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Archive for January, 2010

The People’s Therapist is of course strictly non-partisan.  It is hardly my place to take sides in political matters, and I am loathe to betray a hint of bias in these pages.

However.

How could anyone NOT admire our magnificent President, Barack Obama, as he faced down those ignorant Republican hacks in Baltimore last week?

The most striking feature of the President’s performance, beyond his clarity of purpose, intellectual stamina and firm grasp of the issues, was his perfect calm under pressure.  There’s a reason they call him “O-calma.”

The Republicans hurled their snide partisan attacks, distorting the facts in their own inimitable way.

Obama stood at the podium, holding his ground, even smiling, and reached out in friendship and cooperation.  His face expressed perfect equanimity.  When a brief lull came in the Republican attack machine, he explained why it wasn’t about politics – it was about action.

He was masterful.  It reminded me of the Buddha.

I’m serious.  Here’s why.

When Siddhartha Gautama, the historical Buddha, renounced wealth and privilege and left his father’s palace to wander as a monk, one of the first disciplines he sought in his path to enlightenment was meditation.

Following the meditation practices of his time, the Buddha embraced three refusals.

First, the refusal to move.  He learned to sit perfectly still.

Second, the refusal to breathe.  He mastered slowing his breaths until they were barely detectable.

Third, the refusal to think.  He cleared his mind of all extraneous distraction so he could sit in perfect peace.

These refusals were designed to promote calm – to permit an inner space to exist, where he could be strong within himself.

Like a mighty tree – the wind blows, the storms howl, the seasons change.  But you are stillness, firmly rooted in the earth.

A self-barrier, an invisible boundary, protects you from attack, granting you the space to contemplate all paths and decide on your direction ahead.

Young children have no self barrier – they spill their emotion in all directions and confuse other’s emotions with their own. But an adult can learn to contain his feelings, and to insulate himself from the attacks of others.  He can find a place of serenity within.

I have no doubt that Obama felt anger at the Republicans’ hypocrisy.  Perhaps he also felt fearful of the immense challenges ahead in his administration.

But, like the Buddha, his self-barrier remained intact.  Within, he located a place of calm. The clamor and tumult outside only strengthened his resolve to walk the Middle Path – the path of moderation.

There is a useful lesson in the President’s grace and his dignity.

Let’s save the planet from environmental dangers.

Let’s treat immigrants with the respect and gratitude they deserve.

Let’s provide every American with decent healthcare.

Let’s give LGBT people equality, which is all they ask.

Let’s work to establish understanding, and peace among nations.

This isn’t politics – it is an expression of our best selves as humankind.

We can follow the path of the Buddha, and remain strong within ourselves.  We can refuse to be drawn into fear or anger.

In so doing, we can make the world a better place.

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That word, “co-dependent,” gets batted around a lot.  I have patients who confidently alert me to the fact that one of their friend’s is “co-dependent” because she’s too needy and can’t leave her boyfriend alone. Or because he seems to need a relationship in order to feel good about himself.  Or because she keeps breaking up and getting back together.  Or because he argues a lot with his partner.

“Co-dependent,” used this loosely, ends up being a grab-bag term for anyone who isn’t ready for a relationship but ends up in one anyway.  That seems too vague to be really useful.

And is it even called “co-dependency”  or is it “co-dependence”?  Does it get a hyphen – “co-dependent” or is it just “codependent”?

I can’t answer all these questions – and I’m not really sure how to spell it, either.

But co-dependency (however you spell it) is real, at least as I define it.  It is a specific syndrome occurring within relationships that is fairly common and worth understanding.

For the record, here is The People’s Therapist definition of co-dependency:  it’s when you express your own need for care by lavishing care on someone else.

That’s it.

In worst case scenarios, I’ve had patients who have taken care of other people for decades whom they don’t even like.  One patient cared for a man whom she hardly knew for years, just because she couldn’t seem to kick him out of her life.

In more subtle cases, relationships are thrown out of balance as one partner gives and gives and the other falls into a dependent stupor, hardly bothering to lift a finger to participate.

It is an odd syndrome.  It seems strange that someone would voluntarily offer so much to someone who seems to offer nothing in return. But like all neurosis, it has its own logic.

Co-dependents grow up in a world in which they are taught not to ask for care.  Maybe their parents are busy with problems of their own, or distracted with other children.  One of my patients who fell into the co-dependent pattern had a younger sibling with severe health issues that distracted his parents, and made it awkward for him to ask for care for himself.  For whatever reason, the co-dependent learns that the best way to attract positive attention, and a few crumbs of the care he needs, is to offer help to others.

It relates to something I call “the birthday party syndrome.”  As a child, birthday parties are a big deal.  Some parents throw elaborate parties for their kids.  Even for kids who aren’t so fortunate, there is the hope of this day being special, a time to be celebrated – one day when you are the center of attention.

But as we grow into adults, our parents drop this duty, and the task of celebrating our birthdays devolves onto ourselves.

We all want to be celebrated, but for many people, arranging for your own birthday feels wrong, forbidden.  So you have to trick other people into celebrating it for you.  Instinctively, you concoct a tactic – you’ll celebrate other people’s birthdays for them!

So you throw birthdays for all your friends, pulling out the stops.

And then you wait.  Surely, they couldn’t forget you.  Surely, they must remember your birthday.  Maybe they’ll throw a surprise party. Maybe  that’s why they’re all acting like they forgot.

And then you realize there is no surprise party.  They simply forgot.

That’s because, instead of spelling out your need for care directly, you attempted to do it indirectly – through co-dependent behavior.  You lavished care on others in a desperate attempt to attract attention for yourself.

For some co-dependents, caring for someone else seems to be an attempt to care for themselves by identifying with the recipient of their care.

For most, it is a frustrating, unsatisfying life lived like a silent cry for help.

One of my patients would go to singles bars and end up going home with whoever walked up to her. She couldn’t say no – she felt obliged not to hurt his feelings.  She ended up dating some of these guys for months, going through the motions for his sake, unable to face rejecting anyone.  She eventually decided to avoid dating altogether, staying home by herself – anything to avoid getting sucked into co-dependence again.

The key to beating co-dependence – like so much else in life – is awareness.  Once you understand where this pattern started, and why, you can break it.  No one should have to subordinate his own needs to everyone else’s.

You can only share yourself in an effective way when your own needs are being met – when you have a sense of abundance in your life, and can share it with others in a way that brings both of you joy.  It’s like the oxygen mask on an airplane:  you have to put it on yourself before you can help the child sitting next to you – or you’ll both suffocate.

Co-dependence can be a hard habit to break because it dates back to early childhood.  That child who learned to give care in the hopes of receiving care was fighting for his life.  He needed care for himself in order to survive.

As an adult, you can move past the old fear, and the old patterning.  You are independent and self-sufficient now, and you can address your own needs.  A balanced, healthy partnership is about two equals caring for one another.  Care moves both ways – caregiving and care-receiving – nourishing both partners in the process.

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My patient was beside himself.  The younger woman he’d been dating was jerking him around, he fumed.  Last week, when he was finally out on a date with someone else, starting to enjoy himself, she’d left him an open-ended text message, asking what he was up to and whether he wanted to get together sometime.

Suddenly, in the middle of this date with another woman, he could think of nothing but her, and his hopes were once again raised that their relationship could be what he’d long desired.

Feeling too distracted to wait, he interrupted the date and hurried to the men’s room to reply to the text.  She answered right away, proposing that they go see a movie together the next day.  He dropped all other plans to be with her.

The next day they ended up returning to his place where, to his surprise, things turned steamy.  They had terrific sex, and he was asking himself afterward if this meant they were back together as a couple.  That’s when she started gathering her things to leave, and delivered a speech about how she didn’t want this to “mean anything” – just “no big deal.”

Since then several days had gone by, he hadn’t heard from her, and things were right back to where they were before.  He hesitated to contact her to ask her out again, since she’d made it clear in her speech that she liked to be the one to contact him, not the other way around.  So he didn’t know what to do.  Meanwhile, the other person he was dating was calling and asking what was wrong and he didn’t know what to tell her.

This was the last straw, he insisted.  It was like running in a maze.  He was going to cut this young woman off once and for all. This was it.  He’d give her an earful.  He didn’t care if he never spoke to her again.

I could see why he was angry.  Clearly, the young woman he’d been dating was ambivalent about their relationship, and it felt like she was sending him mixed signals.  One minute she behaved as if they were together.  The next she said she wasn’t sure. Then, when he was convinced it was over and crawled off to lick his wounds, she would appear out of nowhere, as though nothing had happened.

It might be she was simply too young.  He was more than 20 years older, and he knew what he wanted – commitment.  She had less experience with relationships and avoided the topic, and it was causing a lot of friction.

He told me he wanted to confront her with his anger – burn bridges, end it, have it over with and done.

I suggested something better:  enforcing boundaries.

Burning bridges – discharging anger in an attacking way and cutting off communication – is destructive and creates hurt and misunderstanding.  I proposed using direct communication instead:  telling her what concessions he was willing to make for their relationship – and where he drew a line.

We spent some time together exploring precisely what his boundaries were.  Interestingly, the more we defined his needs, the more sympathetic he grew to hers.

He began to realize that, to some degree, she had communicated her own boundaries to him.  She didn’t want commitment, at least not now.  She was willing to date him, but with the understanding that it was entirely open.  She didn’t know where she stood, and she couldn’t pretend she did.  She was still feeling her way and wanted the freedom to do just that.

It was his turn to decide where his boundaries lay, and to communicate them back clearly and actively.  He’d been avoiding that task, he realized, because he’d been hoping her boundaries would shift to suit his own desires.

He decided to write her a letter.  In it he explained his boundaries.  He communicated clearly that they were at different stages in their lives, and that a committed relationship was his first priority.

He didn’t feel that he was rushing her – they’d been dating for over six months.  And his purpose wasn’t to threaten or to pressure – it was simply to tell her where he stood.

If she didn’t wish to commit to him, that was her choice, but he was going to discontinue their romantic relationship so he could move on.  He needed space to find what he really wanted, and that meant asking her to please stop treating him as though he were just a guy she was dating.  He wasn’t.  He couldn’t be.  He needed more than that, and he wanted to find someone who could provide it.

The act of composing this letter brought my patient a measure of resolution, and relief.  Just organizing his thoughts into a piece of direct, active communication brought him further along the path to understanding his own needs.

This was his best self, his most conscious, authentic self, speaking through that letter.  No one could ask for more than that.  He respected himself for doing the hard work – containing his anger, examining it, and putting it into words.

It wasn’t about burning bridges and never speaking to her again.  It was about enforcing boundaries – expressing his own needs in a way another person could hear and understand.

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The recent arrest of the actor, Charlie Sheen, on domestic violence charges will make for a very brief, very important post.

I have no idea if Mr. Sheen is guilty of these charges, or what actually happened during this incident.  I only mention it in order to raise the vital issue of domestic violence.  Violence between partners and families happens.  It is all too common, and it can devastate lives.

Here’s what you do if someone with whom you are in a relationship turns violent towards you:

Leave.

That’s it.  Pack your things and go.  Or kick him out and change the locks.  It’s over.

If you need to, call the police, or request an order of protection to prevent this person from returning to your life.

Sound harsh?

Think about it.  You deserve a partner who treats you like gold – who cherishes you and celebrates you and adores you.

No one – NO ONE – deserves to be violently assaulted.

If someone has assaulted you violently, that person is in no place in his life to be in a relationship with anyone, least of all you.

He might be ready sometime in the future, but he needs to find the help he needs to change.  That will take time, and that is his job, and he will have to tackle it on his own.  It is no business of yours.

You cannot change someone from within a relationship.  You can stay or you can leave.  That’s it.

With something as serious as domestic violence, you must leave.

If you feel an urge to blame yourself, or explain it away, or return to a relationship with an abuser, there is a serious problem that must be addressed in your own therapy.  It could be a return to feelings you had during previous abuse, during your childhood.  I don’t know – that will have to be explored.

But you cannot return.  You must leave, and stay away, and not look back.

Okay.  That was easy.  Shortest post yet.

And one of the most important.

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How does psychotherapy actually work?

Good question.  The answer is interesting and has to do with how your brain works.

The basic idea of psychotherapy is that you take emotional content from a primitive part of the brain and bring it to another more sophisticated, thinking part, where it can be examined and understood.

Here’s a quick primer on the design of your brain.

Due to quirks of evolutionary history, the human brain contains three distinct parts, which evolved separately.

In the center, there’s a small, rather rudimentary brain.  It resembles the brain of a lizard.

Wrapped around that, a second brain evolved much later – the paleo-mammalian brain.  It resembles the brain of a dachshund, or any other warm-blooded animal.

Sitting atop these two brains, there is the cortex.  That’s the grey, wrinkly stuff that you probably think of when you think of a brain.  It’s much larger than the other two brains, and is unique to humans, having evolved only very recently.

Like all higher animals, you have five basic emotions:  anger, fear, caring, hurt and happiness.  They exist entirely in the two more primitive parts of your brain – the lizard and dachshund parts.

Your thoughts – and your sense of awareness – exist only in the outer, sophisticated brain – the cortex.

There’s a reason for this.  All animals feel some emotions, but only humans have higher consciousness.  We alone think. (Actually, it could be argued that dolphins and some higher apes do too, but I’ll set that debate aside for now.)

Anger and fear reside in the innermost, lizard brain, because they reflect the primitive fight or flight instinct.  Faced with a ferocious predator, a tiny lizard needed to reflexively know whether to get angry and fight, or get scared and flee for its life.

The other three emotions are located in the paleo-mammalian brain.  That’s because they relate specifically to childcare instincts.

A lizard lays eggs – lots of eggs, and it doesn’t invest much time in caring for its young.  But a mammal bears only a small number of live young, and its off-spring are helpless for a period after birth.  So while a lizard might ignore its own large brood of young (or even dine upon a few of them), a mammal, with its small number of helpless off-spring, developed three important emotions related to childcare:  caring, hurt and happiness.

These emotions, located in the paleo-mammalian brain, lead the parent to care for its young, love them, and find happiness in caring for them, or hurt if they leave before the parental bonds are detached.

That’s your emotions, explained.  Now for psychotherapy.

Speech, and communication in general, including non-verbal communication like art and dance and music, are located in the cortex.  Psychotherapy is talk therapy.  A therapist’s goal is to get you to put your feelings into words.  In neurobiological terms, the idea is to take emotional material from the two inner, primitive parts of the brain – the lizard and dachshund parts – and translate them into speech – forcing them through the neural passageways of the cortex.

In essence, the thinking you is forced to process material from the feeling you.

In Freudian terminology, the two inner brains are the “unconscious” (the superego and the Id) and the outer cortex is the “conscious self” (the ego).  By funneling primitive brain activity into communication, therapy forces the unconscious into consciousness, integrating the self.

It’s a bit like an intellectual holding a conversation with a lizard and a dachshund, which is why the process isn’t always easy, and can take a while.

In any case, it’s better than living unconsciously – walking around thinking you know what’s going on while a lizard and a dachshund are secretly operating the controls.

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We found out last week that Tiger Woods has checked himself into a posh rehab center for sex addicts.

This raises the issue of whether sexual addiction really exists.  I think it is a fair question.

After all, we’re all sex addicts, to some degree – sex is a normal, necessary human drive.

Sex also seems harmless.  It feels good, and if you use a few sensible precautions, no one has to get hurt.  With other addictions, like alcohol or drug abuse, kicking the habit entirely seems like a sensible goal.  But except for a few monks and nuns, no one abstains completely from sex.

So maybe it’s like food – moderation is the goal, controlling your appetite so you don’t get fat.

But that doesn’t seem right either.  No one can say how much sex is enough for another person.  Maybe you like it every night. Maybe you like it every month.  Maybe you like it two or three times a day.  That would appear to be nobody else’s business.

Does sexual addiction exist?

In my experience, it does.  It’s a bit like marijuana addiction.  Plenty of people have sex – or smoke pot – without any detrimental effect.  It isn’t innately addictive.

It only becomes an addiction when you decide there’s a problem.

Usually, the indicators are:

1) you’re no longer enjoying it the way you used to; and

2) you don’t feel in control of your behavior.  In other words, it becomes compulsive – you can’t stop.

I’ve worked with sex addicts who cruised online for hours, exhausted, but unable to leave their computer. Some patients set up endless series of anonymous hook-ups, staying up all night until they were so physically exhausted they lost their jobs.  These patients didn’t look forward to the sex anymore – they felt compelled to repeat the same weary pattern.

Typically, with sexual addiction, it isn’t the sex act itself that you’re craving.  It’s the feeling of being pursued by someone for sex – catching a stranger’s attention, and making him want to have sex with you.

Think about it.  When was the last time you had someone’s positive attention focused entirely, like a laser-beam, on you? Probably back when you were a small child, and then it was a parent’s attention.  It made you feel important, loved, cared for – the center of someone else’s world.

As an adult, you rarely get that sort of focused positive attention – except when someone is pursuing you sexually, trying to get you into bed.  It’s hard to compete with a sexual pursuit.  It brings an affirmation, a high, an ego boost that can feel terrific.  All they want is you, now, right away.  The focus is entirely on you.

Once the sex is over, though,  you crash.  The other person’s interest fades, and you realize you hardly know him.  You might even feel awkward in his presence and just want to be alone. It’s a bit like a hang-over.

A sex addict, like any addict, runs to what once felt really good – especially when he gets angry and feels deprived in other ways. He keeps searching for the easy high of being pursued for sex – trying to escape again into that good feeling.  It becomes like a drug.

After a while, like all drugs, it stops working.  If you do manage to attain the high again, you crash even harder afterwards.

That’s sexual addiction.

The treatment – which Tiger is presumably undergoing right now – is similar to the approach you’d take with any other pattern of addictive behavior.

First, there’s an intervention, in which the people in his life let him know how his addiction has harmed them.  Certainly his wife, and maybe the other women he’s been sleeping with, could confront him with how he’s hurt them by lying and betraying promises.

Then, fellowship is created.  Tiger goes to a place – a rehab center or a 12-step group – where he can meet other people who share his problem, and exchange stories and experiences.  He is educated about his addiction.

Finally, self-awareness.  He is encouraged to be honest with himself, and own up to how he’s been living, and decide for himself whether he wants that pattern to continue.

I haven’t met Tiger Woods, and I cannot say for certain if he is a sex addict.  He might just be a guy who needed to get out of his marriage and do some dating and decide what he wants in a relationship.

Only Tiger can decide if he has this addiction, or whether he’s going to address it.

But that’s the nature of any addiction – no one can make these decisions for you but you.

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Patients often arrive at my office complaining of feeling “stuck.”

“Stuck” means you’re caught in a stasis, balanced on the fulcrum between anger and fear.

On one side, there’s anger – frustration at not pursuing your dreams.  We all have dreams – that’s what drives us forward.  It is the most human thing in the world, and what makes living possible.  In the end, we all know where we’re headed (oblivion).  But we have the amazing human ability to ignore that, for the time being, and concentrate on that carrot dangling from a stick.  We want to chase it.

On the other side, there’s fear – old predictions from our past that warn us not to take risks.  Sometimes it’s what psychotherapists call an “introject” – an old voice, probably a parent’s – telling you that you can’t do it, that you shouldn’t expose yourself to the possibility of failure.

So you freeze up.  Stuck.

If you want to get un-stuck, it’s time to take a reckoning of your life.  Sound daunting?  Let’s make it easier.  Every life consists of three elements:  playing, working and loving.  We’ll take them one at a time.

Playing:  this is the fun stuff – enjoying yourself and relaxing.  Your hobbies.  The major challenge here is making friends – overcoming social anxiety and building a support system of people you trust and respect.

Do you have a network of friends you can count on?  Are they truly friends – people you can say anything to, and who feel the same way about you?

If not, social anxiety could be the issue, and it’s time to start thinking about becoming more conscious of your feelings around being with other people and sustaining an authentic contact with them.

Working:  despite rumors to the contrary, work is not something you do for money – you do it because it is a fundamental part of human life.  Your work reflects your essence.  It is what you “do” with your life, and what you leave behind you when you’re gone.

To know the work you want to do, you have to know who you are.  Discovering your work can be one of life’s most difficult challenges, but it must be tackled head-on.  Only you know who you are, and only you know your true calling.  Making that discovery can be the result of a long, honest conversation with yourself, and an exhaustive exploration of the world outside.  Eventually, when you find yourself smiling, and getting excited about getting down to work – you’ll know you’re on the right track.

Loving:  A satisfying relationship must be balanced – two whole people, not two half people, walking down a path together as equals, toward a mutual goal.  There must be attraction, trust and respect.  If you don’t have the relationship you want, or simply aren’t having fun in your current relationship, there could be a problem.  It might be time to ask yourself why you are where you are, relationship-wise, and whether it’s more about being stuck than addressing your needs.

Ironically, one of the reasons people get stuck is that they rush things.  Playing, working and loving are best addressed in order.

Your play – your hobbies and interests, and your friends – will lead you to the work you love.

Your work will help you discover who you are, and build your confidence to go out into the world to meet a partner.

If you try to skip a step – rush into a career before you’ve discovered what you enjoy doing for fun, or hurry into a relationship before you’ve found a satisfying career and know who you really are – it could contribute to feeling stuck.

Where can you get un-stuck?  Psychotherapy is designed to get you talking to yourself, hearing yourself, responding to your own needs.  If there’s anyplace in the world where you can get down to the work of breaking a stasis, it’s sitting in your therapist’s office, putting your thoughts and feelings into words.  If you’re feeling “stuck” – it’s probably time to call your therapist.

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