Friday, December 24, 2010

Therapy Issues: Discerning the Professional from the Personal

What's the difference between friendly advice and therapy?
A lot. Compassionate boundaries of respect and limits, for a start.

Therapy Issues: Discerning the Professional from the Personal

Saturday, December 4, 2010

Chronic Illness and the Family

The good people at www.GoodTherapy.com have made me a Topic Expert in Family Therapy. I write a column monthly - here's the latest:

It may be the idealized image of television shows, or perfect, ever-present pictures in advertising in newspapers and magazines, or just the plan hopefulness with which we all start our families. But most of us don’t plan to include chronic, life-long health problems in our family plan.

Our bodies are quite amazing creations, able to fight off disease, recover from injury, grow, age and change every day. We aren’t minds that have bodies attached, but we are instead bodies that think. We must eat, move, think, rest, work and love with our physical selves in mind. And for the most part, this natural rhythm of self-care makes life work.

But life isn’t smooth, and our physical systems aren’t perfect. Some of us will encounter injury, disease or disability that does not respond to time and care. For many of us, that process comes quite late in life, after the children are grown and gone, and our work life blessedly finished. But for others, this physical change comes much earlier, as a child, or teen, a young or middle adult. And suddenly life is different.


Chronic illness. It’s a disease, like diabetes, that robs the body of its natural resources and requires hourly attention to diet, activity and insulin. It’s asthma that can be quiet for days and weeks and suddenly constrict airways. Spina bifida, cerebral palsy, brain disorders, arthritis, paralysis, cancer, and blindness: the list of disorders, diseases or injuries that can change our lives is seemingly endless. None comes with our permission. But once it comes, if we want to keep our families and marriages healthy, happy, and productive, we must figure out how best to cope.

While those who live with chronic illness in themselves or close loved one have to create their own way to manage, there are some common factors when people find themselves faced with permanent life challenges. Perhaps one or more of these resources may fit you and your family now or in the future.
  1. Support. Being suddenly faced with disease or disability can be an enormously isolating experience; we feel overwhelmingly alone in our loss. Reaching out to others who have been there before us is a great relief to many. Local, in-person support groups or electronic on-line discussion groups are a wonderful way to break that isolation, find help, advice, and new friends who can walk the new journey with you.
  2. Education. Many of us have found the Internet and it’s endless resources both wonderful and awful: some of what we find is inaccurate and it’s hard to sort out which information is true or not. Finding the most authoritative sources of information about our condition is important and life giving. Medical libraries on-line, medical professionals, and research foundations may be the best places to start when researching a disease.
  3. Insurance companies. Believe it or not, most health insurance companies want to help you manage your disease so that you maintain or improve your symptoms. Many diseases have been shortened, improved or cured by the research done in clinical trials. Ask your physician if you qualify for research studies, and then be in touch with your insurance provider. You may find, as I have, that your insurance will cover an important, life-giving clinical study.
  4. Mental health care. As a psychotherapist who has been a therapy patient herself, I know how critical mental health care is to living with disease and chronic pain or disability. Reach out for mental and emotional support before you feel overwhelmed, and find a private, confidential healing place to think about your feelings, behaviors, relationships, and changed body. Internet directories like GoodTherapy.org are great places to search for quality therapists in your area.
  5. Spirituality. Nothing is more important to the long-term adjustment to change and disability than working within one’s sense of faith, belief, ritual and higher power. Faith and spirit can help one recreate a sense of purpose, meaning, self-care, self-acceptance, love and forgiveness in the midst of loss and change. When we can feel connected to a Being or community that loves us in the midst of our personal storms, we can experience a safe harbor for our hearts and minds.
Even with some or all of these important resources, living with chronic disease is a difficult and exhausting journey. Be sure you make time and space in your life for love, laughter, and joy, the things that hold families together. Despite the challenges, you may find life really worth living, together.

Tuesday, October 26, 2010

Personality: Does Birth Order Matter?

     For generations, family members have noted the differences that naturally arise in children raised in the same family. How is it that John, the first born and only boy, seems to have such different personality characteristics than his younger brother, raised in the same house by the same parents just two years apart?  Good question!

     Theories of personality abound. You may be familiar with some of the more popular models, often used in work or educational settings. The Myers-Briggs Type Indicator (MBTI), based on the four major personality styles described by Swiss psychoanalyst Carl Jung, is a favorite. The Enneagram, a model developed in religious communities and often used in spiritual direction, and other forms of personal discovery, is another.  These are models that seek to describe common types of personalities. Other models, such as the Big Five theory, attempt to describe personalities using the idea of common traits shared by human beings across the world, such as extraversion or neuroticism.
    
    Whichever way makes more sense to you to describe human beings, by types or common traits, we have a collective curiosity about how people become who they are, and how much we can or should adapt ourselves to others and our environment.

     How did I get to be the way I am? When my clients ask me this question, I answer this way:  our personality is constituted like a recipe, with three primary ingredients. The first main ingredient is our individual nature. We are born with a particular style of personality, inherited from our parents and our larger family system. It’s part of our genetic code, and forms the basis of who we become.  Our general sense of the world, our innate optimism or pessimism, our sense of humor; this basic personality is another thing we have inherited.

     The second main ingredient of our personality is formed by the way we are cared for by our parents; it’s the nurture part of the recipe. Was our mother well nourished, healthy, and ready to become pregnant? Were our parents free from addiction, major illness or injury? Was our birth relatively normal? Were we welcomed into the world with joy and cared for with love? The way our parents meet our vulnerability, suffering and growing sense of self makes up the great majority of our personality relationship style.

     If our parents or primary caregivers have enough sense of self that they can sacrifice and respond to our needs consistently, we learn to trust that others will meet our needs, and that others are trustworthy. We offer ourselves to them, and get care and love in return. In the research done on this concept of emotional attachment, about half of us get just what we need to feel secure. The rest of us learn some combination of security, anxiety and withdrawal to cope with inconsistent parenting.

     The third part of our personality is made up of all the unique, individual experience we have in life and what we do with it. It’s the fall you took in second grade from school jungle gym, the trip to the hospital, and the cast that you had to wear through the summer. How did that fall affect you? How did it shape the way you think, feel and respond to the world? What happens, and how you chose to respond, makes up a large part of your personality.

     What about birth order? I think it fits in this third “what happens to us” category of personality development. While research is still battling it out whether first born children actually are more independent than their second born siblings, therapists and other social scientists have found a common pattern in family position that seems to fit many families, at least in Western cultures. In general, first born and only children are commonly more self determined and disciplined, having been born into an adult system and most closely associated to adults, even as infants. The second born child is less connected to the adults in the family, and if followed by a third child, may feel a bit lost in their parents’ strong relationship to the first born and emotional focus on the baby of the family. The farther away from the parent system, the more independent and even rebellious that child may become (Sulloway, 1997). Additionally, the more older siblings a child has, the more accustomed they often become to letting other people lead, and can more easily go “with the flow” than those born first.

     Family therapists differ in the amount of importance they place in this theory of birth order, but most will inquire about how a client’s family is constituted, and where in the family their client “fits.” Why it matters at all is that it may help people better understand some of their unconscious preferences for friendships, marriage partners, relationship styles, and even how they may connect to or discipline their own children. It’s all just part of our individual personality recipes.


Sulloway, F. J. (1997) Born to Rebel: Birth Order, Family Dynamics, and Creative Lives. New York:
     Vintage.

Saturday, October 23, 2010

Losing the Boundaries

I've been reading about blogging, and it seems that I'm not doing it right.

Those in the know about such things tell us writers, mostly in their blogs, that to blog is to create a personal online community, one which is thirsty for the writer's words and self revelations; writing that steps toward the daily Diary or Journal, and away from more sedate Opinion or Editorial. The most successful of blogs these days - and it seems to change every day - drone on and on about the personal trials of having a newborn, or looking for a job, or recreating the work place, or reinventing the government, or the economy, or the Church. Again. These exemplars are often writing on the fly, with nary a concern for punctuation, spelling, brevity, or privacy. It's all about capturing the reader, and capturing as many as possible.

You may have noticed that I'm not much of a rebel when it comes to the niceties of the published essay. I have spent far too many years putting words into sentences to drop punctuation or spelling for the sake of being current. In fact, I hate it when I find a mistake after I hit the Publish Post button. And having a couple of deadlines to meet (in newsprint and online) makes me very unlikely to post here too often.

But for this writer/preacher/therapist to blur the boundary between self and audience, to say more than is prudent, to share information that I've been asked to hold as private: that's a scary thought. 

To have good human relationships, in part, means to know that there is a real difference between me and you. And the differences need to have breathing room, space to breathe, and respect from each of us to flourish. If I blather on and on about just myself in this space between us, there isn't any room for you. If you trust me with personal, sensitive information and I write about it, I've broken your trust. Even if someone else wants to read about it for the drama of it all. Even if it seems entertaining.

So, I guess I'll be at the back of the blogging pack on this one. I won't write specifically about any of my clients. I won't share anything of my family without thinking several times and then asking permission. I'm going to stay away from the most personal in order to say more about the shared. I'm going to be a blogger who posts less frequently, does more editing, and points more often beyond my little life to the world beyond.

Call me a slacker. It's just how I roll. Or write. :-)

Thursday, September 16, 2010

Go To the Limits of Your Longing

God speaks to each of us as he makes us,
then walks with us silently out of the night.

These are the words we dimly hear:

You, sent out beyond your recall,
go to the limits of your longing.
Embody me.

Flare up like a flame
and make big shadows I can move in.

Let everything happen to you: beauty and terror.
Just keep going. No feeling is final.
Don't let yourself lose me.

Nearby is the country they call life.
You will know it by its seriousness.

Give me your hand.
  

Rainer Maria Rilke
Book of Hours, I  59