Tag Archives: therapy

How do I…?

How do I…?

  A question that emerges after the story has been told, the problem outlined. A man doesn’t trust himself: he has a plan to stop doing what he’s been doing for a long time, perhaps his entire life. He’s determined; the stakes are higher than they have ever been before, which usually means that others will be affected. Guilt will be key. The guilt stems from the prospect of failure, a background of it, and the implicit knowledge that there is something inside that demands expression.

 How do I…?

 As a therapist, I attend to the question on its own terms, responding with an outline’s semblance. First I mimic the crowd, who also knows the story, the history of the problem, and the stakes. Those stakes are reiterated. Regular reminders about the consequences of problem behavior: the impacts upon self and especially others; the damage to health, career, family. To hear some, you’d think that nothing more than such interventions are called for in the prevention of self destruction. I think that therapy supplies the subtext: people care; the man, despite himself, and despite the observations of some, cares also Further, reality can be cruel. Fate is indifferent.

 Implicit is the call for fellowship. The man in question has been isolating, not talking to others, getting lost in himself. Where is the accountability? I ask. I’m quick to explain: I don’t mean he should answer to me, or that he owes anything to anyone. At an early stage of therapy, I avoid stepping into dynamic roles wherein lines of authority are unconsciously laid. I mean something subtler; having something like structure, containment—that there is someone to speak to, to be honest to, when mania has run its course.

 How do I…?

 Continuity. How do you keep it up, your motivation? A woman changes her mind, doesn’t want what she wanted last month, has forgotten what drove her in another mood; what seemed different. The next twisting, turning switch must be explained while the past is denied. A therapist is memory—an aspect of containment. Something changed. Why? The question doesn’t compel answers as much as it does thinking, the protraction of curiosity, and slowing down. Very little has to happen “right now”.

 How do 1…?

Needs. A subset of the why question: why do people do what they do, especially if what they do generates guilt? Why doesn’t guilt itself motivate change? Why doesn’t remorse always do what courtrooms think it should? People do what they do in spite of guilt, in spite of shame, guilt’s less confident twin. Truth—that something within—hurts; it hurts self and others, and it always will. It needs out. It needs to be released, titrated in the spirit of compromise, for if it can be discharged without anyone knowing, then no one gets hurt.

 How do I…?

 Hope. When continuity has broken down; when the relapse once cast as a mere change of mind has returned the individual back to square one, a knowledge of pain lingers. The day after is another appointment. The fellowship, in all likelihood, is still there. People still care. The questions are still worthwhile. Curiosity is resilient. The therapist is in his office, waiting.

Graeme Daniels, MFT

 

 

 

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Why child abuse isn’t as important as you think

 

When I appeared on the Bill Carroll radio show last year (an LA broadcast), I did so a day after Melissa Melendez appeared. Melissa Melendez is the state legislator who authored the controversial AB1775 child abuse law that is now close to two years old, and which I and some others have been criticizing since its passage in the summer of 2014. At that time, Melendez boasted on her website that she was “cracking down on child porn” with this law. BTW: for those who don’t know the process, “author” means she fronted the bill. It was written by others—lawyers, specifically—lawyers for the California Association of Marriage and Family Therapists, or CAMFT.

I have gleaned from my attempts to dialogue with these lawyers that they did consult with some therapists and social workers prior to writing the bill. I don’t know how many. I imagine them canvasing the wide and diverse opinion of—ahem—San Diego County (where the CAMFT offices are located), homing in on its clique of conversion therapy advocates and thinking, ah…we have found the like-minded!

Like minded in the sense that psychotherapy is deemed by these folks a tool of advocates, of social change, rather than something complex and unaffiliated with policing or justice. Well, you might ask, isn’t the protection of children from pornographers and other abusers a worthy cause? Isn’t the prevention of child abuse via the reporting of criminals something we should support?

Well, since you put it like that, then yes.

However, when you apply logic, the experience of real clinicians, flaws in this ideal leap out. Do criminals enter psychotherapy, looking to change? If they do, do you imagine that upon hearing a psychotherapist’s reporting requirements in the area of child abuse (which we’re required to provide—it’s called informed consent), an as-yet undiscovered child abuser would then say, “well, since we’re on that subject…”

When criminals are mandated into therapy by courts, or as a condition of probation or parole, they might report behaviors that merit our reporting of them, but at that point, if they are speaking of past behaviors, the matter is moot. And if the completion of probation or parole hinges upon NOT engaging in further illegal behavior, why would they further disclose their illegal acts?

The premise of psychotherapy, for those who apparently need this explaining, is among other things to provide a place, a “safe” place as we like to say, for the disclosure of all kinds of secrets, including many heinous crimes. Do you want to know what’s reportable under the law? Basically, anything really dangerous that might happen; meaning, it hasn’t happened yet. Do you want to know an example of something that ISN’T reportable? A murder committed in the past. Unless it was a child that was killed. Seriously.

With rare exception, people don’t enter therapy to boast or even speak casually of abusing or exploiting children, or the enabling of child abuse via the viewing of child porn. They do enter therapy disturbed by such behaviors, wanting to understand what leads them to such things; hoping to learn how to diminish if not eliminate those tendencies. Now, reporting laws can facilitate change in cases of ordinary child abuse (hitting, or verbal abuse), because those interventions leverage important conversations with parents, who thereafter can learn anger management skills, as well as process unresolved problems. However, reporting requirements like those set forth by AB1775 undermine a therapeutic process, because those reported for using illegal porn use are typically arrested, jailed, fired from their jobs, ostracized from family and friends—all of which tends not to encourage further talking with therapists.

I said all this to Bill Carroll, the partially persuaded conservative radio host of a year ago. But what are you saying? He half-complained. Is your office like a confessional?

Funny he should ask that. Shame that I didn’t have time to contradict something Melissa Melendez had said the day before. See, during her appearance, Carroll asked if priests are also mandated reporters of child abuse. At first, she didn’t know, so he gave her a commercial break to look it up. When she returned she quickly offered that priests ARE mandated reporters, and then her segment ended.

Though a sideline to the main issue, this piece of misinformation is the climactic point of this blog entry. In fact, priests (or clergy) ARE NOT mandated reporters of child abuse—at least not if you read the loophole provided for them in California Civil Code 11166 (d), which offers that if disclosures of abuse are heard in the context of a “penitential communication”, then the subdivision (requirement to report) does not apply. Civil Code 11165.7 outlines what professionals are mandated reporters of child abuse. Wanna know who else is not on the list? That’s right: lawyers. For good reasons, you might think; at least, reasons implicitly more important than the protection of children from child abusers.

Two weeks ago, I wrote the office of Melissa Melendez, asking if she’ll revisit the issue of AB1775 in 2017, perhaps get someone to craft an amendment to section 11166 (d), close that loophole for clergy. Neither she nor a member of her staff has responded to me yet. I’m not holding my breath. I wonder if she’d consult with priests on this matter, or contact officials within the Catholic Church, to challenge the sanctity of their offices, compel them to be advocates, not mere listeners. I hear they’re a bigger organization than the California Association of Marriage and Family Therapists. They have lawyers too, don’t they?

 

Graeme Daniels, MFT

 

 

 

 

 

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Statement To The Recruits

In a recent statement to the membership of the California Marriage and Family Therapist Association (CAMFT), association lead counsel Cathy Atkins issued guidelines for members regarding the controversial new law AB1775. It’s an interesting report featuring answers to questions posed by members, numerous interpretations of intent, none of them explicated in the Penal code, but leaving therapists and other mandated reporters (not to mention our clients) still wading in ambiguous waters.

* Firstly, it’s good to read a (sort of) acknowledgement that AB1775 is much more than a legal addendum designed to keep us all in touch with advancing technology. It is in effect a re-definition of sexual exploitation, to include the viewing of child porn (CP) alongside a pre-existing definition that was previously  confined to its production and distribution.
*Cathy’s guidelines addresses what I’ve called the conflation of child porn viewing into a definition of sexual exploitation by pointing out that the words “downloading” and “accessing” could be interpreted as meaning the exchanging of files, and so the additional language is designed to reinforce the original Child Abuse and Neglect Reporting Act ( CANRA) laws. She suggests that police will not investigate the mere “downloading” or “streaming” of child porn, and implies that law enforcement will take into account a therapist’s opinion as to whether CP use is “stumbled upon”, whether there are  “factors to be weighed” (such as a spouse’s contrary characterization of CP use), or whether CP use will lead to direct harm of a child. In short, she suggests that therapists will have discretion  in their reporting and that social services/police will take into account our opinions about our clients, but warns that said discretion will not protect us from liability, or even prosecution.
*Hmm? Do we accept this explanation? I’m dubious, obviously. Firstly, I think it likely that police will think that therapists who dispute potential direct harm to children are merely advocating for their clients; that police will not think the viewing of porn is “accidental” simply because we think it is (and wouldn’t such reports be a nuisance?); that police will think the viewing entails (or has entailed) exchanging by virtue of the aforementioned technological advances/nuances related to the internet, and will thus have a pretext for investigation, plus the ensuing legal fall-out, leading to disruption of existing therapeutic episodes, not to mention child abuse prevention efforts,  via the hegemony of the CASOMB system (an issue not referenced by Cathy), as I have described in previous messages to the CAMFT e-tree. So much for therapist discretion, I think.
*Also, I think police are likely to agree with the 2012 US attorney general’s opinion that viewing CP alone does indeed constitute exploitation because the viewer is judged to be aware of the abuse depicted in the CP. And since a therapist becomes aware through client disclosure, then that knowledge of the abuse in turn triggers the obligation to report. The logic here is as follows: we are witness to someone who has witnessed abuse, and because we don’t know the victim we report the witness. Next, Cathy warns that if a therapist is aware that a client has accessed pornography, fails to report that use, and the client later abuses a child, then the therapist may be held criminally responsible for the failed report of possession (or viewing, I guess). BTW: unless a solid correlation exists between use of pornography and direct contact child abuse, then this argument validates the use of prejudice as tantamount to reasonable suspicion–another form of conflation. Otherwise, we should be making Tarasoff reports (pertaining to reports of threats made against others) if our clients report owning copies of American Psycho. More topically, perhaps, are we to infer risk to others if clients are enamored with 50 Shades Of Grey? This law, or the interpretation of it,  thus strikes at the heart of the “imminent risk” principle of exception (of when to break confidentiality), so central to an understanding of the original CANRA laws. Oblivious, AB1775 supporters promote an inference (which belies current research, actually): that viewing of porn will lead to child abuse, or might; and that “might” is sufficient to trigger a process that will leave those tentatively disclosing clients wondering what, if anything, they will ever again share with a therapist.
* So it seems like glibness to assuage members that all will be worked out, and that AB1775 “does not affect the standard of intent of the CANRA statute” . We are not investigators, Cathy reminds us. But we are encouraged to do due diligence to protect children which, as the tautological thinking unfolds, invariably connects the viewing of porn with actual harm to a child. The bill’s author, Melissa Melendez, and others, want police making the distinctions between the accidental users, the regular users, and those relative few who will use CP and also directly harm children. Not the lawyers at CAMFT. Not the researchers. Not any mental health professionals. Not us.
We are the recruited.

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Full Metal Self

Had a few ideas recently, after watching the film Whiplash; made a few links, reignited certain determinations, sighed and resigned to my fate on a few other matters. The film stirred hope and–dare I say, inspiration–on many levels: firstly, I learned that the film had been out for nearly a year already, though it was only recently making a splash in theaters. I am reminded that promoting a film, like promoting a book, takes time, hard work, and no little amount of salesmanship. This parallels the story of Whiplash somewhat. Miles Teller plays Andrew Neyman, a young would-be jazz prodige, a drummer in a prestigious music conservatory band. Scouted and then selected by the school’s jazz maestro, Terence Fletcher, he joins a band that is further elite, and is initiated into rehearsals in a manner that is at once predictably brutal, yet also fascinating and entirely gripping. Actually, more so than any thriller or action flick I can think of, this film had me gripping my seat for almost its entire length, such was the tension created between the quietly narcissistic hero and his near sociopathic mentor. In scene after scene, I watched with mounting angst as Fletcher alternately seduces and then terrorizes the naive yet ambitious Neyman. He flatters him, telling the class he’s found his Buddy Rich; then, minutes later, he is tossing cymbals at Neyman’s head, mocking him for not keeping tempo, threatening to “rape him like a pig” if he fucks up his band. For my part, as non-musician, I had no idea drummers were this important.  Meanwhile, the Fletcher character brought to mind a few teachers from my past, sort of morphed with that terrifying drill sergeant character from Kubrick’s Full Metal Jacket.

About two thirds into the story, we get Fletcher’s rationale for being the way he is: modern jazz, like modern society, is in a sorry state, he says. The words “Good job” constitute the most harmful phrase in the English language (I’m paraphrasing). He’s an advocate of tough love, obviously; of the belief that teachers must push people beyond expectations in order to get the best out of them. The ends, as in the preservation (or growth) of standards, justifies the brutal means. The film’s counterpoint is to indicate casualties: a former prodige whom Fletcher had allegedly driven to suicide; the girlfriend whom Neyman dumps so as to focus on his drumming. Neyman’s father, a loving but feckless man, voices opposing values, decrying Fletcher’s abuse, challenging his son’s obsession, imploring him to slow down lest he (literally) die on the drumstool. Ultimately, the story seems a celebration of going for it; of not compromising standards. It’s just that it doesn’t ignore the costs.

Again, the film brought up a lot for me. I wonder how much of Neyman and Fletcher’s drama is transferrable to the world I inhabit. If you’re a would-be client of mine reading this, don’t worry. I have no plans to emulate Fletcher or the drill sergeant from Full Metal Jacket. However, I reflect on the opinions I expressed in Working Through Rehab, my book about adolescent drug treatment; sympathetic views about the dinosaur-like, similarly tough-love ethos of the much maligned Therapeutic Community Model. This week, I shall be teaching a short-term class on the Masterson Model at a community service agency in Marin, and espousing the value of, among other things, therapeutic confrontation, the importance of having boundaries, a therapeutic frame in which consistency, self focus–striving beyond expectations–are at least analogously observed. The dialectic I anticipate will mirror the drama of Whiplash, and maybe FMJ: principled agreement about driving people to their best, tempered with compassion for those who, for a variety of reasons, fall short.

As for myself, I go for it in my own way. Inspired by Andrew Neyman and the indelible image of his blood-stained drumkit, I might stay up late tonight, working on my latest manuscript: tightening the prose, adding pieces of subtext, changing a character or a plot point, correcting sundry mistakes in punctuation and spelling. I am well read with respect to my own books. I read them over and over again. It’s like combing the text, looking for tiny bugs. Sometimes I am satisfied; more often, I am not. Figuratively, I bleed. I have expectations.

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Feel Before You Think Or Do

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Think before you act. That’s culturespeak—dominant culturespeak, some say—for a certain brand of lay-counseling that infiltrates business and industry, schools, anger management classes, parent-child conversations, social cliques, young and old. Feelings? That’s a therapist word. Therapists are often counseling individuals to express feelings, use “I” statements that gird the framework for feelings, the growth of intimacy. Feelings.

 

Why are feelings important, actually? Many people, especially left-brain bullies who extol the virtues of logic, or compulsive survivalists who ever assert the need for action, often ridicule those who draw attention to an affective (emotional) underpinning to any given issue or conflict. Others still consider that giving weight or time to feelings, especially negative feelings like fear, guilt and shame, is an indulgence—an exercise in what some term “navel-gazing”. Given certain contexts (do I really need to enumerate them?), the weight given to thinking or action is appropriate, but all too often the ethos is extended, given inappropriate width, while underlying feelings are either dismissed or given pat, superficial meanings, such that individuals, couples and families—the world—can move on. The person who exhibits rage, behaves with violence, is likely someone who, when later asked about their feelings, speaks pridefully of feeling “disrespected”, but makes little (if any) space for the likely truer feelings: fear, hope; desires for closeness, the experience of danger or abandonment.

 

I’d like to give readers a practical example of why acknowledgement of negative feelings is important, and why the sustaining of feeling is also important. It’s a story of a couple that struggles to slow down and really communicate: In this anecdote, a struggling pair has made room in their busy schedules for a “date night”, which will include, among other things, a night of sex. Problem: their evening is intruded upon by one of the countless distractions in their lives. The woman receives a text—someone from work needs a call back. The husband, anticipating (based upon actual past events) that the interruption will be prolonged, sarcastically gripes, “Well, so much for our so-called night of intimacy.” The woman, feeling “disrespected”, assures him she will not be long, but resents his attitude, which she casts as “entitled”. Later she returns to him, and finds that he is pouting. The “date night” proceeds, sex included, but without the earlier goodwill and spontaneity.

 

In speaking to this couple, I challenge both to recall, possibly experience, consider and then lead with feelings, rather than focusing singularly upon “what do we do.” I challenge the husband to say what he felt when he first learned of his wife’s seeming distraction. “I was disappointed,” he says. Upon some expansion, I ask “What kept you from saying that?”

“I did,” he remonstrates fully believing he’d done all he could to connect with his wife on the night in question. “No you didn’t,” I argue—respectfully: “You made a sarcastic complaint to her, and later ‘pouted’ when she returned, saying little if anything about your true feelings.” He shrugs, transforms his voice into an affected whine, and says, “What am I supposed to say, ‘gee, I’m really disappointed that we’re not having sex’. I can’t say that.”

            “Why not?” I counter. This is where the therapy really begins.

            “Because that’s not the way I am; not how I was raised, to talk about my feelings.” Note the distancing of opinion, plus the excuse, the implied helplessness: I can’t. For the moment, I ignore the historical dimension (and the affected expressions) and stay in the present.

            “Why can’t you say that you’re disappointed, if that’s your true feeling?” After one or two more fumbling replies (this man is at a loss), he says, “I don’t know.”

            “What do you mean? You don’t know why you can’t express your true feelings, your full experience?” The man shrugs. I choose to help…this time.

            “You were disappointed that a planned evening of intimacy was disrupted. That’s understandable. There was an opportunity to say you were disappointed; to point out that your wife had agreed to devote the evening to a date and not work, and that you were anxious that work seemed more important to her than working on the relationship.”

            The man nods, understanding, but looks defeated. “I can’t say all of that. Or, I couldn’t remember all of that. I’m not that articulate. Could you say it again so I can write it down?”

            “It’s not about being articulate, or memorizing lines,” I reply quickly. “It is, however, about being in the habit of recognizing your true feelings, staying with them long enough so that thoughts and eventually words, may follow. (BTW: I level a similar confrontation at the wife) You experience a feeling—disappointment, and beneath that, the pain of rejection—and because that feeling seems so difficult to experience, you move to get rid of it as soon as possible. Thus, you use humor, aggressive humor, to distance yourself from both your wife and, more importantly, your own experience.”

 

** this example is a fiction in one sense, but in another, a coalescing of exchanges noted over time.

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The Careless Passage of Time

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In the next section of Candace Orcutt’s book, Trauma in Personality Disorder, we read of Mr. H. and Mrs. M. Mr. H., she describes, presents a case with “traumatic overtones”, though the trauma isn’t obvious at first. Is it the rejection from his wife? The business failure, coupled with the partner’s nefarious financial actions? The problems with his adult children? He is depressed, Narcissistic, manifestly so (exhibitionistic?), and according to Orcutt, needful of mirroring, and not always with an accompanying interpretation. The Narcissist has an antipathy towards interpretation, she writes (p. 100), but she points out that the Masterson model bypasses this antipathy by wrapping such interventions with empathy for the patient’s vulnerability. With that seeming understanding in mind, one wonders why her transcripts appear to wander so often from the technique: instances of reassurance (p. 97: “it will get better in the end”, p. 91: “you have your kids and your pride. You’re managing”); so-called reasoning (p. 88: “Wouldn’t it be easier to stop fighting and accept the offer?”); a warning (p. 86: “Maybe it’s important to remember that reaction plays into others’ hands”); a confrontation (p. 85: “are you really defending yourself by turning this into WWIII”). The mirroring aims at maintaining idealized unity with the therapist; the confrontation a containment of acting out; the reassurance perhaps girds Mr. H. for his subsequent disclosures about an incestuous relationship with his mother. He ends therapy having broken a secret, and seems happy enough, with a new woman in his life and a better relationship with his kids. 

Orcutt writes that mirroring alone may be necessary when the patient is feeling especially vulnerable. This feels very permitting somehow, as though the interpretive piece were an extra chore for both patient and therapist; both are spared the task of dealing with the question of criticism that ambiguously lies within mirroring interpretations. Mrs. M is stoical, likes to “fix” problems. She seeks to control feelings, often by dismissing them, and thinks that having feelings and acting upon them are conflated concepts. She also discovers a family secret, through the experience of an accident in which no was injured, though Mrs. M. begins to suffer symptoms of PTSD. She wants medication, and hypnosis; she doesn’t want to dwell. She resists the psychologizing of her reaction from doctors, but soon integrates the therapeutic suggestion that her symptoms derive from stress, and more importantly, she acknowledges helplessness with respect to her fears. This appears to open up memories, including an incident in her teens wherein she felt responsible for a friend’s accident. Symptoms persist, and the therapist gives homework for Mrs. M. to interview family members about recurrent dreams of a little girl being killed. The investigation unearths a horrific family secret: a tragic incident in which Mrs. M’s four year old twin sister is accidentally killed by her mother’s first husband. Mrs. M. had witnessed the scene, but was thereafter amnestic, and the mother resolved to not talk about it. This is a painful story, one that had me reflecting sympathetically upon the father of the deceased girl as much as the horror of Mrs. M. She is distraught by the discovery, and blames the therapist for not preparing her for the burdens of memory. The therapist reassures that life will be put back “into one piece”, and adds that perhaps time will bring a change. Cliches aside, attributing change to the passage of time seems incomplete, even careless.

 

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The Trauma Wire

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Emotional amnesia. That was the term that flashed in my mind as I read Donnel Stern’s “Witnessing Across Time: Accessing the Present from the Past and the Past from the Present”. Starting with a familiar idea, Stern writes that for survivors “the past of trauma cannot be understood in the present”; that it is drained of vitality, and that memories lack “plasticity”. As practitioners, we experience this in the affectless way in which trauma patients recall life events. Of course, this article refers to several sources and therefore Stern is not the author of each idea. I won’t attempt to credit them all, but rather represent them as best I can.

A second kind of effect: that of contemporary trauma upon capacity to experience the past is the focus of much of this paper. The three clinical examples, one drawn from a fiction, feature situations in which a character or a real-life individual has experienced a contemporary trauma, and that trauma robs the past of any goodness. This is seen in the example of Michael, the character from The Wire. A positive memory of his saving a child from a gang, uttered by Dukie, the boy Michael had saved, is denied. The positive is forgotten. That life is gone, and goodness is dead. With Menachem, the child who is smuggled out of Krakow, we learn of another kind of trauma: the reunion with a mother who has been beaten down by war: sick, emaciated, barely surviving. Menachem’s experience of his mother violates the memory of her vitality, as preserved in the picture he’d kept of her and even prayed to—a witness of Menachem’s creation. Upon reunion: “Something accessible becomes inaccessible”. Meaning, the former memory is tainted. Thirdly, we read of Darryl, the amputee Vietnam veteran who enters therapy, but continues to act out violently after previously suffering a psychotic break while in combat (he fires his weapon at home, terrifying his family). Darryl seems good natured and quiet in sessions. He came from a family of origin that was warm and related, but trauma has soiled nurturing, and only in therapy can a good relationship be preserved.

So trauma distorts an experience of the present, spoils an anticipation of the future, and even robs the past of its once seeming integrity. Witnessing, the article suggests, holds the key to “retranscription”. I am reminded that secret-keeping, if sanctioned, is so because many assume that secrets (not speaking of the past) will protect individuals from pain. Stern’s article more or less echoes this, but adds that the absence of witnesses sends the message that no one cares. “Nobody ever gets over anything,” Stern quotes from a contemporary novel referenced as House of Meaning. The line is despairing, suggesting an absence of hope (or meaning?) for those living in the wake of trauma. Incidentally, the reference in his article contains a mistake. I happen to own the Martin Amis novel in question, which is about a love triangle in a Russian Gulag. The actual title is House of Meetings.

 

 

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