His decision, your outcome: dealing with father alienation

Thursday, March 31st, 2011

Today, I would like to talk about women who have never had a relationship with their fathers or any father figure while growing up.  In the field of psychology, we call this ‘father alienation.’  Even adult women who were raised with their fathers can still experience father alienation if their father was not available to them emotionally.  Whether the reason is that a father was not around or available to his little girl, for some adult women it has left a social and relational deficit when dealing with the opposite sex.

The adult woman from a family where she experienced father alienation can go without answers to some of the most difficult questions such as:  why did my father leave, and why did he not try to make any contact with me; why was he emotionally distant; and  how am I like my father?

She might also struggle with questions that can change the landscape of her relationships.  Those questions might be:  who will walk me down the aisle;  how do I relate to a man if I have never had a man in my life; and, where does he fit in my life?  For many women the answers to these questions have set them on a journey of unhealthy relationships, self-doubt, low self-worth and body image challenges.  The internalized pain of being abandoned and never being affirmed by the first man in a female’s life can take on the appearance of  biological and psychological disorders.

In addition, the unconditional positive regard that a little girl did not get from her father sets in motion a social, relational and psychological development trajectory that can result in that daughter growing up to be a woman who lives a co-dependant, unhealthy lifestyle.  Most women would like to believe that the impact (or lack of impact) of a father has nothing to do with the type of woman they have become, but most researchers and psychologists believe otherwise.  As a father shows unconditional positive regard to their daughter, that daughter observes her father on a deeper level with expectations of the future.  These futuristic expectations are grounded in four fundamental principals.

  • Positive Self-concept
  • Feeling confident in male-female relationships
  • Comfortable with showing affection
  • Healthy interpersonal skills

Each one of these principals are essential for raising healthy daughters who then turn out to be healthy women.

Have you experienced father alienation?  Let’s talk about it.  You might be surprised to find that you are not alone in living with the residue that father alienation has left like fears and self-doubt in your current heterosexual relationship.

What is Personality Reconstruction?

Saturday, March 26th, 2011

A term I use frequently in the work of therapy is “personality reconstruction”.  This term can cause a lot of misunderstanding.  I am not saying that I do not like people the way they are; I’ve always found something to admire in every patient I’ve ever counseled.

When I say personality reconstruction, I mean repairing the damage a person sustains through life. That damage is different for each person: trauma, loss, or some other set of events. This damage has prevented the person from actualizing their full potential self. For example, maybe a past trauma has stunted their progress towards his or her native talents and gifts; now, they are in an unbearable state because they aren’t living the life they were meant to.

The term personality reconstruction refers to the process of accompanying a person through whatever process they need to become the best person he or she can be.  Now the crafty among you are saying, “You’re mean I’m not being myself!”  To that complaint, I respond with a resounding YES!  Too many people walk through life not being the self they truly are; they are bagged by symptoms and know deep in their hearts that they are living some kind of false self.

In short, they are living a lie of some sort.

To borrow a term from Martin Heidegger, they are living an inauthentic existence, giving way to desires that are not truly their own.  They are living as if they are  part of the “herd”,  borrowing their ideas, affections, and even sense of self from everyone else but themselves.  What analytic psychotherapy does is afford a person the chance to become the person he/she most truly and deeply might be.   This process and even way of life is not easy;  it can put one at odds with former friends and lovers.  But as the French writer put it well, “Better to be hated for who one is than loved for who one is not.”

About client relationships: who is the alliance really with?

Sunday, March 20th, 2011

It happens not all that often, baruch Ha Shem, that one will have a young person in treatment that the parents decide needs to attend therapy less often than is clinically indicated. This is a real ethical dilemma.

On one hand, you are committed to the young person and their process. And they usually see the value more than the parents do, especially when the parents are not aware of whats going on in their life. On the other is the commitment the therapist made to the patient, to not demean oneself or one’s services. Even worse, one does not want to model how bullying works.

All too often, the discounted and diminished analyst becomes the object lesson in “This is how you don’t get walked on” and other misguided notions. Worst of all, though, is how the continued work with the therapist creates a rift in the young person’s attachment to the parents. Although this might seem like a good idea at first, creating and living with this kind of rift can only become the source of other attachment problems that will manifest later.

So the question becomes this: is some treatment better than none? In some cases the answer is a resounding YES. If the young person refuses to see any other clinician, and the problems are not set in the personality structure, then some short-term work might be ethical and acceptable. But if the problems are set in the personality structure; have had real-time consequences in his/her life; live in the disturbed attachment field (more on the attachment field later!); and have an inevitable quality to them, then perhaps the clinician has to have the humility to bow out. In this situation give referrals if that is possible. But be sure to keep the door open should some crisis emerge.

Oddly in these situations, crises have a way of rearing their ugly head. The act of setting the boundary with the parents can serve as a model for the patient; although boundaries might look odd and feel weird, they are necessary and help to keep everyone safe. To be on the safe side, document your decision and make sure you have assessed for safety. In this situation, it is the clinician’s job to worry about suicidality more than the parents, who will NOT hesitate to call counsel.

Most of all, trust your well honed clinical instincts, talk with other clinicians, and make sure your decision does not come from any other place but concern for the young person and good boundaries.  Our own unanalyzed counter-transference can always get us into trouble!

Therapy and Money

Wednesday, March 16th, 2011

Now this is a topic that usually gets A LOT of attention.  My approach is pretty simple.  Many times I envy my British colleagues; the government simply gives them a living wage for the year and basically says, “Take care of as many of your fellow citizens as you can.”

I wish I had that arrangement.

Unfortunately, I have to do things like billing and that is clearly NOT where my talent lies. My affection, regard and love for my patients are free.  But the basic needs of living – rent,  food and Bucke’s kibble – are not.  So what’s to be done?  The need is so great I could work 24 hours a day and still not make a dent. I’d burn myself out and ultimately be no good to anyone. Plus people are sometimes resistant to analytic therapy, and the process could become a mess that no analyst could untangle.

Why must people pay for therapy?

Paying for these services is standard and certainly beneficial to both the therapist and the patient.  Why?  A number of reasons:

  1. The therapist brings an objectivity to the encounter that NO friend or family member can. Sometimes that objectivity allows the analyst to say things that appear tough but are actually necessary.
  2. The therapist brings training and experience to the encounter.  This affords the patient greater expertise in how to deal with the issues that he/she is working on.
  3. The therapist also brings a focus on the patient that is unique.  Think about it:  how many times in a day does someone pay attention to you and only you for an hour, thinking only of ways to help move you from one place you don’t like to another you’d like more?  In this distracted society, that does not appear to happen too frequently.
  4. The therapist is available 24/7 – especially at SPARK.  Most people don’t want to “disturb” their friends and family at 3:00 a m.  But that is what the therapist is there for!
  5. The clinician should have no other agenda in the helping relationship.  There should be no thought of “if I do this for this patient, what can I expect from him/her?” I emphasize “should” because, unfortunately, some do not.

This kind of thinking leads to boundary violations and injuries to the self.  In this way, the fee requested for therapy allows the patient to know what should be the only “selfish” concern of the analyst.  The fee helps set a boundary that should help everyone feel safe,  or at least safer.  Once the payment of the fee breaks down, unless the analyst has excellent boundaries, the door is open to all kinds of trouble. And its usually of the sort that leaves permanent psychological scars

Finally, the old saying “that which comes too easily we esteem too lightly” appears to be true.  Every clinical study has shown that people who pay for therapy get better while those who get it with no cost tend to either stay stuck or get worse!  In this way, the little bit of “skin in the game” that therapists asks for is not that much in comparison to what the analytic relationship has to offer.

At SPARK we attempt to make therapy as affordable as possible.  But all too often, I have had patients attempt to manipulate a “bargain” or simply default on their obligation.  This can only make one wonder about that patient’s boundaries.  And if they are parents, as some would say, Oy gevalt!  (It’s Yiddish….Google it.)

One final example

If one had (Ha Shem forbid) cancer, one would not argue with the oncologist about the rads of radiation therapy.  Hopefully, one would trust that doctor’s experience, training, and wisdom.  The same holds true for psychotherapy.  As I have always said, psychotherapy is a relationship. Like all relationships, it is built on trust.  With no trust, there can be no relationship, and thus no true healing of body, mind, and soul.  And wouldn’t that be the point of going to therapy in the first place??

At the end of the day, it’s been my experience that everyone that goes to work expects to get paid a competitive wage for their work.  That seems fair.

The Pace of Therapy

Monday, March 7th, 2011

All too often, I hear people comment on how long therapy takes.  Having submitted to years of therapy myself I can appreciate the “When will this end??” feeling. But having sat with people in the process for as long as I have now, it becomes all too clear why the process of therapy takes as long as it does. There are many reasons, and I want to touch on a few of them now.

Finding and recognizing the symptoms

First off, it takes time to recognize what symptoms are and what those symptoms are doing to one’s life.  One has to maintain hope that change is possible. All too frequently, people live with these symptoms for a long enough time that they begin to identify with them; they think of themselves AS their symptoms. They subsequently forget that there is a symptom-free, optimal life.

Family and Friends that enable us

On top of all this, there are all the usual suspects of family and friends who, consciously or not act, as enablers for people’s symptoms. For example, many addictions specialists will tell you that recovery often involves a total rearranging of a person’s social spheres.

Eventually for the patient to live that symptom-free life, they must let go of ALL the things that hinder them from getting there. And “things” can very well include people.

The fear of recovery

Finally, there is the fear. We all react differently to our fears. Some work hard to burst past them, while others succumb to it. Some of those in therapy have a fear of recovery, of becoming well.  And this can take many shapes including the fear of the unknown to fearing that people will not love the new person that emerges from treatment.

Coping with that fear is done at the patient’s own pace. Once they have dealt with the emotion in a healthy way, the process can continue to move forward. But there is no race; the therapist wants the patient to understand that these things take time and no one is judging.

These are just a few of the factors that can slow down the pace of therapy, not to mention the usual interruptions that can get in the way.  Thus, perhaps therapy moves a lot more quickly than we give it credit.  Or perhaps the real secret is:  therapy moves at the pace for which we’re ready, and no faster……or slower.

Looking for Dialogue Partners!

Sunday, March 6th, 2011

We at SPARK, especially myself, are always looking for other individuals who are engaged deeply in the work of promoting and advocating for human growth.  What is fascinating is how many people are engaged in this work (either for themselves or others–or both!)  and do not know the great number of people who are also trying to achieve the same goals.

In this way, clergy, social workers, psychologists, and care givers under hundreds of other names are often laboring alone. They feel alone and are often sitting on a mountain of wisdom about the journey of growth as a human being.  That’s why at SPARK, we want the entire world to know that we wish to band together with all of you! It doesn’t matter what psychological or religious background you might be from in order to share our collected wisdom. Or whatever pain you’re feeling; all too often our greatest wisdom comes from the experiences of pain we have suffered.

A GREAT example of this is the blog of Facebook entitled Care of Christchurch.  This young individual is using his own personal experience as a way of connecting with the larger world to promote care and connection with the people who have lived through this horrible disaster.  So do take a look at this blog; it will be worth your time.  Also, anyone so motivated is welcome to email or call any of us at SPARK to start any dialogue that will bring us all closer to where we most deeply wish to be.

Therapy and Work

Sunday, March 6th, 2011

One of the most common complaints I often hear about the work of psychotherapy and psychoanalysis is:  “I’m busy as it is, I don’t have time to pay attention to that other stuff!”

I know I can appreciate how busy life can be, especially with all the many responsibilities we all have:  work, family and community just to name a few.  But I can’t help but wonder if we didn’t take some time out for ourselves  — to look at how and why our lives are constructed the way they are — then perhaps we might feel a bit less overwhelmed and not as if we truly are the captains of our ships.

We have to remember that even though we might not be paying attention to our feelings, they are certainly paying attention to us.  Sadly,  if we do not deal with our feelings – especially feelings of pain and loss – in a direct and conscious manner, then we run the risk of having our pain make our most important decisions for us.  And how could that possibly lead to a good life?

Spirituality and Psychoanalysis

Saturday, March 5th, 2011

Many people make the mistake of equating spirituality and religion.  Although they certainly can be related, they are not necessarily to be reduced to each other.  Much will be made of this distinction later.

Suffice it to say that at least on one level, spirituality is a way of knowing the  self.  It is a way trying to know the self completely, in all its light and darkness.  Spirituality is the attempt to know what kind of person one is and of what one is capable – both good and bad, transcendent and despicable.

In the same way, analysis attempts to assist a person in the process of getting to know oneself.  It has been found by many that in order to know the living self in the present, it is necessary to know intimately one’s roots and origins.

The past is often very much not in some metaphysical past that we make up, but living in the present. And it  determines our choices without our even knowing how little true freedom we enjoy.  In this way analysis, like spirituality, is the journey from pre-determination to genuine liberty.  Thus, the path of psychoanalysis, seen from this angle, must be an inherently spiritual one.

What Therapy Takes

Wednesday, February 9th, 2011

To engage the process of analytic psychotherapy, the patient has to bring many strengths to the table. There are too many to mention here, but one I wish to highlight is the capacity to attach positively to the clinician. Exactly how this happens varies greatly among patients. It has been my experience that the deeper and darker the symptom picture the patient brings to the encounter, the greater the need for the positive attachment, indeed to the point where it can described as an idealized transference. This attachment is necessary as it allows the patient the strength and insight to make other necessary adjustments in what I like to call their “attachment field.” Without these other adjustments to previous images of relationships, only superficial progress will be made. Thus, analysis, when done well, affords the patient the ability not only to do different things in relationships but to relate differently. There should come to be a greatly enhanced ability for honesty, self disclosure, and ultimately, the ability to love both wisely and well. All of these goals rest, however, on the patient being able to make the primary attachment to the therapist. If that transference becomes idealized, so be it; it would then appear that precisely THIS kind of relationship is what the patient needs in order to come to healing. My task as a clinician is to live up to the obligations of that relationship and even transference as much as possible. At the very least, I cannot sabotage it, or even countenance the possibility of having that transference sabotaged. I do not believe that being a “blank slate” as so many clinicians do enhances the patient’s ability to connect. Indeed, if anything, I find such intentional distancing a hostile act. A relationship, by definition, takes two. This is not to say that there are no boundaries. Indeed, the whole relationship exists for the sake of the patient’s healing. But my “being in the room” I believe allows the patient to feel less like they are going through the layers of the Inferno by themselves. This way of practicing does at times force the patient to deal with the sometimes quirky and even at times all too human aspects of my own personality structure. In that sense, one cannot be all things to all people. But I believe that this realization would occur to the patient in time anyway. I am simply more upfront about the flaws and warts (as well as strengths) that make up the personality that I am bringing to the therapeutic encounter, both with the patient, and often with the important people in his/her life. As one writer said, “Jews are just like everybody else, only more so.” In this sense, the fullness of my humanity is in the therapeutic encounter, for good or for ill. I simply try to be honest about my own continuing process with my patients. If I cannot bring at least honesty to the encounter, then I am not sure what psychotherapy is about. Some clinicians will discuss how they are less who they are in the treatment room. In my case, I am more myself in the treatment room. More than once it has occurred that my patients and those that love them come to healing by coming to be able to tolerate and perhaps even embrace those flaws that make me who I am, in all my broken humanity. This does not make for a therapeutic process that would be a one size fits all kind of experience. But at least it’s real. I owe my patients at least that much. This kind of encounter is not for everyone, I know. There are days when I’m not sure I want to sit with me. But for those people who are most serious about healing and human growth, I have found it the only way to go. Or as we would say in Pittsburgh, go real or go home. I’m not going home! As Martin Luther, the 16th century reformer would say, “Here I stand, I can do no other. God help me.”

What we learn along the way….

Monday, February 7th, 2011

OK, so the game did not go as I would have liked.  But even in the face of a not so crushing defeat, I was reminded of some of the realizations I want all my patients to make:  1.  no battle worth fighting isn’t worth losing   2.  one must live to fight another day  3.  that even in the face of defeat, it is essential to act like a gentleman (or a lady for my fellow Steeler fans that happen to be women).  No matter what anyone thinks that he/she can take away from us, this person or these people cannot rob us of our dignity.  Only we can do that.  Thus, it is our moment to shine and indeed outshine those that “got their way.”  Once upon a time, I believe this was called “class.”