Thursday, April 28, 2016

Unfunny humor #1: Got up on the wrong side of the couch

I recently conducted an awful therapy session. Both words – “conducted” and “awful” – apply to the fact that I didn’t leave any room for the 15-year-old client to speak. This was his second hour in my office, his first appointment following the Diagnostic Assessment, the “getting to know you” session without mother present. And I lectured the entire sixty minutes as he kept himself conscious – probably in a state of apprehension – by pure brute force.

For those unaware of the common sense plain vanilla instruction given to new counseling students, they are taught that something is wrong if the counselor is “working harder than the client is,” and relatedly, that we should listen much, much more than we talk. I knew that over twenty years ago. And while there have been many times since school when I’ve provided a client strong and critical psychoeducation at length, I’ve always owned the core truth of these injunctions.

So what happened this time?

It is probably true that I had a “chemical imbalance” –, meaning a dysthymic mood substrate caused by the confluence of some negative life circumstances. This put me a bit off-kilter during that fateful afternoon.

But mostly . . . During the previous week’s Intake session, I had listened to the adolescent’s mother describe his tendency to spew pompous intellectual clouds yet be unable to “attend” in class, grasp what teachers were saying. He was failing or doing poorly in all classes except sports. Both client and his mother agreed that at least one teacher didn’t like him, and worse – that she sabotaged him by speaking in an unprofessionally foreign accent. While mother and father – self-described as rule-following, conventional folk – would pro forma tell him he was “lazy,” what she wanted from me was to determine if he qualified for ADHD. At one time he had purchased Adderall from another student, and it had “helped.”

Throughout that hour the boy was mostly silent by fear or condescension (I couldn’t tell which). He had a girlfriend, was already into sex, was into working out, and wanted to become a nuclear physicist. Math was his worst subject. He couldn’t do it, didn’t like it.

I came into the second hour with a kind of futile sense, a sense that this mini-man wanted to see himself as Attention Deficit Hyperactivity disordered, needing pills. God help me, I may have been wrong. I had the feeling that he was born opaque, the Perpetually Clueless – much like the Somatoform clients who present with an absurd physical distress (“My hands have tingled for the last two months. Now my feet are starting to tingle. I can’t work”) and whose feathers are mightily ruffled when the therapist suggests psychological stress. (These clients are sent to the shrink by their eye-rolling family doctor.) That feeling came from the vibe that his family had always seen itself as a solid object of normalcy, where parents know best, there’s a “straight A” daughter, and the requisite life passage of grandparent dying.

And . . . I picture him now, and again there’s the feeling that this teen muscle sex boy cannot have insight. After all – blaming his failure on the teacher’s accent? BlasĂ© about math and wanting to be a scientist? The hairdo of a Romeo? Parents whose cachet is to be the statistical norm? I know I felt stuck, and therefore had to use my ice pick and drill.

My cattle prod and drill of interior information.

ADHD is a nonsense diagnosis. There is no disorder of the brain. Children can’t concentrate, are fidgety because of stress, which comes from the home environment, the family. I quoted Breggin's Toxic Psychiatry*:

Andy, remember, had been diagnosed as ADD, meaning that he lacked the ability to focus his attention. The real “attention” problem Andy had was the attention he wasn’t getting from his father – the good, loving attention and consistent, firm discipline he needed as a normal, energetic child. A better diagnosis for Andy was DADD – dad attention deficit disorder. Mom was also missing out on attention from dad, causing her to express hostility toward him and to cling too closely to Andy. She was suffering from HADD, husband attention deficit disorder. The couples therapy for Mom and Dad dealt in part with their own childhood experiences. . . .
I talked depression and the inability to focus; depression’s connection to loss of feelings, feeling lost when there’s lack of empathy, lack of empathy from decent but distracted parents; the true self with its desire, fire, its true north that disappear when there’s no one to express to because they can’t hear you. I talked about the past, his past (generically). I asked (or dared) no-insight-boy to look inside, be aware of where he came from.

And he stayed awake. . . .

If there are lessons here, they would probably include – * Don’t think cynical of your client at the very beginning. * Listen first: Even if it’s a fallback, it will give you gold for when you’re back in shape. * It’s still OK to realize that “ADHD” is a dumb-as-shit abuse concept by the professionals; and that * even glamorous teenagers should know they have depth.

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* Peter Breggin, M.D.'s Toxic Psychiatry – Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the “New Psychiatry,” St. Martin’s Press, 1991. Excerpt from p. 276. I accept Breggin's statement that the concept of “chemical imbalance” was created by Eli Lilly and Company to sell Prozac.

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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.