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Posts Tagged ‘Alcoholic’s Anonymous’

minimeA client recommended a book, and I read it, only to be bowled over by the parallels between the author’s experiences and my own. It’s a novel, “The House of God” by Sam Shem, and my client alerted me to it, he said, because “the author reminded me of you.” I’m flattered by the comparison, and I have to admit, the parallels between our work, and our lives, are striking. I feel like I’ve stumbled onto – well, maybe a role model, maybe a hero, maybe a friend, if we ever manage to meet up.

“Shem” is the pen name of Stephen Bergman, a psychiatrist who wrote his novel about becoming a doctor – it recounts experiences drawn from his residency at Boston’s Mount Sinai Hospital (which is where Jewish kids from Harvard Med went in those days.) Bergman used a pseudonym because his book was controversial and still stirs controversy today in its honest depictions of sex and use of humor to expose the hypocrisy surrounding the practice of medicine and medical education. I employed a lot of the same tricks in my own book, turning my gaze on the practice of law and legal education.

Okay – let’s list a few of the striking parallels, because, as I said, they’re striking.HouseGod

Bergman didn’t want to go to medical school – he went to avoid the draft, and to please his father, a dentist who, as a Jew, couldn’t get into medical school himself, due to anti-semitism. Bergman wanted to be a writer, but thought medicine would earn him a better living.

I didn’t want to go to law school. I did it to satisfy my mother and in an attempt to earn money. I wanted to be a writer. Oh, and my family’s Jewish, too – and my father was a psychiatrist.

Bergman went to Harvard, a first-tier medical school, then to a top internship.

I went to NYU Law, a first-tier law school, then to train at a top law firm, Sullivan & Cromwell.

Bergman began practicing medicine at Mount Sinai, and I began practicing law at Sullivan & Cromwell. That’s when we experienced what we both refer to as the worst years of our life.
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“If I don’t pass this test, I’m going to lose it.”

My client was a nursing student, who had to pass an important math test before she could receive her degree.  She failed her first attempt, and her second was coming up.  She was getting the jitters.

I pointed out that her approach to this situation – all or nothing – didn’t make sense.  That’s because the likely outcome of this set of circumstances – like most everything in life – lay along the contours of a bell curve.

If you look out into the future, you are confronted with an array of foreseeable outcomes, some good and some bad.

My client, for example, might fail her last two tries at this exam, and be delayed in her attempt to finish her nursing program.  That seems a remote possibility, because in past years only 8% of the class failed all three times, and to date she has scored near the top of her class.  That bad outcome, while possible, exists on a narrow tail of the curve.

Out on the other tail, amid the unlikely positive outcomes, she might discover the school mis-graded her first test, and she already passed.  That would be nice, but it’s a slim possibility.

The big, fat center of the bell curve, where the most likely outcomes reside, predicts she’ll pass during her second or third try.

As things turned out, she passed on the second try – with flying colors.

People tend to ignore the bell curve.  You prefer to see yourself as the hero of your own adventure – the blessed, untouchable protagonist who sails into success.  Or you go too far the other way, towards powerlessness, and go martyr, seeing yourself as the unlucky recipient of a cruel fate, singled out for suffering at the hands of the gods.

Neither is true.  The future is a set of foreseeable outcomes that lie on a bell curve.  You can look into the future right now, from where you stand in the present, and forecast the most likely outcome, and the less likely best and worst outcomes.

If you look at things realistically, there’s no reason to “lose it” if the actual outcome isn’t what you’d wish for.  You merely fell onto a different place on the curve – but you’re still on the bell, and it’s still a foreseeable outcome.

Treating the future as foreseeable can be empowering.  You are not all-powerful, and you are not helpless – you are doing your best in a world where you metaphorically roll the dice each and every day. (more…)

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I was chased down the sidewalk by a breathless woman.

“You’re the guy who made me vegetarian!” she announced between gasps.

I didn’t know what she was talking about.

It turned out she’d worked as a paralegal, years before, at Sullivan & Cromwell.  I didn’t feel guilty about not remembering her.  We only toiled together once – a grueling all-nighter preparing for an M&A closing.

We ordered take-out burgers that night, and I opted for a veggie burger.  She asked why I wasn’t eating meat.  At first I played it down – mumbled something like “don’t feel like it.”  Carnivores can grow testy if you fail to consume meat in their presence – they take it as a personal affront.  I’ve learned to tread lightly.

But she persisted, with genuine curiosity, so I told her the truth:

“You don’t have to go there – no one’s asking you too,” I said.  “But if you do go there, you’ll stop eating meat.”

That was it.

Ever since that night, she told me on the sidewalk, she’d been vegetarian.

All it took was going there – well, having someone tell you there was a “there ” to go to, then making the trip.

No, I’m not going to spell out where “there” is – you know perfectly well and I’m not here to preach.  I’m here to talk about consciousness-raising, not vegetarianism.  Specifically, consciousness-raising around alcohol.

You know, alcohol – those lambent elixirs stored in gleaming bottles; the all-American can of beer that pops open to seal friendship and inaugurate cherished memories; the cork shooting from a pricey bottle of champagne to harken in merriment and delight.

Yeah.  Ethanol.  Ethyl alcohol.  Let’s tackle the popular mythology surrounding this stuff. We can start with what I call the Maya Angelou rule.

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This month on “The Alternative” with Terry LeGrand, we talked about staying conscious of the real impact of alcohol on our lives – especially at New Year’s Eve.

You can listen to the show here.  My segment starts about ten minutes in, but as always, it’s worth sticking around for the whole show.

To find out more about Terry and “The Alternative” on LA Talk Radio, check out Terry’s website and the show’s website.  And be sure to check out Terry’s new show “Journey to Recovery” which deals specifically with substance abuse and recovery issues.

If you enjoy his shows, you can become a Terry LeGrand “fan” on Facebook here.

Thanks, Terry!  See you next month.

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Check out The People’s Therapist’s new book:  “Life is a Brief Opportunity for Joy

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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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