and will almost certainly be influenced by it. If medicines are prescribed and the patient exercises their own prerogative to not take the medicine, they may be labeled as “non-compliant” (a variant of “hostile”) When I see a patient for a first visit, the power dynamic is set in motion long before I ever meet the patient because they assume the posture of one needing help and I in turn posture myself as one who can help. I am ordained by my education, the State of California and the Clinic by which I’m employed. Because my name (with the requisite initials) is on the door, because I have an office, because my chair is different than their chair, because I have a desk, because they must make an appointment with me, because they pay to speak with me and many other reasons, the power dynamic is set. They need help (have less power) and I am expected to provide help (have more power).
• In a closely aligned profession, the clergy has invested much time becoming experts in the history, liturgy and traditions of their faith. They are “ordained” by governing bodies to be “shepherds of a flock”. They are authorized to perform the rites of sacraments. When members of the congregation are ill, the pastor is called to offer prayers for the afflicted. Priests, rabbis and pastors are also “ordained” by the state to solemnize weddings and bless other events not within the purview of the unordained. The Roman priest can forgive sins, hear the confession of the penitent and is the sole mediator between man and God.
• Academia is another profession sharing many of the same qualities. The academician invests years of training, studies the works of expert predecessors, writes exhaustively so that other experts might determine if entry may be granted to the rarified air of the ordained. Titles are bestowed: master and doctor and if one is fortunate, they will become an assistant professor and then full professor. Like physicians, no longer are they called by their birth name; now they take the appellation of achievement and expertise – they are referred to as “Doctor” or “Professor”. The professor stands before the class of students and if the students are to become themselves experts, they must learn from the professing expert and pass examinations.

Foucault wrote and spoke about the problems of power, control and knowledge quite a bit. You may find yourself wondering what all this blather has to do with “therapy”. It has quite a lot to do with it. “Therapists” are in the same (dare I say it) game as those mentioned above. My own language shows how much I have been influenced by my heady “profession”. I talk with PEOPLE but often, I will call them “patients”. I am not a doctor but many of my “patients” will call me “doctor”. I correct the misnomer many times. Some tell me they understand I am not a doctor but they feel better calling me doctor. Psychology/psychiatry is not a hard science (yet). Simply reading the “patient” information sheet on a prescription medicine will illustrate the fact. When explaining the pharmacologic mechanism of the drug, the manufacturer typically says, “It is believed …” i.e., it is not KNOWN. Therapists offer beliefs and opinions; frequently with a mantle of undeserved “authority”. Therapists position themselves as relational “experts” (but no one asks how many times the therapist has been divorced), we present ourselves as experts in family matters (but no one is present to see us during family get-togethers).

In large measure, the culture has benignly conspired to rob individuals of their autonomy. Often, those labeled “patient”, have the ability to deal with and understand the meaning of the challenges encountered. As “professionals” we thoughtlessly impose our “clinical” diagnoses and assessments rather than LISTENING to the language and descriptions used by those sitting in the “patient” chair.

It is an act of self-betrayal when any of us abdicate our personal agency and carelessly turn it over to one deemed to be “expert”. When we hire an expert we should always retain ownership of our own personhood, it is after all, sacred.


Addendum: Recently, I spoke with the person referred to in the beginning of this column. I had asked for his/her comments and their comments are an important counterpoint to my comments. They made the point that when one is as "clearly very distressed" as they were, one is not carelessly turning over their personhood - because in that moment, they have lost touch with the sense of personal agency. In that moment, they would like nothing more than to have a sense of ownership of their life.They have sought the help of "professionals" because of the overwhelming distress. 

Again I thank those who help me to understand more clearly the human experience.

Trust - Control - Anxiety - Fear

I just finished speaking to a young woman (between 17 – 23), she made a comment that was the essence of a comment I’ve probably heard every day during the course of my professional practice.

Basically, she told be that since a certain event, (Not an uncommon one – but one that is hurtful and involves loss as well as a sense of betrayal by one who she’d considered trustworthy.) … she “can’t trust anyone.” As I said, I hear this or close variants almost every day as I sit in my chair. (Maybe, instead of sitting during appointments, I should be on an elliptical machine during appointments?)

What does the statement suggest? Probably there are some different meanings but there are also shared implications.

Throughout my blog columns, probably the most common and central themes are the concepts of power – control – trust – anxiety and fear. These are all points of a loop of experiences. All are natural but when there is a distortion of one or more, it becomes the likely (not always) source of problems. 

For those with an unusual desire to read more of my comments on the matter, refer to the links below:

How things get off-track
Anger Management
Fair Fighting
Power/Control
Your Anchor
Who are you



In these columns, I discuss various ways these issues become problematic.

When people tell me about their difficulties in trusting, I am inclined to ask the following:

Regarding trust, what are your expectations?

Let’s assume a relationship (any manner of relationship: mother/daughter, employer/employee, marital, close friends or casual friends). What are the trust expectations? Let’s look at some different scenarios.

• My colleague and I want to get coffee and catch-up. Personally, I am an early-riser; he is not. I suggest 7AM, he offers 9AM. We agree on 8AM. I arrive at the shop at 7:45AM and wait… he arrives at 8:10. Is this a breach of trust? Perhaps his watch is set differently than mine. Perhaps my watch is set early. Perhaps there were exigent circumstances with his family which delayed him. Perhaps the traffic was unusually bad. Perhaps our coffee-date temporarily slipped his mind. Perhaps he got lost. Perhaps he couldn’t find a parking space. What are my expectations and what do I infer from the fact that he arrived later than I? Do I assume he doesn’t consider my time important? Do I believe he’s just being “passive aggressive”? Do I become agitated? Has he violated some rule that I think EVERYONE must know – ALWAYS be on time. Are my expectations reasonable?
• A married couple has a heated argument which is not resolved. During the emotionally-loaded argument, both say things that the other experiences as hurtful. While in the moment of the argument, both felt upset but nevertheless believe their own comments were warranted. Now, hours (or sometimes days or even years) later, one or both think, “I cant believe (s)he said that – or did that.” When I discuss it with the couple, they each have their own differing perspectives of what transpired. One or both suggest, “Until you can ADMIT to what you said/did, I can NEVER trust you again – and without COMPLETE TRUST, there is no foundation for a relationship”. REALLY?                                                                             Considering that many of us believe we are mature and reasonable, do we still expect that someone MUST agree with us? If they have a different perspective are they necessarily lying? If they see events differently does is necessarily mean the other is in DENIAL? If the other sees events differently, can we accept that people can see things differently without being WRONG? If the other says they have been hurt by our words or actions, can we sincerely and contritely apologize? I have talked with so many who insist they were NOT WRONG and therefore no apology is warranted. REALLY? Is your sense of being right (i.e., self-righteousness) so important and certain, that you prefer to let the harm stand instead of doing what you can to repair the damage? PLEASE, don’t say “Well what about what they said…” (It sounds a bit childish, doesn't it?) I agree; they assuredly share responsibility for the damaged relationship – but waiting for the other to be contrite will forever create a stalemate (pun intended). Some will go on to use these hurts as an ever-ready moral caudul, bringing it up at every opportune moment, like a trump card, to WIN a disagreement.
• Assume a relationship between a father and son. The father has reared his son to be a responsible citizen. As the son assumes his role as an adult, can the father accept that the son may have very different values without resorting to suggesting that “something has gone wrong”? My own son decided to be tattooed. Had he asked my advice, I would have suggested that he not get a tattoo – but he didn’t ask (Indeed, it was appropriate for him to not ask – he is an adult, not living under my roof.) Can I accept that his wishes and decisions are his – that he needn’t seek my permission or approval? Can I tolerate the anxiety that we have different values? Must I insist that MY VALUES are RIGHT and that he must conform to MY standards? By living his own life, expressing his individuality and values, does he violate my trust? Do I suggest that because he has chosen a certain behavior that my trust is forever broken? Do I live the life of a victim (a very powerful role) telling any who will listen (or reciting it to myself like an emotional prayer) of my victimhood which I insist was first perpetrated by him – but which I now daily resuscitate? Will I forgive? Will I accept that he has become what I prayed for – an individual – not a carbon copy of myself? (A close expression of narcissism.)
• Last for consideration, a 50ish mother with an adult daughter. Mom is a devoted evangelical Christian. The daughter is lesbian. I think most understand that the mother would have a difficult time accepting that her daughter is lesbian. Probably, this is not what she had in mind when the daughter was a five year old. The daughter states that she too is a Christian. The mother INSISTS that the daughter is WRONG and sinful. During a conversation with me, it seems what the daughter does in bed and with whom precludes any other conversation the two might have. It seems there is no room for, “How was your day? What are your hopes and dreams for the future? What kinds of projects are you pursuing? How do you feel?” REALLY? Is the daughter’s sex-life the most important thing to discuss? I wouldn’t dream of asking my son about his sex-life – it would be a gross boundary violation. If he ever asked me about my sex-life, I’d tell him it’s not his concern. PERIOD.

Does all of this mean that we should continually tolerate UNREASONABLE violations of our relationships? Absolutely not. 

What are unreasonable violations? That can be difficult to answer. Some more obvious violations are blatant. When a person REPEATEDLY violates our relational boundaries resulting in EGREGIOUS DAMAGE and demonstrates no willingness to change behavior... self preservation prevails - but if there is a willingness to change, we must carefully examine our motives to leave.

(excuse my religious-sounding spin: REPENT, GR: metanoia suggests that one changes their direction/behavior. If one was traveling North, they turn around and travel South.) 

What if the violations are minor injuries, unintentional insults and differences in opinion? What if a couple has agreed to an austere budget and one party spends money beyond what is agreed. Is that a reason to cast the entire relationship in jeopardy? What about if one party in a relationship has an affair – the unfaithful partner apologizes, insists it was a horrible human failing and promises to change. Should the injured party accept the apology and continue in the relationship or is this violation too much? 

It is possible to forgive but also decide the relationship cannot continue. 

I have worked with many couples who decide to maintain the relationship. They decide that there is much in the relationship that they want to save. Rebuilding the trust takes time – perhaps a year or more. Forgiving does not mean forgetting. We do not forget terrible injuries. But if we forgive, we agree to not repeatedly bring up the issue.




(Here is an excellent article - thank you BN Forgiving.)

Going back to the beginning of my rant: Continually portraying ourselves as a victim can only result in the suspension of our emotional and spiritual growth. If we are victims, we are not taking responsibility for our life. We suggest that someone else has dictated our fate. 

Who is in the driver’s seat of your life – someone else, your ego – your parent’s expectations. Blame is a game that keeps us in everlasting ignorance.

Is it Love... or is it Wimpy Parenting?

It's easy for me to ask the question and it's even easier for me to pontificate about it as I sit in the ostensibly all-knowing-and-wise Wizard of Oz chair 50 hours each week.  The debate has strong adherents on both sides. 

Many parents explain to me that the realities today are significantly different than when I was leaving the nest of my parents’ home. Quite true.

Of course, we live in a very difficult financial environment. I'm told it is very difficult if not impossible for a young person to find employment that will cover their housing, food and other bare essentials. Also, there have been articles written suggesting that another "developmental phase" is evolving; a  "20-something phase" which follows adolescence but precedes adulthood. This argument supports the idea that it is healthy for pre-adults to stay under a protective parental wing.

I'm in agreement with the first argument; we are certainly living in difficult times - I am not so sure about the notion that another developmental phase is evolving that warrants a protracted adolescence. 

I am continually flummoxed when it's suggested life should be "easy" or "easier". I wonder, when has life EVER been easy - except for during my childhood when my mother did my laundry, prepared my meals, cleaned my bedroom, virtually did my homework and fought my battles with my father. 

Since I matured (in the last few years), I've come to "accept" that Life is difficult. As I survey the situation of others, I think others have a more difficult situation than do I. As I consider those in other countries, it is doubtless that their life is even more of a struggle.

Where did we ever get the impression that life "should" be easy?  

[Disclaimer: I have often said and it applies here also that this is my OPINION - not facts or the conclusion of research - so feel free to dissent.] 

In my professional experience, I generally find it unhelpful to allow young adults to stay in their parents’ home. Young adults are in a developmental period in which it is appropriate to make their own rules - often these rules are at odds with the parent's values and norms. If a young adult is living with parents, one party will have to adjust and often - it's the parents that capitulate. Instead of maintaining clear boundaries about their expectations and allowing the natural consequences to occur, they violate their own integrity (becoming increasingly angry and increasing helpless in the process) and unintentionally retard their child's emotional/psychological maturity. 

Why do parents, again and again postpone imposing significant consequences (i.e., booting the older-adolescent out)? Parents, frequently, will offer a litany of rationalizations - but more often, the real answer is that the parents can't tolerate their own anxiety that would escalate if they "induced labor" to get their child to leave the nest. They feel plagued by all of the "what if" questions. "What if the young adult becomes homeless? What if they turn to crime? What if they go hungry?"  These are real possibilities - but they are possibilities that the parent(s), ultimately, cannot control. The lack of control is what provokes the anxiety. The parents are exchanging a feared future “what if” for the alternative – a surly, entitled and resentful offspring who never develops a sense of competence and responsibility.

It may be worth reviewing the blog entry about the “drama triangle”. The rescuers believe they are motivated by compassion, but more often, the root motivation is their own anxiety. They engage in recuing behavior to contain their own anxiety which would escalate if they were to allow their young adult to face the harsh realities of life. As they continue to rescue, the “victim” suddenly becomes the rescuers’ persecutor who now feels like they are the victim. The familiar refrain from parents and other rescuers is, “After all we’ve done for you, this is how you repay us”?

Commonly, the young adult (or other victim) will charge the rescuers with being too controlling or unfair.

How, you may ask, does one extricate oneself from this kind of trap? The answer, I'm afraid, is not easy. And, isn’t it interesting that the initial desire to provide an easy way became the fertile feild for this very hard dilemma? 

The answer is that there is no escape from the fact that this life is hard and that we do a grave disservice to our children when we try to shield them from this fact. The way out of this dilemma is hard and heart-breaking. The way is filled with anxiety as we wonder if our children will “make it”.

There is a well-known saying – which while sounding hard-hearted is true: Life is hard, so get a helmet.


Two neighbors have a fence between their backyards.
The first man notices the neighbor got a new dog.
Over a period of weeks, as the man observes his neighbor's dog, it seem his tail is getting shorter.
One day, as the neighbors meet at the mailbox, the first man comments that he has seen the new dog.
His neighbor gushes about how cute and sweet the dog is.
The first man mentions that it seems the dog's tail is getting shorter and shorter.
Yes, says the neighbor, "The Vet said I should get his tail docked, but I love that dog so much...I didn't have the heart to do it all at once."

Living Vicariously

Recently, I was asked if I’d written about “living vicariously”. The question has prompted me to write about it. (Most of what I write is directly or indirectly in response to questions my patients/teachers present to me.)

Let’s begin with a definition of "vicarious" that I’ve appropriated from dictionary.com.

• performed, exercised, received, or suffered in place of another: vicarious punishment.
• taking the place of another person or thing; acting or serving as a substitute.
• felt or enjoyed through imagined participation in the experience of others: a vicarious thrill.
• Physiology . noting or pertaining to a situation in which one organ performs part of the functions normally performed by another.

Often the way we use it in the vernacular is when we suggest that one person has consciously or unconsciously avoided the challenges of Life and hope to experience the good parts (Who would want to experience the painful parts?) through someone else. Perhaps some of the better known examples of vicarious living are (please forgive my sexism) the “stage mother” who always wanted to be a performer but for various reasons turned away from their dreams – now, they push their child with a peculiar relentlessness. Another familiar expression is the “sports dad”; when their son or daughter is still a toddler, they begin shaping them into an image that the father wants. More subtle expressions are found in the inverse. Parents who have lived an indentured life of their parents morality – and then they are shocked when their own children express the “hell-raiser” that the parent was afraid to express. Had the parent expressed it (not necessarily in outlandish fashion) the child wouldn’t need to so vehemently express the parent’s unlived life.

There’s something quite narcissistic about this dynamic. Instead of trying to be aware of what talents emerge organically, the parent imposes an image which is not natural for the child. Often as the child matures, the child sometimes doesn't express their own native identity but accepts the image the parent imposes. 

I’m reminded of chánzú – foot-binding of very young girls practiced in China for almost a thousand years. – because small feet were considered more desirable. It was a form of mutilation. Consider the word, “mutilation”. To me, it suggests the act of muting another’s expression. When we force our children into an environment that extrudes some reflection that we wanted to see when we looked into a mirror. When we indulge in this kind emotional mutilation we are violating the unique character of the child.

I am not suggesting that children should not be socialized to be responsible citizens; that is our responsibility as parents – but it is also our responsibility to nurture their unique character.

Most children (I’m thinking about my own son.) despite our best efforts, become their own persons.

I’m concerned for those young people who have demurred individuating because they fear disappointing their parents.

I’ve often said I used to be threatened by a person’s threat of physical suicide… today; I am more horrified by one who commits psychological suicide or psychological homicide. Abandoning your self is gruesome beyond words.

I believe that it is each person’s SACRED OBLIGATION to live their own life with all the integrity they can.

Again, from Dictionary.com

Sacred:

• reverently dedicated to some person, purpose, or object:
• regarded with reverence: the sacred memory of a dead hero.
• secured against violation, infringement, etc., as by reverence or sense of right: sacred oaths; sacred rights

If we abdicate this central task, it becomes the seeds of all manner of problems. If we are parents, I believe we are obligated to create the environment wherein our children can express their unique character and gifts. That means we are not to enable them to remain perpetual adolescents. It means we prepare them for the realities of living in a difficult world. We do what we can to prepare them for the disappointments that are inevitable. We communicate (more so in our behavior but also with our words) that their supreme task is to express their Spirit (not yours), as fully as possible. We communicate that we (their parents) are not the most important ones to please – they must live, as much as possible, a life of integrity.

My teacher, Carl, used to refer to the “disease of abnormal integrity” a mode of functioning wherein one acts without regard to societal expectations, violating any or all cultural norms, having no apparent respect for the feelings of others. A more modern description might be "sociopathy". The opposite is someone who has no integrity; they are people-pleasers in extremis. Neither is the desired state. Finding a balance between them is the trick… and it is quite a trick. 

There is an inherent tension between the two impulses. Knowing (through trial and error), how to navigate between the dangers of these two positions largely is the functional definition of emotional/psychological maturity.

Let me return to “vicarious living”. Vicarious living is dishonest living. Whether we are trying to coercively scapegoat our children into living the life we didn’t have the guts to live ourselves – or whether we are psychological/emotional parasites, getting our thrills voyeristically from another’s life, it’s dishonest and reflects our own failure to mature while simultaneously planting seeds of problems in our children.

I am reminded of a fragment of a letter that Paul wrote to the Philippians, he says, “…work out your own salvation with fear and trembling.” The Greek word for “salvation” is soterios – it means WHOLENESS, COMPLETENESS or HEALING. Note that Paul tells them to work out their own wholeness (not someone else’s) and that it’s a scary process – not for the faint-of heart.

Living a life of integrity – honesty – not shirking our obligations – not drafting our children into living a life from which we turned away, is our endeavor.

Is it easy? No, it’s the hardest thing I can imagine – something I strive to do – something I fail to do – but I keep trying. I hope you keep trying too.

Where is Chistmas? (Hint - look in a mirror.)

Most cultures celebrate the advent of “God” being manifest in the world. In the Western culture, it is virtually impossible to escape the commercialized expression of Christmas. Probably, the number of people who celebrate a secularized Christmas out-number those who celebrate Christmas as a sacrament. Paul Tillich believed a sacrament was an outer expression of an inward Grace.
 
During a recent conversation with a theologian, he commented on the dynamic tension between psychology and Faith. Probably, I would think they share more in common than he would but for the purposes of this brief comment, the differences are not so important.

Many who know me, already know that I have some formal training in the Christian tradition, so please forgive me if it seems the Christian tradition is more prevalent in my comments. I don’t mean to “dis” other faith traditions – it’s just easier and more familiar for  me to speak in my “first language”, the Christian idiom. Other traditions, whether they be tied to a faith-tradition or other-cultural tradition also have expressions of the Divine being expressed in the material world.

For those readers with an antipathy towards Christianity, try to imagine my references as an allegory like an impressionist painting.

Consider the medieval arcane practice of Alchemy; the over-arching idea was to transform a “lower” substance to a “higher” substance – the “philosopher’s stone” of Harry Potter fame. The transformation was thought to be brought about by strange, often tortuous procedures of heating, cooling, pulverizing or combining with other substances. We find a similar motif in Shakespeare’s “The Tempest”; Ariel is the spirit (a higher substance) liberated from the tree (lower substance) in which he’d been imprisoned. In Alchemy, the lower, base substance is often called Prima Materia. In the practice of psychotherapy, the patient comes with a “presenting problem” which is the Prima Materia – it is the beginning base element which we hope to transform to something better and higher.

In the Christian narrative, God is expressed in human form. (Remember… ALLEGORY) The angel Gabriel tells Mary, a virgin, 

“Do not be afraid, Mary; you have found favor with God. You will conceive and give birth to a son, and you are to call him Jesus. He will be great and will be called the Son of the Most High."

 
Here, we find another example of the Divine (higher substance) being expressed in a human womb (lower substance). I don’t think it is just an interesting coincidence that “mother” and “matter” come from the same root, in Latin, Mater and Sanskrit, Mata.


Later, as Mary is ready to deliver the child, we read:

"While they were there, the time came for the baby to be born, and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no guest room available for them. And there were shepherds living out in the fields nearby, keeping watch over their flocks at night. An angel of the Lord appeared to them, and the glory of the Lord shone around them, and they were terrified. But the angel said to them, “Do not be afraid. I bring you good news that will cause great joy for all the people. Today in the town of David a Savior has been born to you; he is the Messiah, the Lord. This will be a sign to you: You will find a baby wrapped in cloths and lying in a manger.”
 
Do you see the leitmotif? The Sublime presented in very crude surroundings.

Many times through Christian writings we find God’s will expressed through less than revered forms; from the mouth of an ass, from a bush and others. We are told that God uses the foolish to confound the wise. We are told of a "building block that was rejected" and how it becomes the cornerstone of a new epoch.

I point to these to set the stage for my “Christmas” message – that it is within YOU that the Divine is expressed, not in those who outwardly appear spiritual. Eckhart tells us that God is found in our weakness. It is when we are most broken that we find the Divine is with us and around us, in fact, IN US.

Are you feeling rejected or demoralized? We all, I am sure, have our psychological low place, our emotional manger; that is the more likely place we will find the cornerstone of our Spiritual emergence.

Forget material riches – forget what you think you know. Be honest about where you are the most broken… and then, get ready for Christmas!

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.

An apology...

Preface:
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.

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.