Dissociative Process and Trauma Survivors

Over the last several weeks, I have had an email exchange with a young lady from Great Britain.

This young lady knows that she is dissociative. She thinks she may have developed this coping strategy as a result of the trauma of multiple deaths of those close to her in a very short time span, including one of her parents. It is entirely possible, but it is not the typical route to a dissociative pattern of survival. What has impressed me most about her is the amount of information she has acquired on her own without professional help or training. She has also taught me some about the National Health System in England as she described her efforts to obtain therapy and  its response to her.

 

 

I thought that I would review some of the fundamentals of dissociative process and write about some of my thoughts on treating individuals who suffer from it.  Everyone dissociates sometimes. If you have ever driven home from work and could not remember the actual drive, if you thought you were driving to the grocery store, but pulled up and parked in your ex boyfriends driveway without realizing you were going there, you have been dissociating. If you have become preoccupied with nothing, but suddenly realized a considerable amount of time had passed and you don’t know how that happened, then you have been dissociating.  Dissociation is essentially an unconscious process for “losing” time and awareness. We do it when we are distracted. However, there are others who do it because being in contact and aware is so painful and so frightening that they cannot afford to be connected to their feelings, their memories or their present situation.

 

 

The dissociative continuum runs from the defense mechanism of repression, which is the selective editing of the memory or awareness to Dissociative Identity Disorder. An example of repression on the less severe end would be: I don’t like to go to the dentist, I am frightened of what will happen there, so I “forget” my dental appointment until thirty minutes after it is scheduled. That way my unconscious protects me from what I fear and resist. This is the skill we all use at one level of expertise or another.  Dissociation progresses from this type of selective editing of awareness or memory, to a more orchestrated and comprehensive blockage of segments of consciousness, history or life. We may lose an entire year of our life. I have had many clients who tell me they cannot remember the year their mom died at all. None of it, not school, not work, not flash memories of parties or birthdays, or happy events, it is gone. But they remember before that year and they remember after that year in perfect sequence. This is an example of dissociation called amnesia.

 

 

Terms such as amnesia and fugue are reflective of the dissociative process. Amnesia may be caused by brain trauma from a blow to the head, or an accident of some kind that injures the brain so that the neural pathways for the memory are blocked. But without injury, amnesia is a dissociative way of protecting someone from something so onerous that they cannot afford to remember it because the fear and pain, or even self -loathing, will be too awful to endure.  The most extreme example of this is what we used to call Multiple Personality Disorder, but now is called Dissociative Identity Disorder. The movie Sybil (1976 Lorimar Productions) is a good example of this. In DID there is a vertical compartmentalization of memory. There will be remembered timelines for multiple slices of reality. Each slice will have a name, an identity, a personality and a history. This history may be limited to a few years, but it will be vertical in the sense that there is a connected awareness for this individual for the entire time slot of their existence.  That is different from the horizontal slice of memory loss we discussed earlier with the example of the death of the parent or the accident (that did not cause brain damage, but which the individual cannot remember.)

 

 

I found that when I worked with dissociative individuals, I gradually began to notice that they would shift or “go away somewhere.” They would disconnect from the conversation and from me. They would lose time in our sessions and they could not remember what we were talking about. This tended to occur whenever I would approach talking with them about something that was at the core of their dissociative skill. If we began to talk about a feeling they were afraid of (i.e., if they had been harshly abused about not crying and felt as if they might cry, they would just go away somewhere and not be present for those feelings.)  If we began talking about an event such as the death of a parent, the pain was so strong for them they would just lose the thread of the conversation and the pain associated with it would go away, as well. Dissociation is a protective behavior. It is a complex and valued skill, and we can use it to discover what is going on. I always make the point to my clients that they should be proud of themselves for discovering a defense mechanism that allowed them to survive their traumas so that they could to get to a place where they could seek help from a therapist. I help them learn that my office is a safe place, they can stand in the presence of the pain or fear and find the memory that is hidden and be safe with it. I also gently begin to ask them to be aware of when they go away. I help identify their “tells” that identify for me that they are “going away.” As they learn to do this, they can begin to identify the triggers and we can begin to explore the feelings that are so horrific.

 

 

I constantly reassure them that they would not be able to feel or remember unless they were strong enough to handle whatever the “knowing” was. I reassure them that I approve of them and value the strength and courage they have used to protect themselves and survive no matter what the trauma was. This is especially important when dealing with horrific sexual abuse. The shame factor is so powerful and has usually been manipulated so skillfully by the perpetrator that the survivor is self-hating and shamed because they believe, or were told, that this was entirely their fault. That a six or seven year old girl can be so strongly sexual and seductive that she can override the resistance of poor old Grandpa and make him be her sexual slave is often what she was told. It was never Grandpa’s fault; it was the girl’s fault. She was bad seed in some way and she had doomed him and made him the victim. Girls who go through this internalize the propaganda from the perpetrator and come to be self-loathing. I honor their survival no matter what behaviors they had to perform in order to survive. This is a very true statement. I do honor the ability of the victim to survive and to continue to work on survival until they can find their way to my office and learn to heal. With help, they can learn how to challenge the script, to stand tall and proud of their ability to survive and to learn to call a fact a fact. What is real is real; six year old girls are not that powerfully seductive. It was grandpa all along!  When the client can realize that, they can begin to cleanse themselves of the shame and self-hatred and they can begin to re-script their definition of self. They begin to learn that the adult them or the “now” them can love and honor their predecessor, the abused and victimized them. Together these disparate parts of their identity can work to meld into a strong and functioning self that is not constrained by the limits of abuse survival. They will not need to dissociate from feelings that are too powerful to behold, because they have beheld them and survived. They stop losing time and contact, and they begin to learn how to regulate their emotional process in the present moment with confidence and strength.

 

 

There are warnings that should be given about working with dissociative process if you do not have the perspective, training and skills to handle the intensity of the emotions or memories. You must remember that as a therapist, it is your job to help the survivor heal. It is not your job to track down and punish the perpetrator. Some survivors want to challenge the perpetrator and tell them the feelings they have remembered and ask for an apology or an explanation. Be extremely slow to support that step. Before they go there they must rehearse the process repeatedly. They must imagine doing it and saying it and all the possible ways that the others in their life will respond when they challenge Grandpa for the dirty old man he is. Many of their critical supporters will abandon them and shame them and side with Grandpa. They must be prepared in therapy for that possibility and learn what they will need to know in order to survive it. Many such individuals, when confronted attack. They deny and they scold and shame the client. The client needs to be strong and practiced, and they need to have a realistic appreciation of what they may get from the perpetrator and how they will incorporate whatever they get into their new definition of self with strength and peace. However, that is a topic for another day. Dissociation is an incredibly powerful defense mechanism and an extremely deft skill for the client to have. It takes an equal amount of skill, strength, and balance for the therapist. Do not go wandering randomly into the dissociative process experience. Get training first.  As a therapist you must not be afraid of emotional intensity. You have to be able to be a grounded presence in the midst of the emotional firestorm. Additionally, when you get angry as you hear their story of abuse, you must tell the client that you are angry (they will have sensed this already, it is a trust and truthfulness issue) but that you are not angry with them you are angry with the perpetrator. This will have to be repeated many times before they can safely believe it. And finally, you have to tell them that you do not need them to be angry with the perpetrator. For some of them it is something they are never able to do. The challenge is to heal them, not rage at the perpetrator, or punish the perpetrator, or justify anything.

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Update on Reflection on a Life Lived Amidst Change

The speech I gave instead of the speech I thought I would give. The Keynote address at the 48th Arkansas Model United Nations.

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Reflection on a Life Lived Amidst Change

My Alma Mater has asked me to come back and give a keynote address to the Arkansas Model United Nations. I was one of a group of students who began the AMUN forty -eight years ago. I am flattered that they think I would have something to offer in terms of perspective. Looking back over the last forty -eight years, how would I say that my life was impacted by participating in an event such as the AMUN? What could I say to this year’s participants about how this experience might contribute to their lives going forward?

I think it is important to take the time to reflect on where you have been and what you learned there. As I think about what to say about participating in this event in college, I also have a chance to think about the paths that my life has taken and the nature of the journey that I have traveled. As I do that, it reminds me of the process that we do in therapy when we meet with the clients and ask them to find a safe space to stand and examine their lives. With clients, I need to be a clinical and supportive observer. When talking about myself, I do not have that restriction.

Once I wrote the speech for the AMUN however, I recognized that much of what I have to say is extremely similar to what I encourage my clients to recognize. I challenge them to look at their lives as a whole, rather than focus on disparate parts or singular events, be those awesome or traumatic. I think it is critical that we put our memories and feelings up against a wall of perspective. I believe that you cannot examine a single thread of the tapestry, but must look at the whole that includes the anchoring knots that will stabilize the tapestry giving it shape and dimension. It is by using each of those individual threads and anchoring knots that we weave patterns that flesh out the fabric of our lives.

What are the anchoring knots that being a part of the Arkansas Model United Nations became for me? Are there any? How do they hold the fabric of my life and allow or encourage the creation of the pattern that I have lived in the intervening forty -eight years?

The words that came to me when I began to think about this were: ethnocentrism, xenophobia, and smorgasbord. When I went to college, I chose to study the social sciences; Anthropology, Sociology and Psychology, as well as History and current events. One of the first concepts that I learned was that all of us are innately and instinctively ethnocentric. We learn things growing up as part of a cultural environment that we never question, examine or think about. An example is the way that we utilize a fork and knife in our culture. If you are able to travel around the world and discover that not everyone eats with a knife and fork in the same manner that you learned growing up, you may be surprised. Depending on the strength of your ethnocentrism, you may be uncomfortable and judgmental about the differences. Your unconscious will “know” that when God invented the fork, he meant for us to eat with it the way we learned to eat with it. These same cultural mores will haunt you with regard to how you interact and participate when among others. For example: When you meet strangers on the street, do you look at them, smile and greet them? Or, do you look the other way and then peek at them out of the corner of your eye to see if they are dangerous? Those patterns are ethnocentric.

Another key term that I learned is xenophobia. Phobia means the fear of and xeno refers to strangers. Many of us are raised to be afraid of those that are different. It doesn’t matter how they are different, we immediately and instinctively fear them. We are socially resistant to change. Change is hard in part because of this instinctive fear. In the world, there is clearly an “us” and “not us.” And, the “not us” are different, weird, fearsome and wrong. We must guard against them and work to maintain our own inculcated values and behaviors. We will resist “different,” “new,” and “other.” Emotionally we are driven to resist change because of the xenophobia and the ethnocentrism.

Getting an education exposes us to other ways of thinking, knowing and being. If we are open to the educative process we can learn how others dress, work, interact and believe. We can measure those things against multiple interpretive matrices. Does the way they work make them happy? Empirically, are their ways more efficient? Do their cultural goals seem to work better for them? Could we learn from them anything about how we organize our families, our businesses, our homes, our lives? What can we offer for their consideration? Are they open to accepting new ways of thinking and behaving? Are we arrogant for thinking they should be like us? Are they afraid of us? Are they xenophobic? Are they instinctively aware of the truth of their “ways” and the wrongness of ours? How do they treat women? Gays? Foreigners? What is their religion like? How does it impact their choices and daily lives? Could we talk to them about our beliefs and religion? Would we have an ethical obligation in return to listen to their myths and stories, and could we evaluate whether those might be more “true” or “better?”

Finally, the word I really want to talk about, especially in terms of going to college, but also in terms of living life as the journey unfolds, is smorgasbord. I strongly believe that life is a smorgasbord, a table full of options and choices. We should examine those options and try many of them. We do not have to eat all that we take off the table, we can taste it and then pass on it, but we would benefit from being open to new experiences and new paths.

My younger son recently went off to college as a freshman. One of the messages that I have given him about being in college is that it is the safest and most free time he will ever have to explore the smorgasbord of life. He is unencumbered with obligations to others. He is free to explore and invent himself as the adult he will become. I want him to get involved in a little of everything that University life has to offer. He hates the idea of giving a speech, I want him to take a course in public speaking. He wants to be an engineer and study math and science. I want him to take a drama course, a poetry course, or a dance class. I want him to join political clubs and go to different churches and see what he thinks. I want him to hang out with new and different people. I want him to open his eyes, his heart, and his life to the possibility of change. Change is scary, but exciting and potentially life enhancing. I tell him “Go for it!” Do not be afraid to fail, do not be afraid to taste a new flavor or learn to think a different way. You will always be you and we will always love you, but exploring new things gives you tools to put in your pocket for later use. I want you to dream dreams and taste flavors and seek new realms of adventure. Weave the fabric of your life from exciting and beautiful new threads. Do not just live in a grey world bounded by your ethnocentrism and your xenophobia. Travel, smell, taste, hear, see, sing, dance and play. If you begin your journey this way, you will more likely live your life this way.

These are the things I want to say to the students at the AMUN. I also want to talk about some of the other lessons they can learn by participating in these types of events. They can learn to negotiate, to understand and manipulate the levers of organizational power. They come to know that all politics are local, and that their ability to relate to others, to radiate an aura of competence and knowledge and confidence will not only help them be safe, but it will help them grow in the ranks of their professions no matter what those are.

Education is about learning, about the defeat of ignorance by the acquisition of skills and information. Education is a training ground for acquiring skills and abilities and information with which to frame your world- view, and through which you can determine the direction of your journey of life. Take the ride, life is about the journey, not about the destination. It is not about being “safe”, one can never be truly safe in an uncertain world. Fear can be a positive tool for growth just as much as adventure can cause you to encounter new stimuli, and openness can help you digest whatever life has to offer. You cannot get through this life without pain and loss, but your journey will be so much more rewarding and fulfilling if you will learn to throw the dice and take a chance that you may fail in order to break the mold of limited thinking and small lives defined by ethnocentrism and xenophobia. Eat at the smorsgasbord! Enjoy.

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Setting the Clinical Frame: Past Life Regressions and Hypnosis in Therapy

I recently attended a conference in Pasadena where I had an opportunity to see Brain Weiss. Dr. Weiss is an author and a classically trained Psychiatrist. The focus of Dr. Weiss’ work is past life regression. This focus evolved over a twenty-five or thirty year period and he has written several books about it. I find his work to be particularly interesting because I am not sure that I accept the concept of past lives and the ability of someone to regress to memories of those past lives. Dr. Weiss writes well and articulately about the experiences many of his patients have had. Part of what I find fascinating about him though, is this argument that no matter what your religious or cultural traditions and beliefs are as a clinician, it is not necessary for you to believe or dispute whether we are dealing with reality here. This is what matters: Does the conceptual framework of a past life regression help the patient to find a way to heal themselves and to alleviate their pain and struggle? If the client is better as a result of the experience, isn’t that the goal?

I find this line of thinking to fit with what I do believe. It also fits with what I learned from Dr. Milton Erickson’s works. Erickson often said that the client always knows what they need to know, and the client knows what they need to be better. They may not be able to share it with the clinician, but they know. Erickson says that the clinician does not need to know because their job is simply to facilitate and to create a safe holding environment that enables the client to safely explore and rehearse what they need to do to improve the condition of their life and the script that they follow.

It seems to me that these men, both classically trained Psychiatrists, are trying to say to us as fellow clinicians, is that the magic of therapy is in the holding frame and in the relationship. Additionally, both Erickson and Weiss speak with a calm, reasoned voice that lacks excitement, passion, or stimulation. They both have trained themselves to speak hypnotically. They softly frame the experience of the client or of the workshop participants so that they allow and support a self-hypnosis. The script they use allows you, as the subject, to frame what you will “know,” “remember” and “discover” so that you can then “understand” or “know” what you need to do with it. In this workshop, Dr. Weiss utilized techniques from Gestalt therapy, imagining the two chair technique where the patient becomes the two conflicted parts of himself and converses in turn from the perspective of each part so that a dialogue and negotiation can occur between the disparate or conflicted parts of the self.

Setting the frame and the holding environment is one of the most important skills of the therapist. As Dr. Weiss began to explain what he would attempt to do over the hours of the workshop, he spoke calmly and hypnotically in a soft and gentle voice. He utilized self-deflecting humor and a quiet, low energy voice modulation to prepare us for the experience of guided imagery that would allow us to become self -hypnotized.

In therapy sessions, I no longer attempt to use hypnosis. My perspective on that changed some years ago. I came to believe that our memory blocks us until we are strong enough to remember. When we have the strength to remember and to deal with what we remember, we will have a flash of recall that will “reveal” what has been hidden. When we can handle knowing we will know. That door will open when we are ready to see what is on the other side. So I no longer use hypnosis as a device to uncover past memories or lost memories. I tell my clients who are experiencing flashbacks that those are not things to be afraid of, rather, they are signs that you are getting stronger. The wall of dissociative separation from the trauma of the memories is beginning to break down because you no longer need it to protect you from “knowing” the truth of what happened. I encourage my clients to accept the frame that the memories breaking through are evidence of their strength and their growth. I warn them that sometimes the truth hurts, but that they are strong enough to know what it is and deal with it. If they are not, then the truth will not come.

That being said, I do use hypnosis as a form of a relaxation trance that allows their bodies to stop the anxieties they feel as distracters. I use hypnosis as a way for them to focus their “third eye” so that they can look without fear and despair, and that they can remember and evaluate their experience from the perspective of the “now.” The stronger, adult “them” can look back at the mental movie of whatever happened. They can be aware of the pain, the fear, or the shame of the experience, but they can filter the affect through the technique of the relaxed hypnotic state. They can watch the movie, pause it, turn the volume down or off, back it up and replay it fast forward it, or do what ever they need. They can even become the director of the film and change the script and the motions and behaviors of the actors. They can rehearse alternative endings to what happened. They can see themselves as actors in the play who change their participation and their understanding, as well as change the words and behaviors of the other players in the drama, if doing so would help them heal. They have the ability in this safe holding environment to have imaginary conversations that never took place. The adult “them” can talk to the child “them.” they can assure themselves that they will survive and become strong. They can explain that the trauma is not their fault, that the shame and hurt of the abuse belongs to the abuser and not the child who is on the receiving end of the violation of power, or on the wrong end of the sickness of the adult. They can praise and honor, with love and affection, the ability of the child to survive and grow to some day become a stronger and functional adult who will be able to take care of them so that they cannot be bullied or traumatized again.

The similarity of how I work to the way that I understand Dr. Weiss and Dr. Erickson work, is that we take the client of today, create a vehicle whereby they can review their past experiences and memories and find a path towards healing and strength. It does not really matter at the end of the day whether or not these experiences are concretely provable. It doesn’t matter if someone remembers being a slave in ancient Egypt, being saved from drowning by their heroic father or being abused by their grandfather, actually had those experiences. It is not possible, nor relevant to identify the perpetrators and prove in a legal sense their culpability. What matters is that the vehicle of the imagination and “memory recovery” enables the client to challenge their ego dystonic processes and navigate a path forward towards ego syntonic choice and healthy self awareness and functioning.

The magic of therapy is not in the wisdom or knowledge of the therapist. The therapist cannot change nor heal the client. What the therapist can do, and should do, is create the safe holding environment of the non-shaming and non-controlling therapy session so that the client can utilize their inner strength and awareness (although unconscious) to learn what they need to know to heal and forgive and grow into someone who does not follow a victim script. The victim script would continue to limit their life choices and cause them to repeat the dysfunctional behaviors and habits. They have used to survive as a result of the abuse they experienced and the script they were taught as a way to protect their abusers.

Do not get your ego involved. As a clinician, it is not about you. Your job is to be calm and safe for the client. You want them to use your strength until they find their own. You are not to rescue or save them, you are not to solve their problem. You do not know what they need. You cannot direct them or choose for them. Your job is to create the therapeutic frame and the holding environment. You can project your calm accepting strength and appreciation of the client. You can encourage them to be aware of your acceptance, your non-shaming, your belief in their innate goodness and their ability to make changes in their lives. If you do that, they will do the rest.

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The Evolution of Therapy- My View

I have spent more than thirty years in private practice as a family counselor and therapist. I was in practice almost five years before Missouri passed a licensure law creating a category known as Licensed Professional Counselor. This was a reflection of a national movement to enhance and solidify the credentialing for Counselors. It was an effort to stake a claim to a name that would build an inherent identity and reputation. Licensed Professional Counselor (LPC) was supposed to become the step down in the hierarchy of professions, i.e. Psychiatrist, Psychologist, Licensed Professional Counselor, Social Worker, Marriage and Family Therapist, etc.. The goal at the time was to increase the standard of training that was behind the legally restricted title, both to protect the public from quacks and charlatans and to improve the marketability of the opportunity for the therapist.

As I have watched the profession evolve over the last thirty years, it seems to me that the focus has become more and more about legalisms, paperwork, limitations and carving out patient segments for matching counselor segments. There is a strong move to suggest that you can’t do internet counseling unless you have a specific credential approved and provided by the national organization. There is a similar restriction on the use of tools such as hypnosis in therapy, working with children with particular disorders or working with married couples and families. We all seem to need to specialize. We specialize by taking extensive, expensive and additional certification training regulated by the national organizations and the State Licensure Boards, who take their guidance from the National Organization. It is my opinion that what seems to be happening is that the generalized approach to being a skilled counselor, serving a wide variety of patients, is being legalized and specialized out of the market place.

At the same time, on another tangent, it seems to me that the universities who are educating the Counselors in Training to become Licensed Professional Counselors are changing their emphasis in the delivery of their programs away from clinical expertise, and more to a message and an expectation that one must get into a Ph.D. program. This requires the LPC to take an additional load of education and debt and jump through another set of restrictive hoops in order to be able to practice. I believe that the primary goal of these efforts is to act in restraint of trade. Ostensibly, it is to protect the public and guarantee that there is supervision, standardized training, standardized diagnostic labeling, standardized billing and office operation, standardized specialization of patient populations and so on.

I worry about all of this. I believe that good therapists, like good teachers, come to the table with a varied background of experience and knowledge. I think the critical ingredient in the productive work of therapy is the relationship that is established between the client and the therapist. I believe that it is the process of developing a relationship in a protected, safe situation that creates the healing environment for the therapy to be successful. If training programs begin to change their focus into an emphasis on research and paper writing, if the national conventions are populated by research presentations of increasingly discreet and selective examples of myopia that typically do not appear in a counseling office, then eventually the profession will lose its way and its validity. I do not think there is anything more important for a counselor in training to learn than the essence of the relational hour.

What are the clinical skills on which a good therapist needs to focus in order to help the random client who wanders into the office? What happens in the session that incorporates the theories and philosophical terms such as transference, projected identification, ego dystonic or ego syntonic behaviors? How relevant are terms like narcissist, bi-polar, borderline etc. for the average therapist who is working in a practice in the community at large, and not for a special unit at a University Hospital? No matter what the label of the diagnosis, what do I as the clinician need to be able to work effectively, ethically and helpfully with the client so that there is an opportunity for the client to make progress towards a healthier and more functional life?

How do we measure success in therapy? Who gets to decide when the therapy is ended? Is it the insurance company that determines payment? Is it the research statistician who claims that depression should be cured or improved enough in fifteen sessions or the therapist who says, “I believe in brief short term therapy and will only see you for twenty sessions or less, no matter what is going on?” Or, is it the client who says I want to come, I need to come, I am not finished yet?

One of the issues which evolved over the years that I have been in practice is note taking. When I was trained, I was taught that one does not take notes during the session. One must train their memories and observational powers so that after the session is over they will remember the salient points of reference. If the need is there to help them remember, make such notes as will help trigger their memories to work on behalf of the client. Today, the rule is be careful of what you write. Make sure that it is not an expression of personal opinion (i.e. George was depressed today, or George was suicidal today) but rather a quotation, “George said he was depressed today.” That way, when and if you are sued and an attorney questions the subpoenaed notes you have written, you won’t have to spend hours documenting your specific, exclusive and clinically focused courses on the nature of depression, the diagnosis of depression, and the treatment of depression, before you can testify about George himself and what he had to say.

Early in my practice, the lawyers recommended that we write down only that which was absolutely necessary. They warned us that our notes could always be obtained and dissected in court, taken out of context and be made to be about us, rather than a reference to our experience of the client. So, they simply said don’t do it. Today the national standard requires you to take notes, that they must be written with in twenty four hours of the session and that they must be phrased in certain “codes.” The clear expectation is that the notes are written for the legal system, not in service of the client.

I worked at the University level for twenty-five years, teaching students what I knew about how to practice as a clinical therapist. I helped them learn how to practice under the supervision of the rules and within the guidelines, but still to focus on the needs of the client and on the question: What will help the client get better? I warned them constantly that they would be in harm’s way each and every day that they worked in this field, but that they could not become paranoid and defensive to the point that it crippled their ability to be open to the client and make a relationship that was based on the needs of the client. I was adamant about my goal to focus on teaching them how to be clinicians, how to do the dance of therapy with the client and not spend too much time on legalisms and standardization of the product for the purposes of the insurance industry and the national organizations of the counseling profession.

It is a delicate dance we do when we set out to be therapist. We must practice with ethical care, we must be aware of the needs of the client and the demands of the law or the license board. We must figure out how to make a living in a career about which we feel strongly and we must attend to the client and their needs in such a way that they get better and go and tell their friends that you, the clinician, are worth coming to see, even if it costs them money!

I worry that the training programs are growing away from a focus on clinical expertise and that the increasingly intent movement towards standardization will lead to a one-size-fits-all set of standards based on diagnostic labels, check lists, defined number of sessions, symptom reduction on demand, paperwork skullduggery, and sub-categorization of specialties so much so that the generic practice of “therapist” will weaken and disappear. I know any number of therapists and LPC’s who have begun to move their professional focus over into a new category called Coaching. I hear from them that Coaching is in the early stages of the same kind of restrictive, reductionist movement that the counseling profession has experienced over the last twenty or so years.

What will become of the population of normal people who have relational and emotional problems who could benefit from therapy if we restrict and ruin the professions who could serve the need by “improved management and administration” strictures and requirements? I wonder. I worry.

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Sex and the Mature Single, A Nation in Flux

I have a number of clients who are in their fifties and beyond. Some of these clients are single, either from being divorced or from being widowed. Many of them want to talk about the question of sex and “dating” after the age of 50. This topic is a real challenge to me for a number of reasons.

As a clinician it is not my job to “judge” people for the choices they make or to “tell” them what they could or ought to do. Most of my clients already come to the table with a boatload of “shoulds” that inhibit, or limit, their options. These shoulds, or musts, really cause them difficulty in part because they are old scripts. Scripts that these warm and wonderful people learned in childhood about sex and sexual behavior are so internalized and reflexive that the individual’s ability to make choices based on current reality become hampered and limited, if not blocked entirely.

In all honesty, I should also confess that I am possessed of a script of “shoulds” around the topic of sex and sexual freedom or sexual behavior. I grew up in an age similar to that of many of my clients. I am in my mid-sixties and I “know” reflexively what I am supposed to do or not do. This helps me empathize and sympathize with the plight of my clients. The script we were taught as children is that we will grow up and fall in love with one person, marry them and live happily ever after. Within the context of that lifetime relationship, sex is expected to be an active and fulfilling part. But what happens if the relationship does not satisfy and/or last a lifetime? What if we discover in our fifties or sixties, or even seventies that we are alone, without a sexual partner, and yet still feel the urge and the need to have sexual relationships? What do we do? How do we “date” and find someone to become a sexual partner? Can that person just be a friend with benefits or do we have to fall in love and marry? What about that old demon, “masturbation?” Can we do that now? I am pretty sure we won’t go blind if I do, but what about the shame, the guilt, the sinfulness?

These are very real questions with which my clients struggle. The examples are the realm of late night comedians. There are many jokes that can be told and movies are made about the conundrums we all face if we find ourselves in these positions. Yet they are painful, disturbing and anxiety provoking problems for those who suffer from them.

Think about the issue of grown children. What do you tell your thirty five year old daughter and her three preteens about your spending the night with your “friend” (or as one of my clients likes to say, “my special friend”emphasis hers.) If you vacation with your grandmother and her boyfriend, do you have issues or feelings about her sharing a room with her “friend?” Suppose your parents have just gotten divorced after thirty five years of marriage and your father begins to date a woman twenty five years old? What if your mother does the same? I have one 54 year old, female client who is having what she calls “wahoo” sex with a twenty four year old man. She is not interested in this man for anything other than sexual release and his athleticism.

Sometimes the issue about which mature people are most concerned is the relationship with their children and extended family, not as much with the issue of being sexual with their new playmate. They worry about making decisions that will protect the assets they have for the inheritance of their own children, rather than the children of their new friend. Entire families often get brought into these discussions and the conversations can be heated and painful. Do you want Dad’s new bimbo to inherit your great-grandmother’s house? How can you prevent it? Should you? Family therapy is a fun-filled challenge when these issues arise. But, I digress from my original topic.

I was recently approached by an 84 year old man in the public library where I was doing some research. He saw me using the computer to look up something and whispered to me, “Do you know anything about computers?” I asked him what he wanted to know and he replied that he had recently met a 50 year old woman in a bar. She was very nice and had given him her name and phone number. He wanted to look her up to see what he could find out about her. His exact words to me were, “I wonder if she is just after my money? You know there is no fool like an old fool! I am afraid she is just looking for a sugar daddy.”

This sweet old man was lonely and alone. We talked for awhile and he communicated that he wanted to make a nice female friend he could go out with and spend time with. I did not ask him if he wanted to have sex with her. He was not my client and it was not my business, but I did wonder. Sex for 80 year olds is still a possibility in the historical understanding of the term, but there are also different meanings that can be applied to the short hand term “sex.” Does he just want to be touched? Does he just want to touch and be held? Does he want to please a woman one more time in his life physically? Does it have to include intercourse and release, or can it just be holding, touching and looking with soft, sweet words?

You may find yourself wondering whose business it is anyway. My point is that the client comes to the therapist to help work through the questions and the social taboos. They have to deal with the “musturbations” of Albert Ellis ( Ellis uses the term to mean the shoulds that we all feel, as in “I must go visit grandma” or I “must” go to church), and the social messages of their religious faith, their cultural blind spots and their own physical energies and needs. My job is to help them figure out what they are really asking and how they would feel about themselves given any of the possible options they might choose. Of course, this presumption is based on the idea of them already having a potential “mark.” What about those who are considering looking for someone? Where does one go when one is seventy- five to find women to court or men to date? Do you go to church, the gym or internet dating sites? How do you vet these people once you have found them? What are the rules? Do you kiss on the first date and move on to second and third base, and then the home run phase?

Since women generally live longer than men, the pool of choice for women is much more limited. Do you know the term cougar? How would you feel if your grandmother was one? What if she wanted to have Christmas at her house and include her boy toy? We may not have thought about the answers, but we have to begin to face the questions themselves and evolve our thinking because it is happening in many families today. Divorce rates are going up among the sixty-and-over population, nursing homes are having to provide “relationship” rooms for those residents who want to have some together time. Grown children are having to check their assumptions and look at the reality of the life their parents are living (often when they are attempting to model and set standards of behavior for their teenagers at the same time.)

Our culture is evolving in part because we are living longer. Our standards and our options are in flux. As a therapist, I have to make sure that I am not blinded nor bound by my own cultural binds. I ask myself, “How can I help? What do I need to hear? What is the client asking me for, and what do they want from me?” I don’t know what my answers will be, but I believe in the process of therapy and in the healing and growth that can come from just talking things through with someone safe and non-judgmental. I want to strive to be that person as a clinician.

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Some Thoughts On the Neurotic Defense of Repetition Compulsion

Have you ever spent time watching the same movie over and over? Have you read the same book many times? Do you find that when you are sad, tired, depressed, or anxious, you can feel better by escaping into the old friend of the book or movie, and at least for awhile, you feel better?

What is happening is what Freud called a repetition compulsion (RC) which is a neurotic defense against anxiety. The theory involves the idea that we regress from our present functioning state into a previous state of childhood and attempt to utilize the behaviors we used then to make ourselves feel better today. What is missing for us is the adult realization that we can act in new ways on the environment, try new behaviors and perhaps have new outcomes. Many of us are not willing to test the new outcomes hypothesis because we fear change and the unknown. Even if our regressive defense of repetition compulsion produces re-enactments of things that wound us, it is better to try that same thing again, knowing the likely outcome, rather than to try something new and open an entirely new universe of options.

One might wonder if this is something that everyone does? Is it RC when I go to my favorite restaurant and order the same thing every time? Or, is it just that I like it? A Freudian would tell you that it is RC. You are trying to recreate the emotional condition of the past experiences, where you felt safe, loved, and happy. Or, Freud thought that you are trying to unconsciously revisit the past experience where you did not feel those things. In this case, you felt anxious and were not sure that you were loved or safe. You anticipated that you would be hurt or punished and you are trying to relive the experience, hoping that this time if you just get it right. You hoped you would have a better, different outcome. So you order the same food, have a wonderful “date” and all of you will go home happy and loved. The problem is that it never works that way.

Of course a non Freudian, would tell you that sometimes a good cigar is just a good cigar, and that it is ok if you always order the pot roast each time because it tastes really good. The question here would not be do you repeat the behavior or thought pattern, but what is the emotional state at the time? Are you anxious? Do you fear you are going to be punished or rejected? Are you testing the waters to see if this time you will be the beloved hero? Is there tension and anxiety in the mix? If not, then it is probably just a self -soothing strategy that you are repeating because you learned that it makes you feel better in the same way that a child sucks its thumb.

But for those of us who grew up in traumatizing homes and experienced the unbalanced rejection by our Objects, the theory says that RC is an unconscious effort we make to re-stage or re-enact scenarios from our past, always hoping that this time we will get it right. If we smile just so, if we wear our lucky tie, if we tell a funny joke, or make some other magical behavioral change then our Object will love and embrace us, rather than reject and wound us. Our thought, consciously or unconsciously, is that we have the power to figure out how to satisfy the Other. We think that we are at fault and we must find the key to the door that unlocks their love and acceptance.

When we grow up, we seek out other relationships that allow us to re-enact the conditions of our childhood. We find friends, bosses, lovers, who will unconsciously play the roles of the rejecting and traumatizing Other. These individuals will dance the dance with us over and over. Our radar selects people who will play the role and help us replay our emotional wounded-ness. We are always hoping that this time we can just get it right, and this time we will have a happy ending and be loveable and loved. As adults, we must learn that it never, ever happens this way. The path towards healing and happy relationships involves our ability to accept that the failure of our childhood was not due to us and our inadequacies, but rather to the failure of the Object to be able to love us because of problems that were theirs.

If we are able to make this giant leap of understanding and trust, we can stop chasing the rainbow. If I am able to tell myself (and believe it) that my father was a broken, wounded man and that his hurting of me was due to character flaws and issues in him, not in me, then I have a chance to heal the wound and not forever chase my father demanding that this time he love me and make me safe. It never happened in real life and it will never happen now unless I can give up the childhood fantasy ideation. I must re-parent myself and love myself because I find that I am loveable, not because of having received my “OK-ness” from the object or the other.

As a therapist I have taken this journey with many of my clients. Can they find enough self-acceptance to be able to stop the negative aspects of repetition compulsion? Can they learn to take the adventurous new road to choose something or someone, new and different? Can they stand on their own two happy feet and trust that they have the right to be loved because they are loveable and love themselves, or will they always chase their broken father or mother and re-enact the losses of their childhood with the constant cry of, “Why does this always happen to me?!?”

I believe that therapy is about re-parenting. The job of the therapist is to create the safe holding environment so that the client can find a safe place to stand. The therapist must be empathic and non judgmental. We must help the client see themselves honestly and accurately, but we must not be the critical parent. The client will project this critical parent onto us and expect that we will react the same way that their parent in real life did; reject, scold, or punish them. Many times clients would come into my office and begin by saying, “You are really going to be mad at me this week,” and then confess some failure of will, or behavior about which I was to be so angry and disappointed that I would punish them and reject them. This creates a self-fulfilling prophecy. When I did not respond in the expected manner, it would shock the client. They would not believe I could react this way and would attempt to elicit an “honest” rejection of themselves from me. When I continue to be myself and not their projected critical parent, they eventually are able to consider what was really going on and figure out a new way of experiencing themselves as an honest reflection of my feedback, rather than an unconscious projection from their childhood.

We all use our primitive defenses. We globalize them, and when our current anxieties overwhelm our grown up coping skills, we regress into what worked for us in childhood. That may be anger or rage (we will scare the monster away and get our way.) It may be seduction (I will have sex with them and make them happy and then it will be safe for me here.) It may be a physical behavior like eating or drinking or it may be taking a stupid risk like driving in a dangerous way (all the while expecting that “God” will take us if we are really bad and will let us live if he wants us to continue.) It is irrational, or non rational. When I find myself in this place, I tend to eat chocolate and read a book that I have read many times before. This allows me to escape into another place and another time for the time being, so that I may avoid my anxiety provoking situation. My challenge as a therapist and my challenge for myself is to continue to generate opportunities for new choices and new risk taking. To learn that risk taking and the unknown is not nearly so scary, or so unrewarding, as constantly repeating the failed and damaging past is a lesson I must model for myself and my clients.

Can you do that as well?

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Transference and Countertransference revisited.

I recently received a complex question in response to my blog on Countertransference. It has gotten me thinking once again about the challenges of countertransference in therapy.

For those of you who do not have much experience with this, the terms transference and countertransference are used in therapy to describe a couple of different phenomena. Transference, according to the theories, involves the assignment of feelings and reactions from within the client, projected onto the person of the therapist. The idea is that the client will experience the therapist as the person in his/her life who is involved with these feelings. For example if the client is afraid of his mother and angry with her, the client will become angry with the therapist and be afraid of them. The belief generally is that the client will have an opportunity in a safe and structured environment to work through, or work out the feelings that have been blocking their ability to live a life of self -ownership and independence and release them.

The role of the therapist in this dynamic is to be the safe counter point. The client is allowed and even encouraged to express the feelings that have been causing them so much distress (either consciously or unconsciously) and to accuse the therapist of being the root cause of them. i.e. “You are going to punish me and hate me because I have not done what you wanted me to do,” says the client to the therapist. This is a projection of transference energy onto the therapist as the “bad” mother who rules over the freedoms of the client to express themselves and own their genuine feelings. The therapist must be sensitive to these projections, not be angered or offended by them and create a safe holding environment so that the client can take these feelings out, examine them, evaluate them, work with them, and finally unblock themselves from these limiting feelings. Hopefully, their relationships going forward, both with the object (the person in their lives such as their mom) and with new relationships that come along will be unhampered by these blockages of fear and anger.

Countertransference is just the opposite. It is understood as the feelings in a therapist from their own lives and relationships that become projected onto the client and acted out by the therapist. Therapists are supposed to be trained to be sensitive to the occurrence of counterT, and to have developed the skills to avoid such things. For example if a client reminds me (literally or unconsciously) of my mother with whom I have a bad relationship and I begin to project my disrespect or anger against my mother onto the client, I will signal to the client that I am angry with them and that they must act in some way to cancel out my anger. It is clearly their fault and they have done something to displease me, anger me, frighten me or whatever.

As a therapist, I am supposed to work through these issues with my own therapy or with my professional supervision so that I do not contaminate my work with the client. This is in service of the needs of the client, and in service of my having the professional skills to block out my own issues during the course of the session with the client. If things are going on in my own life that are causing difficulty with my ability to contain my issues, I am supposed to be able to recognize the signs and take it up with my supervision or in my own therapy. Hopefully, I will have other professionals in or near my office that will be sensitive to my moods and will help call this to my attention. This is one of the reasons that in thirty years of counselor training, I always encouraged my students to work in offices with other therapist present.

The point here is that as a clinician you have an ethical responsibility to not project onto your client your own garbage. I am reminded again and again that all of us have issues and problems. None of us are perfect and none of us are shielded from our own humanity. We are moody, we are depressed, we are angry and petty and selfish. Just like everyone else in the world. We are not some super -clever, super -educated “special” person up on a pedestal who is not impacted by the crush of life. Our relationships flounder and fail, our marriages and our familial relationships are tainted and chaotic, just like those of our clients. In fact, it is our common humanity that enables us to understand with empathy and support what the client is struggling with.

The reason all this came up for me, was that the person who wrote to me felt that her therapist was mad at her and yelling at her. She indicated that he told her that her feelings were dishonest or pseudo tears and that she needed to give that up and be honest. She also felt that the therapist was being inappropriately complimentary or flirty to her. She said she was afraid to go back to them and asked me what I thought and whether or not this was, indeed, Counter Transference from the therapist projected onto her.

You can go back to that blog and read the comment exchange I had with her if you chose, but basically what I had to say was that it is inappropriate for the therapist to be angry with her and to chastise her in the way she was describing. I was not so sure though about the perception of flirting and inappropriate compliments. As you will see from the comments, sometimes the job of the therapist is to reaffirm the attractiveness, strength, intelligence, or courage of the client. When the client shares with us the challenges of their journey and the negativity of their self script, we often find ourselves in a position of “the good parent” who “re-parents” the client by helping them to hear and rewrite a self script that is based on a more objective reality testing of who they are and how they behave.

One of the strongest foundational goals of therapy is the re-parenting of the client. This is to enable them to rewrite the script of their self-esteem, their self-understanding. We all have an interior monologue that narrates our sense of self and our assessment of our worth. This script is sometimes called the superego and it involves all of the messages by which we judge ourselves. Questions such as: Am I loveable? Is it my fault? Why do I always screw up? We have a fundamental script that we learned in early childhood that provides the answers to these questions. We often fight against this script but feel bound by it and doomed to repeat our failures and mistakes. We feel trapped by the circumstances that do not let us explore or experiment with new behaviors and go off on unexpected and unexplored paths.

How can we be free to grow, to unfold in directions of our own choosing? How can we have relationships that make us happy and learn from our mistakes? These are questions that all of us face. We bring these questions to therapy and we fight against the limits of both transference within ourselves, and countertransference projected onto us by the therapist. It is a challenge and a difficult job for all parties involved in the dynamic. It is why we are fellow travelers in the journey of life, not bystanders, not healers. I walk the path with my clients. I share their pain, and learn from their journey how to better walk my own road. It is sometimes exhausting, sometimes frustrating, and sometimes gloriously fulfilling and rewarding.

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Life is Difficult, Pain is Inevitable, Misery is Choice

I received a request this week from David in England. He is doing research on music performance anxiety. In the research he has done he describes a common theme of a wounded inner child. As I thought about what he was asking me in his letter, I was reminded that I believe all of us had painful and difficult childhoods. I believe that by definition, childhood is painful and traumatic. That is certainly not meant to diminish my respect or compassion for those among us who suffered from severe childhood trauma. It is more a statement about the traumatic and challenging series of losses that happen in every childhood.

When we are born, we are the ultimate grandiose narcissists! All of us, each and every one, come into this world having our needs met by others. We are born expecting that when we have needs, someone takes care of them because we cannot. Human babies are helpless in their infancy. Volumes have been written about the cultural imperatives of family and tribal support that have evolved to meet the demands of infant narcissists. What we know is that the more sophisticated and complex the mammal, the more time is spent in infancy where the mammal baby is completely at the mercy of the care by others. Thus, we evolved societies to help meet these needs. We learned about parenting from experts such as Dr. Spock and we create schools to train our young, we are worried about early childhood education. We have to teach our children everything from how to pick their nose without offending others, to the correct way to write the five basic structural sentence patterns of English.

I think it is fascinating to look at the grandiosity of the infant, the innocence and the rage that combine in their awareness as they expect and demand that the universe satisfy and gratify their every need and whim. Babies are made that way. It is life that changes them. Life changes them through denial of their narcissism. Eventually they discover that the world does not revolve around them, they do not command the universe (even though they think they “know” they do.)

As a baby, I want….. and my want is met. I hunger and I am fed. If life fails to feed me, I am rageful. If my rage does not cause the world to respond, I become uncertain and afraid. I panic, and if my needs are still not met, I die. In order to survive, my needs must be met externally until I can adapt, grow and develop the skills I need to meet them for myself. For this learning to take place, I must experience loss. Loss is inherently traumatizing. Those of us who are not supported and taught and naturally strong enough to survive the loss, weaken and die. Humans have amazing adaptive capacities. We do not have to have perfect mothers. We do not have to have full and complete satisfaction of our needs. We just need a chance to make it, as long as we can adapt.

Do you remember the Harlow monkey experiments? The nurturing of the “mother” doll was enough to support the survival of the baby monkey in the sterile environment, as inadequate as it was. In the same sterile environment, the monkey without the doll failed to thrive. Survival does not take much, but it does require that in our lives some support, some sustenance, some opportunity exist. We, as organisms, then begin to learn and to manipulate our environment to demand, cajole, and seduce it into meeting our needs as best we can. I believe that this is traumatizing and hurtful, and childhood is made up of thousands and thousands of losses, each of which is a blow to our narcissism and our grandiosity. As we mature and survive, we become less grandiose and less narcissistic. We will always maintain some elements of grandiose narcissism in our personality, but if we are to survive and thrive in our lives and cultures, we must grow out of it. Darwin says those who survive are the ones who learn and adapt, those who do not, die.

As a therapist I always try to be mindful of this paradigm. Life is about loss, but loss is about opportunity. How we manage to survive loss and seize the opportunity to manipulate our environments and grow and change is the key to our level of survival and success. Each of us is different from the other, both in the area of basic and fundamental abilities, and in the area of essential available elements. Life is not fair. I constantly remind my clients of this. Albert Ellis used to say, “Why not you?” when his clients complained about bad things happening in their lives or complained that they did not get what they wanted and deserved. Why not you? Why should you be rich, beautiful, successful and happy? Who are you as differentiated from the rest of us by anything other than luck?

My therapist friends and I often talk about the amount of “historical” revisiting is necessary for healing and good therapy. Many of my colleagues believe that good therapy requires that an individual sit with their pain, remember their losses and generate opportunities for the “natural” relief of healing that comes from processing their wounds and losses. I tend to disagree. I operate from the premise that all of us are wounded, all of us have losses and hurts and all of us have been victims of the inequalities of life and opportunity and of the damage done to us by the selfishness and narcissism of others, including our parents.

My challenge to my clients is to say to them you are not responsible for how you got here. What happened in your life happened. It is not your fault, you did not cause it, you were the victim of the lack of fairness, which does not really exist and of the failings of others. You are wounded and damaged. Okay, now what? How do you move forward? Although you are not responsible for how you got here, you are responsible for how you leave. You can become “response-able” (you are not powerless, you are able to respond.) You can choose a different path than the one that you are on. What will you chose? What is the cost/benefit ratio of your choices. What will it cost you if you do or if you do not? I want them to think about this reality. I want them to take ownership of their power and to carve a path of healthy selfishness to make the adaptations they need to grow and learn, thrive and prosper. I abhor a victim script. Get rid of it! If you choose to keep it you must know that you are making a choice and positioning yourself to have hurtful and wounding things continue to happen in your life. The interesting question for me is why you would make such a choice? What is your pay-off? What do you get out of it?

I have a friend who is struggling with a major life change. She is looking at making some choices that will completely redirect her life and the way she lives it. She is frozen with fear. She wants to complain about the timing of life and why now is such a bad time to face this decision. She wants to do what Freud calls repetition compulsion and continue to re-do the things she has done in the past which leave her in pain. I keep asking her what is her pay-off? What does she get out of holding on to a failure to thrive mentality? She says I am cruel and heartless and that I am picking on her. I laugh because I know she is being dishonest. She knows I care and love her, but she wants to stay stuck because she is afraid. She is afraid of choice, she is afraid of success and she is afraid of change.

All those things come anyway. Life is not fair. Life is an ever- flowing stream, and then it stops and you die. In the meantime, seize the day. Make your choices and experience your losses but do not be a victim!

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Some Thoughts on the Fears of Parenting Teens

One of the chronic worries reported by parents, in general, is their fear of getting it wrong! Parenting doesn’t come with a manual. I can’t tell you how many parents have come to me over the years and identified that they were concerned about doing something wrong…..or failing to do something right to the point that their child was damaged in some grave way. Therapy often involves working through those fears and trying to establish some basic parenting practices for discipline, encouragement, promotion of specific goals or behaviors, all in the context of a philosophy or “world view” that allows the parents to quiet their own anxieties.

Parenting begins before the child is even born. Parents have to give thought to their ability to provide a safe, secure, and nurturing environment for the child. Mothers in particular, have to be aware of prenatal health concerns and changing habits such as smoking and drinking alcohol. If the mom is on antidepressants, or some other strong medicine, it becomes a question between her and her physician regarding whether or not she can safely stay on these meds while she during her pregnancy. Hopefully, (in healthy families anyway) the mom and dad are having conversations about their parenting values. What is the worst consequence you are willing to provide for your child? Do you spank? Shame? Lecture? Do you take things away? Will you nag and scold? Do you give multiple warnings, or do you provide an environment that is based upon good boundaries, with clear warnings and consequences known in advance? Perhaps the message you will consistently give your child is: You are making a choice. You can choose to have a tantrum, but if you do, you will be choosing to spend a half hour in your room. If you choose to call your brother names, you are choosing not to watch TV tonight. It will be breakfast before you get anything else to eat. I do not want to do this, but I will honor the choice you are making.

As parents, do know how to say this to your children? “I respect and love you enough to allow you to experience the consequences of your choices.” When children are young they can be and should be micro managed. There need to be opportunities for experimentation and failure. Children should be allowed to fail, they should be encouraged to try for things beyond their capacities, even when those things lead to hurt, failure or disappointment. We need to create an environment where they are allowed to practice decision- making, analysis of consequences, and develop skills for the manipulation of their environment while they are young, and the failure costs are minimal. If a young child has never failed, never learned how to console themselves, nor to get up and dust themselves off and try plan B, then, when they are teens or adults, and encounter their first loss, it can be devastating. A child who has never experienced loss and failure and resilience and recovery might be suicidal if they do not make the dean’s list or the cheerleading team. If a child has always been on teams that gave everyone a trophy and they encountered a competition as high school seniors where they actually lost something they wanted (such as a scholarship) they would not have the resources, or coping strategies, for dealing with it.

As parents, we need to structure these environments for our young children, but as the children age, we need to step back and make the box larger and larger. They need more freedom and more room to maneuver. We still want to surround them with safety, involvement and supervision, but we want them to continue to practice their survival and adaptive skills so that they can handle the stresses and costs of life. This process is called the “Dance of Separation.” The goal is to get them out the door at some point so that they live independent, autonomous, contributing lives rather than living in our basements, emotionally handicapped, unable or unwilling to engage life and unable to accept or face the challenge of independent living, employment, or the development of friendships and relationships.

These are pretty universally accepted goals for parents in our culture. For most parents, the question is not should we engage in this type of parenting, rather how do we implement and pursue it? What do we, as parents, do to push our children into or onto paths of independence? What do we do when they make choices we do not agree with or think might be harmful? What if they do not want to be what we want them to be? How do we discipline when they still live in our houses but feel that they are all “grown up?” Here are some of my thoughts.

I think we need to articulate and communicate as clearly as possible what our bottom lines are, to the degree that we know what those are. What are we willing to support, to allow, even to indulge? Would you let your 19 year have a sleep over with their opposite sex friend? Would you let your child drive the car if they did not have insurance that was up-to-date? Would you let them smoke in your house or your car? Would you buy them cigarettes? What if they skip school, or even drop out? How will you handle it when they don’t want what you have prepared for dinner and demand that you fix them something else? Do you give them an allowance? Until what age will you provide their spending money? Do you require them to participate in household maintenance activities such as mopping the kitchen or cutting the grass? As the parent, YOU need to know your answer to these questions. You and your partner need to be on the same page as much as possible, so that you can give a consistent message to the child of what the boundaries and expectations are, along with the costs of non- compliance.

I believe that young people who are beyond the average age of a high school senior, no longer live at home as an entitlement, rather they live there as a courtesy. This is a privilege they are given in return for acceptable behavior and compliance. If they do not provide either compliance or acceptable behavior, then they should be asked to move out. I am always dismayed when I hear adolescents (or young children for that matter) speak to their parents in hateful, scorn filled voices, seething with anger or contempt. For me that is a hard line. My conversation goes something like this: “You will not speak to me in that tone of voice no matter what your level of distress is. I do not permit myself to speak to you or anyone else that way, and I will not tolerate your speaking to me, or your mother that way! Should you choose to not require yourself to speak in moderated tones and civilly negotiate for the things you want, you can choose, in fact, you are choosing not to live here. If you choose to live elsewhere, then you are also choosing to support yourself financially.” As a parent, the fact that you have healthy boundaries does not mean that you have abandoned your child or your responsibilities (despite what she may tell you.) Quite the contrary, it means that you are strong enough in your commitments that you are willing to allow your child to become independent. You can still love them, and support them emotionally, and even with some financial help. But, at some point, the goal is for them to support themselves.

What if your child struggles with the idea of independence? What if they refuse to move out, to get a job, or to pay their way? Then what? Obviously these situations do not happen in a vacuum. You do not wake up one day and find that your child has become someone you do not know. These behaviors will have been tested over time. There will have been in-vivo experiments where they practiced challenging your expectations and your use of consequences. They will have experimented with saying no to what you want or expect. How you handle these things when they happen is of critical importance. You must provide boundaries and consequences. You need to have them proactively established and known in advance. You must allow them to experience the consequences of their choices, or the child will learn from their experiment that you are a sucker and you cannot be taken at your word!

Many parents who find themselves in this trap are afraid. They are afraid that they will do or have done something wrong. They worry that their child will hurt themselves, often the child threatens suicide or self-harm. These are very scary times. They fear that their child will not be able to do the things to provide for the same standard of living that the parents have provided for them and that they must wait until that capacity is there. They are depriving their child of independence and of the joy of learning how to take care of themselves, of having self-ownership and self-capacity rather than “self-esteem” which is hollow and unfounded. Self-esteem comes from capacity and the ability to accomplish what you set out to do. Self-esteem does not come from entitlement, praise, or the absence of real-life consequences.

Remember, that as your child ages, you must stop micro managing. Do not tell your teenager to brush his teeth three or four times a day. Do not nag him about his homework. He must internalize the reasons for doing well in school and must take ownership of his grades and his progress. If he does, then he will strive to do well in school and love learning. You will see him grow and blossom. If he does not, even if he drops out of school, he will learn what it is like to be poor and not have many options in life. This is a painful lesson. But if he learns it, he will choose to go back to school, perhaps in a non -traditional way. He may go to night school, trade school, or work one or more part times job in order to make changes to his circumstances. He will learn to be a good worker, to be employable, or to save his money and pay for college. Just as you have, he will learn to recover from his mistakes and learn to pay cheaper prices for his choices.

The goal is to try to manage these situations rather than reactively and emotionally respond to them with fear, hysteria, rage, shame or embarrassment. You do not own your children. They are not detachable extensions of you. They must separate and become independent and you must shove them out of the nest. A child will not learn from false praise, pandering, and the lack of consequences. Learning is painful and growth is hard. The best learned lessons are the ones that result from experiencing consequences, failing and from engaging in the great game of life, knowing that you may win or lose by the nature of your effort and your choices. As parents, we often question if we have done enough for our children. When in reality, we often have done too much, given them more than they need, and we have been reluctant to let them lives the experience their own choices.

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