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A laugh. A sneeze. An orgasm.

Posted in Thoughts and Musings, tagged comedians, laughter, orgasm, relaxation, sex, sneeze, trained response on February 14, 2010| 5 Comments »

The orgasm has been compared to a sneeze – they’re both involuntary muscle spasms.

I think I can draw a more useful parallel: a laugh.

Laughing is certainly more fun than sneezing, and there’s another useful similarity – they’re both about relaxing, and letting yourself have fun.

Most of my patients who have trouble attaining an orgasm are able to climax when they’re alone, but not with another person – especially not with someone they know.

It’s hard to relax enough to have an orgasm in someone else’s presence. It’s also hard to laugh with a stranger. That’s why the number one thing my patients say they are looking for in a partner is “someone who can make me laugh.” It’s a sign that you’ve achieved a connection – you can let go and relax and laugh. You feel safe enough to be yourself.

Sex is a barometer for communication in a relationship. If a couple stops having sex, their communication has usually shut down. There’s something they aren’t talking about, and it shows. They’ve tensed up and stopped talking – the trust in their relationship is compromised. That breakdown of trust is reflected in their discomfort opening up sufficiently to do something as awkward and private as get naked and have sex.

For some of my patients, having sex with strangers is easier than sex with someone they know because they can hide with a stranger. In some sense, they are alone, since there’s no real connection, so they can let go.

It’s interesting that a good comedian’s job is to relax us enough that we laugh in the presence of others. The best comedians can make you laugh even if you’re trying not to – it really is involuntary. They do this by surprising us with forbidden communication. Ironically, one of the easiest way for a comedian to get a cheap laugh is by “working blue” – talking about sex in an open way that surprises the audience into admitting truths about themselves.

In order to relax enough to have an orgasm, you need to own the forbidden feelings around this act of supreme openness. Instead of beating yourself up for having a “problem,” you can treat your feelings with respect, own them, and explore them.

Why is it scary to open up and relax around another person?

Probably because when you did it before, in the past, you got hurt.

Simple enough. A trained response, just like Pavlov’s dogs.

So you’re going to have to respect that trained response, and address it by reassuring yourself that this time you’re safe.

Maybe, as a child, it wasn’t safe to open up and be yourself, relaxed and present. You learned to close down and assume a defensive posture.

But as an adult, there’s nothing you can’t handle – because you always have yourself nearby.

Someone’s got your back.

So go ahead. Laugh. Or sneeze. Or whatever.

It’s going to be okay this time.

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I do it all for you, my fans

Posted in About This Site, AboveTheLaw series, Thoughts and Musings, tagged Facebook, Fan, fan page on February 14, 2010| Leave a Comment »

The People’s Therapist now has fans. Literally.

I’ve created a “fan page” on Facebook.

To become a “fan” please go to my Facebook “fan page” and click “become a fan.”

Voila!

You will subsequently become eligible for all the rights and privileges that befit a loyal fan of The People’s Therapist.

Mostly, that means I can send you updates about the site and perhaps the publication of a book or an event I’ll be featured in – that sort of thing.

It will also make me feel good.

Thanks.

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The bearded woman

Posted in Current Events, Thoughts and Musings, tagged ambassador, beard, bearded woman, divorce, divorce rate, Dubai, marriage, veil on February 13, 2010| 16 Comments »

Most of the Western world seems to have had a good laugh this week at an unidentified Arab ambassador to Dubai.

This gentleman rushed to annul his marriage contract and cancel his wedding after he finally got a look at his bride-to-be’s face and realized she was cross-eyed and had a beard. She’d worn a niqab, a heavy veil, during their courtship, so he’d never actually laid eyes on her until moments before they tied the knot.

It’s a great story, and it does seem pretty silly to marry a woman when you haven’t even seen her face.

But before we laugh too hard at another culture’s ridiculous, sentimental notions, maybe we should take a look at some of our own.

Like marriage.

The People’s Therapist is well aware that he sounds like a grinch when he writes about this subject, but here goes.

Marriage makes no sense. It is a lot of sentimental clap-trap.

And I’m sorry, gay folks, but you’re out of your minds if you think this tired old convention is going to make you any happier than it’s made the heteros.

A couple is happy because it’s happy. Getting married, if it has any effect at all, usually only helps to break you up.

Before you start drafting that angry comment, consider the reality of a wedding. You stand with your partner, your best friend, someone with whom you share a very personal, private relationship – in front of a roomful of family, friends and near-strangers. What do you do in front of all those people? Promise you will stay together forever.

No one can promise that.

A relationship takes place in the moment. You probably have a shared dream – someplace you want to go together, and that’s great. But no one knows if that dream will last, or if you’ll get there. That’s why it’s a dream.

Relationships are like movie film – lots of tiny boxes with a little piece of shared experience captured in each one. When you take all those little moments of shared experience and line them up, it tells a story that seems inevitable. But it never was inevitable, and there’s no way to know what’s coming next.

The worst part is that couples often become hyper-focused on the wedding itself. These affairs can be enormous undertakings nowadays, which grow into monsters that gobble your life. The wedding -essentially a big party for your relatives – can become the shared dream.

That means, when the wedding’s over…there’s nothing left to chase. Some couples find themselves staring at one another, blinking in the sunlight, wondering what to do next. And that thing to do next might not be something they want to do together.

Maybe the ultimate reason I’m so down on marriage is that I’m a therapist, and I’ve seen divorce, up close and personal. And yes – gay divorce, too.

It’s awful.

I don’t know if it’s the rotten state of divorce laws – they date back to the Victorian era, when a woman was essentially a piece of property – or just the broken dream itself, but people can lose their minds during divorces. I’ve seen couples sue one another until they’re both bankrupt, and then keep suing. The lawyers are happy to take their money until there’s none left, at which point they walk away and leave the unhappy partners to battle it out on their own.

It’s ugly.

But most marriages end that way. In divorce. In the US, 50% percent of first marriages, 67% of second and 74% of third marriages end in divorce.

Wow.

I’m sorry. I might be the Grinch. But I didn’t invent that reality. It just is.

Instead of bemoaning the death of family – or whatever you want to call it – how about we face the fact that you can’t judge the quality of a relationship based upon its longevity. You might spend a marvelous three years with someone and decide that it’s time to move on. Or you might stay together for sixty years and be totally miserable.

It’s not about staying together with the same person forever. It’s about finding something that works in the moment – the here and now – and enjoying it. Wake up each and every day as though it were the first day all over again, and decide then and there if it’s where you still want to be. If it is – great. It is isn’t – also great.

Why does that seem so awful?

Because there’s a child inside you who longs for stability. All children crave stability – it’s what they thrive upon. And marriage regresses us into that child.

An adult doesn’t need a relationship or a ceremony to provide him stability. He carries it within himself. He can leave one relationship, be by himself, or enter another relationship. It doesn’t matter that much. He’ll do just fine.

An adult doesn’t need a parent – he contains his own parent. His partner can be his friend, his ally, his playmate, his companion – his equal.

An adult is a whole person, not a half person. And if the other whole person leaves to try something different, he remains a whole person.

I suspect there ought to be some sort of legal protection for couples who have children. Perhaps civil union is the answer for those legal issues.

But traditional marriage is a silly, out-dated custom.

When you pull up the veil, and see what’s really there, you might be in for an unpleasant surprise.

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You’re not ugly. You’re beautiful.

Posted in Intriguing Patients, Thoughts and Musings, tagged Beauty, inner child, negative introjects, physical appearance on February 12, 2010| 7 Comments »

The other day, I was listening to a patient explain to me why he was ugly and no one could possibly find him attractive.

This was news to me, because so far as I could tell he was a very handsome guy – film star handsome. It was a puzzling case.

Let’s talk about beauty – plain old physical appearance.

The first steadfast rule is summed up by the old cliche – beauty is in the eye of the beholder.

If you’ve never thought about what that really means, let’s do it here.

The fact is there is no standard for beauty. That’s a myth. The gossip mags and entertainment shows on television hold up one star after another as the ideal, but it’s not true. Only you decide to whom you are attracted, and your taste doesn’t have to match anyone else’s.

Different eras have held widely varying ideas about what is beautiful. Even now, Americans are only beginning to open their eyes to the beauty of different ethnicities whose images were almost entirely absent from the popular media for centuries.

Just as you have a right to decide whom you think is beautiful – other people have that right, too. And it is quite possible someone might decide his ideal of beauty is…you.

My patient had been told by various people that he was handsome, and some had even attempted to pursue him, but he’d always dismissed their interest. He couldn’t accept that other people didn’t see what he saw when he looked in the mirror: he was too short, had bad skin, bad teeth, a bump on his nose. Even as he enumerated these terrible flaws, I strained to see what he was talking about. I looked – and saw a handsome guy.

The problem wasn’t with how this guy looked. It was with the messages he was given as a child.

His parents had him when they were very young, and their marriage soon broke up. The father, caught up in a nasty divorce battle, fought for custody of my patient and won it, only to dump the boy on resentful relatives. My patient grew up receiving the message that his presence was a nuisance – that people wished he wasn’t there. He learned that he was nothing special – certainly no one whom anyone would notice or be attracted to.

My patient went on to succeed in his career, against the odds. Despite his parents’ disinterest, he worked hard in school and rose to an impressive position in the business world. But he still felt ugly – nothing special. His physical appearance became a container for all the feelings his parents put in him about himself.

In our session, I reminded him that his parents were old now, and far away – he hardly saw them anymore. Nowadays he was the one in charge of parenting the little boy inside him. And he was doing a lousy job of it.

I asked him when he first became ugly.

He shrugged.

I asked him whether he was ugly back when he was a little boy. Was he ugly at 6? At 10? At 12? When did the ugliness first arrive?

He shrugged, and said he’d always felt that way.

I asked him if there was such a thing as an ugly little boy.

He said, no, probably not.

So were you ugly when you were 7?

He said he didn’t know – probably.

I said of course not. There is no such thing as an ugly 7 year old. In fact there is no such thing as an ugly child. No child is ugly because every child is unique and beautiful.

So why are you treating this child with such cruelty – telling him such terrible things about who he is?

The messages my patient was addressing to his child were the same ones his parents sent him. A psychotherapist calls these messages “negative introjects” – voices that were put inside you as a child, messages that keep playing years later, like:

You are a nuisance. You are nothing special. You are always in the way. We wish you weren’t here.

I asked him to create some healthier messages for his child self.

He looked at me blankly. Like what?

Well, let’s pretend your mother wasn’t absent from your life when you were little. Let’s pretend she took you up in her lap when you were a boy and said something like:

You are my little one, my precious little fellow. You are handsome and good and you make me proud. You are my boy, my special boy. You are beautiful. You are my treasure.

Tears started to run down my patient’s face.

She never said anything like that.

I know. But you can say it. You don’t have to feel ugly. There’s nothing ugly in you and nothing ugly about you. You deserve love because you are beautiful. Inside and out.

Please don’t tell your child he is ugly. He isn’t. He’s you, and he deserves your love, so he can learn to accept love from the world outside. It’s critical to his happiness. Please be a better parent to that little child.

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Scrooge McDuck explains everything

Posted in Thoughts and Musings, tagged A Christmas Carol, Dickens, Freud, Scrooge, Scrooge McDuck on February 10, 2010| 5 Comments »

Here’s further evidence that Sigmund Freud didn’t invent the concept of psychotherapy out of thin air:

There was a precursor, and his name was Charles Dickens.

Way back in 1843, thirteen years before Freud was born, Dickens wrote a book summing up the process of psychotherapy.

The title of this scholarly tome? You’ve probably read it – or perhaps you are familiar with one of the film versions. My personal favorite stars the legendary Scrooge McDuck.

I’m only half-kidding. So let’s review the storyline of A Christmas Carol, and see how it relates to the process of psychotherapy.

The plot should be familiar to most of us:

It’s Christmas Eve, and the old miser, Ebenezer Scrooge, is at his office, being unpleasant to everyone around him. Scrooge scoffs at his nephew’s invitation to a Christmas party, refuses to donate to charity and scolds his employees, letting everyone know his top priority is money, not relationships with other people.

The diagnosis is pretty clear. Scrooge is unconsciously clinging to money as a surrogate for love. He doesn’t feel cared for by anyone, and perhaps he believes he is undeserving or incapable of attracting the love he needs. Scrooge discharges anger indiscriminately at whomever is nearby, chasing away anyone who attempts to offer him care.

Eventually Scrooge leaves his office and heads home, where he is confronted by the ghost of Marley, his old business partner, who has organized an intervention. Marley informs Scrooge in no uncertain terms that he has to do some work on himself or he’ll end up just like Marley did – dragging metaphorical chains around, miserable and unloved. Marley recommends psychotherapy.

Plenty of my patients come to me on the advice of friends. There’s something about hearing from a good old comrade for the one hundredth time that you “really should think about seeing a therapist” that eventually brings someone around. That’s especially true when – like Scrooge – it’s clear that you’re miserable. It also helps when the friend, like Marley, admits he’s had some of the same issues himself.

Marley goes so far as to recommend his own therapists – and to make the appointments. He lets Scrooge know that three ghosts will be dropping by that night for some serious counseling work, and that it will be very experientially-oriented, probably with a Gestalt focus and incorporating some aspects of psychodrama. Marley has even paid the fee in advance. There’s friendship for you.

Scrooge is skeptical – after all, he’s never done psychotherapy before, so he figures he’ll play along, but doesn’t expect much.

The first ghost arrives – the ghost of Christmas past. He’s an old school psychoanalyst and wants to start right off with deep psychodynamic exploration – digging deep into Scrooge’s past, examining the environment in which little Ebenezer grew up and how it shaped his patterns of behavior and the assumptions he makes about the world around him.

Scrooge learns that his fear of risking authentic contact – opening himself up in a way that would permit meaningful contact with others – resulted in his fleeing to money as a replacement for the love he needed. Instead of being generous and open-hearted like old Fezziwig, his first employer, and containing his anxiety, Scrooge acts out on his unexamined feeling and flees from Belle, the girl he loves. Scrooge ends up surrounding himself with money – a compensation for feeling that he is unloved and unlovable.

The next therapist (er, ghost) to visit is representing Christmas present. This guy is probably from the Albert Ellis Institute – his orientation is clearly cognitive-behavioral. He has no time to waste digging into the past and finding precursors for Scrooge’s behavior. This therapist wants to work horizontally, not vertically – in the here and now, examining Scrooge’s thinking as it affects his daily behavior. He takes Scrooge to see the folks who populate his life – Tiny Tim and Bob Cratchit at their humble home, and Scrooge’s nephew at a Christmas party.

Scrooge realizes he’s been self-isolating. This is depression – Scrooge has been acting in on unexamined anger he’s long harbored at not receiving the care he needs. His cognition – “money is the only thing I can trust” – needs to be reality-tested, and counter-thoughts formulated, such as “maybe people are important, too” and “perhaps if I stop being such a grump people might give me a chance.”

The third and final therapist arrives looking like he means business. This guy is hard-core, probably one of those French existential types who reads a lot of Lacan and takes no prisoners. This guy isn’t messing around. He puts death front and center – the eternal inevitability at the conclusion of every life ever lived. Scrooge sees what death really means – that his life is nothing more than a brief opportunity for joy – and that human connection is crucial to attaining that goal. He realizes that this isn’t a dress rehearsal – it’s his one chance at existence, and he doesn’t get another run-through.

That does it. The session with the French guy cracks Scrooge’s resistance, and new awareness arrives fast and hard. He wakes up a new man. With consciousness comes the desire for change. Now that Scrooge can see himself – the roots of his patterns of behavior, the distortions in his current cognition, and the pressing insistence of his mortality – he longs to express his authentic self, his best self – to become the man he truly is.

Voila! Another happy customer. Psychotherapy changes another life for the better…thirteen years before the birth of Freud.

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Prince William and why your wife might be just like your mother

Posted in Current Events, Intriguing Patients, Thoughts and Musings, tagged adaptation, Diana, Kate Middleton, marriage, narcissism, Prince William, Princess Diana on February 9, 2010| 5 Comments »

The People’s Therapist was working out at the gym on the elliptical trainer the other day when he realized he’d come to the end of an issue of The New York Review of Books – his customary cardiovascular/literary fare. In desperation, I reached for whatever other reading material happened to be lying around, and discovered a deliciously tacky gossip mag.

Flipping open at random, I found myself confronted with a headline about Prince William, the future king of England. Apparently, he’s got a new girlfriend – Kate Middleton – and the rumors are that she’s “just like his mother, Princess Diana.”

What caught my psychotherapeutically-inclined interest was how commonly this trope – marrying someone like your parent – emerges in popular culture. It’s so unremarkable that we take it for granted.

But it raises an interesting question: Why does it seem like people really do choose partners who are just like their parents?

The answer relates to how you adapt, as a child, to your early environment.

One of the patients I saw this week, for example, grew up with a father who was extremely narcissistic.

When I use this term, I don’t mean it in the sense of merely being egotistical, but in the Freudian sense of being unable – like Narcissus in the Greek myth – to see past his own reflection and realize that others have separate needs and concerns.

The whole world, for this woman’s father, was about him. He sucked up all the attention and ignored everyone else’s needs. His wife – my patient’s mother – fell into a caretaker role, appeasing and placating him. When dad had one of his rages, mother and daughter ran around doing whatever it took to calm him down. Their own needs were ignored.

My patient evolved behaviors to handle living in an environment with a narcissist – mostly running around doing everything for him and always letting him have his way. When she grew up into an adult, she went out into the world expecting to find another narcissist for a partner. That would feel familiar, and almost comfortable, since it was what she was used to – it matched the skills she’d adapted as a child. She knew everything there was to know about handling a narcissist – dating anyone else would bring fresh challenges she wasn’t sure she could handle.

Sure enough, later in life, my patient found herself dating guys just like her dad – high-maintenance guys who demanded all her attention but never seemed to notice her needs.

It’s as though my client – and perhaps Prince William and everyone else – adapted to an environment the way an animal evolves. If you live in a pond, you evolve web feet. Once you have web feet, you expect to live in water, because you aren’t much good anywhere else.

But humans aren’t ducks, and the strategies you adopt to survive in your childhood environment don’t have to become permanent physical characteristics.

Children have little choice but to adapt to their environment. They don’t control much of anything – they need to adapt to survive.

But adults can choose the environment in which they wish to live, and they can shed an old adaptation if it becomes self-sabotaging.

My client didn’t have web feet, and she didn’t have to live in a pond. She could change, and choose a new environment that better suited her adult needs.

That meant she could stop dating men like her father, and ask herself who she really wanted in her life. It also meant she could learn new adaptations to address this new sort of person.

For someone used to placating and pleasing a narcissistic tyrant, it was an adjustment to meet someone calm and relaxed and caring – someone who expected a balanced give and take in a relationship. My patient had to remember not to do everything for her new boyfriend, and to enforce her own boundaries as well as respecting his.

It was all rather new, and a bit scary – like a duck acquiring new feet and learning to live on land. But she caught on fast.

Prince William, for his part, might choose to marry someone like Princess Diana, or he might not. His mother may well have been a lovely, giving person and the perfect model for a mate.

The key is that the prince be aware of his unconscious adaptations and ask himself what he, as an adult, truly desires in a partner. He’ll never find what he needs marching blindly into an old pattern simply because it feels familiar.

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Not opposition. Alliance. Like when you first met.

Posted in Intriguing Patients, Thoughts and Musings, tagged alliance, couples counseling, first date, opposition, partnership on February 7, 2010| 4 Comments »

The couple sitting in my office were clearly in no mood for social niceties. It was strictly down to business with these two.

There seemed to be nothing they agreed on.

She insisted he marry her as a sign of his seriousness. He wanted to wait until she stopped verbally attacking him.

He hated her family and had a special loathing for her brother. She said it was unfair for him to split her from those closest to her, and that she hated being forced to be the go-between in these situations.

She attacked him for not taking his career seriously enough or earning enough money. He said that was unfair, since he’d had to work part-time for the past year while he cared for his dying mother.

It seemed like this might be a long evening.

During initial appointments like this one, a couples counselor has a variety of options for how to proceed.

One general rule, especially when things look dire, is to remind the couple that my goal isn’t to keep them together – it’s to create a greater awareness of where they are. So I did that – reminded them. And they shrugged. Staying together wasn’t looking likely. These two weren’t expecting miracles.

Next, I tried to establish the parameters of their issues with one another, and prioritize those issues. I did some sentence completion exercises, in which they finished the phrase “this relationship would be more successful if…” But this couple wasn’t having much trouble with that. They knew their issues backwards and forwards.

I worked to get them to hear one another. I had them repeat back a paraphrase of what the other had just said. But they were hearing one another – they just weren’t agreeing.

I instructed them to to lead with their feelings when they addressed one another, employing “I-statements” in which they described their own feelings in response to the behavior of their partner – e.g., “I feel sad and hurt when you…” They had no trouble detailing their unhappiness with one another.

I investigated how they were relating outside of my office, specifically how they were experiencing the partnership. I asked them both to estimate what percentage of the time they spent together was “fun” for each of them. They agreed it was fun about 60% of the time. Not inspiring, but not hopeless.

Finally – in desperation – I used my secret weapon. I asked them how they first met.

“Well,” said the guy, who was suddenly wearing a shy smile – the first hint of a smile I’d seen all night, “we’re both Puerto Rican. And we were at a Puerto Rican club in Queens – someone’s birthday party. And there was this beautiful girl across the room….”

She giggled. “You were staring at me for about an hour. I had to say something. There was no way to avoid it.”

The secret weapon had worked. In an instant, the mood had shifted. From two people who looked like they wanted to kill each other emerged two people back on their first date, remembering what it was that brought them together in the first place.

A partnership is not intended to feel like a chamber of horrors. It’s supposed to be fun. There’s really no other reason to bother attaching your life to someone else’s. You do it because you want to.

The first time you met your partner, you probably got together because you wanted to.

Later, if you hit rocky times, one good trick is returning to that first date and trying to figure out what happened to make things go wrong.

Generally speaking, problems arise when a couple switches from alliance – working together towards a shared purpose – to opposition – battling over everything.

These two in my office were like the US Senate: nothing could progress because all they did was argue.

Now that I had them at least smiling, I asked what their shared purpose was, the mutual goal that – back in those early days – originally brought them together in alliance.

They both grew silent. It seemed a struggle just to admit that things had once worked.

He finally began to speak. “Well, we were both Puerto Rican,” he said. “And that meant a lot to us both. We wanted to raise a traditional family. We wanted to get a house together, with enough space to have lots of people over and cook a mess of food and have fun, the way we grew up – the way our parents would bring the whole family together for good times.”

“And we were both serious people,” She added. “I take my job seriously as a nurse, and he was in law school, and he knew from day one that he wanted his own law firm. We were both ambitious, but we shared the same values around work and family.”

So what happened?

The more we talked, the more reflective, and the less combative, they grew. There had been a plan – a project – a sort of shining city on a hill in the distance, and they were walking towards it together hand in hand…until they lost their way.

That’s when the focus on where they were going disappeared, and they turned to battling one another.

A couple is drawn together for a reason. They want to chase a dream. If you lose that dream, you can end up enemies instead of friends.

Reject opposition. Embrace alliance.

That person you’re living with is not your enemy – he’s your ally. If he isn’t – you shouldn’t be living with him.

Maybe it’s time to renew your purpose, and make sure you’re both in it together. It’s a lot more fun that way.

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In memory of Christine Daniels

Posted in Current Events, Thoughts and Musings, tagged bi-sexual, Christine Daniels, cross-dresser, drag king, drag queen, gay, intersex, lesbian, LGBT, Los Angeles Times, Mike Penner, remembering our dead, sportswriter, trans, transgender, transgender day of remembrance, transsexual, transvestite on February 5, 2010| 2 Comments »

Christine Daniels was a transsexual sportswriter. For many years, she was known to thousands of sports fans as a columnist for the Los Angeles Times, writing under the byline “Mike Penner.”

Christine transitioned into a woman in April 2007 and began using her female name on her column. In late October 2008, she returned to appearing, and writing, as Mike. On November 27, 2009, she chose to take her own life.

This is a tragic story. It’s also an opportunity to talk about gender – an important and often misunderstood topic.

We’ll begin by differentiating, and then examining, three gender-related variables that define all of humanity. They are:

(1) gender assignment at birth;

(2) sexual orientation; and

(3) personal gender identity.

You can think of these variables as three separate sliding scales – everyone falls somewhere on a continuity within each one. You – like everyone else – had a gender assigned to you at birth, awakened in childhood or adolescence to some sort of sexual orientation and discovered within yourself some type of personal gender identity.

1. Gender assignment at birth: I’ll take this one first because it seems simple. What could be more obvious that the gender you’re born with? We’re all born either a boy or a girl, right?

Actually, that’s not the case. Perhaps as much as 1.7% of the human race is born with a degree of sexual ambiguity, and between 0.1% and 0.2% of people are ambiguous enough to attract specialist medical attention, including, in some cases, surgery to disguise or correct sexual ambiguity. These people used to be called “hermaphrodites” but the modern term for them is “intersex.”

Intersex people exist and always have. They are a normal part of the range of human difference. Unfortunately, they live in a world that mostly ignores their existence or treats them like freaks. And they can have a tough time of it, dealing not only with the medical issues involved in their difference, but also the accompanying stigma of not looking, or feeling, like everyone else.

2. Sexual orientation: This variable should be familiar enough to most people. Orientation refers to which gender you choose for a sexual partner – essentially, with which gender you choose to fall in love.

You’re probably used to hearing about lesbian and gay people and their lives, but even sexual orientation can get a bit tricky to parse. Bisexual people exist, and sexual attraction can be fluid and change over time. Sometimes people are surprised by an attraction they weren’t expecting to feel.

It should be common knowledge that gay, lesbian and bi people face discrimination and even violence in their lives, as they fight a campaign for greater understanding and acceptance of their difference.

3. Personal gender identity: This is where things get really interesting. There are countless ways to experience one’s own gender, and perhaps even more ways to express it outwardly.

The transvestite – or “cross-dresser” is a person who enjoys dressing like someone of the opposite sex. There are male cross-dressers and female cross-dressers. A “drag queen” or “drag king” is a man or woman who is a performer, and cross-dresses as part of his or her work as an entertainer.

A transsexual is a person who feels that his or her gender assignment at birth incorrectly represents who he or she really is. For example, a person with the outward appearance of a male at birth, but who is transsexual, will come to understand (usually during his early childhood) that he is actually female. It is as though a female brain were placed in a male body. Transsexuals often take hormones supplements or seek gender confirmation surgery to confirm their personal gender identity by matching it with the outward appearance of their bodies.

If this is beginning to sound complicated, that’s because it is. There are countless terms used to describe people who express their gender in ways that don’t conform to societal norms. My favorite, for its sheer simplicity, is “trans” – a sort of catch-all word for people who experiment with gender appearance and identity. But there are many people who would argue with that definition and that usage. That’s the nature of gender – it’s complicated, everyone is different, and the topic triggers fervent debate. Mix in the additional complications of gender assignment at birth and sexual orientation and – well, you’ve got nearly endless diversity and plenty of room for misunderstanding.

Christine Daniels was a transsexual woman. She decided to return to her male identity and live as Mike for the final year of her life, but I have chosen to honor the women whom I suspect she really was by referring to her as a female.

I have had the privilege and honor over the years to know and work with many trans people, including transsexuals and cross-dressers, as patients and as friends, neighbors and co-workers. I have also known and worked with a number of transsexual psychotherapists, who remain valued and respected colleagues.

If it’s tough negotiating society as an intersex person or a gay man or lesbian, it is even tougher to live each day as a trans person. I don’t know what it is about gender in particular, among the vast array of human differences, that ignites such misunderstanding and hatred. Perhaps it is simply sexism. The widespread oppression of women across the globe is an example of humanity at its very worst. However you account for it, trans people face horrendous discrimination and persecution.

I have no doubt that Christine Daniel’s life was made more difficult by the misunderstanding of her trans identity. Her death was a terrible waste. We lost a talented, valuable, unique person.

You might think you don’t know any trans people. Perhaps you do not. It is far more likely that you do, but don’t realize it. Many transsexuals are “stealth” – they do their best to disappear into the background. Their only desire is to live in a way true to themselves, and they are well aware of the persecution and violence that could greet them if they were found out by the wrong elements.

If you do have the good fortune to welcome a trans person into your life, I implore you to be gentle, and supportive, and sensitive. These are some of the best people you could ever meet and know – and, if you win their trust, they might introduce you to a world of folks who do things their own way, in their own inimitable style. They are a group of human beings whose path in life has taught them profound lessons in compassion, understanding and personal strength.

I’ll close with a link to a site that I wish didn’t have to exist.

Remembering our Dead, and the International Transgender Day of Remembrance, were created to honor trans people who have been victimized by violence. It is a sad statement on the condition of humanity that these innocent people were murdered simply for being true to who they were.

In honor of Christine Daniels, please vow that you will become one more voice on the side of acceptance, and celebration, of trans people and transgender identity.

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Kvetch. Kvetch. Kvetch.

Posted in Intriguing Patients, Thoughts and Musings, tagged Active listening, bitching, complaining, kvetching, mirroring, moaning, parallel processing, psychotherapy, syntonic communication, tolerating feelings, venting on February 2, 2010| 5 Comments »

I can’t complain.

Really, I shouldn’t.

But I will.

Because it feels good.

We all need to ventilate anger. That means containing it, taking it to an appropriate place (like a therapist), and putting it into words.

A patient told me last week about his elderly mother, who, after a long, healthy life, was struck down unexpectedly in her mid-eighties with a severe illness, and hospitalized for two months.

Now, recently released and confined to her bed, she is miserable – and making everyone around her miserable, too.

She has plenty of reason to be angry. This illness was plain bad luck, and it seems unfair that it should strike a woman who has always exercised and taken care of herself and never before been sick a day in her life.

It’s a lot to adjust to. She will require kidney dialysis every other day for the rest of her life. Her limbs are swollen and painful. Her attention span is short, and she has painful headaches. She was once an avid tennis player, but is now reduced to using a walker to get around.

The problem, my patient told me, is that his mother is taking her anger out on the people around her, specifically her long-suffering husband. She barks at him, criticizes everything he does – essentially makes his life miserable.

I proposed psychotherapy, but my patient only shook his head. His mother’s rule has always been self-sufficiency. Asking for help is out of the question. She survived the Holocaust, and she’s tough as nails. It is a point of pride for her never to complain, and never to ask for any assistance whatsoever.

That’s a shame. Admitting weakness can be a sign of strength.

The problem with my patient’s mother is that she’s filled with anger, but has no healthy way to express it. Putting it into words – complaining – is forbidden to her. Instead it leaks out as misdirected anger, which usually ends up aimed at those who happen to be closest to her but least deserve it, like her husband.

Since his mother absolutely refuses to speak with a therapist, I told my patient he’d have to fill that role – to try to be the therapist his mother refuses to see. I gave him a few pointers.

First of all, he has to get her talking – and keep her talking. That means staying syntonic – going her way, not offering any resistance to any of her thoughts and feelings, but encouraging them. Active listening, or “mirroring” would help, too. That’s a technique in which you repeat back snatches or paraphrases of what the other person is saying, so she knows you’re there, and that you’re paying attention.

Like this:

His mom – “I hate this damned walker! It’s humiliating to be disabled like this!”

Him – “It must be tough for you to have to use a walker after always being so active.”

A couple more pointers:

He will have to monitor and contain his own responses to her. It wouldn’t be very productive if he lost his temper in the middle of their time together and started yelling back at her. I recommended he wear “emotional insulation” while listening to her. He could have his reactions – anger at the outrageous things she might say, or fear at the terrible experiences she’d endured – but he would contain them so they didn’t distract from his mission. He couldn’t lose track of the goal: to let her vent her upset in a way that would provide her relief.

One final thing: I told him not to try to problem solve. His mother – and most people – don’t want advice. They want to be listened to and heard. Real problems don’t have easy solutions, and the person with the problem is best-positioned to find one if it exists. The goal is to parallel process. While he listens, she explains the problem – and in doing so, works out an answer on her own.

I warned him that it might take a while – maybe an hour, the length of a psychotherapy session – maybe several hours divided over multiple sessions. But eventually, if he stuck with it and got her to vent some upset and unhappiness, he’d detect a change. I would expect to see a lightening of mood, with a return of interest in other people. She might suddenly snap out of her gloom and say, “wow – it’s good to get that off my chest. So how have you been?”

There are a lot of ways a psychotherapy session can play out. One of them is simply a release of pent-up feelings. It might not sound as inspiring as a breakthrough session in which the therapist produces a startling intellectual insight. But sometimes just listening – good, focused, active listening – can make all the difference. An hour of bitching and moaning to someone, who’s job is to listen, can feel good – and stop all that anger from leaking out or being discharged on some poor, unfortunate by-stander.

One of my patients said therapy sometimes feels to him like a psychic massage. You walk out feeling relaxed, looser and ready to face the world.

That’s what my patient’s mother needs. I hope he’s able to provide it.

We all need a good kvetch once in a while. If you’re in a therapist’s office – or with someone who’s willing to listen and tolerate your feelings – I don’t see how it does any harm.

It might even help.

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You are one tough little kid

Posted in Intriguing Patients, Thoughts and Musings, tagged inner child, resilient children, Shin, surrogates on February 1, 2010| 1 Comment »

Studies have been done of resilient children – kids who have faced down tough times and survived intact. They share one key finding: These kids locate surrogates – replacements – for what is otherwise missing in their lives.

Whether it’s a teacher or a neighbor or an uncle or a grandparent – somehow, these scrappy little children overcome difficult circumstances to find someone to take care of them, to love them, so they can find a way to love themselves.

The challenges these kids face can be pretty severe – physical, verbal and sexual abuse, neglect, parents who are missing or mentally ill or addicted to alcohol or drugs. By some miracle, they find what they need to survive and make their way forward to happy, healthy lives.

One year ago today, an old friend of mine from high school, Shin, died of breast cancer. She couldn’t have been much over forty, and left behind a husband and two young children.

Shin and I reconnected in the days and weeks before she died. She was in Singapore and I’m in New York, but thanks to the internet, we were able to video chat regularly. Towards the end she was having trouble breathing, so I spoke and she typed her replies.

When I realized Shin was dying, I expected that my role, as her old friend the therapist, would entail simply listening and being there for her. Knowing Shin, I should have realized how much she had to teach me about what it means to be alive, to love, and to care for others.

Again and again, Shin repeated to me that her children were the most important thing to her. Josie and Toby were very young, and she knew it would be devastating for them to lose their mother.

She created a sort of ritual as a way to prepare them – taking the children aside each day and asking them the same question:

“Where’s Momma?”

They answered as she’d taught them, by pointing to their hearts.

“That’s where I’ll always be,” she said. And she held them tight.

Shin knew what she was doing. She understood that her kids had a terrific dad – but they were going to lose their mother soon, and they’d need somewhere to go to process that loss. They would need to look within themselves.

Studies of resilient children overlook another place where tough little kids find the love they need to survive. They don’t just locate it in neighbors and uncles and teachers – they also find it within their own hearts.

You have a little kid inside you – the same kid you used to be. And that kid needs love. You’ll never receive everything you need from the outside. Even the best parent or parent-substitute can provide only some of what a child needs.

The rest has to come from you.

When Shin taught Josie and Toby that Momma would always live in their hearts, she placed her own strength within them, setting them on a path towards self-sufficiency. The unconditional love of their dying mother will remain within them forever – a well to draw on when times get tough. They will never forget that there was a young woman named Shin, who was their mother, and that she loved them absolutely.

Shin’s goal was to place a love in her children that would evolve into a love for themselves – to make them secure in the conviction that they deserved care.

You need to find a way to love yourself, or you cannot survive. You need to hear that message from within your own breast – that someone cares for you, and always will, no matter what.

Maybe you’re not always at your best. Maybe you have regrets, and remorse. Maybe it feels like there isn’t much love out there for you sometimes.

But there is a child within you. He means no one any harm. Offer him your love – carry it within you.

You can be a resilient kid. You can stay conscious, and be your best self, and love the best, most authentic you.

You can be deserving of love – love from within your own heart.

Just like Josie and Toby.

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Obama, O-calma and the Buddha’s refusals

Posted in Current Events, Intriguing Patients, Thoughts and Musings, tagged Baltimore, Buddha, gay, healthcare, immigrants, lesbian, LGBT, meditation, O-calma, Obama, Ocalma, Republicans, Three refusals on January 31, 2010| 8 Comments »

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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What IS co-dependency, anyway?

Posted in Thoughts and Musings, tagged care-giving, care-taking, co-dependence, co-dependency, codependence, codependent on January 30, 2010| 7 Comments »

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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Stop burning bridges! Enforce boundaries instead.

Posted in Intriguing Patients, Thoughts and Musings, tagged burning bridges, commitment, direct communication, enforcing boundaries on January 29, 2010| Leave a Comment »

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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Just. Leave.

Posted in Current Events, Intriguing Patients, Thoughts and Musings, tagged abuser, assault, Charlie Sheen, Domestic Violence, order of protection, police on January 28, 2010| 1 Comment »

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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This is your brain. This is your brain on psychotherapy.

Posted in Thoughts and Musings, tagged brain, evolution, lizard, mammal, psychotherapy on January 27, 2010| 4 Comments »

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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Sex addict? What’s a sex addict?

Posted in Current Events, Intriguing Patients, Thoughts and Musings, tagged 12-step, alcohol, anonymous sex, cruising online, drugs, fellowship, food, intervention, marijuana, rehab center, sex, sex addict, sexual addiction, sexual hook-ups, Tiger Woods on January 27, 2010| 1 Comment »

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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Clowns to the left of me, Jokers to the right

Posted in Thoughts and Musings, tagged becoming unstuck, introject, loving, playing, psychotherapy, stasis, stuck, working on January 26, 2010| 2 Comments »

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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Dear Brangelina (& Madge)

Posted in Current Events, Intriguing Patients, Thoughts and Musings, tagged adopted child, adoption, adoptive parent, Angelina Jolie, birth parent, Brad Pitt, hyper-compliant behavior, Madonna, testing behavior on January 25, 2010| 3 Comments »

Dear and Brad and Angie and Madge:

I think it’s great you have chosen to adopt children who needed homes.

But I want to make sure you know what you are getting into, so you can do it right.

Here are some pointers on adoption.

First of all – please do not fall for the myths. An adopted child doesn’t come from “heaven” or a baby store – he is someone else’s child. That birth parent – usually due to terrible circumstances – has done the unthinkable, and abandoned his child to someone else’s care.

That is a tragedy. In an ideal world, no child would ever have to be taken from his parents.

Your adopted child will feel this separation at a cellular level – even if he was removed from his parents at birth. He will live with the pain of that trauma his entire life. He will want to understand what happened, and he will have fantasies about his birth parents, and feelings about them, including anger at them for what they’ve done, and fear about what it might say about him, and his ability to find the love he needs. This is normal and natural and unavoidable. It is your child’s right to have these thoughts and feelings.

Your job isn’t to erase your child’s trauma. It is to help him process it, and to support him through a recovery into a new life with you.

Please don’t ever utter that old line about adopted children being special because they are chosen. That’s nonsense – and it minimizes the reality of an adopted child’s pain. Adopted children are special because their parents gave them up. They are wounded, traumatized children who need extra care because of what they’ve been through.

As you process your child’s trauma with him, please do your best to be honest and open. Never, ever lie to him. If you can include his birth parents in his life, please do. He has a right to know the truth, and to try to maintain whatever relationship he can with the parents who brought him into this world and share his genetic material. If you feel threatened by the presence of his birth parents, please recognize that this is your problem, not your child’s. Deal with it on your own.

Be aware that adopted children often display two responses to their situation: hyper-compliance and testing behavior.

The hyper-compliant child realizes he’s not with his “real” family, so he plays along, but he doesn’t trust it. He’s on his best behavior because he doesn’t want to receive another shock, and another dislocation. He tries to be everything you want him to be – no trouble at all. Along the way, he may neglect his own needs in his attempts to please you.

The testing child is also distrustful. If his own birth parents disowned him, why should he trust you? So he tests you. If you claim to love him just as much as your birth children, then how will you react when he smashes a toy, or refuses to obey you? He wants to know if your love is real – if it is the truly unconditional love he needs so badly. He may attempt to drive you away in the process of testing your love. There could be some tough times ahead as you struggle to enforce boundaries in a way that communicates love and safety.

Raising a child is never easy. With an adopted child, you’ll have a slightly different task – one laden with unique challenges.

If you do it right, you’ll bring joy to the life of a child who needs you. And a special joy to your own life as well.

Namaste.

The People’s Therapist.

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It’s all the rage

Posted in Current Events, Thoughts and Musings, tagged Boxer Rebellion, Chairman Mao, Hitler, Iraq, lynching, Mahatma Gandhi, Mark Twain, Martin Luther King, Muslim world, Rage, Taiping Rebellion on January 24, 2010| Leave a Comment »

Rage is helpless anger.

If anger finds a productive outlet, it can achieve great things (See Martin Luther King, Mahatma Gandhi, et al.) King and Gandhi believed their words could be effective agents for change. There was a receptive audience somewhere – white Northerners, the British public – who would listen, and perhaps embrace a new direction.

But when you feel no one is listening, you lose a sense of efficacy, of control over your environment. So you go into a rage. Instead of turning your anger into words, you go into action on unexamined feelings.

Rage is essentially a temper tantrum. Just like a frustrated toddler who throws a fit because he can’t have his way.

There is nothing more destructive. Especially when the phenomenon takes place on a large scale – affecting an entire culture.

Mass rage occurred in China from 1966 to 1976, during the so-called Cultural Revolution.

China was humiliated during the 19th and 20th centuries by the fact that it had somehow slipped a couple hundred years behind the Europeans in terms of technological advancement. This was a temporary situation – China led the world in technology for eons, and they caught up quickly. But the humiliation and helplessness of those years led to a feeling of rage that exploded in such bloody events as the Taiping Rebellion of 1850-1864 (a civil war triggered by religious fanaticism) and the Boxer Rebellion of 1898-1901 (an outburst of violence by ultraconservative forces against foreigners.) The ultimate scream of rage was the Cultural Revolution, in which the Chinese, lost in a cult-like worship of Chairman Mao, turned their fury upon themselves, destroying their educational system, smashing their monuments and treasures – and losing an entire generation of human achievement.

It hasn’t only happened in China. Hitler somehow convinced the German people that they were “humiliated” during WWI, and used it as the trigger for a convulsion of violence against innocents that resulted in the virtual destruction of Germany as a nation. American Southerners convinced themselves that they’d been “humiliated” during the American Civil War, and used that as the pretext for a bloody outbreak of violence and oppression against innocent African-American citizens during the late 19th century – around the time Mark Twain termed the USA “The United States of Lyncherdom.”

Exactly the same thing is happening today in the Muslim world, and we can only hope they get over it soon.

The pattern is familiar – the “humiliation” of the Muslim nations by foreign occupiers, a deep sense of helplessness and the fall-back into conservatism and reaction, clinging to backward traditions and rejecting anything new that might smack of acculturation. Then comes the violence – always the violence, officially focused outward on the forces of change, then turned inward, producing cruel persecutions of helpless minorities, and – ultimately – an orgy of self-destruction.

In the end, rage always results in harm to yourself.

The Chinese Red Guards during the Cultural Revolution destroyed their own institutions, persecuted their own intellectuals, dismantled their own universities.

It was a source of amazement, during the 1992 Los Angeles riots, that the rioters were burning their own neighborhoods. They weren’t burning down Hollywood, they were burning down South Central.

Muslim reactionary fanatics – so-called “terrorists” – destroyed the World Trade Center. But most of their continuing violence seems aimed at other Muslims, mostly within Muslim countries. If some young man wrapped himself in explosives and blew himself up in a crowd in the USA, it would be a national trauma. But this awful event appears to occur on a weekly basis in the Muslim world.

The answer? A familiar one in the world of psychotherapy: put your feelings into words. Don’t go into action on unexplored emotion. Contain the feeling, and investigate it.

Humiliation is when someone tells you something true about yourself that you’ve avoided seeing. It was hard for the Chinese to own up to falling behind in technology, especially when they’d always led the way. And it was hard for white Southerners to own up to human slavery being a heinous crime, or for Germans to accept that an imperial age had passed Germany by, and that their boundaries would be limited to those of a mid-sized European country – not a world empire.

It must be tough for the Muslim world to realize that it is due for some self-examination and fresh thinking around issues like democracy, freedom of speech, the treatment of women and separation of church and state, where they are clearly falling behind the rest of the world.

These are truths that need to be heard, and processed. Instead of lashing out in violence, they could put their upset into words, and achieve personal growth.

If only someone in the Muslim world believed we were listening, and would open up – take that risk – and tell us what’s upsetting him. Perhaps he could write an article, or give a speech, or start a movement – a peaceful movement – that would bring attention and understanding to what Muslims are experiencing around the world. He could answer the question on everyone’s lips after 9/11 – “why do they hate us?”

Then perhaps we could understand what their upset is really about, and bring this horror to an end.

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Don’t fall in love like a kid – do it like an adult

Posted in Current Events, Intriguing Patients, Thoughts and Musings, tagged adult, Alice B. Toklas, attraction, child, Gertrude Stein, John Lennon, Josephine, love, monogamy, Napoleon, partnership, religion, respect, romantic relationship, trust, Yoko Ono on January 24, 2010| 5 Comments »

A patient told me she couldn’t get over a guy she’d been seeing.

He was no good for her. He didn’t even seem to want to go out with her. But she couldn’t let go.

“But I love him,” she explained.

Well, in a manner of speaking.

She was in love with him like a child – the way a child loves a parent.

A child’s love is based upon dependency. A child loves whoever takes care of him, because he cannot take care of himself.

When a young child says “I love you,” he means “I worship you and you are all-powerful and I depend upon you utterly and you are everything and I couldn’t survive without you.”

It’s the same way religious people relate to their chosen god-objects. It’s no coincidence they often kneel before statues or altars and refer to “Lord” and “Almighty” and “Heavenly Father,” and so on.

If you live in an island with a volcano and it erupts and burns down your village, you can respond as an adult, and take up volcanology research. Or you can regress under the stress into a child, and talk to the volcano as a parent-object, asking what you did wrong to make it angry, and trying to please it.

A child is so utterly dependent upon a parent that, if he displeases the parent, he will always locate the fault within. He will not think – oh, it’s just a volcano, they erupt sometimes. It must be about the child, something he did – his fault.

My client was relating to the guy she was dating the same way. And she was beating herself up pretty bad.

Adult love is very different from child love. It begins with loving yourself.

Then you add three ingredients:

Attraction, Trust, and Respect.

That’s what it means to love someone else, romantically, as an adult.

1. You are attracted to him. This is simple enough. The common mistake here is trying to ignore sexual attraction and turn a friendship into a romantic relationship. You cannot go out with the guy you SHOULD go out with. You have to go out with the guy you WANT to go out with. “But he’s so nice” is not a reason to date someone. You have to be into him, too.

2. You trust him. If someone values you, his attention is focused on you. Monogamy is the clearest manifestation of a mutual fascination. But even in the early months of dating, before monogamy enters the picture, trust is already an issue.

Are you worried he might not call?

You shouldn’t be. You should trust his interest in you. If you don’t, there’s probably something wrong. If you value yourself, you will find someone who values you as well. And if he values you, he won’t leave you wondering if he’s going to call.

3. You respect him. The best relationships contain a note of mutual awe. You think your partner is pretty darned terrific – and he returns the compliment.

Happy partnerships are a bit mysterious – they are secret clubs, with only two members. We don’t know what Napoleon saw in Josephine, or Gertrude saw in Alice B, or John saw in Yoko – but these famous partners were clearly fascinated with their spouses, and their fascination was returned.

A mature, respectful relationship between equals might seem pretty dull stuff compared to the headlong thrill of worshipping a parent-object like a child.

Yes, it is a bit calmer. Far less drama.

But believe me, it has its pleasures.

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Will Meyerhofer, JD LCSW-R is a psychotherapist in private practice in TriBeCa, in New York City. You can visit his private practice website at: www.aquietroom.com. Will holds degrees from Harvard, NYU School of Law and The Hunter College School of Social Work, and used to be an associate at Sullivan & Cromwell before things changed... Now, in addition to his work as a psychotherapy, he writes books and blog entries and a column for AboveTheLaw.com.
The People’s Therapist writes books

The first book is called "Life is a Brief Opportunity for Joy"

Life is a Brief Opportunity for Joy

The second book is called "Way Worse Than Being A Dentist"

Way Worse Than Being a Dentist: The Lawyer's Quest for Meaning

And the SEQUEL has just come out!

STILL Way Worse Than Being a Dentist

I've written a comic novel about a therapist, called "Bad Therapist: A Romance"

Bad Therapist: A Romance

...or come by my office and I'll sign one for you.
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