As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.
I've been working with Hank and Mary for about a year. They often struggle due to the confluence of a many challenges between them: diabetes, depression, ADHD, and a history of verbal fights that can be pretty sharp. Divorce has been in the air, more, I believe, as a signal of desperation than intent. When they're both calm, they genuinely express their love for one another. And this has gone on for decades.
After one of their tougher disagreements - they didn't speak much for a couple of weeks following a disagreement on how to manage their business - they came in having reached the predictably calm after the storm state in their marital music. The atmosphere between them was soft and caring, unlike the last meeting we had when they were in the middle of their business argument. So I made an observation, drawing on their mutual love of jazz - not that I'm a big jazz guy, my tastes go much more towards classical and classic folk, rock, blues - but I know enough about music and jazz to through around a few comments.
Hank and Mary riff back and forth with one another all the time on themes of her sense of guilt and responsibility - honed at the feet of her critical parents - and his accommodation of her penchant to feel guilty, often depressively so, by criticizing her actions, inactions, or whatever tune she throws to him. One common topic of their conflict is their business - though somewhat surprisingly, given their frequent ups and downs, it's been very successful.
We discussed the subtle ways in which they can go back and forth on the theme of Mary's sense of guilt and the way she over performs in their relationship and business to try to make things better, to try to make Hank happy. And Hank can be somewhat irascible, so she has a broad canvas (if I can mix metaphors) on which to paint. The more Hank's unhappy about this or that issue, expressing his riff on their song, the more Mary will play back with her variation of her wanting to make it right by over functioning, trying to come up with a different, better, novel idea in their business or marital life, rarely to the mollification of Hank and, the improv is on. She struggles to accommodate his dissatisfaction with his topic of the day, and her lack of success in molifying him breeds yet another reprise of the tune of her trying something else, ultimately leading to her fatigue, frequent depression and tears and so often a fight between them.
They've been at this for years, so I don't know if their participation in our discussion using their shared love of jazz might help them see the dance in which they're engaged (mixed artistic metaphor #3 if you're counting). It's a discussion we've had, in one way or another, a few times already, but they have yet to inhibit their repetition of the chorus. Maybe speaking their jazz language will help.
Tuesday, July 28, 2015
Sunday, July 26, 2015
Standing In His Truth - A Neurotypical Sib's Strength
As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.
Standing in his truth. It's a phrase I always found a bit psychobabble-ish, so I rarely use it. But recently, I sat with an 11 year old boy, Andy, who did so remarkably.
There was, let's say, a difference of opinion between the boy and the child's stepfather about a specific incident. Andy, his sister Crystal, his biological mother and stepfather and were reviewing the incident in my office, the mother, understandably, wanting to create an allegiance, a "united front" with her husband of many years. Crystal is 15 and has high functioning autism and is often a challenge to her parents and step parents, but Andy generally stays out of the fray. Crystal's done a lot of work on a lot of issues and, generally, is doing well.
Now I have to say, I'm overwhelmingly a fan of parents presenting a "united front" when they're dealing with their kids. I've long held that parenting can be at risk of devolving to a game of football where the child "splits" the parents as effectively as a good offensive line can split the defense and scores a goal while parents proceed to fuss at one another about who did what when and why. It's a very well established play that kids call upon given their highly sensitive ability to detect the potential for parental differences. It also can, in the best of circumstances, help parents sharpen their team playing skills - which are often needed when dealing with kids.
But I'm not so sure that Andy was splitting. This is a situation where step dad's depression has become worse we've been working in couple's therapy on the challenges that Crystal brings to the family. Step dad's been using meds to treat his depression, but it's a hard slog, as depression can be, and additionally, Crystal's behavior is indeed a stressor. Men, classically, can become irritable when depressed, which is what I think happened in this case. I've seen stepdad's irritability arise in the office and he has a history of his anger flying a bit off the handle.
When reviewing the incident between Andy and stepdad, the conflict was evident and it looked like a "he said she said" situation, with Andy and step dad on either side of the line and mom wanting to support her husband. Andy impressed me. He related his version of the incident quietly and calmly - remarkably quietly and calmly. Admirably, step dad did not raise his voice or try to leverage his adult role to make Andy submit. He was calm as well, reviewing his view of the incident. Crystal, mostly quiet sat and listened.
Andy's a typically developing kid, the classic "neurotypical" (NT) sib. He and Crystal are shuffled back and forth between the mother's and father's home weekly. There's very little tension between his biological parents and historically, Andy's coped well with the weekly transitions (not as much so for his Crystal), which says a lot for an 11 year old boy with an older sister on the spectrum. Andy is the classic "opposite" of his sister. He is well behaved, responsible about his schoolwork, doing well in scouts, active in sports. Pretty much everything one might want in an 11 year old. Andy has begun to participate in therapy in an extension of the family work mom and stepdad are doing with Crystal.
What impressed me the most was Andy's calm nature when he said his piece. He wasn't defensive, his story didn't waver or change as it was reviewed (and it had been reviewed a lot by the time they brought it to therapy.) He just stated his view of what happened. Strongly, softly. It was quite a moment - and it left mom and step dad a bit befuddled. Later it was step dad who walked his story back a bit, admitting that he's been on edge and struggling with his depression and how to deal with other stressors in his life.
Andy remained calm. It was a bit of a moment, Andy showing his strength of character while mom and step dad re-evaluated what they thought was their united front.
The main thing I took from the exchange was Andy's ability to "stand in his own truth" of what happened. Mom and stepdad will continue to work on their relationship and coping with a teenage girl on the spectrum - which can certainly be challenging to everyone. Stepdad's come out of past depressive slumps OK before.
But Andy - won't he be a force to be reckoned with in the coming years - in very good and exciting ways.
Standing in his truth. It's a phrase I always found a bit psychobabble-ish, so I rarely use it. But recently, I sat with an 11 year old boy, Andy, who did so remarkably.
There was, let's say, a difference of opinion between the boy and the child's stepfather about a specific incident. Andy, his sister Crystal, his biological mother and stepfather and were reviewing the incident in my office, the mother, understandably, wanting to create an allegiance, a "united front" with her husband of many years. Crystal is 15 and has high functioning autism and is often a challenge to her parents and step parents, but Andy generally stays out of the fray. Crystal's done a lot of work on a lot of issues and, generally, is doing well.
Now I have to say, I'm overwhelmingly a fan of parents presenting a "united front" when they're dealing with their kids. I've long held that parenting can be at risk of devolving to a game of football where the child "splits" the parents as effectively as a good offensive line can split the defense and scores a goal while parents proceed to fuss at one another about who did what when and why. It's a very well established play that kids call upon given their highly sensitive ability to detect the potential for parental differences. It also can, in the best of circumstances, help parents sharpen their team playing skills - which are often needed when dealing with kids.
But I'm not so sure that Andy was splitting. This is a situation where step dad's depression has become worse we've been working in couple's therapy on the challenges that Crystal brings to the family. Step dad's been using meds to treat his depression, but it's a hard slog, as depression can be, and additionally, Crystal's behavior is indeed a stressor. Men, classically, can become irritable when depressed, which is what I think happened in this case. I've seen stepdad's irritability arise in the office and he has a history of his anger flying a bit off the handle.
When reviewing the incident between Andy and stepdad, the conflict was evident and it looked like a "he said she said" situation, with Andy and step dad on either side of the line and mom wanting to support her husband. Andy impressed me. He related his version of the incident quietly and calmly - remarkably quietly and calmly. Admirably, step dad did not raise his voice or try to leverage his adult role to make Andy submit. He was calm as well, reviewing his view of the incident. Crystal, mostly quiet sat and listened.
Andy's a typically developing kid, the classic "neurotypical" (NT) sib. He and Crystal are shuffled back and forth between the mother's and father's home weekly. There's very little tension between his biological parents and historically, Andy's coped well with the weekly transitions (not as much so for his Crystal), which says a lot for an 11 year old boy with an older sister on the spectrum. Andy is the classic "opposite" of his sister. He is well behaved, responsible about his schoolwork, doing well in scouts, active in sports. Pretty much everything one might want in an 11 year old. Andy has begun to participate in therapy in an extension of the family work mom and stepdad are doing with Crystal.
What impressed me the most was Andy's calm nature when he said his piece. He wasn't defensive, his story didn't waver or change as it was reviewed (and it had been reviewed a lot by the time they brought it to therapy.) He just stated his view of what happened. Strongly, softly. It was quite a moment - and it left mom and step dad a bit befuddled. Later it was step dad who walked his story back a bit, admitting that he's been on edge and struggling with his depression and how to deal with other stressors in his life.
Andy remained calm. It was a bit of a moment, Andy showing his strength of character while mom and step dad re-evaluated what they thought was their united front.
The main thing I took from the exchange was Andy's ability to "stand in his own truth" of what happened. Mom and stepdad will continue to work on their relationship and coping with a teenage girl on the spectrum - which can certainly be challenging to everyone. Stepdad's come out of past depressive slumps OK before.
But Andy - won't he be a force to be reckoned with in the coming years - in very good and exciting ways.
Monday, July 6, 2015
King Solomon, Hillel and David Burns: If I Am Not For Myself.
As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.
Pretty disparate title, no? King Solomon lived almost 3,000 years ago. Hillel, a Rabbi authored many important opinions in the Jewish Talmud lived about 900 years later. David Burns is a psychiatrist who is still living. What on earth could they have in common?
Kim hs just started HS and has been working hard on dealing with anxiety. Anxiety disorders occurs in 25% of all teens from 13-18 according to the NIMH. That's a lot of kids. So Kim's situation is pretty common. Indeed, I see lots of kids with anxiety.
Kim's dad had, dutifully upon my recommendation, bought her a book about anxiety written by David Burns, the psychiatrist who wrote the seminal book Feeling Good about depression. He's gone on to write about anxiety and panic disorders, and "cognitive behavioral therapy" to which he is a foundational contributor. It's a well documented treatment for anxiety, depression and panic disorders. His books have lots of information, worksheets and the like about anxiety - and Kim and I recently embarked on a detailed discussion about her experience with anxiety as she's begun to go through the book. In the midst of our discussion, I was reminded of comments that seemed so apropos. Historical comments that took us on a millennial trip.
She first observed that if Burns had known so much of this, there had to be a lot of people with these issues to study. She noted that she's likely not as alone as she has feared. I commented reflexively "There's nothing new under the sun," originally stated by King Solomon in Ecclesiastes, commenting upon the pursuits that occupy people's lives. He didn't use the term "cognitive distortions" but, I dare say, would have understood the term in light of his writings about how we develop meaning. Yes, Kim, there's been anxiety since we had to worry about being attacked by saber toothed tigers. Our job is to balance when it makes sense to worry - and when it doesn't.
We then moved on in our discussion about Burns' musings on anxiety and turned the corner into the burden many of us have prioritizing our own needs over the needs of others, and how, if we focus too much on the needs of others, our own needs become neglected. Again, reflexively, I stated Hillel's famous comment from about 2,000 years ago:
"If I'm not for my self, who will be for me? But if I am only for myself, who am I? If not now, when?"
Kim and I discussed that indeed, we are not islands where we never need others, nor do we ignore others' needs. Neither are we able to be a fountain of unlimited giving to others. But we do have to connect and contribute to others. Hillel's goal, if I may be so bold to say, is balance, a skill that many folks with anxiety (and depression) struggle to maintain.
And of Hillel's last statement: "If not now, when?" I think that brings Kim right back to Burns' book. He's quite clear in his books that they are not just for reading. They're for using. Using the tools, the worksheets and the exercises that are outlined to challenge the preconceived conclusions that we have that keep us anxious or depressed. This practice enables learning - in the same way kids play catch with a parent - so they can master the skills involved in throwing and catching the ball. They create muscle memory that sticks with them for a lifetime. The practice with Burns has to do with creating the neural pathways - the neurological equivalent of muscle memory - in order to successfully address the anxiety/depression at hand.
So, Kim is, hopefully, on her way to the path of creating these different strategies to address her anxiety. She's a good kid, a hard worker, and I have faith in her desire to challenge the current "cognitive distortions" that keep her anxious. I was a bit surprised, however, that our discussion of her journey brought us from today, back 2900 years to the days of King Solomon with a short - but meaningful stop some 2000 odd years ago with Hillel.
Pretty disparate title, no? King Solomon lived almost 3,000 years ago. Hillel, a Rabbi authored many important opinions in the Jewish Talmud lived about 900 years later. David Burns is a psychiatrist who is still living. What on earth could they have in common?
Kim hs just started HS and has been working hard on dealing with anxiety. Anxiety disorders occurs in 25% of all teens from 13-18 according to the NIMH. That's a lot of kids. So Kim's situation is pretty common. Indeed, I see lots of kids with anxiety.
Kim's dad had, dutifully upon my recommendation, bought her a book about anxiety written by David Burns, the psychiatrist who wrote the seminal book Feeling Good about depression. He's gone on to write about anxiety and panic disorders, and "cognitive behavioral therapy" to which he is a foundational contributor. It's a well documented treatment for anxiety, depression and panic disorders. His books have lots of information, worksheets and the like about anxiety - and Kim and I recently embarked on a detailed discussion about her experience with anxiety as she's begun to go through the book. In the midst of our discussion, I was reminded of comments that seemed so apropos. Historical comments that took us on a millennial trip.
She first observed that if Burns had known so much of this, there had to be a lot of people with these issues to study. She noted that she's likely not as alone as she has feared. I commented reflexively "There's nothing new under the sun," originally stated by King Solomon in Ecclesiastes, commenting upon the pursuits that occupy people's lives. He didn't use the term "cognitive distortions" but, I dare say, would have understood the term in light of his writings about how we develop meaning. Yes, Kim, there's been anxiety since we had to worry about being attacked by saber toothed tigers. Our job is to balance when it makes sense to worry - and when it doesn't.
We then moved on in our discussion about Burns' musings on anxiety and turned the corner into the burden many of us have prioritizing our own needs over the needs of others, and how, if we focus too much on the needs of others, our own needs become neglected. Again, reflexively, I stated Hillel's famous comment from about 2,000 years ago:
"If I'm not for my self, who will be for me? But if I am only for myself, who am I? If not now, when?"
Kim and I discussed that indeed, we are not islands where we never need others, nor do we ignore others' needs. Neither are we able to be a fountain of unlimited giving to others. But we do have to connect and contribute to others. Hillel's goal, if I may be so bold to say, is balance, a skill that many folks with anxiety (and depression) struggle to maintain.
And of Hillel's last statement: "If not now, when?" I think that brings Kim right back to Burns' book. He's quite clear in his books that they are not just for reading. They're for using. Using the tools, the worksheets and the exercises that are outlined to challenge the preconceived conclusions that we have that keep us anxious or depressed. This practice enables learning - in the same way kids play catch with a parent - so they can master the skills involved in throwing and catching the ball. They create muscle memory that sticks with them for a lifetime. The practice with Burns has to do with creating the neural pathways - the neurological equivalent of muscle memory - in order to successfully address the anxiety/depression at hand.
So, Kim is, hopefully, on her way to the path of creating these different strategies to address her anxiety. She's a good kid, a hard worker, and I have faith in her desire to challenge the current "cognitive distortions" that keep her anxious. I was a bit surprised, however, that our discussion of her journey brought us from today, back 2900 years to the days of King Solomon with a short - but meaningful stop some 2000 odd years ago with Hillel.
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