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Archive for March, 2010

The People’s Therapist had fun the other night on the radio, chatting with LA Talk Radio host Terry LeGrand about some common misconceptions that gay and straight people hold about one another.

Here’s the interview.  I come on about 10 minutes into the show.

Terry is an interesting guy – and his show – “The Alternative, with Terry LeGrand” is not to be missed.

Here’s where you can find a schedule and an archive of past shows.

Here’s Terry’s webpage.

and Here’s Terry’s fan page on Facebook.  Please become a fan!

Terry is not only an LGBT rights activist and popular radio personality – he’s also a retired physician and the Co-Chair of ACT UP Southern California.  He’s invited me to come back on the show again next month.  I’ll let you know when the interview is available online.

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Watching the most recent Oscars ceremony was a healthy reminder of the most fundamental instinct in human nature – the desire to please.

You want everyone to like you.

Admitting that is a big step towards authenticity.  Because it’s true.

It is also true that everyone will not like you.  Not even such masters of public relations as Bill Clinton and Barack Obama can make everyone like them.  Some people have their own issues – they might dislike you simply for being liked by so many other people.

Why do you want to be liked so much?  It relates back to the evolutionary necessity to please your parents.  A young animal must please his parents in order to survive.  Often, in the wild, where food and care can be in short supply, only the young animal who pleases survives to adulthood.

You crave delighting others because it regresses you into a happy child, secure in having pleased his parents and thus surviving and flourishing.

Even as an adult, you have a place in the back of your mind where everything you do is still directed at pleasing your parents.  That promotion at work, the book you published, the shiny diploma on your wall – there’s some part of you that’s hoping mom and dad will notice, just like those folks up on the stage at the Oscars, thanking their mom and dad.  And you’re watching those people because you enjoy identifying with them – pretending to be them for a few moments of rapturous pleasure in receiving approval.

Some part of you also wants to experience that cliched but endlessly replayed scene from every “feel-good” movie ever made.  It’s the scene where, after a lifetime of commitment and hard work, the unsung hero is finally recognized by…everyone.  Think “Mr. Holland’s Opus” or any of thousands of other cheesy Hollywood films.  Finally, after quietly doing your part to improve the world, you get your standing ovation.  The entire auditorium (or the stadium, if it’s a sports flick) is on its feet, cheering, applauding, weeping with joy – for you.

Moi?

I’d like to begin by thanking the Academy.

The problem with this instinct to please others and seek their approval is that it displaces your source of assurance about your own value onto other people.  They become the arbiters of your value as a person.

It’s lovely to receive accolades – the little kid within you dances for joy.

But the judgment of others cannot become a referendum on your value as a human being.  An adult needs to look within himself for approval.  And you can only achieve that approval by becoming your best self.

That means staying conscious of who you are at all times, and checking in to be certain it is your most authentic identity, the person you want to be – the person you can look back on afterward and be proud of.

Your respect for yourself must be earned.

The respect of others is nice, but it can be fickle.  Back in 1985 , when Sally Field won the Oscar for Best Actress for “Places in the Heart,” after having won in 1980 for “Norma Rae,” she didn’t actually say “You like me, you really like me” – although that’s what she’s remembered as saying, and that’s what she still gets made fun of for saying.

Here’s what she actually said in 1985: “I haven’t had an orthodox career, and I’ve wanted more than anything to have your respect. The first time I didn’t feel it, but this time I feel it, and I can’t deny the fact that you like me, right now, you like me!”

Perhaps it was her putting it so bluntly – telling the audience that they liked her – that made them flinch, and change their minds, and switch to making fun of her.

Sally Field probably realized once and for all in 1985 what will always be true – that you must look within yourself for the approval that matters. No one else – not even your parents – can satisfy your craving to be accepted as the person you truly are.

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I was working this morning with a patient I’ve been seeing for a few months.  At the end of our session I suggested he join one of my psychotherapy groups that meet once a week in the evenings.

“What?  You can do psychotherapy in a group?  How does that work?”

I was a bit surprised – most people have at least heard of group therapy, but it seemed the perfect time for The People’s Therapist to explain the basics of this mysterious and powerful psychotherapy modality.  At very least, in my limited space here, I can dispel a few of the myths:

Myth #1:  Group psychotherapy will be like a 12-step group. I think this idea comes about because the most familiar group therapy-like experience for most people is AA, or another 12-step group.  Some of my patients who have done AA or another 12-step group in the past act like they know what they’re getting into, and march in to my groups with extra confidence, only to find that this new experience is very different from what they’re used to.

There are a lot of ways to run psychotherapy groups, and most groups are far less structured than an AA group.  The dreaded “cross-talk” which is forbidden in AA is not only permitted in most groups – it’s encouraged.  There’s no opening ritual or closing prayer – it’s open and free-form.  You sit down and talk about whatever’s on your mind.  The only rule is that you keep it real, so you don’t waste time.

Most psychotherapy groups also meet weekly, and are closed – not drop-ins, like most AA groups.  If you are a member of a psychotherapy group, you are committed to the other members, possibly for years, and it is your duty to show up every week and participate, even when you don’t want to.

Myth #2.  Group is just cheap therapy for a bunch of people at once. One of the advantages of group therapy is that it is cheaper than individual sessions – with so many people, the fee is lower for each person.  But it is not cut-rate cheapo therapy.  In fact, I strongly encourage my patients to participate in “conjoint therapy” – which means going to group every week and dropping in for an individual therapy session every two or three weeks, too.  Group is very different from individual treatment, but they complement one another and the combination is more effective than either on its own.

How is group different?  It is not so much vertical, like individual, but horizontal.  You don’t dig deep into your past so much – you already did that in individual.  The focus in group is on watching how you interact with others.  I think of group as taking the work of the individual sessions out into a laboratory, where you can test what you’ve learned in a controlled setting.  There is nowhere in the world like a group room – a place where you can sit with perfect strangers and the assignment is to put your authentic thoughts and feelings into words and interact.  It is a powerful, often life-changing experience.

Myth #3. For a group to work, everyone has to share a common life experience. I think this myth arises from people’s familiarity with support groups, rather than broader psychotherapy groups.  A group focused on one issue – such as survivors of sexual abuse – is a support group.

I led a support group specifically for HIV+ gay men for many years, and it was a rewarding and useful experience, but my favorite groups have no specific focus and include the most diverse possible population.  The HIV+ group created a safe place where guys dealing with that disease, and the stigma it still carried, could loosen up and share their experiences.  But even in that group, there was plenty getting talked about besides HIV, including friendships, dating, career issues and lots of other topics.

I’ve had all sorts of people in my groups over the years.  All ethnicities have been represented, people as young as 18 and as old as 78, rich and no-so-rich, men, women and trans people, gay, lesbian, straight and bi.  Diversity only enriches the experience.

Myths #4 and 5:  If I go to group, (a) I won’t want to share my therapist’s attention, so I’ll dominate too much or (b) I’ll be too scared to open up in front of all those strangers.

If you’re having these common worries about group, then it’s already working.  These are transferences – you are transferring your expectations from prior life experiences onto a prediction about how group will play out when you get there.

The first lesson of group is that you will unconsciously relate to the group the way you related within your family.  It’s useful to understand how that mechanism plays out, because it is also the way you relate to the world as a whole.

If you grew up having to fight to get the attention you needed in your family, you might play that role out in the group room when you arrive.  If you grew up distrustful of others, expecting a negative response, you might shut down in the presence of the group.

Becoming conscious of these unconscious patterns, and practicing different ways of being, is the work of group therapy.

I could write about group forever – and I’ll probably be writing about it a lot more on this website.  Group is some of my most challenging and rewarding work, and I’ve seen people take enormous strides in a group room that might have been impossible with individual therapy alone. Humans are social animals, and co-exist with one another.  Group incorporates all those other people into the therapy experience – with powerful results.

If you’re like most people, now that you’ve learned a bit about group…you’re probably thinking about giving it a try.  It’s a commitment.  Most therapists require that you commit for at least 10 or 15 sessions, and this new way of doing psychotherapy will become a regular part of your life.

I promise, whatever happens, you’ll be changed by the experience – and you won’t forget it.

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Last week I did a first session with a typical client – a young lawyer worried about starting at a big firm.

I couldn’t do real psychotherapy with this guy. Some lawyers are like that – they don’t trust anyone enough to open up. It was more like an awkward coaching session. When I tried to explore his feelings, he cut me off and got down to business.

He was fine, he assured me. He’d already decided he was going to take the money. He just wanted some advice. Then he related bad experiences from the summer program, and asked for my take on big firm life.

I suggested ways to maintain emotional insulation from the worst aspects of a big firm. I also proposed that he do psychotherapy, and maybe group psychotherapy, for emotional support while he was there. This didn’t make much of an impression. His mind seemed elsewhere.

He mentioned wistfully that he “wanted to be a writer, but couldn’t make a decent living at it.” I waited for more, but he changed the subject.

Eventually he left my office, and I thought that’s that. I’d never hear from him again – another unhappy lawyer who’d contacted me in a moment of weakness, then retreated back to his cave, alone.

The next day I received an email that pretended to be a thank you, but was really a warning from this guy not to mention his story in my column. It was a curt, condescending note which ended like a law firm letter, with “best regards.” Only a lawyer could write a note like that to a therapist.

I’ve received a few of these threatening notes over the years. I consider them a by-product of working with lawyers.

I know what you’re thinking. Yes, I’m a therapist, and I charge people for my services. And of course I disguise identities in this column to preserve confidentiality. He has a right to send me any letter he wants, and to have his confidentiality preserved.

But there’s a larger issue here. Trust. And sharing. And honesty.

My column and my work as a psychotherapist are intended to help people. I work with plenty of patients – most of them non-lawyers – who open up to me and find relief.

It’s always tougher with lawyers. They hesitate to trust anyone. That makes things harder for me – but incalculably harder for them.

Big firm attorneys live in a closet. Inauthenticity is the rule at these firms – it pervades the culture. No one admits what they’re feeling because no one is supposed to trust anyone else. The result is isolation, which exacerbates every other toxic element of that life.

It’s a kind of macho code: Act like you’re doing fine. No matter what.

One of my patients said she broke down in tears last week in the bathroom stall at her firm, after a partner tore into her for some screw-up. She chose the bathroom because of her firm’s “open door policy.” She wasn’t allowed to close her office door for privacy.

I asked her how everyone else at her firm was holding up.

She shrugged.

“Fine, I guess.”

According to her, about two-thirds of the associates were fleeing after three years. I doubt they’re all doing fine.

Lawyers are good at hiding things. Especially how they feel.

(more…)

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