Trauma & Attachment Therapy

Interesting 45-minute documentary of DID woman who got her father put in jail.

https://www.youtube.com/watch?v=lsXFcbPbvI4

Interesting, somewhat sensationalized, video from the Australian 60 Minutes show, about a woman who went to the cops and won in court.

The story is brutal, as is often the case for people with massive dissociation. The outcome is lovely.

Check it out!

Differentiation and Integration in The Big Sick, Fun Home, and Trumpet

    In the last three days I've had the pleasure of watching the fabulous movie, The Big Sick, the incredible musical Fun Home, and reading Trumpet, A Novel. All three are great art. The first two are based on the writers' lives. All are about "coming out", or not, to one's self and one's family and culture. All show how how when people hide who they are, they are separated from the people around them and have internal parts that are dissociated from each other.

    In Big Sick, Kumail Nanjiani (who plays himself) is a Pakistani-American in love with a white, non-Muslim woman, who cannot show his parents who he is and who he loves. In Fun Home, Alison Bechdel does come out to herself and her parents. Her father, a closeted gay man, commits suicide rather than being fully known in his small town. Jackie Kay's Trumpet, is a novel about the fallout surrounding a married transgender man's outing upon death and it's effects on a variety of characters, in and outside the family. 

We all have ego states. We may have a different persona in a work situation, at home, hanging with our best friend, or dealing with an emergency.  Unless we are highly dissociated, we can move smoothly between "parts" and roles, bringing up the most germane set of skills for each situation. When we are not "acceptable" as we are, we may hide that part, even from ourself. We may repress it, or simply develop a separate persona in a separate arena--the secretive gay bars and "tea rooms" of the past, the hidden online communities for any "kink" you can imagine, of the present.  

When we accept who we are and what we are, and can be that person, we can be whole, but the process is not easy. Telling the family that we are not practicing the religion, the gender role, the choice of partner, the expected occupation can bring us disapproval (at the least), ostracism, and in some cultures, death. Even if it's "mere" disapproval, it's difficult. We are wired to please those people, to belong, and to be protected by the family. We define ourselves by how we are seen and treated. Going against that by choosing differentiation (being who and what you are even if people don't agree or approve) is scary and can bring up big shame. Not doing that, kills the possibility of true intimacy: being known. And it may separate us from ourselves.

In Big Sick, we get to see Kumail, after being accepted by another family, be able to "come out" as secular and in love with a blonde. In Fun Home, Alison goes to college, falls in love, and is able to accept herself and tell her family. Later in life, she creates a (wonderful) graphic novel about her coming out, and the tragic end of her father, who never could. In the musical, Alison as a child, a college student, and an adult sing together, bringing all parts together for a perfect integration, that brought down the house.

After 25 years of marriage and 36 years of doing therapy, I can speak to the importance of self-acceptance and true intimacy to my life and my relationship. As a bisexual person, a Jew in a Christian country, and not-very-gender conforming person, I can speak to the importance of being out and known, even when I'm not accepted. I am known by the people who want to know me. I am self-accepting (knowing that I can always improve). My husband and I strive for openness, even when the other one doesn't adore or agree with an opinion or aspect of us. 

As a therapist, it's my job to help people accept all of themselves, heal what can be healed, and bring all parts to eventual integration or integrity.

 

 

    

"Love and Mercy"

I just saw the bio-pic about Brian Wilson's (of the Beach Boys) genius, decline, and fall into the hands of a sociopathic psychiatrist, who became his legal guardian.  It's a good movie and a hard one to watch, especially for a therapist.

Wilson is portrayed as a genius by Paul Dano and John Cusack (at different ages.) We get to see how his obsessive brain honed the music in the studio over take after take, until it perfectly matched the sounds in his brain. We see how the awful physical and emotional abuse he suffered from his father impacted his later life. And how his anxiety disorders, PTSD, drug use, and dissociation drove him crazy, for a time, and made him a docile target for an unscrupulous doctor, who over-medicated, berated, and threatened Wilson into signing over his finances and power of attorney.

Spoiler alert: Love saves the day. Whew!  And the doctor is thrown out of the profession. And if you watch the credits, you'll see the real Brian Wilson playing with his current band, looking healthy, alert, and present.

If you see the movie and have a different diagnosis, I'd love to see it. Here's a trailer for the movie: http://www.loveandmercyfilm.com/

Defining Rape and Sexual Assault

I've been working with survivors of rape and sexual assault since I started in the mental health field. Here are my definitions:

Rape: The sexual use, involving penile, digital (fingers) or objects on a woman's, man's or child's body without that person's consent, with forced consent (threats) or if that person cannot conset due to age, mental disability, state of drunkeness or druggedness, or relative social position to the rapist (employee, slave, patient, lower rank, parishoner, etc.)  

Rape can include penis in vagina, anus, or mouth, or forced masturbation. It can include objects. It can include rubbing genitals on a person with clothes in between. Women can, but rarely do, rape people by forcing them to touch or otherwise sexually interact. People of any age can be raped. People in an otherwise consensual sexual relationship can be raped, if they say "no" or are asleep or passed out, and their partner is sexual with them without their consent. 

Sexual Assault: Unsolicited, unwanted touching, grabbing, or other sexualized physical utilization of another person. All rape is sexual assault. Not all sexual assault is rape.

Molestation: See Sexual Assault. Often used when describing either the Sexual Assault or Rape of children. I wish this word would go away. I'd prefer "Child Rapist" to "Child Molester" since it's the true definition of what happened.

Effects of Rape and Sexual Assault: It depends on what happened, by whom, and to whom.

• Adults who are raped by strangers tend to experience full-blown Post Traumatic Stress Disorder. No matter the circumstance, they tend to feel dirty, culpable, and ashamed. It ruins, at least for a while, their healthy sex lives, their sense of safety and trust in the world, and their image of an autonomous, safe self. If the adults had a history of childhood sexual abuse, the new rape often brings forth the same feelings, ego states, and flashbacks of the earlier time. Sexual situations with beloved partners can bring up flashbacks of the rape. Men who are raped can have a sense of loss of maleness and a whole other level of loss of self.
• Children who are raped by strangers tend to experience all of the above including a pervasive sense of "badness", and without treatment may carry that sense of shame and fear of sexual situations to adulthood
• Date rape: Rape by someone in dating situation, when the victim has said no or cannot show consent, brings another layer of self-blame, lack of trust, questioning of "fault", and social complications. ("I shouldn't have worn a short skirt; drunk so much; gone out with someone I didn't know well; etc.") along with PTSD.
• Rape of a child or teenager by a parent, coach, teacher, older sibling, uncle, step-parent: Kids can't give consent, even if it's "friendly", it's rape. The worst thing I often hear is "It's (being an object of sex) what I'm for." Child rape by a person on whom the child relies for protection creates huge issues of identity, safety, goodness, worth, and sexuality.  Some kids, after chronic sexual abuse/rape, become prostitutes. 75 - 95% or prostitutes were sexually abused as children.  http://www.womenslaw.org/simple.php?sitemap_id=148. Many have flashbacks for the rest of their lives, unless treated. Many are not believed by their families. (The response of the family and/or institution in which the abuse occurred is strongly correlated with healing, or not, after the rape.) Kids who are raped tend to freeze, then go limp during the act. Afterwards, any sexual threat or even solicitation can bring the same passive, obedient response, making further exploitation more likely. Some re-enact their role with sexual acting out, a warped attempt of mastery of the situation. Most, but not all, people involved in sadomasochist "scenes" were sexually abused/raped as children. Child rape by trusted adults is a factor in most serious dissociative and Borderline Personality Disorder diagnoses. 

Complicating factors:

•     Not all rape is violent or actively coercive. When attachment bonds are used to manipulate kids or adults into sexual activity it confuses the issue of desire, identity, and fault.
• People can be physically aroused and even orgasm during a rape -- by the mechanics of the act. It still doesn't mean they wanted it. This is a huge issue in therapy.

Treatment: Many psychotherapies are helpful with rape and sexual assault survivors. My favorites are EMDR, Somatic Therapies, and, with victims of child rape and long-term abuse, Ego State Therapies. With permission, my favorite phone message from a client, after 3 sessions of EMDR for childhood sexual abuse: "Robin, I just called to tell you that I had sex with my husband today and it was great. After 12 years of marriage, this was the first time we made love and my grandfather wasn't in the room! Thank you!" 
 

Politics: Misinformation by the anti-choice people has muddied this issue. Some of them don't want women to have abortions. Some don't want women to be able to get pregnant from rape, necessitating the need for discussion of incest and rape exceptions in laws. Women who are ovulating can get pregnant from rape. It's a fact. "Legitimate Rape" appears to mean a violent rape by a stranger, only one kind of rape. 

A Song: Illegitimate Rape. the only good thing to come out of this political kerfuffle: http://youtu.be/mg_4O6XmKAQ

Psychotherapy Works! And Not Enough People Use It.

According to a meta-analysis of over 50 studies, psychotherapy works better than medication and (Suprise!) has less side effects. Drugs have better promotion and are easier to get, so more people use meds. Read about it here: http://www.sciencedaily.com/releases/2012/08/120809190641.htm

NBC's Awake: Creative Grief Avoidance

It starts with a horrible car crash. Jason Isaacs flips his car in a California canyon. Either his wife (in one reality) or his son (in the other) dies in the crash. Every time he sleeps, reality switches. He has two therapists, one for each reality, who are set on proving that their particular realities are the correct ones. Isaacs plays a cop who uses information from one reality to inform his cases in the other. He either has a grieving teenager or a wife (way too beautiful for any reality) who refuses to grieve. Somehow it all works.  

One therapist is pedantic, one more experiential. None of them do somatic work or EMDR or brainspotting. In all of the protaganist's sessions, I was itching to ask him where he felt the grief and what he was telling himself about his culpability in the death(s).  I'd love to see EMDR clear up this problem. But then there would be no series.

Prediction: At the end of the season, we'll find out that he is either 1. In a coma and dreaming it all and or 2. Grieving the loss of both his wife and his son.  I'm going to keep watching to find out. And I'm going to keep itching to see effective affective therapy in either reality.

P.S. The most emotionally true show on TV: Smash. And the most fun.

Francine Shapiro in the New York Times on EMDR Research

Three years ago, while I was at the at the Olympus Women's Spa celebrating the publication of EMDR Solutions II, a woman in the same jacuzzi interrupted my conversation to attack me about my obvious misperceptions about EMDR. "Everybody knows it doesn't work . . . it's woo-woo-bullshit . . . and it's just exposure therapy, anyway . . . and there's no good research about it."  She was a researcher of cognitive and exposure therapies. When I tried, gently, to refute her, she spit on my friend and me, in her rage. Today, in the New York Times Health, Consults blog, Francine Shapiro has brilliantly refuted every point. Read the article here.  HAH!

Psychiatric Diagnoses: The Epidemic of Mental Illness

The New York Review of Books carried and a scathing and mostly right-on article about the medicalization and over-medication of mental illness by Marcia Angell. It's a review of three books about the history of psych meds, the power of the drug companies, and the minimization of psychotherapy. Read it here.

Next To Normal: the bipolar musical

I went to the opening night of Seattle's production of Next to Normal, the amazing Tony-winning dramatic musical about a bipolar mother, her family, her delusions, her therapy, and her slow, painful growth. Components: amazing 3 story set, great singing, great score (though a little loud), believable story, believable characters (even the imaginary one), and the best song about psychotropic medications that I've ever heard.

The writer, Brian Yorkey, has done his homework about the disorder and its effects on spouses, kids, family dynamics, and frustrated practitioners. His take on the etiology, genetics, exacerbated by trauma, is plausable. He's got an over-functioning husband, who tries to keep his wife from expressing her real pain. The daughter, also over-functioning, is isolated, ashamed of her family, fearful of trusting or leaning on others. 

The pills only treatment in the beginning turns into four-day-a-week analysis turns into the new two-week long, daily mini-electroshocks.  (See http://www.healthyplace.com/bipolar-disorder/treatment/ect-electroconvulsive-therapy-for-bipolar-disorder/menu-id-67/  )

The play is devastating and often funny. It gets into every character's head and makes you care for them in their struggles. I cried through a lot of it, reminded of clients, friends, and family members who have struggled with this awful disease. My friend Janis, who doesn't have the same job or history, cried just as much, when we weren't laughing. I haven't seen a piece of theater that has moved me so much since Tony Kushner's Angels In America, 16 years ago. 

And the therapist didn't sleep with the client! That alone made it better than nearly every movie or play about psychotherapy. I so wanted to drag each character out and do EMDR on their issues. But EMDR would be extremely boring on the stage.

Go see this play!

The King's Speech

Some of the best therapy I've seen on screen is in a great new movie, The King's Speech. Geoffrey Rush plays Lionel Logue, an Australian speech therapist who tackles the debilitating anxiety-driven stammer of Colin Firth's, "Bertie", who become the king of England on the eve of World War II. 

The film shows the stifling lives and roles of the Royals, and the intense pressure on them from their subjects, the Anglican Church, their governments, and each other. It shows how a therapist to the King has to tear down the class barriers in order to make a strong, attached therapeutic relationship. Logue creates the frame be insisting that "Bertie" come to his office ("My castle, my rules."), be on time, and be addressed by his family name, rather than "Your Royal Highness". He sits close, and mixes standard speech therapy with elements of somatic and expressive therapies (some of which are riotously funny) and holds the therapeutic relationship above all. He watches his client carefully, and crafts his client-centered therapy and the environment in which the King must give his speeches to his client's needs. Logue leads his client to uncover the childhood traumas that precipitated the stammer, and the family dynamics that kept it going. And he uses brilliant and funny strategic therapy to hook his recalcitrant client into therapy, and keep him there.

Helena Bonham Carter plays Bertie's supportive wife, Elizabeth, and is excellent, as usual. Derek Jacobi is the Archbishop of Canterbury, with whom Bertie finally shows his adult and kingly differentiation. Michael Gambon plays King George, Bertie's father, as a well-meaning, impatient, worst father a stammerer could have. (It's strange to see Dumbledore be jerk.) Guy Pearce plays Edward, Bertie's brother who abdicated the throne for a woman Mrs. Simpson (Eve Best).

I knew a lot of the history, and I painlessly learned more of the particulars in this wonderful movie. The King's Speech is suspenseful, beautifully acted, funny, sad, and hopeful. I hope you see it, too.

 

 

Tricare Refuses to Pay for CRT & EMDR for Veterans

National Public Radio wrote and spoke about the "Battle Over the Science" of Tricare not paying for cognitive rehabilitation therapy (CRT) for Traumatic Brain Injury (TBI) "despite pressure from Congress and the recommendations of military and civilian experts, the Pentagon’s health plan for troops and many veterans does not to cover” cognitive rehabilitation therapy — a “limitation that could affect…tens of thousands of service members who have suffered brain damage while fighting in Iraq and Afghanistan.” See article in Veterans Today:  http://www.veteranstoday.com/2010/12/21/battle-over-science-money-blocks-widely-recommended-tbi-therapy/ and the NPR story: http://www.npr.org/2010/12/21/132203864/philanthropist-provides-care-that-the-pentagon-wont

It turns out that Tricare hired a research company that it knew (or maybe told to) would find this well-researched therapy to be "not scientific", despite unanimous by 50 clinicians and researchers on a special governmental commission. The reason: It didn't want to pay. CRT is expensive. And necessary. Thousands of military people are returning from Iraq and Afghanistan with TBI's from exposure to roadside bombs. The shock waves from these explosions move through brains, temporarily jellifying the tissue and causing lasting cognitive problems and difficulties with affect regulation. CRT helps people learn to cope and manage despite brain damage. It's necessary therapy.

This is reminding me of Tricare's refusal, until just this week, to pay for EMDR therapy for vets, despite EMDR's acceptance by the VA, the APA, and other entities as an "evidence-based practice". This was more about politics than money. Cognitive behaviorist and exposure people had colonized Tricare's committees, not allowing support for other effective therapies. I'm sorry that our active duty people and veterans have been victimized by the political and financial b.s. at Tricare. They deserve better.

In my experience, many "researchers" quote studies that support their beliefs and not the ones that support the facts. Or else cling to lab-based double-blind studies. Many effective therapies were not hatched or researched in labs. They work despite the lack of studies. Some, even after the "appropriate" research is complete are debunked because of the belief systems of the meta-researchers.  My belief: Do what works for the client in front of you.

 

Video with Amen brain scans and EMDR treatment of PTSD

Here's a 6 minute video of a Gulf War soldier's PTSD diagnosis with brain scans and then treatment with EMDR. He had a scary childhood, fear for his life in combat, and then was retriggered by witnessing a horrible accident. 

Therapeutic Metaphors from Star Trek and other Popular Culture

Utilization is the idea that therapists should use the culture and the language that their clients already use. If your client has watched Star Trek, they already know how to utilize these great tools. 

• Safe place: "Do you know what a containment field is on Star Trek? Great! So imagine your safe place has a containment field around it. No one can see it, no one can get through it, and it will keep you completely safe from harm."
• 
  
• Sharing between Parts with highly dissociated clients: "We've cleared a lot of the trauma that that part holds. Does the Adult part feel ready to know what happened back then? Good. Then let the child do a Vulcan mind-meld with the adult and share the information about what happened and what it was like for her. Let me know when the transfer of information is complete."
• "So lets bring this to the Holodeck and run through the event so you can control how it turns out this time."
• Practicing: "So lets create this situation on the Holodeck, you can direct the Holodeck to create facsimiles of all the players and you can practice how you want to talk to that person/ those people until you feel that you know exactly how to do it in real life."
• "Now imagine transporting that 5-year-old self out of that bed and out of that time, letting her rematerialize right here and right now. Is she here? Then let her know who you are and where she is and that she's finally safe from that guy."
• Other magic:
• "What would Harry Potter do? What spell would you cast?"
• "Imagine you had Superman's/Wonder Woman's strength? What would you do then?"
• "So could you go back in time with Doctor Who and rescue that child?" (For Brits)

My clients are delighted when I speak their language and use what's already in their brains. If they've spent years with Star Trek or Doctor Who or the mutants in Heroes, their mirror neurons have already had them doing the magical activities, and are ready to take them into a different reality. 

Years ago, a cult-abused DID client cured her insomnia by imagining a Star Trek containment field around her bed, which she turned on before sleep. Later, after years of trauma-clearing and Vulcan mind-melds between related parts, she did a mind-meld between all remaining parts and integrated (mostly) in my office. 

  

"Anxiety" on To The Best of Our Knowledge

A great hour of interviews about anxiety on one of best radio shows around. This one includes Patricia Pearson, author of A Brief History of Anxiety, Yours and Mine, and her own experience with anxiety medications and learning to self-soothe; Ethan Waters, talking about the globalization of American psychiatric diagnoses and pharmaceutical cures; Dr. Daniel Carlat, a psychiatrist talking about the problem with psychiatry, especially in regards to medications and drug companies; and a cool discussion about anxiety-provoking sounds in Kafka's writing. Lots of good links on their website. Check out the anxiety podcast at the top of the links page here.

"Mental" Is Terrible

There's a new fantasy show on Fox: Mental. It's supposed to take place in an inpatient psych unit.

So, first, the new head of psychiatry strips down in a room full of clients to connect with a psychotic guy who has pulled his clothes off. Later, he breaks into a woman's house in order to check out his hunch that her schizophrenic brother is an artist. And he thinks it's a good idea for his patients to go cold turkey off their antipsychotic medications. And he doesn't lose his contract, immediately.

All the psychiatrists are cute. All the patients are reasonable. The families just don't understand. And the residents and other psychiatrists have endless time to spend with their clients. Oh, and they invented a radical new idea: intensive outpatient day treatment.

I saw bad treatment, silly ideas, and a romanticization of extreme mental illness. I saw nearly every 1960's cliche possible. It's really bad. Except that all the psychiatrists are cute. And the new head of psychiatry looks to be about 32. That would happen, too.

 

Waltzing With Bashir

Ari Folman has made a beautiful and devastating movie about trauma, dissociation, and war. As a young Israeli soldier, he was in the 1982 Lebanon war. When a friend came to him with troubling memories of that war, Folman realized that he had no memories about being in Lebanon. A therapist friend told him to ask fellow veterans about what happened and Folman interviewed people until his own memories came back. The movie is animated. It flips between "talking head" interviews with middle-aged men at home, and their younger selves in Lebanon. The animation is amazing; the music, perfect; the characterization of the various soldiers/veterans makes them totally human.

You see the trauma and the men's attempts to cope with it. One man,was considered a genius as a teen. As an adult  he hides on his Dutch farm, constantly stoned.  Some seem untouched. Others still devastated.

As the movie unwinds, you see the event begin to come together--The assassination of Bashir, the Lebanese Christian Falangist leader, led his followers to slaughter men, women, and children in a Palestinian refugee camp. The Israelis, their allies, were supporting the Falangists to "find the terrorists". By the time the Israelis understood what was going on, and the word finally got to the Israeli leadership (slowed down by idiocy and disbelief), it was too late. The last few minutes of the movie are film footage of bodies and wailing women in the camps. There is no other resolution. Nothing to make us feel good.

The movie brilliantly portrays what trauma looks like. Its director also directed the original Israeli In Treatment , which portrays among other things, the therapy of a soldier who inadvertantly bombed an orphanage. I wonder if he was compelled to do In Treatment, before he remembered what he forgot about his own war experience. Here's a link to some "stills" from the movie, and an interview with Folman.  http://lukeford.net/blog/?p=4343 My favorite lines in the interview are, "Having made WALTZ WITH BASHIR from the point of view of a common soldier, I’ve come to one conclusion: war is so useless that it‘s unbelievable. It’s nothing like you’ve seen in American movies. No glam, no glory. Just very young men going nowhere, shooting at no one they know, getting shot by no one they know, then going home and trying to forget. Sometimes they can. Most of the time they cannot."

Evidently the movie brings two distinct responses from some Israelis: "Folman should be shot as a traitor for bringing up the incident."  Or "It's good, he's finally showing the world that it wasn't our fault." My response and the response of the two Israelis with whom I watched the film, was devastation and hopelessness. In the light of our despair over the recent attack on Gaza, we were stunned. We had to walk in the cold wind, swing on swings, and watch children play in order to bring ourselves back to here and now in our safe Seattle neighborhood. Today, I'm back to thinking that the little we do as trauma therapists makes a differences. As Hillel said, "If you save one person, you save the world." I need to keep this always in mind, or I get paralyzed by the trauma we humans create.

NYT's PTSD in Iraq Vets article: Counting the Walking Wounded

The New York Times published this article today. If you haven't starting gearing up to work with soldiers, get some training now. There are online trainings, in-person trainings, and books. You can even start by watching movies: In the Valley of the Elah is supposed to be a great one. Understand that, so far, EMDR has been statistically superior to any other training for PTSD in soldiers.

Counting the Walking Wounded

By LAWRENCE M. WEIN in the New York Times

Published: January 25, 2009

Stanford, Calif.

Related

Times Topics: Veterans and Post Traumatic Stress Disorder

THE American troops in Iraq daily face the risk of death or injury — to themselves or their fellow soldiers — by homemade bombs and suicide attackers. So it is not surprising that post-traumatic stress disorder is a common problem among returning soldiers. But how many, exactly, are affected?

This question is key to determining how large an investment the Department of Veterans Affairs needs to make in diagnosing and treating the problem. The United States Army's Mental Health Advisory Team, which conducted a survey of more than 1,000 soldiers and marines in September 2006, found that 17 percent suffered from P.T.S.D. Similarly, a Rand study put the number at 14 percent.

But these estimates do not take into account the many soldiers who will eventually suffer from P.T.S.D., because there is a lag between the time someone experiences trauma and the time he or she reports symptoms of post-traumatic stress. This can range from days to many years, and it is typically much longer while people are still in the military.

To get a better estimate of the rate of P.T.S.D. among Iraq war veterans, two graduate students, Michael Atkinson and Adam Guetz, and I constructed a mathematical model in which soldiers incur a random amount of stress during each month of deployment (based on monthly American casualty data), develop P.T.S.D. if their cumulative stress exceeds a certain threshold, and also develop symptoms of the disorder after an additional amount of time. We found that about 35 percent of soldiers and marines who deploy to Iraq will ultimately suffer from P.T.S.D. — about 300,000 people, with 20,000 new sufferers for each year the war lasts.

Consider that only 22 percent of recent veterans who may be at risk for P.T.S.D. (based on their answers to screening questions) were referred for a mental health evaluation. Less than 40 percent of service members who get a diagnosis of P.T.S.D. receive mental health services, and only slightly more than half of recent veterans who receive treatment get adequate care. Those who seek follow-up treatment run into delays of up to 90 days, which suggests there is a serious shortage of mental health professionals available to help them.

Proper P.T.S.D. care can lead to complete remission in 30 percent to 50 percent of cases, studies show. Thorough screening of every soldier upon departure from the military, immediately followed by three to six months of treatment for those who need it, would reduce the stigma that is attached to current mental health referrals. The Rand study estimates that treatment would pay for itself within two years, largely by reducing the loss of productivity. This is the least we can do for our veterans.

Lawrence M. Wein is a professor of management science at the Stanford Graduate School of Business.

 

 

WALL-E, a Story of Attachment

WALL-E, the new Pixar movie, is the perfect anthropomorphic attachment story. It's also a great movie and funny as hell. The first half, and most of the rest is an amost silent movie. Our hero, is a trash compactor robot who lives with an indestructible and graceful cockroach for company. He watches "Hello Dolly" video daily for 700 years while creating pyramids of trash on an empty, toxic Earth. When a probe robot, EVE, shows up, his latent "right brain" capacity for attachment is awakened. He wakes hers up, too. And the robots' attempts to follow their directives and their robot "hearts" save the human race. And did I say it's funny? And if I were Walmart, I'd sue Pixar. The world was run and destroyed by an enormous retail conglomerate that turned humans into docile, inert, disconnected babies. 

Pixar's brilliance turns ugly monsters, toys, animals, fish, and trash compactors into seekers of love, connection, and attachment. At the end of every movie, they list the babies of the production crew. Yes they are technically brilliant, Yes, they know how to write compelling narrative. But they know how to create characters who make the movements, vocalizations, and gestures of  yearning and connection. My husband and I were delighted to find ourselves weeping during the lost and found moments of this movie. While our left brains delighted in the subversive construction of the corporate run future, our right brains were constantly engaged with the growing intersubjectivity between machines and machines, machines and people, and finally, people and people. (Intersubjectivity: when you know that I know that you know that we're feeling the same thing at the same time. It's what makes attachment, and therapeutic repair of attachment deficits, work.)

See it. Take the kids, if any. They won't get the corporate jokes, if they're little, but the giggles and cries of alarm around me let me know they got the important stuff. And I think there's a message about rampant consumerism in there, somewhere. 

 

New Sybil movie. DID in the media.

CBS aired a new Sybil on Saturday, starring Jessica Lange as the therapist and Tammy Blanchard as Sybil. It was less fantastic and spooky than the original Joanne Woodward/Sally Field movie, and was a realistic depiction of a poly-fragmented DID person. The movie depicted realistic switching behavior, flashbacks, losing time, and amnesia between parts. It showed recurrent triggering that brought out different parts.The therapist was as competent as she could be, with no training, and fiercely attacked by colleagues for "making a multiple". The movie showed the kind of early abuse that creates DID. My husband kept saying, "How can that happen to a child?" And I kept saying, "I hear this at work, nearly every day."

It was worth watching: the acting was great, the depiction realistic, and the state of therapy pretty bad. Unfortunately, CBS isn't making it available for replay on its website, or I'd provide a link.

The Soldiers Project, Washington

Nicole Brodeur featured "The Soldiers Project"  in her Friday Seattle Times column.  This some of what she said:

" Trisha Pearce, who lives in Stanwood, is starting a Northwest chapter of The Soldiers Project, a network of licensed mental-health counselors who offer free psychological treatment to active-duty soldiers, National Guard members, reserves, veterans and their families.

The nonprofit Soldiers Project was founded in 2004 by Los Angeles psychiatrist Judith Broder, who was moved to act after seeing a performance of monologues written by an active-duty Marine and featuring Iraq veterans.

Some 35 percent of Iraq War veterans seek counseling in the year they return. This year, the U.S. Department of Veterans Affairs will spend $3 billion providing mental-health care to about 1 million veterans.

That helps, Pearce said, but the VA's culture of bureaucracy alienates some veterans.

Others don't want to get in any deeper with the military. Or they don't want mental-health issues to be on their records. Or they were dishonorably discharged and aren't eligible for benefits.

Then there's the National Guard: "They're not coming back to a military base," Pearce said. "They're in Baghdad one day, and then they get off the plane and they're home in Bellevue and their wives want them to clean the gutters.

"They are not going to come back and be who they were."

Before she can help them, Pearce must first build a network of psychotherapists willing to volunteer at least one hour a week to soldiers in need.

Once that's done, clients could call or e-mail and, within 24 hours, receive a response from a clinician who will gauge their needs, then search the database of therapists.

On April 28, she will hold an informational session for therapists from 7 to 9 p.m. at University Lutheran Church in Seattle. (RSVP to [email protected]).

The project has given Pearce a new purpose and forced her to abandon the antiwar sentiment she embraced in the 1960s. "We should all be saying, 'We're here for you,' and support veterans by making it simple for them to get psychiatric care," Pearce said. "It should be our responsibility, like paying taxes, to go out of our way and do something."

The Soldiers Project started in Los Angeles and has offshoots in Chicago and New York, and of course, Seattle. Check out the LA website at  http://www.thesoldiersproject.org/ for more information, or better yet, if you'd like to start your own chapter in your town.

IN TREATMENT

HBO's new show, In Treatment, after a good start, is beginning to go down the tired road of most TV portrayals of psychotherapy. The therapist is as crazy as his clients, if not more so. He's incapable of handling the attractive narcissistic young woman who has an "erotic transference" with anything close to honesty or skill. He's hugely defensive with his wife and his therapist, showing no insight into his own process. Yada, yada, yada. Same old thing.

And I'm absolutely addicted to this show. Monday through Friday, from 9:30 to 10, I get to watch someone else's therapy sessions. And his clients are pretty wild. This week Paul's Monday narcissist, after being romantically spurned by by him, and ineptly asked to consider if she'd like to leave therapy, seduces the Tuesday PTSD client. This plot seemed vaguely familiar. . . Tony Soprano seduces and later kills the borderline client of Dr. Melfi in the 4th or 5th year. . .In 30 years of practice, I've never had an existing client start to date another client. I'm obviously not doing it right.

There is one good therapy: Sophie, the Wednesday client, is a 16 year old, suicidal gymnast, who is way too involved with her coach and his family, and way too ignored by her depressed mom and narcissitic, absent father. Paul handles her beautifully. I'd use her therapy, at least so far, as a training video. He has boundaries, humor, connection, and true caring for this girl. He handles her evasions and confrontations skillfully. He's just about perfect with her. This being TV, I fear that Sophie will be dead by the end of the series.

In Treatment is taken, sometimes session by session, from an Israeli TV program. It has Israeli producers and writers. Some parallels are obvious. The black, perfectionistic, aggressive Iraq war pilot who inadvertently bombed a madrassa and killed 16 children, could easily have an Israeli counterpart. I imagine that his most chilling family story (his father strangled the grandfather while trying to keep him quiet when the Klan invaded their home) started as a Holocaust story. All the clients are loud, confrontive, and combative. They all constantly interrupt the therapist. Each characters is much more a bold Israeli than an overly nice American.

I'm going to watch until the end. I posted my advice to the therapist a few weeks ago, but it somehow got deleted. I may consult to him again.

"In Treatment" & Dr. Dippy, Meet Dr. Evil

The Sunday New York Times featured a great article about therapy in the media called Dr. Dippy, Meet Dr. Evil. (click on the title to go to article) Guy Trebay relates that there are three types of movie or TV therapists: Dr. Dippy (Newhart), Dr. Evil (I didn't watch that movie!), and Dr. Wonderful (Judd Hirsch). He does a great job of discussing the issue. In the article he announces a new HBO show, In Treatment, that follows a fictional shrink through entire sessions with "a pouty anesthesiologist with attachment issues, a Navy pilot suffering from post-Iraq war stress, an aspiring Olympic gymnast given to troublingly incestuous urges, and a married couple. . ." It's 5 half-hour sessions, one each week night for several weeks. If you've got HBO, check it out. I'll give you my opinion later. Click here for more info.

"Tell Me You Love Me"

HBO's new show, "Tell Me You Love Me" premiered this week. It follows 4 couples, 3 of them 20's-40-year-old clients and their 60-year-old therapist Jane Alexander and her husband through their relational and sexual lives. It is the most sexually graphic, though not the most erotic, show I've ever seen on television.

The sex is a problem. Due to the strictures of television, even the 60-year-olds acheived orgasm in under 3 minutes. All, including the 60-year-olds had perfect model bodies, skinny, unblemished, buff. The women didn't need a "hand", unlike the majority of women in any survey I've read.

The therapy is a problem, too. The therapist makes no attempt at relationship before she asks the most intimate questions. Every client lies to her about their thoughts, their feelings, and their behavior. (I'd lie to a stranger, too.) And on returning for the next session, they lie again.

I don't think the writer/producer, Cynthia Mort,  understands the relational aspects of sex or therapy. I don't think she knows that while hard bodies (and  hard body parts) often start the initial attraction, it's the attachment that keeps good sex and good therapy going through the hard times. And I don't think she understands that in relationships, especially with her viewers, narrative is important.

So what's the show about? 4 couples. One couple is young, engaged, and dealing with the man's already roving eye, and difficulty saying he'll be monogamous. One couple is trying to get pregnant. For the woman, fertility trumps everything else in the relationship. In the third, the two young children are the center of the relationship and there's been no sex for a year. Neither partner can "climb over the wall" to touch each other, except for perfunctory pecks on the cheek. Jane Alexander and David Selby were the only actors I recognized. They play the therapist and her husband, who have an affectionate and active sex life.

The show contains vignettes of sex, or missed opportunities for sex, with each couple, and a little bit of their middle to upper-middle class lives, interspersed with unsatisfying therapy sessions.

Here's the rant part: Why can't anyone show good therapy on TV? Why can't people on TV look like people look! If the producers/writers/directors want to show realistic sex, make it realistic, messy, hesitant. Have the 60-year-olds use lube. Have people talk to each other during, or guide each others' hands or positions. Have the foreplay last longer than 30 seconds. Don't have every orgasmic person make exactly the same head movements. They don't!

I know why. The producers are selling a product and they want to make it pretty to sell it to the buyer, HBO. They've forgotten about the huge viewership all of the reality talk shows with fat, working-class, dysfunctional people parading their problems. "Tell Me You Love Me" had only 900,000 viewers, a miniscule viewership for an HBO premiere. I think they could find more viewers if they "kept it real", rather than fantasy. 11 million of us watched Tony Soprano, in all his largeness, have sex. Even the gay character was fat, and hesitant. Make it real! End of rant.

Sopranos, Media, and "Starting Over"

At least they're consistent. During the penultimate Sopranos, Melfi, the psychiatrist, is outed at a dinner party, by her consultant/therapist, as the therapist of the notorious Tony Soprano. (I'm thinking that Tony ought to whack the consultant for breach of confidentiality.) The discussion at the party is about therapy for sociopaths. According to "research", criminals become stronger in their criminality, and learn to rationalize better. They practice manipulation on the therapist and get better at that. And they don't change in any substantive way in therapy. So at the next session, Melfi, visibly cold and angry, fires her client of 7 years, by shaming him and throwing him out of the session in the first 5 minutes.

My first question: "What kind of psychotherapy doesn't work?" Other questions: What if Melfi had consistently confronted Tony about the effects of his lifestyle on his family and himself? What if she had guided him through imagining the emotions of his victims? (It works with many sexually abusive people.) What if she had done values clarification and explored where his values came from? What if she had fired him, in a discussion of her moral stance of not condoning/supporting his immoral behavior? Better therapy, worse TV.

I once fired a client, who had become a (non-using) drug dealer. I explained that my brother had died of drug addiction (true) and that I couldn't,  emotionally, and in conscience, continue to work with him. I referred him to a colleague. My former client was moved by our session, and according to the colleague, quit selling shortly thereafter.

Here is a link to a good article about Tony Soprano's chances for redemption and the appeal of the Sopranos:  http://www.boston.com/news/globe/living/articles/2007/06/01/tony_soprano_is_a_monster/

Somebody sent me an email about therapy and the media. There was a show called "Starting Over" in which women worked with a "Life Coach"/therapist to change their lives. Here's an excerpt from the email: 

"Six women, each of whom were stuck in some way in their lives and wanted to change or do something.  Two life coaches supported them, and in seasons 2 and 3 they added a therapist. 
Most of the women stayed for at least 8 weeks and some stayed for perhaps as much as 16 weeks.  The show was on 5 days a week for an hour and, over time you saw each of the women change.  There were small and large steps forward and some backing up, also.  Of course the viewers became attached to some of the women and were irritated by others. 
While the coaches were only supposed to be doing life coaching, by seasons 2 and 3, I would expect that some therapists would say that some of what they were doing was therapy.

As each of them graduated, and you saw a flashback of what they were like when hey entered the house and some of the major exercises that they accomplished and how they changed, well it was powerful.

Unlike many other reality shows, no one was playing for $1,000,000 or voting people out, etc.  Just 6 women supporting each other as best as they knew how and 2 life coaches guiding them, mainly with a group meeting each day, some specific exercises, and some 1-on-1 talks."

To learn more about Starting Over, click on its website:

http://www.fearlessliving.org/about_us/starting_over

The Sopranos and therapy in the media, a rant

I admit it. I've watched every episode of the Sopranos, since the very beginning. And I've relished hating the therapy. For a few seasons, I watched with another therapist. We would literally scream at the Dr. Melfi on the screen. Here's what she did wrong:

1. Kept the process in Tony's head at all times. She never helped him into his affect, just talked about it.

2. Never confronted his psychopathy.

3. Dealt poorly with her counter-transference and had a horrible consultant who is more interested in the glamour of the mafia than in helping Melfi deal with her client.

4. Wore little bitty skirts, showing her legs to a psychopath twice a week.

5. Never pulled him in with attachment behavior.

6. Didn't really help him through any of his trauma, which would have allowed him to drop his defenses, and maybe find a new job.

So now, Tony's son, Anthony, Jr. is suicidal. He's traumatized by his dismissive and dangerous parents, the loss of his girlfriend, and the violence that goes with the Mafia lifestyle. And he's seeing Dr. Vogel, a totally flat, non-intervening, affect-avoidant, idiot of a psychiatrist. In this week's episode, Vogel is allegedly doing family therapy after Anthony's recent suicide attempt. Vogel is nearly silent, letting both parents attack their son while encouraging Anthony to complain about things that happened years ago. There is no other intervention. It was a scary-bad session.

If I knew about therapy soley from watching the Sopranos, I would think that therapists are weak, confused, and unhelpful. I would think that interventions, if they occured at all, didn't work well. I'd avoid therapy, especially if I was traumatized, depressed, in need of connection or anxious.

What other lessons do we learn about therapy from the media?

1. If therapy works, it's because there's a big catharsis, usually by the 2nd session. (Ordinary People)

2. Most therapists are crazier than their clients. (Good Will Hunting and many others)

3. Therapists will sleep with their clients or their family members. (Prince of Tides)

4. They're silly, funny, stupid and ineffectual. (Bob Newhart, et al.)

5. They murder their clients. (Law & Order)

Of course, real therapy, even when it's stellar, would often be boring to watch. Long silences, slowly leaking tears, the small moments of intersubjective affective interplay would not play well on the big screen, or the small one. Still, I'd like to know of one show that depicted good, connected, effective psychotherapy. Do you know of any?

Here is a link to another discussion of the Sopranos and therapy: http://drjohnriolo.newsvine.com/_news/2006/09/29/379592-psychotherapy-and-the-sopranos