License to diss

In Ohio, you’d scour the Help Wanted section of the newspaper and see jobs for hospital mental health workers. I’d eye these little plums offered at Riverside Methodist Hospital and OSU in Columbus. But at your second glance, you’d notice the hospital is only targeting licensed social workers (LISW), not licensed counselors (LPCC). And you’d learn that they really mean it. Another one bites the dust. Once, momentarily infuriated (panties in a bunch) not to be given a high load of clients (as a per-unit independent contractor), I made a solicitation to a different group practice in the neighborhood. This was for a psychotherapist position. But I was informed that only social workers would be considered. Who informed me of this? A licensed counselor.

Here in Nevada, while working at a good clinic, a nice job, I nevertheless put my name in at a hoity-toity-sounding group practice (the website features principals’ head shots that look like airbrushed stock photo beauties). But there was a glitch. While in Ohio, every Master’s-level clinician and her brother was either a Social Worker or a Counselor – the marriage and family therapist license (LMFT) was brand new there – in Nevada, every brother and his half-step-niece is a Marriage & Family Therapist, often courtesy of University of Phoenix® Online. The coin of the realm, whatever its value. So at Pretty Place, no counselors admitted! I’ve seen the same with hospital ads here. Imagine – an ER or med-surg or psychiatric unit needs a clinician to do crisis intervention, brief intensive counseling and resource referral, and it desires a Marriage & Family Therapist! How sweet! The Borderline is screaming like a harpy with a turbine up her ass, vomiting charcoal and waving her oceanic ridges of red arm slices, and she needs Systems Therapy!

Folks: All of you who hire. Please know the right positive and the right negative. Each one of us (positive) is his own person, with qualities and experience inimitable. No social work, psychology or counseling program (negative) makes a fine psychotherapist. Please know that most, probably all of us in this field come to it because of our garbage scow of neuroses. The question will then be: Who of us knows it, who of us has done ultra-serious acid Ex-Lax work on our problems, and has lived to tell it. This is what matters, not your judgment of my license.

A new hire here, a Marriage & Family Therapist, does not want to see schizophrenics or other psychotics. And she will not have to. Treat the fragile Phoenix gently.

Socratherapy

I believe the best therapy is holistic therapy that is feeling-heavy and thinking-light. As I (and other primal and primal-related clinicians) see it, people become false lives in their heads. This is because we had to give up our child life, our “blueprint,” when we were hurt or otherwise directed away from it. We become blinkered People of Thought, seeing ourselves and the world high above the quicksand in which we’re rooted, so out of touch with our birthright and essence that we may as well be someone kidnapped early and thrown in a prison tower for the rest of his days.

I once treated a woman who was a living caricature of analyzing intellectuality. After months of sessions, I still didn’t know if this was Asperger’s or a facet of psychosis (it well exceeded “within normal limits”), but I did know there was a childhood of grief. It was bemusing how her mind cerebrated diligently at every second about everything, like Spock on crack, even when I tried to put the brakes on. In the midst of one of her labyrinthine études, I had her sit in my chair and look at a brief scenario in Vereshack’s on-line book, as I read it aloud:

“ – I don’t know why I should have that feeling every time I enter my mother’s home.

– Please just stay inside the feeling without asking the question why.

– But it doesn’t make any sense, why should it happen like this?

– Please just enter the feeling, image your mother’s home and you walking into it. Stop asking for reasons before you feel the feeling. It keeps you in your head.

– All right. I’m standing just inside the door of my mother’s home.

– What do you feel?

– I feel that I want to run away.

– Please allow the feeling to deepen. Don’t think and don’t ask questions.

– Please don’t hit me again mommy. Please don’t hit me again (crying).

– So now your question has been answered.

– Yes it has.

“When we drop our ornate intellectual questions and our need to know, feeling the feeling will allow us to experience our truth.”*

The moment I completed the reading, my client fell into the longest and deepest bawling that the thin walls of my mental health center could abide. Afterwards, a surprised person, she felt different. And better.

Feeling is the sine qua non of life-changing therapy. But most clients don’t crash through to a breakthrough place. They can’t, for a number of reasons. And many shouldn’t. This is why I’m a therapist “of the people” rather than one of the sometimes more effective Primal therapists who treat the radical and scarce elite. I face and accept the frustration of having to be adults in a world made of our defenses. And yet, my work is strongly founded in the ultimatum of feeling and in the holism of mind, body and time.

Most often there is talk, not exactly Socratic, but challenging. I challenge the present self.

- A twenty-four-year-old woman with a deep suicidal splinter, what may be a birth-body feeling that is a certainty even with her smiling and gracious manner, is shown her exact birth trauma in the psychological and medical literature. The trauma is associated with adolescent-stage suicide. We picture it. This in a way disenchants her sense of being, alpha and omega, a person who is meant to die. It is only alpha: the first pain, and the meaning it contained. “We are more than this first seed.”

- One of a fair number of clients in Las Vegas who had once been well-off but was now homeless or on rent vouchers, on a bus or on a bike – he recognizes that “anytime my life is going well, I seem to let it all go to crap.” What’s the feeling of that? If a childhood is sour, empty, where parents and brother and sister are strangers to each other, where there is no bond, how is “success” ever going to be strong, true? There will always be a downward pull to a place and time where there needed to be love.

Conversation rides in a sea of history. Everyone on my couch is a child, but of course also a hurting adult or teenager. Even when it is a parent who feels guilty, devastated, about years of cruelty and intolerance to her little children, we say “You may try to run a marathon with a knife in your back, but you will fall.” We say “It is almost impossible to see beyond your own unmet needs, to feel warm and generous when you were starved. You need care, finally.”

Conversations are nearly universally moving, because of a sort of parental empathy that stirs the emotions: it strikes major and minor and complex chords that have been waiting to be touched since childhood. The adult feels a mild air of being parented, of acceptance for her whole self. We challenge a man’s present anger and he sees that it comes from the quicksand of his childhood. We “argue” the messy reality of children and a woman admits enjoying sex with her father when she was an older teenager. Shame mitigates in the dialogue.

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* http://www.paulvereshack.com/, at http://www.paulvereshack.com/helpme/chapt20.html#6b.

Meds and personality

“Medications should not be used as the primary treatment for BPD as the benefits are unclear.” -- https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

Today I’m going to talk psychiatric medication from a position of full ignorance about meds other than the elementary facts a counselor absorbs. Logic, of sorts, will co-opt knowledge. A client with Borderline Personality Disorder has been medicated for the past thirty days with a mood stabilizer and an antidepressant. Their effect has been injurious, she says. What had always been verbal aggression transformed into physical violence. Micro-dissociations and amnesias occurred throughout the day – locking her keys in the car three times in one afternoon; forgetting to go to work the entire day, thinking it was the weekend. More “borderline-ish” extremes than usual. The client had come to her Psychiatric Nurse Practitioner with two diagnoses – Bipolar II (from a doctor) and Borderline (from a family member’s Internet research) – along with my first-glance diagnosis of the personality disorder. Looking for the quarter beneath a street lamp rather than in the dark alley where it was lost, the NP prescribed only to the Bipolar and hoped for the best.

In session, we worked a thought experiment. Give a baseline “normal” person a mood stabilizer and Xanax – or two beers, for that matter – and he may react more benignly toward a slow or unsolicitous waiter. Give the same drugs to a Narcissistic Personality. Would he react so temperately to the waiter’s behavior? I suspect the Narcissist would be as entitled and arrogant as ever. He might even be worse, with his feeling of intrinsic “unique specialness” – critical to inflate his prosthetic ego – chemically flattened.

Or – Imagine giving Jeffrey Dahmer an antidepressant to deal with his ‘anger’ (catch-all term for the bad, monstrous feelings of a psychopathic Antisocial Personality). Do you think this would stifle his cannibalistic urges and the view of life that supported them? The logic of a personality disorder says the serial killer’s moods are not simply chemicals in his brain, but chemicals embedded in his formative identity – the “psychological birth of the human infant.”*

From a progress note on my Borderline: We looked at possible reasons for the difficulty of medicating her personality disorder, based on the understanding that Borderline has its origin in the dys-formative mother-child bond and creates a “full-body chemistry” that supports the global warp of the personality. From this perspective, it seems likely that there would be greater difficulties in medicationally addressing symptoms that have an “identity basis.” We considered an example: Her mother was aware that as a child, her daughter had to create chaos (which might be seen as a cry for justice or help – to unmask the “cover-up” of rightness and OKness): When things were going smoothly, she would invariably “scrape the needle across the record.” Forcibly numbing or “chemically lobotomizing” (Breggin) the feelings behind this need would create a psychic turbulence that was even more uncomfortable – the equivalent of putting a straitjacket on someone running from a wolf.**

We all know that psychiatric medications have different effects on different people (no perceptible effect, to life-saving, to suicidal and homicidal, to the stripping of one’s emotions or one’s conscience) just as alcohol does. Here I’m saying that one reason for this difference is the chemistry of personality, which could be considered the global, seamless defense that has become the Self. To medicate the person is to change this radical survival Self into – it must be said – the non-self. How could that feel right to anybody?

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* Borrowing the title of Margaret Mahler’s seminal book that deals with “separation and individuation” of the self.

** Borrowing from the title of Theresa Sheppard Alexander’s book, Facing the Wolf – Inside the Process of Deep Feeling Therapy.

Oh, the many ways I remain a child!

I prefer to dry myself while I’m still within the glass shower enclosure, because the air in the room is too cool for my fragile skin. I want to stay huddled in the warmth. * I like the emotional melodies and harmonies of some Romantic classical composers. The more pristine Mozart, the more dissonant Bartok and the more abstract Modernists are too adult for me. * I chew on my fourth finger like a pacifier. * I grow my hair way too long and bushy for a sixty-five-year-old. Short hair feels ugly to me. To others, it looks more appropriate, and actually makes me look younger, but to me it looks and feels hideous. * I wait for and expect others to talk to me, rather than make the overture myself. * I feel a spasm of specialness whenever I use a big word. * I wish there was no work, just an eternity of coffee shops and mild adventures. * I remain purposely oblivious about our money situation; I let my wife handle it all. * I often sport a lost puppy dog affect and manner and believe that others find it appealing. * I feel like a lost puppy dog. * I like pretty pictures. Guernica and abstract paintings are very unattractive and unnecessary to me. * I much prefer time travel stories about the future to those about the past: The past happened, is factual and un-modern and therefore boring, while the future is a fantasy dream. * Similarly, I prefer the magic-impossible superheroes, such as Superman, to the pedestrian ones such as Batman. In fact, Batman has always disgusted me: a regular guy who just uses a tool belt, brawn, and a workaday brain. * I have mocking contempt for radio hosts who talk about finances, stocks, hedge funds, etc. How pathetic they are, acting so fakey grown-up! * The idea of being “old” will always, always be unacceptable to me. * A big part of me still thinks my adoptive grown daughters should reach out to me, even though I was the parent, and a lousy one. * I sometimes still think I should write poetry, while knowing I have no ability to do it, and that it is an effete, childish wish. * When there’s free food at the office, I steal as much of it as I can. At one place, I’d wander into the break room under false pretenses, stuff French pastries in my pants pockets, lock myself in the restroom and eat them. * At night and sometimes upon awakening, I snuggle under the thick comforter and blanket like a baby trying to get lost and unconscious in his mother’s womb. * I think about my old elementary school peers more than I think of my college peers. * When I get a facial blemish, I rip it to shreds. I need my beauty, not my adult soul. * I’d actually like to sing Kumbaya around a campfire.

Is this childishness my real self, or is the adult me my real self? The best answer, I think, is that the two fuse into one reality, creating a very wounded salvation. As a therapist, I know that most and maybe all of us are these two facets. I’ll say that beyond a certain extent, it doesn’t do me a whole lot of good to know and accept all these regressive components – not to mention, to know they’ve endured more from failure than from healthy holism. I’m sure, though, that it helps the client to have her injured child respected with open arms. It is, after all, a little more real than her adult.

Florida womb (pre-Trump)

I lived in a non-serious place in my late twenties and thirties. Most things were bad in my life in that time. I was decapitatedly neurotic. I was married to a Borderline personality (this was before I could distinguish psychology from a fortune cookie). I was “father” to two stepdaughters while I was still a child myself. We were just above poor and dead-in-the-water irresponsible (our psyche said “immediate gratification” as it contained no future sense). But I lived in subtropical Sarasota, Florida with palm trees and blue skies and sunny breezy days with pelicans and seagulls flying here and there, and the bay and the Gulf of Mexico right there. The Sandbar had steel drum music at the outdoor patio, where patrons applauded the sun as it sank into the Gulf. Anna Maria Island, remote but just down the road, had Fast Eddie’s (slogan: “Warm beer and lousy food”) at the end of a planky wooden pier. On weekends, the family would shuffle into the bayou up to our waists and pick up sand dollars with our toes, as perfect as the ones in the souvenir shops.

But all these things were just the pretty shells on a spiritual beach, which was: Life is a vacation. That was the feeling I could never escape, even on dismal days with a born-aggressive wife or with debt problems or parenting incompetence. My life was a vacation. What’s hard to explain is how this wasn’t a dream I had conjured. It was, I believe, a sense produced by the fusion of some paradisiacal template in me, from birth, with the subtropical setting of Sarasota and Lido Beach and Siesta Key and Marina Jack’s and the always-moving and musical water.

So . . . I lived a non-serious life, though I worked every day, built a small business, paid bills. I believed I was happy, which kept me there for eleven years before running away from the terrible marriage.

Twenty-five years on, and I won’t be going back to Florida ever again, I’m sure. My wife and I are here in the glamorous part of the desert; I can’t get licensed in Florida (would have to return to college); and probably would never have enough money to move and retire in my very old age.

But I know it calls to me – the one still place despite everything in the molecular mess* of my history that means ease and lightness and brightness, that means dessert, and an OKness to be a person with simple natural thoughts, no adult posture, quirky reactions, beer, beach, sun burning the toxins out.

I wonder – Do others have this childhood beach in them?

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* “Molecular mess” – an idea of mine described in different (searchable) blog posts.

Bad supervisor

I don’t have the clinical supervisor credential here in Nevada, and maintained it only briefly when I was in Ohio. I don’t mind the work of guiding a new counselor – with provisos. The coursework to become a supervisor, however, is so horrendously cold-oatmeal plywood boring and depressing and generically empty and ‘eurythmics on the greensward’* properness-heavy that I will never again glance in that direction.
 

I would be a terrible supervisor! To prove that, here are three dished-up scenarios with a neophyte counselor, based on composites of some past cases.

I.

Therapist – I just saw a fourteen-year-old boy who is very bright, according to his parents, but he refuses to do any work in school. He bypasses homework in general, and when he does it, he often “forgets” to put it in his backpack and bring it to school the next morning. His parents are frightened, but they show anger more. They see him ruining his future and they don’t know how to get him to do the work. They’ve tried removing his electronics and grounding him from friends and school activities, but he seems indifferent to punishment.

Supervisor – How does he express or show this non-caring about consequences?

T – He just says to me, “I’m not concerned.” But it really goes beyond that. His mom said there are Christmas and birthday presents from years past that he’s never unwrapped, sitting on his shelves and in his closet. That seems to be more than just not caring.

S – I think you need to sit his parents down and say something like this to them: Your son is failing in school? Good! That’s exactly what he should be doing. Because that’s his way of being true to himself, to his feeling. This is his way of communicating to you, very clearly though indirectly, that he hurts, that his life is wrong in ways no one has seen. Why would he be this indirect? He has lost touch with his deeper feelings, or is afraid to give them to you. Ask yourselves why he can’t sit down and be himself – his real self – with you. Look inside yourselves to see if you know how to hear him as a separate person, as his own person, not as reflecting or disagreeing with your own expectations or agendas. Look inside yourselves to see if you even know what I am saying.

II.

T – I’m not sure what I should do about this situation. I have a new client, a woman in her early thirties who brought her husband to the second session. My “countertransference” must be ringing off the hook because this guy really made me seethe. My client, Cheryl, complained that three or four times a week he drives off after work to spend the evening with his parents, who live about fifty miles away. This happens on weekend days, too. His parents don’t need him, they’re early sixties and not disabled, but he helps them with all sorts of things – mowing the lawn, figuring out the remote, even doing the dishes with his mother. He’ll sit around and play chess with his father. And his wife and two little girls are left alone at home! What’s so aggravating is that he seemed to me to be perfectly bland about this. He had this dreamy clueless look on his face when she described her grievance. When I asked him if he could address her concerns, he had a simple response: It doesn’t seem a big problem! How do you think I should approach this, without giving him a lecture or a steel-toed boot to the ass?

S – I think what you should give him is a toy or a bottle, because he’s a little boy. He never grew up. Many people never traverse the psychological developmental stages, never become actual adults. I mean this in every way except, possibly, looks, height, income, vocabulary and ripeness of cynicism. Your client married an infant. You might ask if he’ll come in by himself. Then you would present him with his problem: The umbilical cord is still attached, mother to baby. He is fooling himself into thinking he has a normal, grown-up relationship with his parents, when in fact they are still his masters, they are his home. Stare him down: This is not casual information, but the main problem of his existence. We can’t make him grow fatherly and husbandly feelings, but we can disturb him with his abort. Only then will he have a chance to feel what he still needs – what his parents never gave him and that he waits for in their home. You will have to talk to his wife. Can she live with this? Can she give him the fear of loss of his family? This is not a marital therapy issue, but the deepest intrapsychic stuff possible. You may have to face that this will result in failure.

III.

T – I hate to say this, but a new client is making me feel totally incompetent. I’m fighting the feeling: Why the hell do I think I can be a therapist? He’s in his mid-forties, teaches computer science at Otterbein, has no financial stress, his marriage is solid, they’ve put their two children through college, and all seems well. He can’t tell me what’s wrong: He said, “I don’t know.” There’s never been any significant depression, but lately he’s found himself doubting the value of life. Suicidal thoughts are starting to pop into his head, like an academic question that feels legitimate. This is smacking me in the face like a problem with no answer. Growing-up years were “normal,” no abuse or trauma, just working parents, vacations, the standard. His siblings are adequately successful, though his sister has had a problem with prescription opiates. His parents are retired; everyone gets together for the holidays and they talk frequently. The man looks at me politely, expectantly, to figure him out, and I can’t even generate a question – much less answers. The fact is he makes me furious: the damned nerve of him to be so beautifully obtuse so early in my career! – is how it feels.

S – For one, I can tell you that you don’t need to panic, because the answers he seeks are entirely within him. Literally: The reasons, his nature, are buried in his history, and his history is in his words that he doesn’t know yet. He will find them in your room of truth. What feels intimidating to you is that he’s presented you a head question – the professor’s intellectual query – which pushes you into your head, where you want to find answers. But when you get into your own inner space, feel both of you as time-dwellers, touch your own grayer feelings that give you meaning that isn’t perfect and happy; when you even feel the connections between your present states and the underlying child – then you’ll be able to show him that deeper place.

Many people, maybe most, have a depression, an empty place they don’t see that comes from critical losses in their childhood. The emptiness is pushed to the side, redescribed, covered up by all the challenges of life – graduating from school, getting through college or maintaining a job, prosecuting a career, working a marriage, swimming rather than sinking, raising children. But at a certain point there’s going to be a plateauing effect: the challenges are accomplished or now appear less meaningful than the face of middle-age. On that destination plateau, feelings reappear, and if they are emptiness, they are the childhood and its losses. There are some losses that feel like death – thanks to our human psyche.

Ask him to get out of his head – he’s been there long enough. Ask him to feel what’s true. With time, and luck, and your instincts and your silence, he will find his depression, his losses. And then he can grieve them – a good thing.

My guaranteed failure as a supervisor would come from several directions. Supervision is supposed to help a new therapist find and error-correct his or her own approach. But I believe most counselors’ paradigms are shallow or wrong, and I would try to sell mine. Cognitive therapy is the ubiquitous theme of psychological help nowadays, and I would dispute it in most supervision conversations. Most new clinicians would need depth therapy to know who they are, avoid their own poisons, and to avail themselves of the best kind of empathy, which might be called “deep health empathy.” This is not normal kind-person’s empathy, or paint-by-the-numbers “unconditional positive regard,” or the sick symbiotic identification with the client that has no boundaries. It would be an arrived kind, benevolence to acorn and oak tree from one’s own loss, repair and part-redemption. But most new counselors are young, pre-arrived, and never have that therapy.

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* https://reason.com/archives/1974/07/01/viewpoint-hatred-of-the-automo, sixth paragraph. Article by the ponderous deceased anarcho-capitalist libertarian economist Murray Rothbard.