Tuesday, December 21, 2010

When The Worst Thing Is Not The Worst Thing: EMDR & Unpacking Meaning

A couple of months ago I received a request from the Mesothelioma Cancer Alliance asking me to include a link to their organization on my website (www.maybenatar.com). My contact noted that she was specifically interested in reaching out to therapists who provide EMDR therapy, as research had shown this technique particularly helpful in helping individuals deal with illness and loss.

I have not seen the research but my own experience would confirm this finding.

One has to ask how and why this is so. The diagnosis of a life threatening illness like mesothelioma is devastating. How can waving your hands in front of someone’s eyes or other forms of bilateral stimulation change that?

It turns out, devastating illness means something different to every patient, just as trauma
means something different to every “victim.” The prospect of loss of function, painful treatments, and a premature death is coded differently in each of us. And unpacking that unique meaning seems to facilitate processing. Maybe we can’t even process loss without that first step, unpacking meaning.

There are many paths to understanding meaning. Psychoanalysis utilizes free association;  relational psychotherapy uses the tool of the relationship as the main vehicle to meaning. Self psychologists focus on the state of the self; their major tool is empathy

In my, admittedly, limited experience the EMDR technique can provides a short cut to meaning.

The web of memory and meaning is an intricate, unpredictable one and EMDR can help one navigate the thicket.

EMDR is a technique that utilizes a very specific protocol that unpacks aspects of specific target symptoms and then stimulates, through the use of eye movements, taps, or alternating tones an internal process that seems to move individuals through a web of associations to the presenting images/symptoms back, back, back to some memories, earlier life experiences that may hold the key to unlocking the meaning of symptoms. This is free association on steroids.

See the following links for two short videos that demonstrate in pictures what would take me too many words to describe and describe poorly at that.



Sometimes the worst thing is not the worst thing.

One middle aged gentleman came to me when the lung cancer for which he had previously been successfully treated, returned. And it returned with a vengeance. He was at stage 4. Although he still had many treatment options and his doctors held out a great deal of hope, he was understandably devastated. He was alternately enraged and despairing. He was declining treatment, fighting with his doctors, unable to eat or sleep, alienating friends and family.

It would seem obvious that his fear of death was the primary cause of his suffering. At least that was what was obvious to me. But that is not what emerged with the EMDR treatment.

What emerged within one session was a memory of having wronged a good friend many years before, in his early 20’s. He felt enormous shame and guilt when remembering this during out EMDR session. The feelings were vivid, immediate, and intense. This one incident in which he had hurt and shamed someone else made him feel that he was a bad person.

Subsequent discussion over several sessions, revealed that some important part of him felt that he was being punished for his early cruelty. Lung cancer was the pay back.

Bringing this to light made it possible to process this event with the maturity now available to him. He found some compassion for his younger self. It was also now possible to reconsider that perhaps his misdeed had not caused his cancer. Cancer is awful. Facing death at 45 is awful. But feeling that you are a really bad person and that is why you are ill, that is worse.

Sometimes the worst thing is not the worst thing.

Tuesday, November 30, 2010

The False Memory Wars: A Short Primer

Do you remember the false memory wars?
Probably not,  but I do.  Its effects continue to linger in a way that troubles me. 
This was a “controversy” that consumed the field of trauma therapy throughout the 90’s
It did incredible damage to the field of trauma therapy.   Therapists and patients alike were victimized by the charges of “the false memory foundation (FMSF),” that patients who were being treated by either misguided or malicious therapists were being guided to “mis-remember” childhood
events of sexual violence perpetrated against them.  Therapists lost their licenses,  patients lost their nerve,  and the whole field of trauma treatment contracted in the face of the onslaught.

Unfortunately the media embraced wholeheartedly and uncritically the charges of the FMSF.  There was a shocking lack of balance in the coverage of this controversy.

Interestingly it took the trauma of 911 and the treatment of psychological victims of that catastrophe to bring the field back to respectability.  Trauma treatment programs proliferated after 911.  Now trauma was and is about terrorism and war,  not sexual abuse.

The phenomena that was being questioned by the FMSF was the way some individuals who in the course of therapy,  or indeed just in the course of life, would be blindsided by previously unremembered events from their childhood of savage abuse usually at the hands of trusted caretakers or other family members.  Jane Smiley, in her wonderful Novel  A Thousand Acres has a wonderful description of the phenomena of being struck by such a memory.  Jane Smiley does this so artfully that the reader is “assaulted” by the information much as the character is.

How can such a thing happen?  Being literally assaulted in living color by a previously unremembered event.

We all know how unreliable our memories can be.  I could swear that I hid my expensive jewelery  in the freezer.  Why isn’t it there??  Didn’t my oldest daughter walk at 9 months?  I distinctly remember that she did.  These might be distorted, they might be wishful thinking, or they might not.  Plenty of psychological research has establish that memory deteriorates over time.  Eyewitnesses to crime are notoriously bad witnesses. This is established science.

What isn’t so well accepted and understood is that traumatic memory is different.  Through a mechanism call “dissociation” child victims of horror, torture, abuse, betrayal find a magical way to cope.  Adaptation is well served by filing away, sequestering these memories, severing them from the mainstream of experience so as to be able to go on, grow up, continue to stay attached to important attachment figures who might also be perpetrators. By the way there is neuroscience to back up this understanding of "dissociation."

When it is safe,  sometime in adulthood these “dissociated” memories can return unbidden.  And when they return they are intact—they haven’t degraded at all.  The smell of the room, the smell of the perpetrator,  the texture of the rug,  the cracks in the ceiling, they are all there.

This is the nature of traumatic memory.  And almost always these are unwelcome events, the return of the repressed.  The adult individual doubts their veracity, disowns them,  tries to forget, hides them from the therapist.  I have never known a victim of childhood abuse who didn’t try to run as far away from these memories as they could.  Trauma therapy is a torturous enterprise because the memories are so unwelcome,  so painful, at times almost unbearable.

 It is not like my memories of where I hid my jewelry.

Which is not to say that there are not unscrupulous or poorly trained therapists who prime the pump and  solicit “false memories.”  There are also individuals who present a false narrative for some secondary gain in psychotherapy.  Those are not so difficult to spot.

There have been a few and pretty small studies that have sought corroboration for their trauma patients narrative and have found a high rate of  veracity.  But for me the acid test has always been,  is the patient getting better as you lend them your unqualified support in their attempt to remember.  If the answer is “yes”  that’s all the corroboration that I need.

Monday, November 8, 2010


 I’ve just read a book that combines two genres: science fiction and historical fiction.  In Galileo’s Dream, Galileo  is teletransported in time and space—the time is 3020- the space: the 4 moons of Jupiter, known as the Galilean moons. 

Much of the science, fictional or not, is beyond me.  But the psychology is not   If I understand correctly the purpose of these periodic teletransportations is to manipulate the outcome of Galileo’s life.  In real life G. was tried and found guilty of heresy by the Catholic Church for, among other things,  arguing for the correctness of the Copernican view of the universe,  that the earth rotated around the sun, and not as the Biblical view had it, that the earth was the center of the universe. 

The bad guys on Jupiter want G. to be burned at the stake.  They think this would mark the end of religion and clear the way for the ascendancy of science.  But not everyone agrees.  The good guys attempt to teach G. about his life so that he can maybe even avoid the heresy charges altogether.

What caught my eye was the third millennial version of a psychotherapist or even psychoanalyst,  a mnemosyne.   In Greek mythology, Mnemosyne is the Goddess of memory and the mother of the Muses.  With the help of a helmet-like device the Mnemosyne accesses nodal points in the brain where intense emotional memories are filed.  The  subject “remembers” in the deepest way.

If the,  poorly remembered past could be vividly recalled,  the theory goes,  a person will be changed and their future will be changed, not just their current “symptoms” but their future.  In the context of the book  G. held a better chance of surviving what was in store for him at the hands of the Catholic church, if  he knew himself better.  What gets changed is not the past, but one’s experience of the past and thus the future..

One of many things that caught my attention was that the technology described in this imagined Jovian future already exists.  Its called EMDR (eye movement, desensitization, reprocessing).    The modern mnemosyne (read psychotherapist) uses the protocols of EMDR to access connections between the presenting problems and the past.

In EMDR one stimulates alternately the two hemisphere of the brain by way of sound,  eye movement, tapping, or some such.  Very little special equipment is necessary, maybe ear phones for sound, or a light bar with which the subject follows lights without head movement.  This process seems to faciliatate both relaxation and a kind of free association,  so one starts with a target image and quickly begins to link to other images, that are cognitively if unconsciously connected to the original target image and symptom.  Typically what comes up in a session is an early memory that has set the individual up for the difficulties they are now experiencing.  These image and the memories that arise are “re-processed” and the anxiety, the symptoms diminish.  They really do.

The EMDR protocol  is typically part of an overall treatment process, and my description here is barely adequate.  For more information see   http://www.emdr.com/briefdes.htm 

My point here, is that with the aid of this technology we can help an individual revive the relevant memories from the past that can change the present:  ameliorate symptoms and perhaps even change the future. 

The Mnemosymes of Jupiter have nothing on us.

Friday, October 1, 2010

Consult Your Inner Wisdom: It Has All the Answers

This past year, or two, in my clinical work, I experimented with a therapeutic technique that I cribbed from clinician/writer Sarah Krakauer. I found it useful both for my clients and for myself. I share it with you.

The assumption behind this idea is simple: at bottom, no matter how fractured our identity, or sense of self, there is within us a wholeness and a wisdom that we can consult as a sort of inner gyroscope. The theory goes that there is a unity within, and if we can gain access we can find a treasure trove of wise guidance.

I have worked with individuals who were highly “fractured” due to  severe trauma histories, as well as more intact individuals. The technique worked well with all kinds of people but I found that individuals with these fractures had an easier time accessing the “inner wisdom.”

The technique involves a simple visualization. One woman with whom I was working is diagnosed with Dissociative Identity Disorder, formerly known as Multiple Personality Disorder. This means, simply, that her identity is complex and multiple: she has very distinct and separate identities within a seemingly stable “self.”

Each “part” of this individual has a discrete and often contradictory point of view on any matter you could imagine: what to buy in the supermarket, for instance, junk food or organic kale . Or on any particular day if I am perceived as benign or as a threat. So checking across parts as to what the inner wisdom might suggest on any given topic is relevant to our enterprise.

What surprised me was that when we went through the inner wisdom I got the same answer to the question of the day: no contradictions, no evasions.

With this particular client I was often uncertain as to how to go forward in any given session, which part to address, how much to push for the traumatic memories that were just outside of her awareness. They could either liberate her from painful symptoms and/or de-stabilize her. Actually I was almost always struggling with these choices.

The inner wisdom always directed me to the traumatic material: go for it, it seemed to say. Don’t pay so much attention to the complaining about the pain that this causes. And the inner wisdom was right. After a period of turmoil, which was always difficult to weather, my patient was more solidly grounded, more mature, and eventually more integrated.

Now this is not magic, if the client was in retreat, warding me off, defending herself from incursions, I might get nothing. But this was relatively rare.

I describe the technique belo. Do try this at home.  Its perfectly safe.  Its probably more effective to have someone read this to you,   or record it yourself so you can hear the suggestions, not just imagine them.
Sit in a quiet place, close your eyes and visualize a corridor. This is a safe place. Off the corridor are doors. The door on the left is labeled “Hall of Inner Wisdom.” Open the door into a room that resembles a small movie theatre. The seats are comfortable. Sit down and see that at your finger tips is a keyboard. Type in the question that we are working on today: why does my hip hurt so much today, or what should I do about a troublesome relationship, should I change doctors, etc. Look up at the screen in front of you and there will be an answer.

Here you may see pictures or writing. You may just get thoughts popping up. If nothing comes, just sit quietly for awhile and see what happens.

I have tried this myself, going through the same steps of visualization. It feels a little like meditation, but with a very specific goal. Sometimes I get an answer. Not as frequently as my patient, alas. Often the answer surprises me. That’s what makes me think that this really is coming from a source quite different than my logical, linear, and deliberative mind.

What I think is going on here is that with the right tools and probably a bit of practice, one can have access to a part of the mind that is less rigid, less defensive, more intuitive, and more astute than the reasoning mind. I find it exciting and re-assuring that there is a guidance within with which I can make contact.

Friday, August 27, 2010

More on Story-Telling: The Cambodian Healer

Phaly Nuon is a Cambodian survivor of Pol Pot’s killing fields of the 1970’s. An educated woman who managed to disguise her origins and her learning in order to survive the mass murder of the educated classes, she witnessed the rape and murder of her teenage daughter and the starvation of her baby. She survived for three years in the jungle, trying to protect her two surviving children, living in isolation, hiding and eating only what she could forage in the jungle. She and one child walked out of the jungle. Her baby died.

While in the refugee camps following the war she noticed many women whose mental state made them virtually inert, unable to care for themselves or their children. Their PTSD (post traumatic stress disorder) was going to kill them and their children. She set out to help them and developed her own system of psychotherapy which was remarkably effective. This woman has been on the short list for the Nobel Prize many times for her work with these depressed women as well as the development of an orphanage (the Future Light Orphanage), which the recovering victim/survivors run.

Phaly Nuon has a three part system of therapy (which actually has at least 5 parts).

1. She teaches the women to forget their atrocities. 2. Then she teaches them to work. Some of the work is with orphans who have lost their parents in the war. 3. Then, she says, I teach them to “love.’

Interestingly both she and Andrew Solomon (¬The Noonday Demon: An Atlas of Depression (http://www.noondaydemon.com/biography.html ). fail to notice that the first step is not the first step. The first step in her system of therapy, as Solomon recounts this, is the telling of the story of their ordeal. And then the re-telling.

I quote Solomon:
"First, she would take about three hours to get each woman to tell her story. Then she would make follow up visit to try to get more of the story, until she finally got the full trust of the depressed woman. "p.36

"Forgetting,"  involves getting them involved in their present life.

Step two, work, is an important part of that. And step three, teaching them to love, is all about focusing on relationship. The women that Phaly Nuon has ministered to have formed a healing community. Just as a footnote, Freud thought the ability to love and to work were the hallmark of mental health.   Evidently Phaly agrees.
There is another step, by the way. This is teaching the women to give manicures and pedicures to each other (!) This is the final phase and as a lover of pedicures myself, I can testify to the healing potency of this process, which is both intimate and impersonal.

This step, perhaps, represents the importance of engaging the body, in the healing process

This story, I believe reinforces the importance of story-telling in healing. Phaly took it as a starting point and created something truly amazing.

I first heard Andrew Solomon tell this story on the Moth broadcast on WNYC. Here’s the link: http://www.themoth.org/

For more on Phaly: http://emailfosterparents.org/PhalyAutobio.htm

Thursday, August 12, 2010

Why Does Psychotherapy Take So Long--Part 2

An important part of the psychotherapy process, as I understand, and have practiced it, involves constructing a narrative of one’s life.

This may seem like a curious task given that we all know, or should know, the story of our lives. We’ve been imagining the movie to be made from that story, forever, right?

Well, that may be true of some us, but a surprising number of people actually don’t have a coherent story, something that hangs together, makes sense, and has some internal consistency to it.

There is some compelling evidence that the coherence of one’s story is a key component of sound mental health. I derive this from solid research findings that the quality of one’s attachment to one’s off spring is strongly influenced by said coherence. What researcher’s found was that the strongest predictor of stable, secure attachment in babies was the caretaker’s (read mom’s) ability to recount a coherent story of her own life. That story didn’t need to be historically accurate. It didn’t need to be positive. It was not necessary for her to have had a happy childhood. She just needed to be able to narrate the story to herself and the interviewer, of course, in a manner that hung together.

A baby’s “attachment” status reflects the ability of the young infant to bond with their parents, an important, maybe the most important, measure of their emotional well being.

Given the robustness of this research finding, frankly, I don’t understand why everyone who wants to be a parent, or is a parent doesn’t run to their nearest therapist. It would seem to be the best argument for undertaking this admittedly arduous and expensive process.

So back to what we do in therapy. We construct a story. This is the story of the client/patient. Its not mom’s story, dad’s story, or the story of the siblings, its not the therapist’s story, it’s the patient’s story.

So many of us have accepted, wholesale, someone else’s version of our lives. If you have been told forever that your childhood was idyllic you might be tempted to go along and not validate some of your own memories, or even weak suspicions that things were not always perfect. If you were always told that you were an overly sensitive child you might buy this wholesale. Never mind your own observations that people were actually pretty mean to you

This is tantamount to not being on your own side. Empathy for others, those adults who did the best for us growing up is a positive thing. But not if it’s prioritized over empathy for the self.

It is truly amazing how much fog, depression, confusion, and anxiety begins to lift when the story one narrates starts to be one’s own. It needn’t be a pretty story or even a wholly accurate story—just one’s own.

Sometimes the story is there but it is self-condemnatory and unfair. A woman who was raped at the age of 16 has told herself forever that she consented to sex with a man much older than her that she barely knew and was therefore a slut. All the adults in her family would agree (if they knew the story): a 16 year old is a grown up and responsible for her actions.

I had her look up the definition of “statutory rape.”

It took years for her to empathize with her frightened and confused 16 year old self and for her to re-structure the story to reflect her naiveté, her fear, her helplessness and her isolation at the time.

Story construction is central to the project of psychotherapy. Coherent stories evolve only slowly.

Friday, August 6, 2010

Parental Narcissism, The Good, The Bad, and the Ugly

You might think the  words “parent” and “narcissism” don’t seem to go together, right?

Actually, wrong.  

First a short dissertation on “narcissism.” Narcissism, self-love, is really key to human survival and healthy development. It morphs over time, as we grow, from believing ourselves to be the center of the world as young children, to something maybe slightly less over-weaning, like being confident of our abilities, and having the instinct for self preservation. Having a good relationship with our narcissism helps one navigate adult life.

I know a 4 year old who confides to me that he is “super-good” at soccer, running off to kick the ball to kingdom come. He thinks he’s great, and this makes him happy, happy.

Over time he will probably come to evaluate his soccer skills in a more modest and balanced way.

Becoming a parent often gives us another stab at satisfying these wishes, for we do become the center of our young children’s universe and for a substantial period of time, we get to vicariously enjoy their triumphs, their achievements, their incredibly rapid development. The besotted-ness that is the norm for young parents absolutely in love with their offspring could be viewed as a very benign form of narcissism, the child as an extension of self.

This is mostly good. It facilitates the kind of adoration that young children need to grow. It is fertilizer, sunshine, and water.

That’s the good stuff.

The bad stuff comes in when they are just themselves, not us, not an extension of us. Inevitably they will frustrate our expectations, the ones we are aware of and the ones outside of our awareness. This happens in small ways when they are small and in huge ways when they are not so small.

A digression: The Simpsons. As popular as this TV show is, I have probably seen a half dozen episodes in my lifetime. Strangely I saw the same one twice, as if it were calling to me! This featured Lisa, the saxophone playing sister and the blue haired mother. I was blown away by how very smart was the script. As I recall, Lisa had the blues. She felt unpopular and rejected at school. She was frankly depressed. Marge, the blue haired mom, had trouble with this and kept telling Lisa to cheer up, it wasn’t so bad, don’t be sad, etc., etc. This drove Lisa further into her depression.

One night the mother had a dream, I don’t remember the content. But the dream woke her up to the realization that Lisa’s doldrums were making her, Marge, feel inadequate and she was not really thinking of Lisa when she told her to cheer up and get over her bad feelings. Man, how often does that happen in our lives, that we filter our children’s problems through our own injured narcissism. We can’t stand their pain maybe for lots of reasons, but one may be that it makes us feel we have failed to do our job, it’s a reflection on us. Lisa ended up feeling alone.

Marge teaches us an important lesson about parental narcissism, one that the writer’s of The Simpsons think is important to reflect on. How often are we motivated when responding to our children difficulties with school, friends, sports, whatever, with our own injured self pride forgetting to try to get closer to their trouble, their pain, their felt experience. That can transform a problem for both parent and child.

What do you think?

Friday, July 30, 2010

Why Does Psychotherapy Treatment Take So Long?

This is a question I have heard, in one form or another, many times from my

Sometimes the question is not posed explicitly, but the client assumes at the opening of our work together that he/she will be in and out in six weeks (said client having just told me that she has a long history of failed relationships, periodic dark depressions, and an eating disorder).

There are of course treatments that are shorter, but I tend to think in terms of years, if a client is suffering a great deal and has for some time.

Explaining why psychotherapy treatments are not generally brief affairs is complicated. My model of therapy is of course not everyone’s model. Models of short term therapy exist. I am not a practitioner, although I am aware of these modalities and have read their literature.

I think of the realtor’s motto—there are three things important in the sale of a home “location, location, and location.” In the kind of psychotherapy treatment that I practice, those three important things are : “relationship, relationship, and relationship.” What happens between therapist and patient is the cornerstone for effective change with and for the patient. The relationship is the crucible for change. Obviously building a trustworthy resilient (if not perfect), mostly predictable relationship takes time. If there has been a major betrayal at the heart of a person’s life experience, building trust can take a very, very long time.

In the ordinary course of events the relationship stumbles, there are crises, loss of faith, mistakes made, failures of understanding and empathy. As in life, so in therapy, it is in the repair of those rents in the fabric of the connection that hold the real promise of lasting change in the structure of the self. This is a basic tenet in many theories of therapeutic change.

Within the context of the mostly safe relationship, our clients have the opportunity to develop new skills. Most of us developed our coping skills early in life. We adapted to whatever conditions we faced with the best tools available to us at the time, that time being childhood. Checking out (dissociation), cheerful denial, taking care of others, distancing ourselves from others, controlling others, numbing ourselves, living in a fantasy world are only a few of the popular choices.

As circumstances in our life change we fail to update the toolkit. We go on automatic. This is true for all of us. If you have always been cheerfully unaware of thunderclouds on the horizon you will probably continue to be so, even if the consequences are dire. It takes a lot to get us to reconsider our choices or even to become aware that we are making choices(!) and to re-evaluate the appropriateness of our adaptations.

That’s where the therapist comes in. Its their job to identify those automatic choices and to help the client evaluate them. Dissociation, to take an obvious example, is wonderfully adaptive for a child trapped in an abusive family. Why not check out, if there’s nothing you can do to remediate the situation? Obviously this is not so adaptive for an adult who needs to find the wherewithal to get out of an abusive marriage, a heinous job situation, a sadomasochistic friendship. But now the dissociation is ingrained and it takes real work and real time (!) to turn that around.

So the blood, sweat, and tears that it takes to build a relationship and the difficulties of learning new tricks are two important factors contributing to the long term investment involved in change.

These are only two of several factors that make therapy very hard work. I will leave more commentary for another post.

Tuesday, July 6, 2010

CHOICE AND CONSEQUENCE: Terry Gross and One Life to Live

We went to hear terry gross of NPR fame a few weeks past. It was wonderful. She is wonderful.

There was an interesting moment when she answered a question in the q & a period that was never asked by this particular audience. Undoubtedly she had been asked the question at some other time.

She never had children. It was a deliberate choice. She is probably 60 or close to it. But I guess she knew early on that her life as a journalist, whether it was on her current show “Fresh Air” or not, was going to be all consuming. What she said was (and of course I am paraphrasing as best I can), “I never could figure out how I could do it—do my job and have a child and raise that child well. I know other people do it, but I couldn’t figure out how I could do it.”

For those who don’t know Terry Gross, she has a wonderful interview show on NPR, 5 days a week, interviewing novelists, biographers, historians, political analysts, pundits, musicians, movie and theatre people, etc., etc. The level of conversation she promotes is unusually high for radio and other media. This requires intensive preparation, she reads and understands the books, she listens and understands the music, the theatre, the geopolitical situation under discussion. She facilitates conversation at a very high level. Her job is terrifically demanding.

What struck me about her disclosure was her humility, her maturity. She accepted, probably at a fairly young age, that she was a limited human being, that she could do this or should could do that but she couldn’t do both and she needed to choose.

Elizabeth Gilbert whose book “Committed” I just finished, said something similar about her own choice to remain childless.

This post is not about the decision to remain childless. Both Gilbert and Terry Gross helped me think about the omnipresent work life/balance struggle that so many, maybe all young parents struggle with; women maybe more than men. I certainly struggled with it.   Coming to terms with the push/pull of career choices and family life style choices for those who indeed do have a choice (a privileged class, those who have a choice to work or not), requires humility.

We can neither do everything or have everything. Every decision has consequences: to have a child, to not have a child, to work full time, or to not work full time, to forego the career, to pursue the career full tilt, to have one child, or two, or many.

This is an obvious point I’m making, perhaps, but I have a sneaking suspicion that there is a barely acknowledged assumption buried in the heart of young parents, that if one does it just right, there will be no great pain or sacrifice. The children will not suffer, our careers will not suffer, our spouse will not suffer, our marriages will not suffer, we will not suffer.

I think there is always sacrifice, at the very least there is always consequence, and we can’t always forsee what that will be when we make our choices, or how we will feel on the other end. What’s important in my estimation is an acceptance of that truth.

Terry Gross struck me as surpassingly wise and humble when she decided she couldn’t have it all.

Wednesday, June 16, 2010

Parenting: Where do “bad” feelings come from?

My last post was about the negative feelings that are as ubiquitous in the process of parenting as are loving feelings and the intense desire to hold and nurture.

In my exploration of parenting blogs I came across an interesting post on Motherlode
the NY Times parenting blog:

Rebecca Abrams, a novelist, writes about having “fallen out of love” with her firstborn after the arrival of her son. This was a courageous and frank confession of not-so-nice feelings towards daughter #1.

The comments on this post were numerous, and generous. Most commenters applauded the frankness of Ms. Abrams and openly owned their own negative impulses toward their children. Alas, outside of the blogosphere, this admission is not so common.

Reviewing these comments, I thought about what I would do as a therapist with mother’s (more likely than fathers) whispered their horror and shame. I and most other therapist would get very interested in the well-springs of these feelings: where does this all come from? Where were you in the birth order? Do you know how your mother fared after giving birth to your sibling(s)? Or to yourself? What was going on in the family around that time? What do you know about the early relationship with your siblings, younger and older?

Creating a family of one’s own, inevitably invites “re-enactments.” Not all memories are conscious. We stumble somewhat blindly through unconscious re-enactments from our own early dramas.

A friend of mine spoke frankly to me about flashbacks, horrifying flashbacks, of physical abuse from her own childhood. These pictures came unbidden when her first child was born. She had no impulse to harm the baby, but she became very afraid in caring for her first-born. Her confidence in caring was undermined.

Having a chance to explore all of that, creates a context for the present moment, helps us to be both compassionate with ourselves, which is key to handling all of this, and leavens the guilt, allowing us to be creative in solving the present dilemma.

One never knows what is going to trigger the flashback or the enactment. One can sail through the early days and years of our children’s childhood and then hit a wall when they go to school, or they hit adolescence, or they threaten to go to college and leave us, or they fail to leave home at what we deem the appropriate time, or they act up in a surprising and distressing way. If its not happening now, it probably will after awhile.

When in trouble: think “context.”

Thursday, June 10, 2010

Good parents/Bad feelings: The view from a child therapist

Guest post from Elana Benatar:  Elana is a family and child therapist at Virginia Frank Center in Chicago, IL.

Good parents DO have bad feelings, and those feelings need to be expressed and processed so that the child does not bear the brunt of it. When those feelings are kept in, and pushed to the realm of the unconscious – that’s when the child begins to take it on for themselves

My clients often come in wanting parenting advice. They want to know what is the right way, and what is the wrong way. They want books, articles, and concise Google search terms. Unfortunately, there is no cookbook for parenting.

Parenting is a dynamic process and there is no one right way of doing it. And parenting is not about being perfect, it is about being “good enough.” Part of being good enough is acknowledging that parents are people, with their own feelings, projections, and past experiences – and sometimes this makes for bad feelings about your kids.

I’ve learned from my clients that parenting is a mixed bag of emotions -- sometimes beautiful, loving, hopeful, blissful; other times utterly maddening. So when clients ask me for book recommendations – there is usually only one that I turn to: Parenting from the Inside Out, by Daniel Siegel. It is a practical guide helping parents tune into their own emotional state.

Siegel cites research studies that indicate that parents who have developed their own life narrative, even if it is a painful one, tend to have children with more secure attachment than parents who have no narrative. So often my clients are reluctant to look at themselves. They come in because their child has a problem – not them. It’s too painful. Turning towards their own painful childhoods, makes them feel vulnerable.

What can take years to tap into in therapy can be opened up in one second by a child. Young children are aces at tuning into their parents' issues and sore spots. They have spent most of their early lives in non-verbal communication with the caregiver – their survival literally depending on it. If a parent has a lot of unexpressed anger, you can bet their children will get that anger out, one way or another. The child can feel it there looming, and what is not said or expressed is often much scarier to a child than what is. Children learn from us how to handle emotions, When we can admit that we have angry, sad, frustrated feelings and model what to do with those feelings – they will learn how to handle their own range of affect.

The parent who unconsciously hates their child raises a child who becomes worthy of being hated. But when that same parent can stop and wonder – Why do I hate this child? Who hated me when I was a child? That is when there is an opening for change. And the wonderful thing about children is that development is in process, and change can happen quickly and dramatically. I will never tire of watching a parent and child, of varying ages and backgrounds, get past the unconscious projections and psychic pain and finally connect, fall in love, and attach.

Friday, May 28, 2010


All day long I listen to stories. I listen to stories of survival, stories of triumph. As a trauma therapist, I am a witness to tales of brutality, unimaginable savagery and cruelty directed toward children.

I also witness the more mundane struggles of adult life, including the struggle to be a good, maybe excellent parent. I can identify, as a parent, with both the struggle and the not-so-rare failures. Parents share with me their shame, their deep disappointment in themselves when they have not been able to love as fully, as un-ambivalently, as perfectly as they had hoped and planned.

This is the best kept secret in “parentland.” Good, loving, well meaning, well educated, even well-“therapized” parents sometimes, maybe often, have bad feelings toward their own children.

Parents envy their own children, compete with them, resent their advantages, desire parenting from them, seek to have them enhance their social status, repair their wounds, improve their marriages, redeem their suffering. They are angry when their children get in very public trouble, not only because of the consequences to the child, but also, maybe chiefly, because of the shame of being exposed in all their imperfection themselves. Parents find themselves not always wishing the best for their children.

So what? Why do we need to know this? Why not suppress all of this and do what we can to keep the beast from emerging. The culture has long ignored this phenomena, isn’t their some wisdom in this? I think not.

I share the following parable (from Jack Kornfield) of the poisoned tree. A lone traveler coming upon a “poison” tree is understandably frightened and cuts the tree to the ground, chopping at whatever roots are within reach. The traveler seeks to protect himself/herself from the dangers of being poisoned.

The next traveler, coming upon a similar tree of poison, recognizes the tree, honors its right to exist and decides not to cut it down: “I will build a fence around the tree so that the tree may have its life, but I will be safe from it.”
The wisest person in the story coming upon the tree, thinks a moment and says “oh, goody, just what I’ve been looking for, a poison tree.” The wisdom of traveler #3, is to see the tree as a gift, an opportunity to transform the poison into that which can heal. Medicine is sometimes made of that which causes the sickness. The poison from the tree be transformed into an important remedy for our ills.

In my application here, the poison of the tree is of course all our nastiest thoughts and feelings. Our impulse is to rid ourselves as quickly as possible of what can be terribly destructive and poisonous within ourselves.

If, for instance, one should stumble upon, become conscious of, envy toward our tender offspring we would surely seek to squelch this un-admirable feeling. How can one begrudge the good fortune of our children even if it makes us feel our own deprivation keenly? “Lets cut it down,” Lets banish the thoughts of anger and jealousy and replace them with those of intensified duty, or displaced anger.

Unlike real trees, however, unacceptable feelings can be displaced or even turned inside out, but they cannot really be destroyed. As in the second law of thermodynamics wherein energy can be transformed into different forms but never destroyed, so it is with passionate feelings. Acted out, denied, displaced, walled off , they are nonetheless there. And they make trouble.

The lessons of the consulting room, the lessons taught by my patient patients, have converged with the lessons of child-rearing for me. There are dark feelings associated with parenting, they are as an important a part of the topography of parenting as loving, instructing, and playing with our children.

Unfortunately a parenthood “mystique” permeates the culture in which such feelings are unspoken, forbidden. As a result guilt, shame, and abject horror As a result guilt, shame, and abject horror are automatic in the parent encountering these dark thoughts and feelings. We move quickly to cut down the tree: we deny, suppress, and dissociate when we can. The result are symptoms, unresolvable conflicts with the children, paralysis in the our own lives, and acting out at key transitional phases.

I would like to write more on this subject, but would very much like some feedback from readers: comments on how this strikes you: horror, relief, boredom? Thanks.

Tuesday, April 27, 2010


I was listening to NPR one afternoon. Judith Shulevitz was talking about her book, The Sabbath World: Glimpse of a Different Order of Time. The book is described as both a scholarly exploration of Sabbath practices and an exploration of her own recently acquired practice of Sabbath observance. It was interesting.

There was one thought that she expressed that I both recognized and found paradoxical. To paraphrase: “ I love synagogue, the Sabbath observance, but I don’t believe in Gd.” I have heard many variations of this sentiment expressed. I really don’t get it. I don’t understand what “I don’t believe in Gd” means in this context. What is happening to people who attend synagogue, enjoy prayer, or the observance of prescribed practices, like the observance of Sabbath? What do they mean it has nothing to do with Gd?

A few years back I saw a short clip on the web of a lecture given by Jill Bolte Taylor http://www.ted.com/talks/lang/eng/jill_bolte_taylor_s_powerful_stroke_of_insight.html)

Dr, Taylor was a neuroanatomist, a researcher of the brain at Harvard who suffered a devastating stroke on the left side of her brain at age 37. Her story is about both her recovery and what she learned about “right brain consciousness” as a result of her stroke. I was so moved and fascinated by the lecture that I bought and read her book when it came out several months later and followed her on the talk show circuit, whenever I could.

Dr. Taylor suffered a “slow bleed” into the left hemisphere of her brain, the location of her stroke. For a while she experienced only what could be apprehended from the right hemisphere. Undistracted by the linear, verbal, linguistic, rational, logical and autobiographical left hemisphere, she had access to a unique experience of consciousness.

The right hemisphere of our brains are affective, non-verbal, non-linear. There is no time, only the present moment. There are no boundaries, all is one and one is all. As Dr. Taylor describes it, the right brain experience is close to “nirvana,” or the state of ecstatic oneness, that meditative adepts have been able to achieve.

The right brain seems to house the organ of spiritual receptivity. That is what this brain scientist experienced and came to believe in fervently.
We are two-brained. And we forget this. We think of the logical left brain as being the true mind, and the right brain, which is online much earlier in our development (and maybe is the last to go), as being somehow less valid, less reliable, less real.

As the left hemisphere was blinking on and off at the moment of the stroke, Dr. T. found herself unable to focus on calling for help, dialing or even reading the phone, forming or understanding words. Remarkably she did not die. More remarkably she has almost completely recovered. But most remarkably she has had the experience, and is able to convey the experience, of having full access to right-brained consciousness:living in a space that was truly spiritual.

So this is what I think is happening with Judith Shulevitz and the rest of us wrestling with being drawn to something that we do not “believe” in. I believe that Sabbath observance, prayer, meditation practice, yoga give us a glimpse of right-brained consciousness. If you do not have the ill fortune of a left hemispheric stroke it is not a simple thing to “feel” your right brain. The chatter of the left drowns out the timelessness and serenity of the right. We all have to work really, really hard to get access to that other form of consciousness. Music may get us there, poetry, meditation, prayer, and ritual are some popular routes. For Judith Shulevitz it may be Sabbath observance. But I’m just guessing.

Belief is a function of left brain work, that which is logical,
rational, linguistic. “Is there a GD” is a left brained question.” And there is no left brain answer. If “answer” is a relevant word, and I’m not sure it is, we need to turn to the other side.

Thursday, April 8, 2010



I thought if I waited long enough, procrastinated long enough, this would go away and I would not have to write this post. Not that the crisis would go away, just the headlines about the church/sexual abuse scandal. My comments would be moot. Then yesterday, front page, New York Times: Vatican Priest Likens Criticism Over Abuse to Anti-Semitism. That pushed me over the edge. Perpetrators as victims, that sounded oh, too familiar.

As a long time psychotherapist, the church scandal that broke several years ago, came as no surprise, not to me, not to many of my colleagues. We had been hearing about severe sexual , physical and emotional abuse of children by priests and even nuns for many, many years. It was validating and freeing for our patients to have this out of the closet and to know that it was institutional.

I have treated many victims of sexual violence, some at the hands of priests. I have treated a priest who was a sexual offender. They have been my teachers.

I have one thing to add to the conversation on the church, the systemic denial and cover up of the scandal and the recent revelations of how high in the hierarchy these matters reach.

Commentators looking to understand what is institutional and systemic have pointed to two factors: celibacy and more offensively, homosexuality. The have also pointed to the probable homosexuality of a substantial number of offenders. This analysis fails to explain why children are the objects of sexual desire, rather than adults, and why the church has failed so miserably to protect children from pedophilic behavior, once the pedophile has been identified. Why is the expression of compassion and protection for child victims of rape so much more tepid than the protection afforded perpetrators? Why does the church view itself as victim, rather than perpetrator?

I believe much about these matters can be explained better by reference to power relationships. In a word its about patriarchy. Power that is “infallible,” where the rule of obedience supersedes all other (moral!) considerations there is bound to be corruption and victimization of those weak and without voice.

Several years before the church abuse crisis, feminist scholars were observing that patriarchal, hierarchal institutions were much more likely to tolerate and produce violence against women and children than less rigidly hierarchal organizations where power and authority is more egalitarian in expression. This applies to family, cultural, and religious organizations.

Judith Lewis Herman, a psychiatrist and scholar in the area of sexual abuse and the effects of sexual abuse on children betrayed by trusted authority figures, writes eloquently about “the rule of the father” in an incestuous family. Herman argues persuasively and with scientifically supported data, that where father’s rule and mother’s nurture , where father’s power is paramount and mother’s power minimal, children are more at risk for the father breaking the incest taboo with his daughter. Children are undoubtedly more at risk for all kinds of violence from the father, where mother’s power is absent.

I believe the stunning insensitivity of the church, the absence of compassion for victims, the decades of denial and cover-up, the arrogation of canon law above civil law and ordinary morality, all make more sense in the context of an understanding of the perils of institutional patriarchy.

If the patriarchal nature of the church could be addressed we might see some real change in victimization within the Catholic church.

Monday, March 22, 2010


We are all part of many communities. I am part of many communities. I am about to leave one of my most sustaining communities: my synagogue. I will be moving away and I will be leaving my synagogue. The synagogue for me has been all about community, very little about religious practice. I have been a member since I was pregnant with my now 31 year old daughter. That’s a long time.

In the Jewish tradition separating yourself from community is seen as a major problem. The community is the very expression of G-D. Prayer is done in community, holiday celebrations are done in community, mourning and addressing one’s soul, all done in community.

I am just beginning to assess what this separation will mean to me. I have gotten a few posts from my unconscious. Thought I would share.

Post #1. I was looking at the facial profile of an acquaintance, a woman I have known for most of 30 years. I do not know her well, but I know that face. I was noticing that it is now the face of an older woman—a woman probably nearing 70. She looks all of those years, but I don’t really see that. I see a montage: a woman of 40, 45, 50. I see a very bright woman, a somewhat argumentative woman, an annoying woman. I see all those qualities accompanied by visual images superimposed on one another. I see her as she really is I think, a collection of all her younger selves. I don’t have an emotional history with her so there is really no affective content—but the visual alone is quite complex.

In this moment, sitting around a table with people who have no history with her, I had a flash as to how she looks to these new friends and acquaintances. I’m sure they look at her and see an older woman. All that that phrase means “older woman” is all that they see. Her current audience doesn’t see the kaleidoscope. They see her as she is now. There is no dynamic picture, the one that carries meaning, the one that has a past as well as a present. That face, that montage: I think of it as the “real” face.

Post #2. Recently I sat at a Purim party in the synagogue watching a smart and funny Purim play. I knew many of the participants. As I watched the “shpiel” I thought: I have known these people forever, and then surprisingly I heard a quiet voice in my head: “and I forgive them.” I wasn’t even sure what that thought meant, but it felt right. In that moment I had enough distance to feel my love for them, and their flaws, their errors, the injuries we have inflicted on one another, small and large. For a moment my ego, my involvement was suspended. For the moment none of that mattered. What mattered was history, shared affection, and forgiveness.

These are people with whom I have an affective history—the photo montage is not just visual, it is emotional, it is real. Over 30 year there has change, growth, maturity,and a lot of loss. All of it. To have something to forgive is meaningful and it comes only with the gift of time.

So in my new community I can only hope to be able to know people well enough to approximate their “real” faces, and have mine be known (approximately) by them. It is, however, unlikely that I will experience enough intimacy enough intensity to become truly, meaningfully forgiving and forgiven.

Thursday, March 11, 2010

Healing II: Adaptation

I read an article today about the role of adaptation in depressive illness, not just your ordinary blues, but debilitating depressive disorders:

It turns out that Charles Darwin himself suffered the blight of depression, describing himself as so undermined by his malady that he could not work one day out of every three. Darwin was unable to make sense of what might be a heritable disorder. He observed, that there was no adaptive value to being impeded by intense sadness. It made people unable to work, caused great pain, killed desire, and it sometimes led to suicide. It seemed to Darwin to be a mistake in the evolution of the brain.

Recently some psychiatrists interested in “evolutionary psychology” have taken a look at depression in a different light and tried to tease out what is adaptive about it. They raise questions on the efficacy of (anti-depressive) medication which may make you feel better but delay the resolution of underlying problems. Therapists are well acquainted with the phenomena: people on medication might feel better (and might not) but after awhile they seem to be more apathetic about their problems rather than energized in the search for solutions.

There is another useful way to look at adaptation, adaptation within the life cycle.

For instance a depressive response may be adaptive in childhood in a particular family. Some families prefer sad children over “bad” children. Depressed children don’t rock the boat quite so much as acting out children. Some children learn to keep very quiet so as not to ignite volatility in their parents, or anxiety in their parents. This is adaptive at the time. Later, not so much.

Depression is described by sufferers more often as an oppressive wet blanket sort of feeling, more of a heaviness, than a sadness. When unacceptable feelings are not safely expressed they need to be suppressed. Chronic suppression becomes depression.

I have a silly story, not a story about depression, a story about adaptation. When I was growing up we lived near a deep pond. The area around the pond was marshy (we called it “the swamp”). We were told that there was quicksand around the pond and to stay away. As I type this I remember vividly jungle-themed movies of people being swallowed in quicksand. Needless to say, I stayed away from the pond.

Fast forward: in my 20’s I heard my mother counsel a new neighbor who had adventuresome little boys, on how she had kept her children away from the pond by telling them there was quicksand around the pond. This would keep them safe.

In a flash I remembered that queasiness I always felt in "the swamp, even in winter when it supposedly froze (quicksand was said to freeze in winter!) and we went down there to ice skate. I never did learn to skate well.

I never remembered the source of the anxiety, only the anxiety. I was now 20 something and I had not revisited this story/memory and therefore never had an opportunity to revise. Until that moment deep inside I still believed it! I was stunned at how “unremembered” this memory was—“unremembered” but not disarmed.

And so it is with so many adaptations, what once kept us safe now keeps us stuck. There are probably no repercussions of the swamp-quicksand story, other than my failed skating career. But perhaps there are, my good girl adaptation borne of both fear and attachment to my mother maybe plays a hidden role in a risk averse lifestyle, a lifelong aversion to taking physical risks.

It was certainly important to keep us away from the pond. No one drowned. But if we don’t revisit early adaptations we are unable to revise. And a healthy life is all about the ability to revise.

Monday, February 15, 2010

Life is about Healing

Creation myths, stories of how the world and humanity came to be,  mythic though they be, give one a template from which one can usefully contemplate meaning, the meaning of one’s own life or the human endeavor in general. The biblical story of the 7 days of creation and the story of Adam and Eve present us with a tale that features paradise and the loss thereof, and a view of ourselves as  temptable, given to sin, and in need of redemption. There are many sub stories there, but I take those to be the main themes.

I prefer the mystical version of the creation story, featured in Jewish Mysticism (Kabbalah) in which in the act of creation, the divine light is accidently fractured (G_D is not perfect!) and scattered throughout the world. Each human soul possesses a shard of that light and the purpose of human life is to raise that shard/spark to the heavens, thereby healing the divine Cosmos. Healing is the purpose of life—to heal ourselves, to heal others, and to the heal the Cosmos. Besides not being perfect, G_D needs us.

If I had known this story early on perhaps it would have been my inspiration for training to do the work I do, psychotherapy. But I did not know the story until recent years, and my choice was driven by family and individual forces, largely outside of my awareness at the time. As I contemplate closing down my psychotherapy practice, my thoughts are very focussed on what this all has meant for me: can I really stop doing the work I have done for 4 decades? will it impoverish my life? will my days still have meaning for me? am I making a terrible mistake?

At present I have not even the whisper of an answer to these questions. Only a dim sense that is time to look for other ways to live my life.

But the coming end to my work as a therapist has made me philosophical about “healing.” I have come to believe, perhaps I have been taught by my patients, that the healing principle, the urge toward self mending is buried deep within, is part of the human soul in probably all cases. I have come to see my job, the job of psychotherapy as one in which I join my patients in the task of moving the trash out of the way. If one can dispose of enough trash the essential impulse toward wholeness arises. That job is never easy and often not very successful, but when it is, the patient’s heal themselves, they know the path. I do not.

I work with a lot of traumatized individual—people suffering from chronic PTSD, individuals whose life histories are replete with betrayal and the horrifying suffering that only other human beings can mete out. Mostly I have found that my spirit has been both repaired and enlarged by doing this work. People get better, very slowly, very painfully through the agency of a trusted, steady, and sturdy relationship as well as through the melting and processing of previously frozen memory “icebergs.” 

Surprisingly, yet frequently, there is a spiritual element that sustains them through their suffering and that element plays a large role in promoting the healing.  Its as if the Kabbalistic creation myth comes closer than others in describing the very real process of healing that takes place on an individual, human level. 

I am not always up to my job, assisting others in "raising the spark".  I have at least my share of failures as a therapist. But 40 years of doing my job has left me, foolishly or wisely, believing that life is about healing.

Wednesday, February 3, 2010


In my twenties I moved a lot. A lot.

The college I attended had a “co-op” program which meant that every 3 or 6 months I moved off campus (and sometimes across the country) for a co-op job or I moved back from a job to campus. After 5 years of this it was on to grad school for two years (where I moved three times). And after that to New York City for a serious career job. I was in N.Y. for 5 years. I moved 3 times.

I married and we moved to New Jersey shortly after our first child was born. 
All of this made me crazy. I swore I would stay put from that point on. I longed to stay put. And that pretty much came to pass. We have moved only twice since settling across the Hudson. We are in our present house for thirty years.

Now I am moving again. Children grown, grandchildren born, retirement beckons and we have decided its time for a big change: more compact digs, new city, new life.

The process has barely begun and again… I am crazy.

During one of my moves from one Upper Westside apartment to another, a psychologist friend who did a lot of psychological testing and analysis told met that there was one Rorschach (inkblot) card that was a surefire diagnostic indicator for schizophrenia. Truly psychotic individuals had a characteristic response that reliably distinguished them from sane folk.

The Rorschach tests consists of a series of images that resemble inkblots—symmetrical blobby pictures that the tester invites the testee to interpret: what do you see here? People’s responses, at least the pattern of responses, are believed to indicate something important and enduring about the individual’s personality and their inner world. Interestingly, though, and she said this to reassure me, when moving, ordinary folk reliably respond like schizophrenics. Indeed I was probably only temporarily crazy.

Not only was I reassured, I regularly pass this information on to others, patients, family, friends who are undergoing a move.

This post is about my musings on this phenomena. Probably it is just the beginning of several posts on this subject, for this process will take many months and probably my craziness will take many forms

When I listen to the dreams of patients I have found that houses (and more women seem to dream about houses then men) a house represents the self in dreams. I have had many dreams in which I discover a secret unexplored room, or a room that I have forgotten was in my house. I remember a dream one of my children had when young about large, scary, snarly animals in the basement. The first dream seems optimistic—more facets of the self to explore, the second demonstrates the ubiquity of scary and probably angry feelings that children have to cope with as they grow into themselves.

My guess is that moving upsets the balance, that it requires a re-organization of the self and for awhile there is chaos inside. Many of the familiar props, those that assert who I am will change: the street on which I live, the stairs that ascend to my bedroom, even the smell of my home as I let myself in the front door.  These props help me to feel safe,  cohesive:  I know who I am.  Without them,  all of that is up from grabs.

My hope is that all of this challenge and change will lead to growth and expansion within myself rather than a term of institutionalization.   Stay tuned.

Wednesday, January 27, 2010


Turning Passive into Active

I’m thinking more about the issue of helping children cope with tragedy. The principle of turning a situation in which one feels victimized and helpless into something in which we can experience mastery is a challenge presenting itself over and over in our lives. On one side lies despair, on the other empowerment. Students of writing are always being instructed to eschew the the passive voice and to design sentences that feel and sound stronger by employing the active voice—“mistakes were made,” a favorite of politicians, has a whole different feel from “ I made mistakes.” If mistakes were made, what the hell can I (or you) do about it. If I made mistakes, there are things I can do about it.

The mechanism of “turning passive into active” is a fundamental building block of psychological development, a way to manage anxiety. Freud and the early Freudians spoke of this. The child who plays out with dolls an anxiety ridden situation making the play the answer to his anxiety is employing this brilliant and highly adaptive defense mechanism. My 3 ½ yr old grandson dealing with the advent of a new and sometimes fussy sibling plays out with his beloved bear, situations which he cannot do much about in reality. He is rocking “bear” much like his mother rocks the baby, complaining about how “frustrated” he is that bear will not stop crying.

I was thinking about a woman I knew who was unable to leave her house. She was poor, unable to work, quite disabled by chronic post traumatic stress disorder. She was agoraphobic: afraid of going outside, afraid of the world. She and her husband lived on a small pension of his. She felt she was totally trapped by her mental illness and her economic circumstances. And to a great extent this was true.

A few years ago, the house next to hers was razed and a construction crew came to work to build a new home next to hers. Jack hammers, electric tools, hammering, loud voices, even dogs barking became part of her daily torment. One very prominent aspect of PTSD is a hypersensitivity to noise, and a strong startle response. Although she was retreating from the world in many ways she could not retreat from this noise. She could not screen it out. Nor could she leave the house to hang out in Starbucks for 3 or 4 hours, or go shopping or visit a friend.

Her mental illness presented insurmountable barriers to these very ordinary options. She was despairing of her situation. She felt totally victimized, and helpless, a chronic condition with her, and in many ways a repetition of the original traumas, extreme physical and emotional abuse throughout childhood. Her very astute therapist (no, not me) told her to make her own noise: put on the radio, play her own music, use her earphones make music herself. Instead of the passive suffering, which was intense, she now had the option of meeting noise with noise of her own choosing. It was a very simple directive and it worked! She needed to be reminded repeatedly that she could do this, as she easily fell back into the very familiar and to some extent comfortable role of passive victim, the legacy of her horrific childhood. While she and the therapist continued to work on the historical roots of her suffering and the role she played in maintaining her suffering , she now had a coping mechanism that was totally new and provided her with a measure of mastery, i.e. think of what you can do to put yourself back in control.

Posted by Note From the Unconscious at 9:30 AM 0 comments Links to this post

Labels: children, Freud, mastery, psychological development


When the world seems too damn dangerous for kids

My first post is inspired by the blog http://countryfriedmama.com (full disclosure, my niece Rebecca Joyner). CFM is struggling with how to explain the immense tragedy that is now unfolding in Haiti to a not quite 4 year old. Miss D., her daughter, is all ears and seems to pick up on just about any mention of death and destruction. Its not hard to imagine the anxiety in store for a tot that has just learned that the earth can open up without warning and bury a couple of hundred thousand people and all of their homes and loved ones. And yet, eventually every pre-schooler will hear about these things, if not from TV or the radio, through the colorful if distorted accounts of other pre-schoolers. We would all love to shield our children foever from these accounts. Just think back to 911 and how that went down with children who could and did watch the towers fall on the TV, over and over, and over....

While we should by no means go out of our way to share every bit of bad news, if it does seem inevitable that they will be exposed, some version can be told. Some children will (strange as it seems) shield their parents if an obvious subject is not broached and not be able to speak of their fears and images which may be quite distorted. As awful as the Haitian earthquake is, I'll bet a small child can imagine worse things: like everybody is dead in the next state, or even the next street over from ours. Something like that. Open talk leads to open talk.

Most importantly though, emphasis should be on what we can do to help. Turning passive helplessness into a way to help can be both empowering and restorative. If you can brainstorm with your kids about "how we can help" you are teaching a coping style that will come in handy forever(!).

Three kids came to the door this week collecting for the Red Cross. Two little girls (really little) were selling lemonade down the street, flagging down traffic on a busy street to collect money to help the homeless in Haiti. These are opportunities to teach lots of things: citizenship, charity, and coping.

I read some years ago about a study on the coping skills of children faced with the threat of nuclear annhilation--a threat very real to my generation. Children whose parents were anti-nuclear activists seemed less afraid, less paralyzed by the threat. If they marched along with their parents, so much the better.