Thursday, December 17, 2009

You Can Go Home Again



For better or worse, we first learn about making and keeping relationships in our families. During our formative years, our parents establish patterns with us; patterns of connection and separation, of independence and dependence, of give and take, that literally shape our developing brains and how they work for the rest of our lives.

The problem, of course, is that this is a very imperfect process. Our parents have inherited their own patterns from their own parents, families and culture and combined them into their own style. Very few of these emotional patterns are conscious; we rarely notice or examine them.  This automatic process is why family emotional patterns are so often repeated generation to generation. When they work for us, they help us develop into caring, connected, loving human beings. When they don’t work well, we can be shaped by anxiety, demands, rigid roles and expectations, and inflexible rules for behavior. Of course, most of us have a unique, messy combination of both.

One of the most emotionally charged family experiences we share are the subtle and not so subtle family expectations that swirl around “The Holidays.” Whether the holiday is Christmas, Passover or the cultural New Year, many families have traditions that involve returning “home,” visiting parents or relatives, eating, and sharing worship or rituals together year after year. For adults who have left their parental home and established an independent life, these expectations can arouse surprisingly high anxiety and worry. We can be caught off-guard by overwhelming feelings of obligation, excitement, frustration, pleasure, anger or any combination of feelings about the family traditions we know but now have a small measure of distance from. And if we add into the mix the distance and cost of travel, or the demands of college, work or a new spouse or child, it can feel like a chaotic world inside our heads.

Most of us solve this internal family stress in just a few ways.

We may promise to return home, but find a conflict at the last minute. We may go, but
bring along a friend, spouse or child, and use them as an emotional buffer. We may go and find the old emotional patterns so arousing we eat, drink, sleep, or spend too much while there. We retreat to the computer, the new novel we brought, or constantly check our smart phones for communication from the outside world. And still others of us find the whole returning to our family so stressful we end up in huge, raging family fights just when we want to be relaxed and connected.

It is hard to return home to our families. We want to behave well, but find our own reactions surprising and troubling. How can we stay connected in a more healthy way to the people and traditions we had growing up, without completely throwing them out? How can we be calmer under the stress of bad communication, or alcoholism, marital conflict, unspoken rivalries, disappointments or fear?

Family systems theory understands the family as both the source of this emotional stress as well as the soil in which new, more flexible personal patterns of connection need to grow. How can we change our point of view of family and behave in slightly more helpful, relaxed ways?




The answer is two fold.

Firstly, we must recognize that we are part of that same family that makes us so confused. We need to return to our families over time, in small amounts, and become a witness or observer of our family’s emotional process. We can enter into our family process as both participant and student. What do we notice? How do this family work? How do I participate in these patterns? What if I were to do something slightly different than before?

And secondly, we make a steady effort to talk with, deal with, and know each member of our family one to one. When we can have real, face to face relationships with the people in our extended emotional system, we stop behaving with them in old, rigid, familiar ways, and have to deal with them as people in the here and now. And not surprisingly, they have the same experience with us.

These basic emotional changes are the building blocks to creating a more flexible self when dealing with our families from a distance. We don’t have to cut our families out of our lives, and we don’t have to simply accept their unique problems and bear our burdens silently. Observe your family system, and focus on your relationships with people individually. You can go home again, with a shift in purpose and perspective, and find yourself better connected and less anxious.


Tuesday, December 8, 2009

Not So Fast

I'm not sure I have anything useful to add when it comes to discussing the extra-marital affairs of Tiger Woods. The whole wide world has been writing and talking about him, and I will say I am now officially bored. (I'd rather talk about actor Meredith Baxter, Alex Keaton's "Mom" on sit-com Family Ties, who disclosed the same day Tiger came clean, that she is now officially out as a lesbian. She was afraid to talk on national TV, but did it anyway with Matt Lauer on the Today Show. It turns out she got overshadowed in the media by Tiger's failures, and I'll bet she is glad, glad, glad!)

Three observations about affairs, though:

1.  Affairs are not about sex. They're about chronic anxiety, and people taking that anxious energy out of the marriage (triangling), creating a new relationship that they believe can soothe or contain their emotional muddy water. Affairs don't and can't. 

2. It's very difficult to repair a marriage after a partner stomps all over the intimacy. And that is because affairs are secrets. Intimacy is about clarity, vulnerability and emotional trust; it dies with secrets. Getting that trust back is something only about 50% of the couples who seek therapy after affairs achieve.

3. Affairs are a bit like emotional barometers; they often indicate that a couple's emotional system is stressed and broken. Each partner owns a part of that problem. While the "fault" lies with the one who does the cheating, the repair must come from each partner, looking at his/her own emotional life, and working on the parts they can improve.

We live in a culture that so distorts sexuality it is used to sell everything from cars to bath soap, phones to teen music videos. Why are we so surprised when someone who makes his living by that media culture acts out sexually? We have a part in Tiger's mess. And it's not just that we have put him on a pedestal and are dying to watch him fall.  We have made this sexualized culture, and this is how many people in it dysfunction.



 

Sunday, November 22, 2009

Instincts and Drives: Powerful Stuff

Human beings regularly ignore the fact that we are mammals: warm-blooded, live-birthing animals who share a lot of DNA with beings as diverse as chimpanzees and elephants.

When it comes to thinking, we win, hands down. At least, most of the time. But we often forget how deeply we are designed to do certain things, like eat, sleep, defend, or mate.

The deer in this photo is dead. It killed itself by head-butting a 640 lb. bronze elk statue in a Wisconsin backyard. In the rutting season, deer will defend territory, attempting to secure mating rights and sending the less powerful males on to other acreage.

I post it because I found it an astonishing image. Mammals, driven by the powerful brain chemicals of hormones, will do a lot of strange things. Like head-butting a statue to death.

Research proves again and again that human beings underestimate the power of instinct and arousal on their own behavior. This one fact of mammalian biology may help us understand why we keep doing what we do, despite our own good intentions: eat more than we should; pressure another into sexual activity despite our more clear-headed promises; start fights when cooler heads should prevail; rest or play when we should work.

It's not quite the Animal Kingdom in our heads, but at times, it can come close. How does remembering that you have powerful animal instincts change, concern or alert you to your own humanity? It's worth pondering. (I've been wondering about people with brain or thought disorders, and whether they can truly be held accountable for some of their most anti-social behaviors...)

Wherever your conclusions about instincts and arousal patterns, thinking is the one thing you have going for you that this unfortunate, driven deer did not.


Photo Credit: Mark Brye, via La Crosse (WI) Tribune

Thursday, November 12, 2009

What Exactly is Closure?

Convicted mass murderer John Muhammad was executed this week in Virginia. He and a teenage accomplice went on a three week killing spree in October, 2002, that left 10 people dead and a whole region of the country afraid.

Reports of the execution included select comments from some of the victims' survivors. Many spoke about getting or not getting, a sense of "closure" with his death. I have been wondering, as I often do when people use this popular emotional term, just what they mean.

I think that closure, in this context, has come to mean this: I can't forgive, and I can't forget. But at least I have some sense of justice done, and that closes the book on that nightmare. I can sleep at night without endlessly spinning on the fact that the one I love is dead, and the one who killed her is alive. I think that closure in the case of state execution may be a soft, acceptable term for vengeance.

But people say they find "closure" when some hidden secret is revealed, or when they find the answer to some perplexing mystery, like the disappearance of a loved one. People don't say "I have closure" when they forgive someone, or when they have attended a funeral for one lost to cancer or accident.


"Closure" is a contemporary image which means, I think, I can put this part of my life to rest. I can close the door on this room and finally walk away. I can shut this window, this file, this book, all the images we conjure of things that are open and unfinished that once closed, we can put down or away or forget. 

But in the end, it's a mirage. Because we will always have our whole life within us, and the whole of us to contend with from day to day. Nothing is ever really completely finished, is it? until the day we die. And even then, even then, God is not finished.

So, is closure just a wish for an end? That is my best guess on how we use it. Yes, we wish for our nightmare to end. And we call down closure upon it. Knowing, perhaps, it's just a dream. But we call for it, nonetheless.

Saturday, November 7, 2009

Secondary Trauma

Lord, have mercy.

We have endured another mass shooting in our nation, this time on a military base. It will take time to sort out the details of this horrible crime, but we are impatient to know: was this an act of terrorism? The shooter is a Muslim, and some have reported that he shouted to Allah as he fired his weapons. There will be a good deal to learn of this man in the weeks ahead.

Of great interest to me: he is a psychiatrist who worked with soldiers suffering with Post Traumatic Stress Disorder (PTSD). Mental health professionals of all kinds who regularly work with trauma survivors often find that hour after hour of listening to people recount horror is traumatizing. Without regular and systematic debriefing of their own work, therapists lose their own resilience and begin to suffer a secondary PTSD. They begin to show symptoms of chronic anxiety, restlessness, easy startle reflex, difficulty sleeping, intrusive images of trauma, and hypervigilance in the same way soldiers returning from battle can.


I wonder if this doctor, whose healing work helped soldiers return to their lives after battle, was waging a private battle of his own with nightmares, fears and overwhelming anxiety. Would he have been able or willing to share that suffering with others in the military? How are these fears linked to his natural anxieties about being deployed to the battle zone? Are there systems in place to have therapists working in PTSD debrief and consult with others about their cases and experiences?

Helping others recover mental health is not work for the faint of heart and mind. The very best healers understand that they are naturally effected by what they hear, and need help for their own pain. Perhaps this tragedy will highlight the continuing true costs of war: that the horrors of destroying others in battle don't stop at a nation's border. War is hell, and it exacts a toll far wider than we can imagine.

Oh God: hear our prayer.

Thursday, October 22, 2009

How To Marry Well

The best marriages are made by people who begin their relationship as friends and use friendship as their marriage model.

Do you know how to make and keep a friendship? Listen and talk, share work and pleasure, respond to a friend's bids for attention, and get some attention back? Laugh and enjoy each other, be flexible when things don't work out, fix your disagreements, stay loyal but open to other people in your friend's life?  If you do, and can keep these skills going with people your own age, you already know how to sustain a marriage.

The dramatic stuff of romantic attachment, the wash of sexual attraction, the focused desire for only that one partner: that biological experience, which is the core of nearly every popular song or relationship movie made in the last 50 years, is a piece of human experience, too. But it is crushingly brief. Most of us will only sustain that brain and body phase for 12-18 months. After that, we begin to readjust to a steady attachment that looks and behaves more like a close friendship than any other relationship we have. Friend with benefits? That's what a solid, happy, sustainable marriage is.


The best advice I give people (when they ask for it) about how to make a successful marriage is to take their time. I know that if they begin their relationship well, move into the infatuation phase, and begin to resolve that roller coaster with a deeper, more loyal friendship intact, they have a good running start on a happy union. This means that ideally, we should know our partner for a year or two before we marry. A lot can happen in two years. Exactly the kind of things that test the best of friendships, and expose our strengths and vulnerabilities to one another.

The best preparation for a happy marriage is not a long dating history, a series of broken engagements, or even one marriage after the other. The best marriages are made by those who have learned how to make and keep friendship relationships. Who'll will stand by you in difficult times, visit you when you're sick, and share their ice cream? That's who you want at your side when the real rubber meets the road: a dear friend. Your spouse.

Wednesday, October 14, 2009

Pastors are a Bridge

When I first began my private mental health practice, I knew one thing was certain: I needed to meet as many area clergy as I could. Today I had the pleasure of having coffee with an another local parish pastor. Thanks, C!

So many people still experience embarrassment, resistance and fear when it comes to seeking therapy for relationships, emotions, or behaviors, they stall when it comes to getting help. They may talk to their friend or family member. They may occasionally tell their physician about how they feel. But as they get ready to reach for help, they may also talk to their pastor.

Most pastors are great at emotional triage. Trained in basic listening skills, taught how to manage themselves in emergencies, experienced at handling emotions at funerals, parish clergy are the go-to folks in many people's lives when it comes to figuring out what to do when the going gets rough. I am honored so many people trusted their lives to me over my years in the parish. I learned early on to have a small group of trusted counselors I knew and to whom I could refer my parishioners who needed more help than I could give. I tried to think of myself as a link between suffering and help, and I kept in touch with those counselors on a regular basis.

Now, I strive to be one of those counselors that the pastors, ministers and priests around me trust. Someone they have met, looked in the eye, and gathered a personal sense of me for themselves. As I reflect on clients who have recovered well, who make the most progress in their personal goals, the ones who feel that therapy was a success: most have come to therapy via their pastors.

Thank you, Pastor, for being on the front lines in people's personal lives. You are under appreciated in our secular culture, and over-worked inside the special world of the congregation. You may not feel it often enough, but you are loved, respected and trusted by your members, and a lot of neighbors and strangers, too. Helping people navigate the details of mental health care is a compassionate gift you give. Thank you for trusting people you care to me, and to other therapists you know and trust. 

Oh, and one more thing: you are often neglectful of your own mental health. Don't forget to reach out for help yourself. Some of us know exactly what your life is like, and can be trusted as a confidential guide to increasing YOUR emotional health.  God's grace surround you!

Thursday, October 8, 2009

The Adolescent Effect: Part 2

Parents of adolescents don't have much fun.

Fun, for many parents of teenagers, is something they watch their children have. Fun at school, fun at the mall, fun on the playing field, fun at parties. What used to be happy times as a family with pre- and elementary school children has transitioned into good times  for the teens, and being the ones who not only pay for those, but also drive the kids to and from these teen-centered events. Having given up weekend after weekend, night after night, to manage my children's sports, music, church, school and friend events, I feel like an event planner. Always making things happen, invisible to the guests, never getting to sit at the head table or get out on the dance floor.

This is what many middle aged parents find when they get to the second decade of their children's lives. A child centered life, but with no emotional reward. No smiling toddler looking back at you as they climb up the slide. No proud 10 year old eager to show you off to their teacher or coach. Instead, the parent must now watch their child's back as they saunter, without a second glance, into the gym, store, house or ball field. The parent ready to drive, wait, and pick that child up when the event is through.


Do I sound resentful?

I have been thinking about my emotions around the lack of fun adult time in my life. Perhaps it has something to do with where we live, a suburb full of families in some stage of doing what we're doing. Years back, when I lived in a small town, adults made time for one another and the kids were expected to come along. One of my closest friends, having moved to Alaska, regularly reports her time spent with other adults in her small town, running, eating, fund raising, skiing, church building. What happened back in our shiny suburb?

I know for my husband and me, these years of chauffeuring came on slowly, incrementally, at the same time we had to manage some serious work and health issues. It was like an emotional tossed salad, trying to keep it all together. We managed to keep the whole one piece, but the pleasure in parenting? the joy in the week? I'm looking, but it's not so obvious anymore.

For families that don't have the funds to finance big vacation cruises, or a second home on the lake, these adolescent days are hard. There is no natural escape. Add into these adolescent effects a divorce, or an elderly parent, a job loss or a health or financial crisis and you see why most of the families I see in therapy are families with teens. We are adults without the focus of small children, adults without the freedom of retirement or the adjustment of an empty nest. We are hobbled, and stressed, and under-appreciated.

We are struggling to re-define ourselves and what brings us joy. If we look chronically worn to you, don't ask us to explain. Just give us a hand, and invite us to dinner. Without our kids.

Saturday, October 3, 2009

The Adolescent Effect : Part 1

As our children are neck-deep into adolescence, I'm trying to pay attention to what this developmental transition does to our family relationships.

We are pretty early in the game. Son is 16, daughter is 13. We have gotten here relatively unscathed, moving through most of middle school with solid parent/child connections, positive opinions of one another and every body part accounted for (not counting wisdom teeth, sports injuries or general repairs). But lots has changed, and what has changed is worth noting.

1.  We know less and less about our children's lives at school. Moving from a single class room in elementary school into the maze of middle and high school meant an immediate and dramatic change: I don't know my children's teachers. I have gone to what passes for parent-teacher conferences in our district only to spend about 10 minutes per subject talking to each teacher about my child in their class. A few of the teachers stand out in their effort to talk to me about my children, and that has made a difference in how I talk about them at home, and how at ease I am in communicating with them. Some really do a great job keeping in touch with emails, but most have as much substance in my consciousness as ghosts. I wouldn't know them to stumble upon them. I am no longer the advocate I used to be for my kid's educations. I have little to no real information on these teachers, and they me. That seems a huge loss for my family. I don't think of the teachers in my children's lives as people I share my children's education with. They have it during the school day, and I have given that influence up.

2.  We know even less about our children's friends and their parents. One of the more interesting things for me to observe in our family life is how friendships evolve. When the children were small, and we drove them everywhere, dropping them off for play time or events, we would spend time in the front halls of these homes talking with other parents and getting to know them personally. None of us would think of simply letting our 7 or 9 or 11 year old stay overnight with a family we hadn't at least met face to face. And that circle of friendships was relatively small and interconnected. But as our children have grown older, and their friendship circle wider, we have loosened our expectations about knowing the parents, and focused a bit more on trying to know the friends. We've learned that the apples don't fall too far from the trees, so if the child is solid and steady, we tend to believe the family is that way, too. This isn't always the case, of course. I know this well, both in theory and in fact, some children are more steady than their parents. And this has occasionally caused some real drama. But in general, we have shifted from a parent-centered to a peer-centered assessment of where our children spend their time.


3.  Our children still need us to be their fierce advocates, but in more subtle ways. Just when I think that our children no longer need me to do for them as much, to speak for them, to argue, plan or problem solve for them, I'm proven wrong. There is an adult they need to speak to, and they want me to do it. There's a plan they need to make, and it didn't get made, would I make it? There's an appointment, a game, a tryout, a field trip form, a PSAT, youth group, lunch money, library book, driver's ed class, special purchase, problem, or phone call that needs my help, my advice, my money, and my signature. Usually at the last minute, and often at my least flexible moments. But I have to hop to it, because in some ways, I am now the cleanup team. They have outgrown their childhoods, but haven't quite grown into their adult selves. And it's now my job, our job, to bend and flex in our parenting as they are in their development. We still defend and protect, just not so often and not so obviously.

Tuesday, September 22, 2009

The Recession and Mental Health Care

The recession has kept people who need care out of therapy.

That was the consensus of a small group of private practice therapists I met with Monday. We are a interesting and somewhat diverse group of folks: three licensed psychologists, three LMFTs and a social worker. Each of us has an individual private practice in the southwest Twin Cities, and we meet every month or so in each others' offices for support, case consultation and resource sharing.

As our meeting was coming to a close, one of us looked around and said, "I think people are coming to therapy less often, and when they do come, they are worse." All of us agreed. We are seeing that in our new clients: more severe symptoms of anxiety and depression; people who need medication taking themselves off and showing up in therapy; couples who might have been helped out of their patterns two years ago, making appointments like a "Hail Mary" touchdown attempt and often not even showing up to their first session.

Stereotypes of psychotherapy, widespread in the American culture, already do enough to keep people away from getting the care they need. The same kind of fear of the unknown (people avoiding their annual mammograms or other preventative exams) keeps them from seeing therapists. People fear that therapy is all about dredging up past pain, and they would rather avoid it. Or they believe that they should be able to "get over it," whatever it is, themselves. To be fair, therapy isn't all about the past, but it takes long looks back in order to understand the present, so the stereotype is partially accurate. What isn't true is that it's a waste of time, or it never works, or that its a huge money drain.

That last part, about the money, is what we've noticed about this recession as providers. People have lost their jobs, or are afraid they will. That anxiety alone makes us more conservative, and hunker down, and save money, and stop doing anything new. The added anxiety about what may happen to health care and insurance in the current political debate stops even more people from reaching out.

One thing I know for certain, though: nothing matters if you feel like you are losing your mind. The mind you count on to talk to others, to do your job, to care for your children, to connect with your family and friends. Actually, good overall health is dependent on mental health. If you are so afraid you can't leave your house, or so despondent you can't get your kids off to school in the morning, it matters little if you have low cholesterol.

Psychotherapists live with the fact that we are the lowest paid professionals in our health care system. We struggle to overcome the giant obstacles to care placed in our way by costs and stereotypes, by stigma and shame. What we wish for is for people to seek help before they are desperate, before they decide to leave their spouses, before they think often about suicide, before they start to think that they can't get any better. Life can be so much easier with good, quality care and a compassionate professional guiding you along.

If you need help, please reach out. And if you know someone who does, ask them to help themselves. Today.

Tuesday, September 15, 2009

This is What I Do it For

After three years of private practice, I'm beginning to anticipate its natural rhythms.

There are some months that I have a steady schedule, and the phone rings with some regularity with requests for information and appointments. These months tend to follow the school calendar and extend into early summer. And then there are weeks that the phone stops ringing, current clients miss appointments and don't return my phone calls, and the calendar starts to have big holes in it. These weeks coincide with major religious and national holidays, and the last weeks before Labor Day.

I now understand why therapists have traditionally taken the whole month of August off. Remember Bill Murray and Richard Dreyfuss in the 1991 comedy, "What About Bob?" (The busy New York City doctor rents a home in New Hampshire for the whole month of August only to be followed there by his newest, most eager patient, Bob.)

So while I have some unwelcome time on my hands, I have been reading. And I have been seeing some of my long term clients. And this is what I have seen: healing. While I can't give you details, I hope it is enough to tell you that just today, I saw a client who had a difficult mental disorder that was controlling her life a year and a half ago. She told me today that she is really feeling "her normal self," the self she remembers before the disorder took over. I smiled through her session.

The same thing happened last week, as a couple client told me that they had "completely changed" the way they moved in their relationship. Wow. We talked about what they were doing differently, and what they had learned. I remembered what it was like for them when we began. And I smiled, and congratulated them on their hard work.

That kind of healing of emotions, mind, spirit and behavior is what I have experienced in therapy as a client, and what I strive for with each new client who comes to me for help. It doesn't always work, for a wide number of reasons. But when it does, I have to tell you: it's joyful for me. This is what I do it for.


Saturday, September 12, 2009

Returning

It's been awhile since I was up north, to Duluth and beyond. I'm going to visit today.

I worked in northern Wisconsin for 12 years as a pastor of three different parishes. I loved many of the people I served, but none more than the friend I am going to see. We have held ourselves together through teenagers (hers), a wedding (mine), work system nightmares (both), cancer, deaths and funerals, births (my children, her grandchildren) chronic health problems, educational endeavors (both of us), aging and the general pressures of time and distance. We love looking at the world together, and from quite different points of view. We are blessed to have found each other and to have remained friends for over two decades. 

Who in your life is the same kind of gift of God, a similar lens through which you see yourself and the world more gracefully, more lightly than you do alone?

Give thanks to God for them. Cherish your relationship enough to go out of your way to stay connected. Oulu is out of the way. But I'll be there, returning, remembering. More whole, more myself. Trusting the same for her.

Friday, September 11, 2009

Fear and What's Possible

Today is 9/11. The bells toll, and the wars continue.

In an email from our school district, we have been informed that the H1N1 virus is up and running. Several children have tested positive, and we are all encouraged to be alert and aware. NPR reported this morning that a single vaccination (instead of two) may be all that is needed to immunize adults, allowing more vaccinations to go to more people this fall.

In listening to the media coverage of this story, I've learned that in an average year, fully 36,000 people die from the seasonal flu virus. That's an average of 720 people per state. Do you know any of them? The predictions for this winter imagine up to 90,000 deaths from H1N1. That would be an average of 1800 deaths per state. The primary difference being many of those deaths are predicted to be our healthy, robust children.

I want to be ready. I will get my family immunized. But in the meanwhile, in the midst of the preparations, I have been wondering: what's the difference between fear and vigilance?

We are washing our hands. We are covering our sneezes. We have a strategy for taking time from work. But I worry that all our worry makes us feel less strong, and more vulnerable. Less confident, and more anxious. Some preparation is the soul of wisdom. Thinking ahead is what keeps us resilient.

But too much hand wringing about what we cannot ultimately control just hurts the hands and stalls the mind. It puts our life on hold, waiting for the worst. A worst that may not come, and if it comes, is still never far from the grace of God.