Category Archives: Uncategorized

Aside

Working Through Rehab: Growing out of it

 

In Masterson’s The Psychiatric Dilemma of Adolescence, published in 1967, the problem of treating kids in the psychiatric setting is exhaustively examined. Noting the tendency of clinicians to dismiss diagnoses of clients, saying “he or she will grow out of it”, in reference to a plethora of acting out and mental health problems. Meanwhile, Masterson recounts that social scientists in the 60s were attempting to organize the phenomena they studied, rather like researchers of the physical sciences, and thus methodology changed; so-called objective research, focusing upon variables like validity, reliability, and statistical analyses, were coming to the fore and changing the ways clinicians addressed problems. Masterson, however, grew conflicted about the differences between the social science methodological point of view, and his and others’ clinical observations.

Masterson found after his twelve year study, that 50% of the adolescents he studied did not “grow out of problems” upon five year follow-ups, and that while symptoms like anxiety, depression, and acting out (with sex, drugs, or violence) did diminish, but that which brought the most difficulty, in terms of sustaining meaningful relationships, activating healthy goals, ambitions, accessing creativity and self-care–their pathological character traits–had not been touched upon in treatment…at all.

As much as anything, my reflections in Working Through Rehab: An Inside Look at Adolescent Drug Treatment, are derived from Masterson’s implied warnings about the costs of a superficial treatment approach. I recall working with a young lady in my private practice–a late teen–who was supposedly drawn to relationships with boys “from the wrong side of the tracks”. Much thought, encouragement, argument, and time had been put into making her see reason, re-think her “choices”, and make “rational” decisions. The cognitive dissonance was pervasive: she wanted safety and “respect”, but was drawn to men inclined to hurt her. She wanted independence, but ended up feeling anything but. She was drawn to the bohemian, the pull of rebellion, and found separation in rejection of her family’s fears. Little did she know how conflicted she was with herself, not others, and how long the conflict would last if she did nothing about it. In my first novel, Living Without Blood, I presented the consequences for a family living by the rule, “time heals all wounds”. The Metcalfs  discover that time passage without conscious intrusion does little more than fossilize understandings, generating alienation.

In Working Through Rehab, I depict therapeutic environments that are either forgetting, actively disregarding, or plainly ignorant of Masterson’s now forty year old caveats. Programs working with kids are operating upon the assumption, “they’ll grow out of it”, seeking to emphasize kids’ positive traits in the hope that their deficits will fall away under the power of love. Or, they’ve taken a subtly defeatist tact, thinking the wounds are too great, the fossilization too hard and too widespread, such that the roots of problems are impenetrable.

Do you think this, my would-be reader? Are you a mental health practitioner? A consumer of services. Who are you that you might be interested in this topic? Who do you need to be? Who am I to make pronouncements on trends that flit in and out of fashion, some sticking, some not. Who do I need to be?

 

 

Leave a comment

August 13, 2013 · 8:57 pm
August 8, 2013 · 9:35 pm

Alice down the rabbit hole into a madness without tea parties

 

This disappearance I keep writing about: it is a misleading singularity. There are several disappearances in Crystal From The Hills. Honestly, there were one or two disappearances in my life that informed my writing. Actually, I think absence is the truer word to apply here–not so much disappearance–for it is the lingering absence that haunts those stuck in either grief, or trauma. Some readers have commented on the relationships in CFTH, wondering which pairing is most pivotal, who is most important to protagonist Chris Leavitt. Is it the awkward coupling with Jill Evans, which manifests conflicts that touch upon sex, money, and adequacy? Is it his obedient bond with Aunt Jenny, the autocratic, aspiring matriarch of the dwindling Leavitt clan? Is it the dawdling friendship with Sweet, his fellow slacker, and likely drug addict. Loser?

Despite the convictions of some, it’s none of these. The most important relationships in CFTH are between Chris Leavitt and the absent: his doppelganger, Weed, the recently disappeared; with his father, a self absorbed, elusive man, now deceased; with his mother, exiled to the east coast, ambigously disgraced and then punished for once leaving Chris’ father and following her heart. The heart was broken. The loving man who replaced Chris’ father was killed in the 9/11 attacks, leaving her catatonic in grief. Chris wanders through the narrative with all this background swirling about him. He strains to make sense; he strains to relate while others gaze into the mystery of his life.

In this way, CFTH is a mystery, though not a conventional one. Its writing coincided with a drama that quietly played out in my working life; the much-delayed publication came from a position (and feeling) of absence, one I have felt keenly. Overlapping the writing of CFTH for about a year was the more driven, didactic non-fiction entitled, Working Through Rehab: An Inside Look at Adolescent Drug Treatment. I worked in this business for fifteen years, after which I was quite ceremoniously, if cynically, marginalized from the workplace until finally dismissed. It would be unfair to call it a disappearance, as it all happened with considerable notice. In concrete terms, there was a month-long and therefore (by my then employer’s standards) unprecedented grace period. In reality–that is, in the murky underlying world of the unconscious/that-which-is-right-in-front-of-me–the signs had been there for over a year. The clues about my feelings are on the front cover of the book. The readers sees a rendering of a youth sitting in between an officious sergeant of a therapeutic milieu, and a distracted case manager, busy with documentation. In the foreground there is a thumb thrust upwards and outwards, in a gesture that will lack meaning until about a quarter into the text. The thumb is connected to a figure who is cut-off, absent. It is me. My fuller self is on the back, leering, seemingly relaxed and free, with a friendly, dedicated doctor standing over the scene, clutching a clipboard. The medicine men of this industry: ultimately, they’re much better postioned (though not necessarily best-positioned) than I am to effect change. 

I hope you join me in this literary walking-through of my fifteen year career in rehab; this protracted diary and essay about kids, drugs, mental illness, and the mad attempts to do something about it all. Like my novel, it’s something of a rabbit hole, this world, but the two books dovetail, I think, and teach–if you read…if you really do read.

 

Leave a comment

Filed under Uncategorized

August 7, 2013 · 6:54 am

A Disappearance

 

So, as some of you know, I’ve been presenting Crystal From The Hills, my psychological fiction, as a story about an accident, a disappearance, a trauma, and a mystery. On one level (perhaps the only important one), these descriptions refer to an incident in which Chris “Crystal” Leavitt inadvertently drives his truck into a lake; the result in which he emerges from the quietly lapping surf but his friend Weed doesn’t; the fall-out that is his dissociation, wandering avoidance of life, preoccupation with so-called shadows, and faultly memory of the event; finally, and plainly speaking, the mystery of what really happened with the accident at the lake, and why.

But, if you’ve been paying any attention at all to these pages, or if you’re one of the handful of people who have managed to sit through all ten or so minutes of my YouTube videos, you’d be gleaning that the accidents, disappearances, traumas, and mysteries of my novel are not only multiple in number, but multi-layered. The dissociated syndrome of Chris Leavitt unfolds over the course of the story, and his supporting cast–his friend Sweet, his girlfriend Jill, and the autocratic Aunt Jenny, are his would-be therapists, or life coaches, if you prefer that sort of thing. Meaning, they confront, encourage, advise, boss him around, and witness. But they don’t see him, not really. They miss his sensitivity to abandonment. Then there’s Costman, a wildcard character inserted about two-thirds into the action (or inaction, as Kirkus reviews would have readers believe). I haven’t written much about Costman prior to this point, haven’t said much. He is, as my drive-by readers might suppose, something of a random character whose meaning is elusive; possibly enigmatic, if one was feeling sympathetic. To review the plot point: Costman is a gardner who works for Aunt Jenny. He’s sort of a societal drop-out, kinda like Chris, or maybe like what Chris might become if he gets his drop-out act together. Thing is, he and Chris have known each other for several years, which is unusual for Chris, as most of his relationships have been short-term or peripheral. Costman is in the latter camp, but nonetheless knows stuff about Chris and his past–he knows enough, at least.

Chris figures he knows enough about Costman also. Like myself, he imagines the gardner is someone who can be taken for granted; can be overlooked and not spoken of, or written about. He further imagines that Costman is undisturbed by such things. Above all, Chris believes that Costman is no threat to him, that he is enviably disinvested in others’ lives. Costman won’t reveal any of Chris’ secrets, neither to Aunt Jenny, the police, or to anyone else who might be interested. He will listen to Chris’ soliloquys, his delusions about shadows, paranoia about authority, and respond with an indulgent chuckle. But ultimately, Costman, whose name is a play upon his one-time job in a money market, will offer little of substance in terms of advice, encouragement, or straightforward provocation. Surprisingly, however, Costman offers what few have given Chris so far in his life: at once a jolting yet mirroring experience, one that helps him feel not alone in feeling alone. How does this come about? Well, Costman, it seems, was once a most unlikely consumer of psychotherapy. Turns out he knows something about others’ disappearances. Read:

“Alright, so he wasn’t always professional. That part was bullshit. The last time we met—our last session—he fell asleep on me. Actually, I think he’d been holding back for some time, I’m not sure. For a while I thought he had this sleepy look in his eye—this lazy kinda drooping—in previous sessions. Then on our last meeting, I was talking, don’t remember about what—probably about my wife’s cheating—and I guess I didn’t look back at him for some time. In fact, it wasn’t even his eyes that gave him away, come to think of it. It was a snort—ya know, like a snore?” Costman let out his latest burst of laughter; a release following his punch-line, designed to preempt reaction. Unflinching, and without any pretense of matching the gardener’s effortful jubilation, Chris ventured another question:

“What happened after that?”

“Nothing really,” Costman replied, quieting his amusement. His tone and his body settled, like a raucous wave being gradually stilled. “I think I waited for a bit,” he said quietly, frowning. “Then I got up and left,” he then said chirpily.

“What? You just left without saying anything?” Chris intuited the latter piece, having pictured the scene.

“I didn’t wanna disturb him,” Costman offered, incredibly. Chris’ jaw dropped perceptibly, eliciting yet another round of laughter from the gardener. “I know,” he uttered amid chuckles, “I guess I should have said something, huh?” Before Chris could respond, Costman stretched out his arm in a gesture of self-defense: “But can you imagine the look on the guy’s face—what he must have been thinking—when he wakes up and sees that I’m gone? Can you picture the ‘Aw shit!’ expression on his face? I didn’t pay him for that session, either.” Costman lay back, continuing to douse the memory with comic emollient. Chris let his head drop.

 

Leave a comment

Filed under Uncategorized

Tagged as , , ,

August 5, 2013 · 7:29 am

Where there is hierarchy there is violence (part two)

 

…Which means there are casualties. They are victims, if you’re feeling sympathetic and outraged. They are losers, if you’re not. Chris Leavitt, my protagonist from Crystal From The Hills, is not much of a victim, but he is much of a loser. And I write that with love. In a way, I prefer losers to victims, though they are in some respects the same. Losers lack the hubris of victims, mostly because they haven’t the fortitude to call themselves victims. So Chris Leavitt is a traumatized individual; a casualty and a loser, not a victim: he is privileged, free for the most part but wary of his onlookers–his shadows, both real and not. Ironically, he pays more attention to the less than real shadows, which render him paranoid yet oblivious to what’s right beneath his nose. He is innocent in so far as he is uncalculated, uncensored and anarchic. Whether too impulsive enough or just lacking in political savvy, he is unequipped for any tight, hierarchically-driven order.

There are hierarchies all around: some are tacit structures, governed by race, class, gender, philosophy, religion–prejudices of various kinds. This is not original, but then neither is the hand-wringing that surrounds public controversies. It’s not nice to judge people for being different, people say on camera. But they do. Of course they do. It’s the correct thing to aim for the center (“the center holds” our President tells us), but all around us (and him), splitting, the thoughtless, triage-like division of life into “good” and “bad”, right and wrong, is occurring, and meanwhile, we are all shepherded into cliques, nurturing our prejudices and providing succor within echo chambers. I was once clique-bound at Thunder Road, the workplace that employed me for fifteen years, and which I depict in another book, Working Through Rehab: An Inside Look at Adolescent Drug Treatment. Contrary to my younger observations, Thunder Road is just another typical hierarchical system governed by shadows who determine who fits and who doesn’t; whose turn it is to be in charge, and whose turn it is to go…what works and what doesn’t. Leaders use corporate tools for the most part: manuals, handouts, HR policies, lawyers and spreadsheets, to create order. Meanwhile, the world they govern is an inchoate mass driven by an oral tradition, and the unconscious.

My turn on the rollercoaster lasted longer than most, though it was never my goal to merely have my turn. It was my pretension to do more, and now I have, only from the outside looking in. The point of my book is that taking a turn is not enough. Being politic, fitting in and censoring dissent may suit a hierarchical system, but it is psychological death to the conscious individual, the growing professional. I could avoid hierarchies, mess with hierarchies, dissent and maneuver only so much until shadows converged and told me that if I was to continue avoiding the trappings of leadership and compliance, then it was my time to leave. Cohesion: it means togetherness, which is good, sort of. But coherence, which is like music, is superior. I remember being told once by someone in charge that if I was to really take a turn being in charge, then I’d have to assert just that, regardless of what is right. The decisions were mine, I was told: ultimately, what I said prevailed, not because I was right, but rather because I was in charge. Reluctant leadership. I nodded compliantly but remained slippery, thinking this a dangerous, undemocratic idea, this thing about being right because it was necessary to be so. The problem with equating rightness with being in charge is that being in charge doesn’t last.   

One of my favorite passages of literature reminds me that the exiled exist in numbers, are neither contained nor containable, even if they’re not in charge. Even if they’re not right. This is John Self from Martin Amis’ Money:

“I hate people with degrees, O-levels, eleven-pluses, Iowa tests, shorthand diplomas…and you hate me, don’t you. Yes you do. Because I’m the new kind, the kind who has money but can never use it for anything but ugliness, to which I say: you never let us in, not really. You might have thought you let us in, but you never did. You just gave us some money.”

 

Leave a comment

Filed under Uncategorized

Tagged as , , , , , ,

Video

Crystal From The Hills — A Review

Graeme discusses reviews and reactions to his controversial novel, Crystal From The Hills

…mostly not with his mouth hanging open

Leave a comment

August 5, 2013 · 7:08 am
August 1, 2013 · 8:24 pm

Where there is hierarchy there is violence (part one)

 

A line from my novel, Crystal From The Hills: a section wherein Chris Leavitt is reflecting upon doomed relationships, including those with authority. Bosses tend not to like him, want him gone. Sometimes the exiles occur abruptly, yet directly. The separations are brutal yet honest. But mostly, Chris’ rejections have been subtle, protracted, and torturous, in work and play. His has ruffled the feathers of doctors at the hospital in which he works as a surgical assistant. Administration is biding its time, following procedure and deliberating on how best to let him go. Jill Evans, his girlfriend, has been inconvenienced, imposed upon, even clumsily assaulted by Chris, yet her most basic complaint about him touches on none of these crimes and misdemeanors. He has let her down, for sure, but mostly because he had once, quite simply, sold himself as being more winning than he really was. Read my novel and you might identify if you’ve ever felt yourself slide from a pedastel; the chill of being slowly pushed out an exit door.

Consider the assault passage between Chris and Jill, which has stirred controversial reactions from my few readers thus far. The reason: there is power involved. Hierarchy in sex: it’s a delicate area, and what I imply is that the lines of authority are unclear. Here are the passages in question:

**Anyway—that day in the supply room: It was a curious moment for her; a hijacking of good sense, with her split-off libido disguised by charitable aims. An unwise decision was made: namely, to sexualize the moment—just a moment—and then maternalize whatever followed. More thoughts followed, mostly containing the word bad. Bad girl: that’s what I’ll be, she resigned.

            As she pulled away from an initial kiss she regarded the aroused grimace that flushed his features, and

considered an abrupt escape. She was following an impulse that seemed real at the time, but pathetic soon thereafter. She kissed him again, thinking one more will placate, and one more will feel good. One more did feel good. Jill, staring past his ear toward the blur of a window behind them, felt the drop of his pants, the aura of his flesh radiating heat against her thigh. “Chris,” she tentatively whispered. His hands started to fumble about her waist. Too late. They were heading toward the string of her scrubs, pushing away her fingers as they tried to leverage their way in. Jill felt the pressure of the closing space; the impermeable softness of his hips as they formed a barrier against her.

She was transported to the night before, when he’d kissed her hard on the lips and then pushed her on to her bed, ultimately breaking a spring. His eyes, transformed in a flash from a light blue to charcoal emptiness, bore into her like the eyes of a black-eyed shark biting down. Jill anticipated the sharp pain of a bite and the tearing sensation of a terrible invasion. She wanted to stop. Jesus, she thought. She had to stop. It, the invasion, never really came, because within a minute Chris did. Time stopped, like it belonged to someone else, and now that someone was seizing control. Jill’s eyes let her down. She closed them as a pain began—the digging in of his fingers into her arms, like they were stakes being driven into the ground in order to fix a tent. He broke his grip just once. Reaching down with his right hand, he pulled from the underside of Jill’s buttock, attempting to leverage her into an inclined position. Jill found a wedge between her body and Chris’ ribs. She inched her way up his torso with her fingertips. Feeling the rub, Chris’ pressure relented as he assumed her cooperation—a dream come true—and so pressed himself against her. Next he felt a blockage and looked down into the thin, dark crevice that could be seen between them. An inexplicable obstacle was stalling penetration. He could barely make out the detail of a wrinkled skin wedged against an opening, looking vaguely like some creature desperately trying to squeeze in through a crack in a door. Though not optimally firm, he

nonetheless felt a gathering within his system. It felt thin, yet insistent, the incipient stream. An ambiguous pain, a drip sent along a catheter, passed through his shaft like a wayward satellite. No, he thought. He panicked.

Round tow: in the closet the next morning she called out, intruding upon his fast wetting reverie, this hasty attempt to wipe out the memory of the previous night.

“Chris!” Jill cried, this time with a contortion across her face. Startled, he opened his eyes and noticed with horror the tight grip he had upon her arms. Immediately he looked down and discovered her hands against his chest, now pushing him away; now working against him. Looking through her hands, he peered down into the chasm between their bodies, as though catching a visual reminder of the previous night’s ignominious effort. This is not how it happens in the movies, he thought briefly. Forgetting himself, he let out a snort of ironic laughter at which Jill growled. With her hand pinned against a shelf, she was by now working with a stubborn pain, and became enraged. She felt the throbbing pinch against her artery and reflected for a second that the self mutilators that fill the upstairs ER will know something of this feeling.

With a quick series of thrusts, Jill broke away and fell back against the aluminum stack of shelves. Though her arms fluttered and blocked him from getting closer, it was the strength of her legs that won the day. Pistoning against him, they ejected her backwards. She slid backwards with surprise, having expected the shelf to form a hard barrier and obstruct her from creating space. Instead the shelf gave way, and let her fall to the ground. Thanks for nothing, she thought of it. A crash of three stainless steel covers, tops to bottles containing needles, sounded out, punctuating the collision. Jill rebounded, and with an instinctive jerk, kicked out at Chris’groin, catching him hard upon his upper thigh. **

So, what’s happening here? It seems to bear explanation, I think because the average reader moves quickly, passing by the repeated signs, the beta elements to which I am continually drawing attention. Clearly, there are two scenes being reflected upon, both ostensibly consensual encouters, and the climax of the first is about premature ejaculation, not rape. The second scene, the incident in the hospital supply room that gets Chris in trouble, not only with Jill but also his employers, is the more ambigous happening–a clumsy grapple combining feelings of lust, anxiety, the influences of adrenaline, memories of past and lurking humiliations. Chris and Jill are kissing, but just as he had the night before, Chris loses himself, loses touch with his own feelings, and in turn, with Jill’s. This is what makes him dangerous–his disconnectedness–and so he hurts her. Fortunately, Jill can fight back with the spirit and athleticism foreshadowed by previous characterizations (not to mention reenactments, such as the street mugging she experiences), and so she can exact revenge, at least spontaneously. 

These passges, story elements, and characterizations are about the problem of conflict: how people contain or exhibit aggression; manage their hate alongside their love; how they navigate power within the confines of intimacy.

BTW, in keeping with my interest in Beta elements, there are some symbolic fragments either referenced in the above passage, or alluded to elsewhere. For example, a section of backstory earlier in the novel references the infamous Versailles Treaty of 1919, which illustrated humiliation between adversaries, and here used as foreshadowing of the humiliation between lovers. Meanwhile, the above passages refer to a broken spring of a therefore broken bed (i.e.: the broken, sexually dysfunctional relationship). Finally, the references to movies (one of several in the novel) are a shorthand characterization of Chris’ flights into fantasy. Image
 

Leave a comment

Filed under Uncategorized

Tagged as , , ,

July 29, 2013 · 7:13 am

Memories of Near Death

 

Dr. Raymond Moody, in his book, Life After Life, explains that near-death experiences are a cross-cultural phenomenon depicted in Biblical passages, the writings of Plato, and the Tibetan Book Of The Dead. He writes that to talk of life after death seems atavistic; a superstitious impulse born of fear, estranged from a scientific present.

In my novel, Crystal From The Hills, I write about a character, Chris Leavitt (nicknamed Crystal), who indulges his own atavisms, struggling with various lives after deaths: most immediately, the death of his friend and doppelganger, Weed; the death of his father from lung cancer; the spiritual death of his mother, mired in grief following the death of her second husband in the 9/11 attacks. Above all, Chris struggles with his own deaths: the literal and the existential. He laments the loss of youth, and acts out a lie instead of dealing with the reality of being adult. He observes the loss of freedom in the workplace, and in the street, and so pounds the pavement of Oakland in defiance. He notes the loss of his sex drive, partly resulting from methamphetamine withdrawal; partly a product of shame–for Chris, sex has brought mostly pain. Meanwhile, he is AWOL from his job; disappeared, like Weed, from his home in Richmond, where he does not belong. He returns, prodigally, to where he once did belong–the hills–to hear strident counsel of his Aunt Jenny, a vital yet aging woman who is awaiting death herself, yet holding so as to live vicariously through youth. Chis is alive yet dead: such is the life of the traumatized, wading robotic through their days(ze), hanging on to the fabric of their lives, their relationships, hoping that something will come along to reinvigorate.

For Chris, as with many who dwell in trauma, memory may provide a portal to healing. The future is in the past and the end is in the beginning. And so my story begins with the words, “He’s dead”, delivered with minimal context and shorn of feeling. Later there is recollection, and with it, plenty of feeling: a blend of terror and hope. Read…

“Chris struggled to the surface amid the unspeakably cold water. The seeming attack of the seaweed had him flailing momentarily, and looking down to see what horror was beneath his feet. The vision was human—his own face staring back at him. For a suspended eternity, Chris left his body and felt enveloping warmth. Death? He wanted to shut his eyes and hasten the end, and yet he could not look away. Then as he blinked the cold returned, as did life. Someone, or thing, was giving him a second chance, he then realized. Problem is: now he’d have to do something with that. Now he’d have some kind of new responsibility. Looking down, he saw the likeness of Weed, gazing up with terror-stricken eyes” (from the novel, Crystal From The Hills)

Don’t want to read it yet? Well, for more, check out the video: http://www.youtube.com/watch?v=l03SL0ZRPXgImage

Leave a comment

Filed under Uncategorized

Tagged as , , , ,

July 17, 2013 · 9:36 am

Last Flight to Costa Rica

 

 

On July 6th, 2013, George Lewis languished in the window seat of a Boeing 777 bound for Mexico from San Francisco. It was a quarter hour after departure time and the captain had just announced that there would be a delay. He delivered the innocuous-sounding news–“waiting for a flight plan”–in a bored voice. George Lewis felt the same way, despite this being the first day of a long-awaited vacation. Seated next to him was his wife, Jean, who greeted the captain’s words with a disgusted sigh and then reached down for a fashion magazine that she’d brought for the journey. It seemed a preemptive action, designed to counter George’s subtle nod in her direction, his supplicant overture. No chance, she was saying. Ok, we booked this thing and it’s too late to get our money back, and we’re on the plane and on our way. But don’t get any ideas. We’re not going there. Not now. In the seats ahead there were some teens gazing out the window and then pointing outward, behind their seats and over George’s head. Annoying, he thought. One teen, a disheveled skateboarder-type about two years younger than George and Jean’s now college-ensconsed only son, let out a shrill, excitable noise. Jolted and glum, George looked up past the youth’s hairy, undeoderized armpit, and stared down the doltish-looking, unsupervised child. 
        “Sorry,” said the boy, suddenly without expression. 
George softly grunted, bit down upon perfunctory forgiveness and turned back to the window by his side. Clouds. Or smoke. That’s what was behind them. He couldn’t tell, but the teens in front could. One kid was from Burlingame and was guessing there was a fire near his old school. “That’s my home, fool,” he started repeating, certain of himself but undisturbed. The other boy was from San Bruno. He reminisced about a fire in his home town from two years earlier–a national story at the time, George recalled. It was “crazy”, the boy recalled; his excitability back in force. Jean didn’t react. Her head was in her magazine, a half-fashion rag, half-gossip journal, featuring women, fully clothed, many bearing sizable bulges, each looking hopeful and happy. Glowing: that’s the expression, George noted. The cover was of the British princess whose name George couldn’t remember–a likeable, girl-next-door type who had stolen the Prince’s heart, earned her fairly tale wedding, and was now waiting on her next big day, ready to give the King-in-waiting an heir. The empowered and not-so-empowered everywomen of the world were waiting with her, living vicariously this princess dream. Meanwhile, George Lewis flashed through his mind thoughts of the skin of semi-clothed women. In Costa Rica, their ultimate destination, there would be plenty of skin, mostly of the exotic, caramel kind and not the ashen complexion of his anglo wife, or the anglo princess whom she so admired.
 
George caught himself. He closed his eyes and winced, and then tried the action that his new therapist had taught him the previous week; this 3-second rule that members of Sex Addicts Anonymous swore by. Give yourself three seconds–that was the rule. Give yourself three seconds, acknowledge the trigger, then watch those thoughts and feelings drift by, mindful of their power, but make a choice. “George, you have choices,” his therapist exhorted. George returned a sad, defeatist look, but nodded agreeably. Now he tried to put the rule into effect. Think of the consequences. That was the next part; the next “tool” to use. The problem was guilt. Consequences? Too late, the consequences are already here, he answered sourly. Ever since Jean had caught him with his pants down, with a white towel over his ass, lying face down on that padded couch in that sordid office, sipping that honey tea supplied by…that woman; that sexy yet unglowing woman whose happiness was actually not important to George. The fleeting visions of supple skin, conjured smells of delicious oils, and hardest of all to summon, the tactile sensations of friction, were now coupled with stinging self-rebukes…George’s self loathing. Somehow, back in the therapist’s office, listening to sage, asexual counsel, he’d forgotten to ask the most important question: what do I do with the guilt? What he asked instead was a question about Jean. As George glanced tentatively in her direction, he thought of the urgent question that dominated the previous session: how do I get her trust back? he’d asked, to which the therapist was non-committal and borderline dismissive, insisting that such things were impossible to predict and that trust wounds, in his experience, were always mutual, or something like that.

George’s eyes fixed upon an overhead compartment several seats down which seemed loosened from its catch. As an attendant walked by George thought to flag the man down, alert him to the problem, the prospect of luggage tumbling out and possibly hurting someone. He’d strike an earnest tone in his voice, make sure to emphasize the threat to passenger safety; make sure that everyone–especially Jean–knew that he cared. But the moment passed. The attendant skipped by as though distracted, his impassive expression glancing over the heads of passengers all around him; past the eyes of George Lewis and out the window next to his seat. The loose compartment made an insistent clicking sound and its cover tilted outwards by an inch. It’s leaking, thought George, transferring more terms from recent therapeutic pedantry. That compartment: they think they have it locked. They think it’s airtight and that everything’s safe and tucked away, but it’s not. George knew that now. Why hadn’t he known it all along? After all, it wasn’t as though he’d not dreamed of the worst happening. In fact, he’d felt it in his gut, the foreboding. If only he’d trusted his…

He glanced at Jean, still determined not to speak to him; perhaps determined to never speak to him again. He felt a chill and stood up tall, looking over the tops of seats, over the heads of noisy teens, and into the distance. An attendant at the end of the aisle was half on a phone near the cockpit, half pleading with an agitated male passenger to return to his seat. Around them there were murmurings, and within earshot, barely, there were emerging fears rippling through the cabin, and more numerous observations of drifting, grey plumes of smoke from an area just beyond the airport control tower. Not clouds. News was filtering through the plane of something big. Someone was on the internet, disobeying the captain’s orders, which had asked for all electronic devices to be cut-off in anticipation of a take-off that was imminent a half hour earlier but now delayed indefinitely. George Lewis started to become suspicious. Reflecting on his therapist’s words, he realized he was not feeling the trust.
            “Sit down, George,” Jean said irritably, though unlike him, she seemed unperturbed by the growing unrest around her. Denial. Good, George thought: she’s still speaking to me, at least. 
            “Sorry,” he replied to her.

At that moment, the captain’s voice sounded out over the intercom, his voice now sounding more tired, not bored. The flight to Mexico City with connection to San Jose, Costa Rica, was regrettably cancelled, he announced–the result, he declared, of an airport closure in Mexico City. He followed up with some rote instructions about how to redeem ticket purchases at the airline desk in the terminal. George was half listening, and now peering out the window by his seat, just like the boys in the seats in front of him. Like a frightened child, he pressed his face against the window, straining to look through the thick double plastic to the sights behind him. He knew now that something unusual had happened. Something horrible: something the captain, and perhaps many others would not talk about for a long time.

* this short story is not based on real events, or real people. If you like this story, perhaps you might read the synopsis of my psychological fiction, entitled Crystal From The Hills.  
 

1 Comment

Filed under Uncategorized

Tagged as , ,

July 15, 2013 · 9:04 am

Sex Offender Treatment: Just Say No to the Dodo

 

Talk about reductionist thinking: try this corner of the mental health industry. It’s a dark little corner, where the journeymen and women of our profession go…because someone has to, supposedly. Not that therapists are wanted, necessarily. As in the treatment mileus depicted in my book, Working Through Rehab: An Inside Look at Adolescent Drug Treatment, administrators and directors of SO treatment programs, or the “supervising officers” (euphemism for correctional officers) that are actually in charge of the three-headed mon–sorry–treatment team, want straightforward instructors for implementing of program protocols. They want containment based upon a structured approach designed to elicit successful behavioral outcomes–a teleological perspective.
       Recidivism: the repetition of offending behavior. That’s the operative concept in sex offender treatment: the standard by which this entire arena of care is judged, or will be judged, if it is indeed on trial. And why not? you may ask. Surely the problem of sexual abuse needs to be addressed as aggressively as possible, with a behavioral lens front and center; with recidivism the criteria for assessing everyone in the process, participants and providers alike.
       The problem is with the research, and thereafter with the spinning upon said research for anxious listeners. At a recent presentation of sex offender treatment protocols at a CCOSO (California Coalition on Sex Offending) conference, I listened to program officials assert the need to implement a structured treatment program consisting of an RNR (Risk Needs Responsivity) model, in conjunction with Cognitive Behavioral Therapy (CBT), and that unstructured psychotherapy (unclear what that was referring to–perhaps the aforementioned “Freud stuff”) was contra-indicated (meaning, ill-advised), because its methods were not associated with a significant decrease in recidivism. By RNR model, presenters were alluding to the work of criminologists Don Andrews and James Bonta, who outlined what are termed dynamic risk factors central to treatment, alongside corresponding so-called criminogenic needs. The list of factors include some of the following: antisocial personality, antisocial cognitions, social support for crime (meaning, friends or family with criminal attitudes), impulsive behavior, family dysfunction–again, such as criminality, low education. Other factors of ancillary importance are early childhood negative experiences, family of origin stressors, age, gender, and ethnicity. Spot the issue yet? Well, the likes of Ward, Melser, and Yates (2007) did, opining that the RNR etiological theory was too general to explain criminal conduct, and as a result, was unfalsiable–meaning, not especially useful.
        As for recidivism, the research here is generally thin and unconvincing. According to Duwe and Goldman (2009), a reduction of 18% in sexual recidivism existed for one in-prison treatment program. But researcher Stephen Brake, who in 2010 published his examination of 37 studies of sex offender treatment outcomes conducted over a quarter century, found that only 41% of such studies indicated reductions in recidivism, with 37% not significantly reducing recidivism, and a remainder of studies indicating mixed, partial evidence based upon different factors (violent versus non-violent recidivism, for example). Overall, it’s been known since the early 90s (via federal reports) that sex offenders exhibit among the lowest recidivism rates (4-12%–tracked over 5 years), compared to other criminal profiles. But it’s unclear whether such findings can be attributed to specific treatment models. The authors of another meta-analysis study, Losel and Schumacker (2005), concluded that there is a significant effect of treatment on recidivism, but the studies they examined indicated treatment programs that featured not only CBT methods, but also surgical castration. Pardon me while I imagine the principals of each intervention strategy arguing over whose method worked best.
       Several critics point out basic problems with research into sex offender treatment: findings that indicate as much effect upon recidivism for no-treatment versus treatment; inadequate control groups; the fact that sex crimes are the least reported types of crimes (thus confounding statistics on recidivism). Add to this discrepancies in study designs, outcome measurement protocols, time-frames for follow-up, and what researchers have is a messy globule of information that strains against the community’s desire for straightforward action. Critics of the RNR model point out its limitations: the opinion that attention to criminogenic needs is insufficient, and that attention must be paid to individual needs, self-esteem issues, personal distress; that treatment alliance is an unassailable factor in positive treatment outcomes. Amen, I say. However, these are borderline heresies for those presenting on the topic of sex offender treatment, for sex offenders aren’t really allowed to talk about personal distress and low self esteem–at least, not until they’ve admitted to all of their crimes and then said they were sorry…like, really sorry. And so, with all this in mind, I wade into this dodgy realm of care, becoming a ‘certified’ provider of sex offender treatment. Why? because I have some clients who fit the profile, and because they are people about whom I care. I’ll nod my head at the pronouncements of those looking to codify practices and reign in the unconscious. I’ve got my eye on the Dodo.
* Stephen Brake (2010) The Effectiveness of Treatment for Adult Sex Offenders.

* Ward, Melser, and Yates (2007) Aggression and Violent Behavior, 12, 208-228.

* Losel and Schumacker (2005) The effectiveness of treatment for sexual offenders. Journal of Experimental Criminology, 1, 117-146.

1 Comment

Filed under Uncategorized

Tagged as , , ,

July 11, 2013 · 9:39 pm

Letter to a therapist friend

 

Hi, sent you a message a few nights ago, haven’t heard back, which isn’t like you. I’m not taking that personally (unless I should be?), but I thought I’d reach out again, imagining you may still be feeling hopeless, as you were last month, mostly because of work. 
I hope this doesn’t sound self-serving, but I think my modest, self-published book about drug rehab and community mental health as a whole does provide hope to those who work in this business. Many like yourself are smothered by the platitudes of directors, administrators, and so on while otherwise feeling technocratic shards of glass pierce into their sides. I felt in your reaching words something(s) unachieved in our world: passion, bravery; risk inflected with humility. I could feel it in your depiction of that unsatisfying exchange with your manager. A “nice” man, you said. It reminded me of something an old SN once said to our group of supervisees in the three-year program: “there’s nothing nice about being nice”–it was in response to a fellow student who was struggling to manage frame issues, and justifying a lack of confrontation by declaring that confrontation was…well, not nice. In my book I am scathing, I think, about rigid adherence to procedure–the tyranny of the HR manual–when not just common sense, but common thoughtfulness, decency, but above all realness, is called for.
 
There are times when I think that the Masterson model can truly be distilled into these qualities. I reflect on my caseload at any one time and I think, with whom  do I feel spontaneous? who do I really know? what connections feel real to me? More often than not, the best work feels like a jazzy, flowing sense of knowing…something that feels right. That may sound a little soft, and a lot unreliable. It certainly doesn’t sound very “evidence-based” or scientific, or “quantifiable”. But the thing is this: it sounds reliable to me. The reason? I trust myself, whether others do or not. Doesn’t that sound wonderful? Doesn’t it sound like a gift, or a real achievement, if I’m to give myself the credit for doing the work. I’m not saying I’m getting it right with all my patients. I’m saying I can tell who I’m getting it right with, and who I’m not getting it right with.
 
I agee that being in the quadrants is tantamount to being unsober. I think this was the basis for our original discussions about blending the Masterson model with a 12-step program. I’m working on myself as I flit in and out of defenses; my therapist is fighting me, I think–thinks me defeatist in my self criticism. Among other things, I defend the hard but fair pronouncements that KS made of me last year. I realize that his cool yet cutting approach stirred something vigorous yet frightened in me. It all lingers, the hurt. I was surprised to read that you “identified” (with being seen? or the “bad” experience you referenced), as I specified being seen in a manner that felt menacing, even sadistic. Did I misunderstand you? Were you writing of being scrutinized, and by KS in particular?
 
You wrote of vulnerability in your last e-mail, “to the toxic foolishness”. I identify with this vulnerability, though I think I have some of the detachment you crave. I’m not entirely free of bad systems. Indeed, there are one or two that are threatening to ensnare me in a fight currently (perhaps more on that in a later e-mail). But TR is nearly two years in my rear view mirror, and completing the book has been, dare I say, cathartic. Anger is draining, despite the sneery, superior tone sometimes evident in the book and especially within this accompanying blog. Whether a handful of people read it (the book), or hundreds more do so, I have cleaned my own internal system of the toxic entity that once dogged me. I have gotten some peace. Like a Schizoid personality, I also have a fantasy, which I’ll share with you: you see, in the future, I imagine achieving a modest, measured (compromised?) fame for my lengthy missive to my peers. I’ll be asked what I think should happen in drug rehabs for adolescents; perhaps what should be happening in all community mental health settings. On the specifics I’ll defer, I think, as I choose to disentangle from Gordion Knots, practice something like a second step, and wait for help from those on the inside. I don’t want to abandon. I don’t want others–least not people like yourself–to give up hope. I just think I need back-up. I need the real selves to present in numbers.
 
Graeme

Leave a comment

Filed under Uncategorized

Tagged as , , , , , ,