Tag Archives: psychotherapy

What is always there

 

But seriously, the “project” that was once psychoanalysis, or now psychotherapy or whatever, has been disrupted by Covid-19. Telemedicine, Telehealth, Telepresence, is here to stay, according to some. This is a watershed moment, a bump or a shove into the next paradigm. No going back? Well, I won’t be the only one kicking and not quite screaming, but rather only moaning and possibly sulking. I’ve lost one or two from the caseload: people who perhaps think the virus scare is not what it’s negatively cracked up to be. Or—here’s a thought—maybe they think I’m not all I am positively cracked up to be, and therefore the crisis that’s upon us is a pretext for a separation. Neurosis aside, this situation is not what I trained for. Something’s missing, and something else has been mobilized in response. Temporally appropriate feedback. That’s a term I heard yesterday, used to explain why the phone, the latest video technology, the e-mail, and even the text message might be used for a psychotherapeutic exchange and why the fax machine never was. It wasn’t quick enough, basically. That’s what temporally appropriate feedback means, by the way. Yes, I know. Talk about unnecessary verbiage, someone’s dissertation nomenclature. Anyway, whatever’s happened overnight, it seems tailor-made for opportunists, entrepreneurs; futurist thinkers with a survivalist edge and a nose for the front of a line. I’ve thought about my peers, even some of my colleagues in all of this. Some of them belong in the jungle, I think, pulling at the bamboo, or squeezed into a tight gap beneath a fallen hut or an all-terrain jeep. They have grease on their hands, an ample toilet paper stash, and numbers dancing across their mirrored pupils, for they have versatile, fix-it aptitudes, which means they navigate well all the toys that mediate contact with the material world and which are derivatives of the childhood games they played better than anyone else.

What is always there is never noticed until it is missing, said Jose Bleger. That’s another of those psychoanalytic aphorisms that are meant to stir thought if not practical solutions. What is it that was always there? I have wondered aimlessly instead of, say, moving to use Venmo, or signing up for What’s App, or whatever, as if those were the clues. I don’t skip along a trail of newfangled ideas the way that others who…don’t use words like newfangled and therefore don’t have issues with planned obsolescence, come to think of it. I thought I had an idea, dull as it may seem, of what was and is always there: the analytic frame, manifest as the office space, with a door leading to a waiting area wherein a would-be patient sits and waits for me to open my door and beckon them towards me. It sounds more authoritarian than it is. And it seemed like it still had a few years left in it, too, as paradigmatic frameworks go. Now it isn’t there. Or, it is there but it seems like an abandoned warehouse with a faintly stale air about it. Recently, I’ve not been getting my money’s worth out of my office. It collects mail, a bit more dust than usual. I can go there once a week and make a phone call from it if I like, but it’s not the same. The nice view from the window’s not the same. There’s no collegial hum across the walls that connect to other suites. There’s nothing charming anymore about the rickety elevator that takes me to my floor, or pleasing about the sudden abundance of parking spaces in the adjoining lot. And after the first week of lockdown—not even the consolation of a few toilet rolls to steal from the bathrooms. What was always there? I haven’t figured that out yet, but like a good would-be analyst, I am thinking, still wondering.

Meanwhile, I am thinking of bigger things, philosophical, mindful ideas. Phenomenology, I think. I’m reminiscing, at least, if not deepening. Back in 2001, I thought 9-11 was a fine how-do-you-do to the 21st century. Now I think that episode less an introduction to doomsday than the residue of the last century, with all of its terrorizing, authoritarian ghosts. Not that we don’t have plenty of nutjobs these days, but you don’t beat the 20th century for tyrants and martial horror: two world wars, a couple of nuclear explosions (not counting the tests in the Pacific and the deserts of the American Southwest); Hitler, Stalin, a few other genocides, assassinations all over the place, at least one war that America lost. Seriously, a total s—tshow. But 9-ll, which made household names of Al Queda and a guy named Bin Laden, seems today like a distant memory of airport inconvenience and yesteryear jingoism: a tough deal for anyone sniffing at a military life, but for the rest of us, not the economic and civil collapse that stares at us now. Images of twin towers burning didn’t make the cut of my recent Dr. Strangelove video, with its “We’ll Meet Again” montage of zeitgeist existential threats, 2020-style. Not topical. Scenes of floods, wildfires, stranded polar bears and penguins on thinning ice were the visual accompaniment, not the cold war terror of mushroom clouds or the once Arab stereotype of airplane hijackings. Covid-19 snuck into the slide show with the odd picture of a solitary figure wearing a hospital mask amid empty landscapes, signifying for me, anyway, the ubiquity of the virus’ impact: the live presentation I was meant to give on Strangelove was canceled, after all.

The ‘live’ has always been there. Nature has always been there, and the notion that it won’t be has long felt like an abstraction, despite the slide show of evidence to the contrary. It’s trite to point out that nature is unforgiving, getting its revenge upon us now or else teaching us a lesson, perhaps in the nick of time, depending on what climate change scientists actually think and wonder. It’s further trite to distill the Bleger reverie and consider that what is always there is a warning to not ignore the signs of danger; to notice the impact of phenomena upon others, environments, even things. Indeed, it stirs shame to consider that Covid-19 has aroused more fear, more loss, or more determination than any other modern calamity simply because, unlike any other world event one might remember, this has truly impacted everyone to one degree or another. I conjure the grim-faced, somewhat unsympathetic gaze of those who have known and felt war, environmental catastrophe, unspeakable man-made atrocities or the constant slaps of racism and other oppressions. They may be quietly saying, Oh, so we’re all in this together now, are we? Maybe some of them got a head start. They’re like California, or North Korea or Singapore, or whomever else might have done this thing right. They were and are good with the things, and technology, that which mediates and distances us from nature, enables, intrudes, obstructs, complicates, and yet may save us. It helps…sort of.

 

 

 

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It’s high time

 

It’s been several centuries since the Sunni Persian poet Rumi waxed lyrical about the value of wine. Intoxication, escapism from anxiety: these were venerated effects once, before the medical or psychological problems related to drugs were apparent or widely known. Ancients bemoaned excess, thinking drunkenness shameful, but they also observed in humans the drive to change consciousness, as important perhaps as our drives towards sex and aggression. We seek freedom from oppressive thoughts, inhibitions…that problem of what others think.

I’ve long felt ambivalent about what intoxicants promise, regardless of what the medical or psychological consequences are. The tacit principles of psychotherapy extol the values of altered consciousness, but through natural means, not via the imbibing or inhalation of a foreign substance. Further, therapy implicitly encourages the exploration of anxiety or depression—the staying with pain—not so much its alleviation, or the substitution of it with pleasure-seeking. These values place my professional (or at least certain sections of it) at odds with many who are not interested in learning about their pain, and therefore addiction or dependency treatment represents a huge faction within mental health services. Implicitly, most of us in this field are wedded to sobriety, and professionally at least, suspicious of so-called altered consciousness, as induced by chemicals. Fortunately, growing knowledge about marijuana, for example, enables a different discussion: one that focuses upon pain, not consciousness. Increasingly, intelligent choices can be made about the types of pain that should be medicated, and those that shouldn’t.

Medical marijuana, or Cannabidiol (CBD), is one of a hundred plus cannabinoids that binds to cannabinoid receptors within the immune system, whereas Tetrahydrocannabinol (THC) binds to receptors only within the central nervous system. That distinction has only been known for a few years. THC has intoxicant qualities—a ‘high’—and impacts various areas of the brain, including the basal ganglia (impacting movement), the hypothalamus (hunger), the hippocampus (memory), the cerebral cortex (reality testing and perception), as well as the medulla, which mediates the experience of pain. That marijuana disaffects short-term memory should remind us that in the context of PTSD, for example, or even certain aspects of grief, we might consider that ‘forgetting’—ordinarily an aversive symptom—is a propitious, as in welcome option. CBD does not get a user ‘high’, nor does it increase appetite, and can (unlike THC) treat rather than stir anxiety or psychosis. As an anti-convulsant, it can also be effective in the treatment of epilepsy. However, it can be counterproductive with respect to eating disorders (because it doesn’t stimulate appetite), and ineffective in treating depression, because it blocks THC from producing feelings well-being.

Research indicates that marijuana, whether in configurations of THC or other cannabinoids like CBD, places teenagers, and specifically males aged 16-24, most at risk for addiction, as that is assessed via DSM criteria. Adolescence is a tender period of life, for sure. We all remember what it is (or was) to worry about what others think, especially as a teen, and perhaps males are less socialized to talk about this–that’s the chestnut theory, anyway. But this vulnerable population constitutes just less than 10% of estimated marijuana users in this country. Now that 28 states have legalized use and possession of marijuana, and that legitimate medical uses for CBD have been established, it seems time to remove non-habit forming marijuana from the federal list of Schedule 1 narcotics (for which lack of medical application, plus abuse potential, is a criteria), and to block what has long seemed a tertiary, social effect: the indirect persecution of the black community via the pretext of illegal marijuana use and possession.

As a therapist specializing in addictions treatment, I have long dodged the legalization debate, especially when speaking to clients who are externally motivated to abstain. The legality question has always been in the way, it seems. The real questions—the ones that will persist over time, are the following: what do you want to do about pain? How do you want to raise consciousness?

Graeme Daniels, MFT

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More things in heaven and earth

 

I am watching it. I am compelled, and I should not be writing of this while I know so little, while so much is unexplained. But that is my life, my “subjective” reality: the unknowing. And not knowing doesn’t stop me from writing or doing my job.

I am four episodes into The Leftovers, an HBO series adapted from a novel by Tom Perrotta which is set in the aftermath of a rapture-like event in which 2% of the world’s population has inexplicably disappeared. October 14th of 2011, is a 9/11-style shorthand for a mass “departure” that scientists can’t explain. This results in a social malaise that recalls P.D James’ Children Of Men. In that novel (also made into a film), the world’s population has become sterile for similarly mysterious reasons, and in the aftermath an aging (and therefore dying) population is variously depressed or psychotic. Cultists speculate that mankind is being punished; that its hubris, perhaps manifest as a privileging of science, is to blame.

In Leftovers, the focus is not so much on a failure of science as it is that of mainstream religion. Major denominations are nowhere to be seen. A baby Jesus replica is stolen and later desecrated by the acting out daughter of a local police chief of a grim, middle-American town. Baby Jesus is later returned, but significantly, the response is indifferent, and the police chief ultimately dumps the rejected figure on the side of a road. Meanwhile, cultists are represented by a group call the Guilty Remnant, a name reduced to the letters GR until episode two. This tidbit of withholding is typical of the series thus far, which parallels the air of unknowing by minimizing exposition, thus keeping viewers in the dark, and not just about the headline departure, but also about personal details. I am gripped, but optimally frustrated—the essence of suspense, I suppose. Four hours in, I am yet to understand the following: why do all the followers of GR smoke (an ironic play on ‘don’t waste your breath’?) Have the departed transformed into dogs or birds, creatures of either violence or passivity, as is also suggested? Why do the dreams of some enter those of others, as indicated by the profusion of nightmares featuring strangers and foreshadowed events? Why is the police chief estranged from his kids and his wife? It seems implicit that something happened, and whatever it was, it happened before the departure.

It’s just a story, after all: a good one that promises more about meaning; perhaps how religion, ostensibly exiled, has a defiant, parting comment on humanity. The stories of those who enter therapy are good stories also, and the details are likewise often obscured; divulgence of truth, not to mention meaning, is delayed. It is a feature of projective identification, a primitive defense yet more ubiquitous than most imagine, that individuals communicate in fragments: through play, language that is reduced to slang, idioms and inside jokes; by ‘acting out’ infused with terse revelations; by somatic displays that medicine can’t explain. Symbolic expression, via the articulate, coherent use of language, has broken down, though it may repair and unfold over time. Unpleasant emotion is dissociated, replaced by a standard of flatness and baffling obsession. When something has happened that is traumatic and not understood, life goes on, promise onlookers. It goes on with ritual, structure; with substitute things to do that mark time but also betray, in pieces, an epistemological drive.

The police chief of Leftovers loses his bagel in its inadequate incubator, and he’s not gonna take it lying down. He bemuses colleagues by not giving up on the search: for his bagels, for that baby Jesus. He finds the bagels also, eventually, through a semi-violent dissembling of machinery. They were stuck in back of the toaster, trapped in a secret passage, burnt. As the chief pulls them out, he sits back, moping over burnt food, dead…something. He is mildly relieved, having discharged energy from a nagging mystery. He is also depressed, aware that mysteries will keep coming, and that unfolding reality may yet be horrific. “Say it! Fuckin’ say it!” he later cries towards the wife who won’t speak, won’t explain. But she wants to leave him, she writes, giving an answer. It’s not enough. He pleads to know why. About everything.

 

Graeme Daniels, MFT

 

 

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The Adventures of Process Man

 

Rick sat on a stool adjacent to his parents’ kitchen, indulging his father’s Sunday night oratory. Tonight, it was about the latest kitchen renovation, proudly completed just in time for his adult son and his wife’s latest visit. Across the way, Rick’s mother was bending Amy’s ear about something which left Rick’s spouse glassy eyed and feigning rapt interest. Rick’s father was a more insistent speaker. To properly placate him, Rick would need to affirm every sentence with a nod, an appreciative hum, or an occasional query indicating sustained curiosity.

“See how it opens up the space and you can look out into the living room, speak to your guests if you want, carry on a conversation while you’re preparing some food.”

“Yeah, it’s great, dad. Really. I can see how it’s gonna work for you.”

“Well, you might wanna think about it for your own place. I could give you the number of my guy. He’d give you a good price, or if you like, we could help you out. Call it an early Christmas gift.”

“It’s April, dad”

“So what. It’s a very early Christmas present.” This was Rick’s mom chiming in, and releasing her daughter-in-law for a moment. Rick and Amy exchanged a furtive glance.

“Yeah, I don’t know,” Rick said with diplomatic caution. He wore the kind of placid smile that he’d been sporting with his parents since his late teens.

“What’s to know. Look, it’s up to you, but see how it opens up the whole place. I’m thinking about your kitchen. You’d be crazy not to do something like this. Look, you can…” Rick’s dad basically repeated everything he’d said three minutes earlier, only now Rick made less effort to oblige him. It was an old pattern, an old diminishing set of returns. While he hung his head, his father continued. Opposite him, his mother resumed her monologue with Amy. Rick sighed.

A flash appeared in the center of the room, accompanied by a plume of smoke but leaving in its wake a muscle-bound, toothy and earnest figure.

“Hi!” said the ephemeral, masculine image.

“Process Man! What are you doing here?” asked Rick

“Who? Who’s this?” asked Rick’s dad, dumbfounded.

Rick quickly collected himself. “It’s Process Man. He’s a legend. He helps people with communication problems—tells them what they’re saying to each other beneath their content.”

“What?”

“That’s right, Rick,” the figure affirmed. “I am Process Man and I am here to help you understand what you’re REALLY saying to one another.” He turned to face the awestruck women. “What you all are saying to one another”

“Wait a minute, what’s going on here?” protested Rick’s dad.

Process Man began his sage lesson, unperturbed. “You see, Rick, what’s being offered here is a parental gift. Your father has money and advice to give you, and will only be satisfied when you allow him to make this gift.”

“I know that, Process Man, but—”

“But what you don’t know or realize fully is that this conversation isn’t over until you give unequivocal support for the idea. That’s why your father is prepared to repeat the information, and will keep repeating it until you agree. He’s the one who decrees when the communication is over. That’s what he’s saying.”

“You know, you’re right,” Rick enthused.

“Wait. I—”

“And Dad, you probably understand that your son’s gotta consult with his good woman, who’s over there listening to your good woman, loyally absorbing the mother-in-law’s words. But what you don’t fully know is that Rick needs to make up his own mind, and the more you repeat your lessons, the less he’ll take in what you have to say.”

“The law of diminishing returns,” Rick’s dad intoned soberly.

“That’s right. You understand.”

“Thanks, Process Man,” said Rick.

“Tell a friend,” said the figure as he and the smoke disappeared.

 

 

 

 

 

 

 

 

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Personality Disorder: the other way (part two)

 

I want to blame someone. James Masterson did also, I think. He will have argued with many over what comprises a real versus a false self, or a personality disorder—whether such a thing exists with some. Were he alive today I think he’d argue with proponents of trauma model, and possibly with authors of novels like The Woman in Cabin 10. Not that these people don’t think that personality disorders exist. They simply call them something else, because mental health services, like any commodity, ultimately, is not just something to be validated by research, or—sorry—evidence-based research. It is something to be sold to the public.

For the average consumer of psychotherapy, a diagnosis of trauma, whether that trauma is episodic, chronic, the result of fatefully aberrant events or an aggregate of quaintly termed little ts that shape development (the theorized etiology of personality disorders) is simply more palatable. The word connotes victimization by an external agent, and thus a diminished responsibility for the sufferer. Treatment encourages a present identity of a survivor (very popular), with a possible future of healing. It’s a meet-them-where-they’re-at-thing. Regarding etiology, the accent is upon recent, precipitating events, with an intellectualized nod towards distant antecedents, that complex internalization of others which blurs a simplified reality.

Trauma model practitioners pay lip service to the antecedents of trauma. Prominent authors even co-opt object relations theories without crediting them, and repackage (reframe in the jargon of the field) personality disorder as something like developmental or relational trauma. A good example is featured in Barbara Steffens’ Your Sexually Addicted Spouse, whose target readership is evident by the title. In her text, Steffens describes PTSD as “something that can last a lifetime”, and that relationship trauma entails “painful coping mechanisms ingrained in personalities” Study the work of Klein, Fairbairn, Mahler, Winnicott, Masterson or Kohut and you’d hear the echo of their theories in such pop psychology literature: that psychic pain is integrated into personality over time, generating a disordered self in which such pain is habitually defended against in relationship.

But again, while trauma model educators pay lip service to old patterns, they mostly ignore it in treatment. The reasons are two-fold: A.) Treatment doesn’t last very long in this model. It’s a two week stay in a group home of some kind, or an eight-week course at your nearby hospital. B.) Discussion of problems is intellectual, academic—therapy as education. You’re given homework, even, to solidify the association with school. This is organizing, some say. Stabilizing for the unsafe person who cannot, it is presumed, manage complexity, the uncertainty of not knowing more deeply why something is happening. They are unable to weigh or contemplate their own mind alongside those of others, which are similarly complex, and implicitly dangerous. This danger is cast as objective reality, and anyone who says otherwise is “gaslighting”. Thus, treatment prioritizes affect regulation techniques and procedures, not the contemplation of self and other; it advises the practice of coping skills, self-care activities—all of which is worthy, actually, as adjuncts to growth. Meanwhile, the model’s adherents suggest that the afflicted let go of the actions, opinions, even the feelings of difficult others, while attaching labels. Fuller contemplation is put off until some ambiguously later time, when the person may be deemed ready. I think that readiness is seldom achieved. Time passes. It doesn’t so much heal as fossilize thoughts about self and other. What’s difficult to let go of are the pat understandings imparted by practitioners who recycle the same lessons in one short-term treatment episode after another.

In a longer-term therapy model, individuals inhabit their adult roles and live their lives as opposed to dropping out of society and going to school. They are challenged to do more than learn how to self-soothe or calm down, or take time-outs when mad, or to leave that bad relationship that your friends all think is wrong, only to start another one that’s similar because you haven’t learned what you got from that bad relationship. Instead, some learn (or are challenged to learn) to hang out with confusion, the grey areas of day-to-day life; to tolerate discomfort, stay with the difficult, as Masterson was once quoted as saying. Reality is learning about one’s own mind and being open to those of others, especially those that are not so easy to detach from: bosses, spouses, children; the memory of those absent but still profoundly influential.

What’s your pain today? Who or what do you want to blame, talk about instead of understand; focus on instead of yourself? Do you really know what your pain is about, what it’s backstory is—it’s underpinning? Do you think you really know the story of others? I know. It’s not what you (I’m) thinking.

 

Graeme Daniels, MFT

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Holden Caulfield would understand

 

Final day of 2016. Possibly the last time I will focus on my most recent novel, the one featuring my most cryptic of titles, Venus Looks Down On A Prairie Vole.

“What the hell is a prairie vole?”, complained one reader, who further implied that he didn’t like obscure metaphors in popular art–that is, until I pointed out that his favorite book was Catcher In The Rye, and that his favorite film was To Kill A Mockingbird, and that his second favorite was One Flew Over The Cuckoo’s Nest.

“Fine, you’ve made your point,” he conceded, only to add, “But pretty please, so I don’t have to bother Wikipedia—what the fuck is a prairie vole?”

“Fine,” I replied. Fine, I think finally: I will explain more pointedly, more comprehensively than I have before, my oh-so-obscure metaphors. I guess I’ll start with the second one: a prairie vole is a monogamous rodent. I’ve written that before and left it at that, feeling cheekily evasive. But there’s more, of course. I learned about prairie voles a couple of years ago, from the book The Compass of Pleasure, a non-fiction about addictions, whose author, David Linden, wrote with similar cheek about creatures that didn’t fit the masculine stereotype of wanton promiscuity—hence a passage about prairie voles, who not only put a ring on it and devote themselves to one partner, they behave aggressively towards other females who impinge. How romantic. What real men prairie voles are.

The latter trait doesn’t necessarily pertain to psychologist Daniel Pierce, my recently widowed and ever faithful protagonist—at least, not until he meets Lira, a former prostitute antagonist, with whom he engages with tense debate, contesting her careless feminism, which underlies her effort to expose one of Daniel’s patients, who is accused of child abuse, among other things. Because of Daniel’s resistance to her, Lira presumes his solidarity with masculine license, and is only mildly convinced by his grief-stricken diffidence, and much less by his ethical stance on privacy. Still, over the course of the story his reluctant attraction to Lira becomes evident, adding to the air of sacrifice in his character.

Which leads me to the other metaphor, the less obscure term, Venus. No one has asked me about the meaning of this one, which is disappointing on the one hand, and mildly gratifying on the other. I guess that readers get the idea. I think. Anyway, though I believe most readers are aware that Venus is Roman mythology’s answer to Aphrodite, and means goddess of beauty and love, what may not be entirely clear is the term’s relevance to the story.

Well, firstly, and most sentimentally, Venus is a reference to Mary, Daniel’s recently deceased (from cancer) wife, who is “looking down” upon her ever faithful husband, lovingly. You’d think this alone might render Daniel likable, or at least sympathetic, and thus gird him from the wrath of readers who might (like Lira) upbraid him for not later doing the right thing, from an average point of view. Because the average view is that therapists and other mandated reporters can and should, if they have the information, violate their patients’ privacy if said information might help the investigation of child abuse and thus yield the protection of children.

Daniel rejects the simplicity of this argument and therefore represents, as my hero/anti-hero, what I imagine to be one of, if not the most unpopular position that any responsible adult might take in today’s society: the protection of a possible sex offender’s privacy. I was acutely aware when I was writing Venus of how this might affect a reader’s sympathy for my central character.

And as a male writer with a male protagonist, I position center stage the opinion of women, especially. What does Venus, the symbolic everywoman, think of Daniel? Would she think him a hero? Probably not. Merely decent? Maybe. Look down on him, so to speak? Would it be enough for Daniel, to be considered decent? Is being decent enough for men? For Women? It seems to me that many in our culture are reappraising heroism: what counts as heroism—who gets to be a hero. Women seem to feature in more traditionally heroic roles in cinema these days (note the deliberate effort in the Star Wars series, for example), so a millennial, unlike a traditionalist, might chide Daniel for being cowardly, but not rely upon him, necessarily. Lira, for instance, will pursue her cause with or without Daniel’s help. She might not need men anymore, though—and here’s my truly final (not to mention obscure) spoiler—she might join them.

 

Graeme Daniels, MFT

 

 

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The old scripts

 

A man sits in a conference room, chatting collegially with a pair of co-workers, ostensibly leading a meeting. Technically, the man is in charge, but he prefers to keep things informal, not throw his weight around. Soon they will be joined by another man—everyone’s boss—who appears to not have such reservations. As a kid, he will have been a problem, this man: if not an out-and-out bully, then maybe just a nuisance; tagged as having attention deficit disorder, and needing a good dose of meds in order to follow directives, play well with others. Today, an observing psychiatrist might say he has poor audience; meaning, a blind spot keeping him from knowing where he treads. A less generous opinion would be that he doesn’t care. He walks into a room and simply expects people to drop what they’re doing and focus on him. It’s how he got to where he is, he might say. His turn to give directives, direct play. That is, if he notices.

The first man has had a different life. Until now, his once subordination to either bullies or the inattentive has been dormant. He’d worked hard, quietly achieved a certain status within the organization, and earned his graduation to civil society, mostly spared the obnoxious company of autocrats whom he’d suffered plenty enough as a younger man. When the boss walks in he begins talking louder than anyone else, instantly turning the heads of everyone present. That other collegial exchange is now relegated in importance, which immediately stirs in the first man a dreadful anger. What is this feeling? the man wonders…later. In the moment, his thoughts go blank as his adrenaline surges, followed soon by a chill sensation. Bad, implicit memories. Anxiety. The resultant compromise between states is a halting, passive, as in barely discernible complaint: “I guess we’ll postpone our talk until later.”

In models of psychoanalytic psychotherapy, espoused by the likes of James Masterson, treatment proceeds with the following assumption: that individuals develop self and other representations, based upon an accumulation of experience of ourselves in relationship with others, which in turn forms a psychological structure that is activated in times of stress. Our explicit (conscious) and implicit (unconscious) understanding of ourselves and others is an aggregate of our object relations (experience with caretakers), derived from early development, and nurtured over time. The task of therapy is to make sense of one’s own mind and that of a therapist, even though manifest content tends to eschew focus on the therapist, especially early in the process.

Self identities—meaning, strategies of being in relationship—are often fixed and rigid by the time therapy begins. They constitute a way of getting by, but not of growing, or of being happy. A kind of quantum phenomenon collapses time, disorienting the distressed patient, who experiences new stressors with an old psychological structure, and therefore people are dimly reminded of unfinished business, though presented with fresh choices. Though I am few people’s idea of an autocrat, I might tread on toes this day, and look into fleetingly bewildered, scared eyes; hear the opening strains of quickly defended selves. I wonder what they’ll say.

 

Graeme Daniels, MFT

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Another three minutes with the CAMFT board

Graeme Daniels, MFT

These CAMFT board meetings: they happen three or four times a year, in hotel conference rooms up and down the state, always on a Saturday. The board of the California Association of Marriage and Family Therapists consists of a dozen members, men and women who don’t talk like therapists, but rather business people or lawyers. They don’t even seem to think like therapists, but for three minutes at a time at the outset of these all day gatherings, they promise to listen to therapists.

Being listened to is not something I expect, necessarily. Recently, it’s been hard going, getting others to take things in. There are clients as well as certain others who don’t return calls. Publishers and agents who won’t respond to e-mails. Even Pete Townshend, who asked to meet me after my Tommy paper got published, didn’t have much to say and walked off before I could start a conversation. Why? I wonder. Why am I so drawn to unavailable men? Anyway, at eight-thirty on a Saturday morning, my friend Ben and I showed up at a San Francisco hotel ready to be listened to, about AB1775, that stupid child porn law I’ve been blogging about, and—from Ben, mostly—the problem of insurance companies not paying claims. That’s actually far more serious, I later thought after hearing him speak.

At eight thirty we were ready to take part in one of these ‘members forum’ segments of a board meeting. They are supposed to last thirty minutes and proceed on a first come first serve basis. Wading through a vestibule, entering the room allocated for the proceeding, Ben and I found ourselves alone, gazing at an array of chairs circling a large table. Moments later, board members sauntered in, chatting, carrying cups of coffee, schmoozing. They looked at us and acted surprised, as they’d not been told there would be ‘observers’ this time around. A woman I recognized named Cathy Atkins, who also recognized me, took a quick look my way but then glanced off, choosing to admonish Ben: “in future, perhaps you could write us an e-mail, let us know you’re coming.” Weird, I thought. Last time I came to this thing there were about a dozen ‘observers’, all ready to speak—no RSVP seemed necessary. I once saw a video of one of these meetings in which the room was filled with over fifty members, also lining up to speak. And by speak I really mean protest. Something’s changed, I realized. The spirit of dissent in this organization has, shall we say, diminished?

After a call-to-order and reading of agendas, a woman in charge announced it was time for our members’ forum to begin. Slightly disorganized, she asked who had the timer for the three minute segments. Then, looking down at the forum sign-in sheet, which contained only two names (Ben and I), she looked over and beckoned me to speak, pronouncing my name correctly, which rarely happens on a first reading. I’d have been impressed but for the sight of the woman next to her, whispering her knowledge of who I was, which was both gratifying and not. The three women at the head of the table were the new president of the board, plus two lawyers. The femicratic air was balanced by four or five men, most of whom sat at the other end of the table, looking detached, if thinly adversarial.

I began speaking through the anticipated personal blocks: the dry parch in my throat, which can drain the life from my hard syllables; the halting pass at stretched vowel sounds—a more common nemesis of mine. Then there were the externals to contend with: the expressions of a dozen people, most of whom gave effortful looks of interest; some bothered to twist their necks around to face me. There were one or two earnest faces, and even a faint nod from a former president—warmly supportive, if relieved to no longer be in charge. So, here’s what I said.

CAMFT MTG. ON 9/24

1.)      A year ago I was at this meeting in Santa Clara protesting 3 things: the passage of bill AB1775, which now mandates therapists to report ‘downloading’, ‘streaming’, or ‘viewing’ material depicting sexual conduct of minors;

2nd: CAMFT or CAMFT attorneys’ role in not only endorsing the bill, but writing it.

3rd: CAMFT’s misrepresentation of several aspects of AB1775 to the CAMFT membership

2.)      Yet it was clear to me after listening to a later ¾ hour discussion by this board that several members were like many therapists I’ve spoken to: they had not fully understood the implications of this bill at the time of its writing. They regretted their support.

3.)      Others appeared to support the bill, but with dubious arguments: that offenders should be reported to authorities, and by implication persecuted, not treated because “sex offender treatment is not effective”. This is an unfair and reductionist view. Another member, unwittingly paraphrasing the US attorney general, suggested that viewers of underage porn enable its production and are AWARE of the exploitation entailed in child porn. Interesting–not to mention one of our society’s staggering hypocrisies. So if we were aware of the child poverty, the exploitative labor conditions around the world ‘enabled’ by our innumerable consumer choices, would we be culpable…reportable? This insipid bill was written for facile people who concern themselves with exploitation, but only as it pertains to sex.

4.) But finally, for the future: member Mark Perlmutter argued that CAMFT should take a second look, as in scrutinize AB1775 in 2017, with a task force that CAMFT members might be invited to join. Well, 2017 is three months away. My requests to be a part of a task force have been ignored or deflected. I cannot get straight answers from CFS officials as to whether abuse reports have increased because of the new law. Well, they’ve gotten none from me, I’m proud to say. And the director of the SJPD internet crimes against children task force does not return my calls. Perhaps he doesn’t talk to therapists. Perhaps, like some lawyers and legislators, he’s got better things to do.

Graeme Daniels, MFT

 

 

 

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The law that will lose us our clients (among other things)

In a recent editorial directed at leaders of the California Association of Marriage and Family Therapists, LCSW Robert Weiss wrote eloquently in protest of AB1775, a new California law (effective in January, 2015) which reduces therapist-client confidentiality, purportedly because it will protect children from the downloading and dissemination of child pornography. It won’t.

Weiss reminds us that the protection of client confidentiality is among the most elemental facets of a productive and meaningful psychotherapy relationship–that without the safety and trust provided by client confidentiality there is no true clinical path to healing. This teaching follows ethical standards dating back to the Roman Hippocratic Oath. The legal exceptions to this principle center on the prevention of imminent direct harm to others.

Perhaps the most significant change in so-called “duty to warn” laws occurred in 1976, with Tarasoff v. Regents of the University of California, a case whose finding determined that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient. A less palatable revision of confidentiality law occurred in 2001, following the 9/11 attacks, in the form of the Patriot Act: section 215 authorizes FBI agents to request a subpoena from a special court, obtain access to psychotherapy records, and further prohibits clinicians from revealing to clients that their clinical records have been subpoenaed. Today, for the moment, the hysteria that induces totalitarian intrusion surrounds pedophilia, hence AB1775. Not surprising, really. If you want to pass a law that is uninformed by research or logic, your best bet is to have it be about sex.

Ostensibly, AB1775 will broaden the scope whereby a clinician such as a therapist can report an individual to authorities if said individual has used child pornography. Under the existing Child Abuse and Neglect Reporting Act, therapists are mandated to report sexual exploitation: “depicting a child in, or knowingly developing, duplicating, printing or exchanging film, videotape, negative or slide in which a child is engaged in obscene sexual conduct”. Failure to report is a misdemeanor, and admittedly, some of the language of this legislation seems anachronistic. Now observe the language of AB1775: sexual exploitation includes “downloading, streaming, or accessing (accessing?), through any electronic or digital media, a film, photograph, videotape, video recording, negative or slide, or slide in which a child is engaged in an act of obscene sexual conduct.” This bill was signed by Governor Brown and filed on 8/22/2014.

Bear in mind that the law defines a child as someone under the age of 18, and given the language of the law (“accessing through any electronic or digital media”), therapists will now have to report to authorities teens who send naked pictures to each other over their cell phones, or someone exhibiting an “obscene” picture of a minor on Facebook. Also, porn use that depicts teenagers (not preteens) constitutes child porn, according to the law.

And if you think this might be a good thing, let me now elucidate other problems, including elements that pertain to this blog’s title: after an individual is reported and later arrested–their computer and other hardware materials confiscated–they would begin an adjudication process that would likely result in a referral to counseling, with a provider who is certified in sex offender-specific treatment, as presided over by a government entity called The California Sex Offender Management Board (or CASOMB). Such a referral is a requirement for those who will likely have to register as sex offenders. Therefore, if a therapist reports an individual for engaging in sexual exploitation, as defined by AB1775, and he or she is not a certified sex offender treatment provider, a court has the authority to remove the client from the therapist’s care, thus disrupting not only therapeutic continuity, but also that therapeutic bond. Now a certified CASOMB provider (BTW: this takes a while), I write from experience on this matter.

Finally, recall the term  ‘imminent harm’ from earlier “duty to warn” provisions. This language pertains to the concept of protecting from harm versus reporting past events. So, we now have a social reality wherein someone can report raping or murdering a stranger, and the therapist is not required to report the event because the event is past tense. Indeed, he or she would be  compelled to maintain confidentiality. Meanwhile, if someone reports viewing a singular image of a minor, of something that could be construed as obscene, the listening therapist is required to alert police. Absurd.

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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.

 

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