Getting back on the therapy horse

Bride trying dress with group watching on Say Yes to the Dress

Since I am expecting a hoard of new clients to swarm my office any day now, I felt it was time to brush up on my therapy skills. I considered reviewing some of the books on my office shelves or going to a family therapy conference or ten, but I’m taking the easy route instead: I’m watching television.

I’ve admitted previously that I have an odd fascination with Say Yes to the Dress, and not just because J. and I both wore jeans to our home wedding. Before I started watching this show, I did not realize that brides-to-be took entourages to shop for the special dress. Makes sense, I guess, to seek input.

I imagined that the bride’s opinion would take precedence in the end. If the bride said yes to the dress, who would care if her mother or best friend or clothing-designer cousin or long-deceased grandfather who spoke through her aunt the medium said no? A lot of people care, it turns out, especially the bride.

I’ve witnessed many a bride crying in her dressing room, afraid to exit for fear of the entourage’s reaction to her choice. Many a narcissistic mother has forgotten that the appointment is actually about her daughter the bride. And many the oblivious father is unaware that his daughter is more concerned with pleasing him than pleasing herself. Because I am a psychologist and not a medium, I can’t speak for the wishes of long-deceased grandfather.

I marvel at the sales associate-cum-family therapist who, while helping the vulnerable bride-to-be find her perfect dress, manages the needs of the highly opinionated crew she has brought with her. Consider this a glimpse into family, and group, dynamics. (Turns out we often play similar roles in groups as we do in our families.) Ms. (or Mr.) Dress-a-Bride manages to keep the entourage happy while ensuring that the bride’s needs are met. This often involves skilled negotiation with widely varying personalities.

Now let’s consider another favourite nap inducer, Chopped. The chefs who participate on this show are a product of their family upbringings, as are we all. There are the only-child competitors who won’t share ingredients vs. the eldests who unscrew their competitors’ unyielding bottle tops, if you believe in that birth-order baloney.

I’ve also learned from Chopped how many adult children are tormented by their parents’ disapproval of their professional choices, despite their successes in their careers. This needing-to-please theme sounds oddly familiar. (See above.) The chefs pray a Chopped win will foster their parents’ acceptance, finally, after all these years. Will these contestants ever understand that what matters most is how they feel about the path their lives have taken and not how their parents judge that path? I fear not, barring help from someone like me.

You too can hone your therapy skills from television shows like these. Who cares how to incorporate cinnamon hearts into an entrée or whether a princess gown or a mermaid would better suit the bride? Focus on what really matters, like I do: how people are getting along.

Once you master the complex dynamic issues in these shows, we can move on to 90 Day Fiancé or even Big Brother. On second thought, maybe not. Even I have my limits.

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Necessity is the mother of my Facebook page

Picture of fingers walking on Yellow Pages phone directory

My office phone has been hopping lately, and not just with free cruise offers and other robocalls. I have had a few new-old clients finding their way back to my office. All have come via a few family physicians who used to send me referrals, until I told them I was out of commission five or so years ago. Remember that brief spell when I abruptly closed my office and abandoned all my clients? Yeah, that. And, more recently, my endless moaning and groaning about missing my work? Someone has been listening to my internal pleas.

Yesterday I met with a client I hadn’t seen in 10 years. She somehow tracked down my number and gave me a call. I realized, upon checking the old file, that she’d initially been referred by one of these family physicians. After our session, I asked the client for written permission to send the doctor summarizing our contact. It would also be a way of telling the doctor that I was not dead.

I scripted a quick one pager. After the half hour it took me to recall business formatting, and the additional half hour spent printing an envelope, I finished the letter and dropped it in the mail. As they say, she who hesitates forgets.

Upon awakening this morning, I realized that I’d omitted my letterhead completely. No address, no phone number, no email address, nothing. If the doctor wanted to contact me, she’d be completely at a loss, unless she’d recorded my number somewhere or had held onto an old business card. How long do you hold onto someone’s old business card?

I am an idiot. When I told J. what I’d done, she said, “Are you sure you’re ready to go back to work?” That seemed a bit harsh. I’ve been doing the odd bit of therapy, but I haven’t scripted a business letter in five years now. I forgot how it’s done, but I believe I’ve learned from this experience and will never forget to include my contact information again. Tomorrow, in my I’m-still-alive notes to other family physicians who’ve recently made referrals, I’ll most certainly include a business card or two.

In my panic this morning, though, I asked J. to google me. Googling myself would force me to accept I’m invisible on the internet, and I don’t need that humiliation. She did a search, and found my telephone number from an office I left a decade ago. I couldn’t believe my current work number of 10 years was completely absent on line so I was forced to google myself. I discovered that a) I really am invisible; and b) my current number and my old number are equally represented. At least clients seeking me have a 50/50 chance of choosing the correct number. Perhaps I shouldn’t have been so quick to cancel my Yellow Pages account.

I need to create a web presence pronto. For now, I am creating a business Facebook page, complete with my correct telephone number and email address. I hope potential clients are able to find the right Annie, since there are two Annies with my last name on Facebook. FYI, in case you can’t tell from the picture, I’m not the Annie from Fresno, California.

Believing something doesn’t make it true

I don’t really believe in anniversary reactions. I’m referring to the emotional upheaval people may experience around the time of year of a previous traumatic event. If you were in a terrifying car crash in the fall, you may become more nervous about driving around that time, for example. These reactions may sometimes reflect post-traumatic stress disorder.

Whether or not I believe in anniversary reactions, I seem to be having one. I was out of sorts last week and my sleep became disrupted (tired J. can confirm that), yet I had no idea why. You’d probably expect me to figure it out because I’m a psychologist, but I didn’t.

I hadn’t made the connection with what was happening five years ago at this time. Remember my height of attention seeking when I almost died? The whole period is a blur, but September 27 stands out in my mind. On that day, I was moved from the ICU to a private hospital room. I have three distinct memories from that day.

On the wall by every hospital bed, there is a white board with the patient’s name, the patient’s nurse, the admitting physician, and the date. I recall looking at the white board in my room and being sure that the date was wrong. It was September 20th, not the 27th, I thought. When my liver was failing, my brain fared poorly too. My grip on reality was tenuous at best. I was confused and disoriented and hallucinating. No wonder I didn’t know the date.

Later that day, for the first time in weeks, I witnessed how much my body had changed over my hospital stay. (The ICU doesn’t have a lot of mirrors, for obvious reasons.) My legs and arms were spindly from weight loss, and my skin was yellow with jaundice. I was unrecognizable. In that moment, I realized how sick I’d been.

My anxiety peaked that night. In one day, I went from having a nurse assigned solely to my care, her desk positioned so she could see me at all times, to a secluded hospital room with only occasional monitoring. I was sure I would die in this room and no one would realize it for hours. I was a wee bit anxious.

I hadn’t been aware I was thinking about that period of time, but while I wasn’t sleeping one night, I made the connection. My anniversary reaction snuck up on me unexpectedly. II may have to reconsider my belief in the whole phenomenon.

Five years ago, as I regained awareness, I was hit by how close I’d come to death. Did I ever address how scary that realization must have been? I can’t recall. And even if I did deal with it at the time, sometimes such intense emotions resurface when you least expect them. Or maybe I should reconsider this whole anniversary thing and accept my reaction as predictable.

I feel a bit better already. Last night I even slept. Today’s anniversary is truly celebratory: on October 2, 2012, I was finally discharged from the hospital to recuperate at home. Had you seen me then, you wouldn’t have thought I’d still be alive today, but here I am. I can only thank God for that.

Person in hospital bed, staff saying,"if gave you nice food, you'd stay here instead of going home to your loved ones."

Siri, do you seriously think you could do my job?

Cell phone displaying, "What can I help you with?"

I have nothing against modern technology. I save a lot of time banking on line rather than going into my branch. When I run into the grocery store for a few things, I check them out myself rather than waiting for a cashier. Driverless cars may scare me but I’ll likely die of natural causes before they take over the road.

Nonetheless, when Siri recently threatened to horn in on my territory, I took offence. C’mon Siri, what are you thinking? I’m grateful that, if I choose to, I can ask you the weather or directions to the nearest bakery. I’m sure you could tell easily me when the Roman coliseum was built if I cared to know. You might even be able to help me not to overwhip my egg whites, and to determine the best oven rack for my baked goods. More power to you.

But counselling? Really? Will I have to listen to your annoying computer voice for a full hour at a time? I realize that Employee Assistance Programs and even some real clinicians are experimenting with newer modes of communication with their clients, ones that do not involve sitting in the same room facing one another. Clients text and email their therapists these days, but I want to believe they do so mostly to book or cancel appointments, not for the therapy itself. Then I heard of someone who participated in counselling solely through email–he never met the person who was helping him. Is this negligence or am I just old fashioned?

Could you really address my most vulnerable problems, Siri? How will you grasp inflection and intonation and other subtle aspects of language? What about all the things I don’t say, that I communicate solely through my body language? You’ll have your work cut out for you, Siri.

Since I haven’t been to see my therapist for a while, I thought I’d try Siri out for myself. I started with, “Hey Siri, I’m feeling blue.” Siri responded appropriately, “Sorry to hear that.” When I said it again, she said, “I would give you a foot rub, but I don’t have hands.” Whoa Siri! If this whole therapy thing is going to work, you’ll need instruction in maintaining appropriate physical boundaries with clients. When I told her I was feeling sad, Siri said, “It’s your party…you can cry if you want to,” which I didn’t find that comforting. When I asked Siri if she ever got sad, she said, “This is about you, not me.” Touché, Siri.

I’d like to think I have the upper hand on that whole clinical-intuition thing, Siri. Knowing when to push a client and when to back off, when a client is holding something back and how to help them let me in, and most importantly how to help a client feel comfortable and safe. And you, Siri?

For now, I’ve decided not to feel overly threatened by your plan to expand into my territory. You’ll need some time to get up to speed, and I’m not sure you’ll ever master the tough stuff. I hate to dash your hopes, Siri, and I know my services may cost a little more, but I think I’ve got you beat for now.

 

My day of awe

Yoga class with overweight woman doing warrior II in forefront

I was in a yoga class the other day, holding my Warrior II pose, when I made the mistake of turning my head to look in the mirror ahead of me. Yes, the front wall of the yoga classroom at the gym is all mirrors.  I like being confronted with the shape of my body on a regular basis, but sometimes the honest feedback is a little much.

Over the years, as my spleen has expanded, I have stopped looking at myself from the side. I can look at my body straight on, but from the side all I notice is how disproportionately large my belly is relative to the rest of my body. When I glanced in the mirror the other day, I was confronted with a painful realization: despite my recent marked weight loss, my spleen has not gone down in size. Turns out my internal organs haven’t shrunk with the rest of me. I may no longer store much junk in my trunk, but I still look kinda pregnant.

Then I came to my senses. My recently transformed body is perfect for me. I have not an ounce left to lose, and still I am critical of myself. I should know better. I’m a psychologist, for God’s sake. I help people accept themselves as they are, and, hypocrite that I am, all I can see is my own room for improvement. Some role model.

Are women ever 100% satisfied with their bodies? Is it any surprise that they’re not? I recently met a young woman who used to skate professionally. Sk8tr grl spoke of the constant pressure on her and her fellow skaters to lose weight. One of her coaches actually insisted on weigh ins every two weeks. One day, as an act of protest, sk8tr grl stepped on the scale holding her bagged McDonald’s lunch. Eventually the skaters’ protests resulted in the end of the weigh ins, but in the meantime, many of sk8tr grl’s friends developed eating disorders, one even suffering a heart attack in her mid-twenties. Sk8tr grl was strong enough to resist these pressures, thank goodness.

After my recent lapse in body acceptance, I knew exactly how to whip myself back into shape, so to speak. I headed to Eddie Bauer. If you are ever questioning your body, especially if you should not be, I suggest a visit with Eddie. Eddie and I have never met, but I believe he must have a distorted body image because his sizing is so absurd. I can count on his clothes’ fitting me in a smaller size than I’d wear in any other clothing line. Might this be a marketing ploy? “You’re a size 10? I think a size 8 would more than suffice,” says the Eddie salesperson.

Eddie or not, here I come. I will stop hiding my body under layer upon layer of oversized clothing. (The worst habits die the hardest.) I will embrace my spleen in all its ginormous glory. I will look directly in the mirror at yoga, even during Warrior II, without wincing in shame. I will love my body as it is. Anyone want to join me?

 

 

So much for fresh-picked apples and honey on Rosh Hashanah

Very run down country home, holes in roof and walls, abandoned

I have an annual ritual before the Jewish New Year. I go to the market the weekend before the holiday and buy the best fresh-picked apples I can find for dipping into honey. This year my favourites, the crispy tart Macs, are in season. I had a busy weekend with few windows of opportunity but I thought Sunday afternoon was clear.

It wasn’t. Remember last year when I thought I’d found the house of my dreams but we who hesitated were lost? Since then, we’ve continued to keep our eyes open to homes in our neighbourhood. We have a very specific set of criteria and a price range, and when a house comes up, we’re checking it out. We are frequent attendees at open houses.

So far, we haven’t had much success. Each home we’ve viewed has been wanting: a bedroom short, yard deficient, run down, overpriced. J. loved one recent listing beyond our price range so much that she rushed out to buy a lottery ticket. She said, as she always does during her semi-annual lottery-ticket purchase, “We’re good people. We deserve to win the lottery, don’t we?” She wasn’t even hoping for the jackpot, just a few hundred thousand dollars to cover us. Guess how that panned out?

Sunday afternoon, smack in the middle of my scheduled apple picking, a home that looked absolutely perfect was open for viewing. The listing said it was the right size at the right price on the right street. Pictures suggested it had a nice yard and a spiffy kitchen and three decent-sized bedrooms. The separate entrance with stairs to the basement would even give it office potential.

(Did I happen to mention I have not one but two clients scheduled this week? Maybe if I worked a little more, J. could stop buying lottery tickets.)

Reluctantly, I set my annual apple buying ritual aside. Off we traipsed to check out the house, showing up at 2 p.m. alongside the realtor. The crowds were eager to enter as he changed his “Coming soon!” sign to “For Sale”. But J. and I weren’t waylaid by his tardiness: we went straight to the backyard first.

Somehow the gorgeous photos didn’t capture the many doggy deposits and the ashtray overflowing with cigarette butts. While we were watching our step, we met the friendly furry depositor, who’d been left at home to greet potential buyers. Had we only known it was a dog-friendly home, we’d have brought Jelly, who would have loved a tour of the home, especially if it involved racing around after the four-legged resident.

I regret to inform you that those gorgeous interior pictures must also have been Photoshopped. The inside of the home was in shambles. Counters were filthy, appliances were dented, blankets were strewn around couches, toothpaste dotted the washroom floor. I could go on, but I’ll spare you. Because I am infection prone, we didn’t linger.

Our look-and-dash left me time to go marketing, but my hopes were so profoundly dashed that I needed the time to mourn. All is not lost, however. Maybe the next house will be perfect, even without Photoshop or a lottery win. They say you gotta kiss a lot of frogs….

The sun will come out tomorrow.

Quote: Here, take my advice, I'm not using it.

I was not surprised when I found the newspaper on the landing the day following the muffin pickup. Even better, Mr. RAK wrote a note on it, thanking us for the muffins and signing it with his name. Thank goodness at least I can call him by name next time I see him.

Did you know that yesterday was World Suicide Prevention Day? Neither did I, until I read a story on the news. Suicide seems as good a topic of discussion as any, don’t you think?

I recently saw a client who was chastising herself for feeling down because there were so many people around her dealing with much worse. She kept telling herself she had no reason to be depressed because her road was relatively easy. Can you hear her completely devaluing her own experiences and feelings? Why do we use others’ challenges as the benchmark for how we should feel? I do this all the time, and I should know better.

What could I do for this client but give her heck, gently of course. (I realize I was telling her to do as I say, not as I do. Please don’t tell her.) Who cares what other people are confronted with? All that matters is what’s on her plate and how she feels about it. If she was finding her challenges overwhelming, she needed to respect and acknowledge that. Then she could find her way through it.

As our session was ending, I asked her whether she felt it helped at all to talk. Her response was lukewarm, with reason. I didn’t say anything she didn’t already know, and she had no great eureka moment. She left the session looking as down as when she had arrived.

We all have bad days. I can wake up in a funk and have trouble pulling myself out of it, but thankfully my funks are usually short lived. The distraction of exercise and dog walks are probably my best funk abaters. Because of my own experiences, I appreciated my client’s despair, and wished I could have helped her more. By session’s end, I worried I had let her down.

This client contacted me the next day. She wanted me to know she’d woken up feeling a bit better. I was relieved for her and grateful that she’d contacted me. Clients are more likely to call when they’re feeling distressed than when they’re feeling better. I welcome the distressed calls, but I love the happy calls.

I often worry about my clients. When they come in feeling down and leave feeling downer, I fret the most. But I can’t forget that people are resourceful, and usually those who leave my office feeling the worst arrive at their next session feeling remarkably better. .

So next time you’re feeling down, I ask you to trust that tomorrow, or the next day, or even the next week, will be better. Give yourself time to muddle through, and get help if you can’t do it on your own. If you don’t feel comfortable talking to a friend, call a crisis line or get yourself to the hospital. Whatever you’re struggling with, suicide is a crappy solution.

Do you eat the red ones at all?

Red smarties coming out of the box in the shape of a heart

After the lovely small wedding we attended last week, Tom and Harry hosted the minister and his wife, as well as J. and me, at a fancy schmanzy restaurant for a celebratory dinner. Over the course of our meal, we had no end of engaging conversations.

At times, we shared our most private thoughts. Tom mentioned, for example, that, when he was younger, he had hated the taste of red Smarties. He tried to convince us all that red Smarties tasted different from the others, at least when he was a child. He was quite insistent. He was so animated I wondered whether red Smarties were so abhorrent to him that he refused to eat them.

As a chocoholic, I was curious about Tom’s assertions. I had to find out for myself if there was any truth to what he was saying. Thank goodness that clinical psychologists like me are trained in both research design and clinical practice. I could tell you with my eyes closed exactly how to assess Tom’s hypothesis. And, yes, my eyes would have to be closed.

In mere moments, I had designed the perfect study. I picked up a box of Smarties at the grocery store a few days later. (They happened to be on sale.) I coerced J. into being my assistant as well as the second subject in my study. I would pay her in–this is obvious–Smarties.

First I divided the Smarties into two groups: the red ones vs. everything but red. Then I sorted the Smarties into groups of three, each group having one red Smartie. I turned my back to J. and asked her to hand me a group of Smarties one at a time in a random order. When I received the first Smartie, I forgot to close my eyes as I brought my hand to my mouth. What a dummy. I kept my eyes shut through the remaining trials.

J. agreed to participate in my study but she refused to be blind to the colour of the Smarties she was eating. I recall she said, “Just give me the darn Smarties.” She didn’t believe knowing the Smartie’s colour would influence her taste perception at all. She wasn’t taking the study as seriously as I was, apparently, and her responses may be biased as a result.

In any event, the findings were as I expected (I’ve just added experimenter bias to subject bias): neither of us disliked the taste of the red Smarties. We also concurred that the red Smarties didn’t taste any different than the others. Over the course of the brief study, we didn’t spit any red Smarties out in disgust; we savoured all of the Smarties because Smarties are inherently yummy.

My interest in Smartie research did not stop there, however. I began to wonder what proportion of Smartie lovers suck them very slowly vs. crunch them very fast. (I, for one, am a slow Smartie sucker. Ah, the taste of smooth melting chocolate…but I digress.) This burning question has prompted a second study. If you would like to participate, contact me at 1-800-SMARTIEPANTS. Compliant subjects only need apply. That means no Smarties for you, J.

Introducing the intermittent reinforcement schedule

Basset with tongue in bowl

Despite what I may have led you to believe, Jelly has many advanced dog skills. She can do all sorts of magnificent tricks, like shaking a paw while laying down, sitting, or standing. She sits and stays while we fill her bowl with high-priced kibble, and refrains from eating her meal until we release her, which happens as soon as we hit our tolerance threshold for drool on the kitchen floor.

Now that she is maturing, I am enjoying my trips with Jelly to the off-leash park more. Jelly stays fairly close by. If she lags behind, it’s only to sniff a particularly fragrant blade of grass. Rarely do I have to call her to me anymore; she usually remains within a reasonable distance.

Except when she doesn’t. I attribute these lapses to my never training her to come when I call her. You’d think I’d have mastered this command, which requires an understanding of basic reinforcement theory. You learned all about reinforcement theory in Intro Psych, right? If so, you likely received a better grade than my mediocre B, thereby better preparing yourself for elementary dog training.

I know how I should have trained Jelly to come. First, I was to reward her every time she came, or as we say in psychology speak, to reinforce her on a continuous-reinforcement schedule. This approach is best when a dog is learning a new behaviour. The reward could involve my greeting Jelly excitedly or, more often (bad Annie), my giving her a treat.

Once Jelly came every time I called–did she ever?–I should have stopped giving her a treat each time (in other words, I should have shifted to intermittent reinforcement). This means I should have rewarded her occasionally, on what’s known as a variable-ratio schedule. The best way to maintain a learned behaviour is not to know when to expect the next reward. I want Jelly to comes each time thinking she might score a treat, which she may or may not.

Diligent dog trainers stop rewarding with treats altogether once the behaviour is mastered. These trainers naively believe that their dogs will come simply in order to please them. Forget that. Jelly comes only if there’s something in it for her, and that something must be edible.

But that’s only part of the problem. Recently I’ve realized that, rather than my training her, Jelly has been training me. Every so often I turn around, only to find my sweet dog MIA. When I look her way, I barely see her head above that long fragrant grass. Eventually she looks my way. She knows she should come but is waiting for me to call her first. That’s because she’s learned that if she runs to me out of the goodness of her heart, I’ll greet her excitedly but won’t proffer a treat. She knows I give her a treat only if she comes when I call her, so she’s learned to wait until I beckon, and then she comes a-running.

Now you probably understand why I received that B in Intro Psych. Not only have I failed at basic reinforcement theory, my dog understands the theory better than I do. She has me wrapped around her huge Basset paw.

Nobody’s perfect, or is it just me?

Jelly with her long yellow tennis-ball-coloured toy

After a few worrisome days, Jelly is slowly coming back to life. She has howled a few times, brought us her favourite toy (you know which one that is), and managed a few short walks. She’s slowly on her way to a full recovery.

Every step she takes forward, it seems our parenting takes a step back. For example, in our desperation for her to eat again, we’ve been doling out treats out left and right. No need to sit or shake a paw or any other awe-inspiring manoeuvre; a mere visit to the kitchen is all it takes. And we’re normally pretty stingy on the treat front.

Then there’s the sleep issue. After a few days of sleeping longer than me, imagine my excitement when Jelly woke me early Saturday morning to give me a kiss. Could there be a better way to start my day than with a kiss from a perky pooch? In my joy, the fact that it was 5:20 a.m. didn’t even register. What happened to the rigidly consistent parent who would normally send Jelly back to bed?

That parent was MIA Saturday. I was so excited Jelly was feeling better that I leapt out of bed at that ungodly hour and took her out for her morning piddle. Then I fed her a little bit of food to assess her level of hunger–she’d eaten very little for two days by then–rather than holding off until her usual breakfast time.

Then, I disclose with deep shame, I let her come up for what we like to call “family bed”, a very occasional Saturday occurrence (Saturday is  laundry day) when Jelly joins us in the human bed so we can all sleep in together. She was snoring within seconds, allowing her parents another hour or so to snooze. Boy did we need it. All that fretting was interfering with everyone’s sleep.

Is this good parenting or bad? Must we judge it at all? I’d call my behaviour typical parenting, but maybe I’m being defensive in a time of weakness. Even parents who normally set diligent boundaries with their children lapse sometimes. It’s simply harder for many parents to set firm and consistent limits with any being, two- or four-legged, who has some kind of health or emotional challenge. Finally I understand why parents let their children into their bed in the wee hours: they’re too exhausted to send them back to their own beds.

All rules were not forgotten, however. At no point did we let Jelly up on the couch, despite my really really wanting to invite her. Is merely wanting to break a rule a parenting sin too? I’m told that so long as I don’t act on it, I’m okay.

Firm and consistent parenting is an ideal, but there has to be some room for flexibility too. Rules are hard to uphold, and sometimes I’m guided by emotion rather than reason. I’m weak, I admit.

Today, we were already back on track. I sent Jelly back to bed rather than celebrating her early morning awakening. Then we headed to a PALS visit, where I met a woman whose dog sleeps until 10 a.m. most days. Dare to dream, Annie, dare to dream.

basset sleeping on bed, head out and human's feet out as well