Multiple Blog Topic Disorder!

I have so many ideas and so many different topics I am thinking about and wanting to blog about my head is spinning! This happens to me in other areas of life, like my art making: Suddenly presented with even 20 minutes (which is a ton of time to have to myself these days) in my studio I have to make a quick decision as to whether to start something new, work on my graphic novel, get back to my big huge project, do another weird mixed media thing that is newish, or pick up a piece and keep working on it, or just chill out and do a collage in my journal. In a case like this, luckily being alone and in my studio, I just go for it and usually just do what feels easiest. If I am at my home and have a very rare opportunity of being alone with a million choices and a few hours time, I am extra challenged. Either I try to do a little of everything, or force myself to just clean some area or do what I did yesterday: I had a book I wanted to read and just sat on the couch reading that book for several hours. That was relaxing for me. No noise whatsoever, no need to look around at the chaotic apartment or be distracted by other things, just focusing on a fascinating riveting book I was learning something every page.

So I could blog about that book or topics related to it. But I have so many topics buzzing in my brain. In no particular order:
1. choose the easy way out and find a cool cultural ritual to discuss and celebrate.
2. pick something to add to the series I’m doing on society’s view of mental illness and separating fact from fiction
3. Mindfulness and how it is used in therapy and everyday life, prescription for any human suffering from anything or avoiding suffering
4. Basic fundamental of the idea of DBT, the dialectic between acceptance and change…
5. Self worth, liking yourself, self esteem, self love, whatever you want to call it and why it is so difficult to deal with in oneself and others and as a therapist as all patients seem to share this issue…
6. Importance of validation for parents
7. Trauma, a million topics emerge from just that word!
8. A holistic view of what “Recovery” means and how it can be empowered and person centered…
9. Borderline Personality Disorder, the hush that still surrounds it, despelling myths
10. many things you might share wtih someone with Borderline Personality Disorder even though you don’t have it, so why does everyone get so angry at even the name of it and why did people argue about it not existing and not being correct to put it in the DSM5 or changing the wording…
11. 9/11 is creeping up on us downtown New Yorkers, what ghosts still lurk down here and in our psyche and collective psyche as humans?
12. All healing boils down to finding balance, following the “Middle Path”. Why is this so incredibly hard to do???
13. Body image again: how can someone say that their low self worth has nothing to do with their body. Liking yourself starts with liking the form that you are in as a person, your shape and size, the inside of your body, things your body does, things you don’t know it does, what you do to it, put in it, stimulate it with, relax it with, soothe it with etc. what is the definition of negative and positive body image? If our own culture is any sign of our relationship with our body, we Americans have a very distorted image about what a body is and a lot of preoccupation with what shape and size it is and what kind of outside appearance we have, and obsession with food, nutrition, good eating, bad eating, dieting, fasting, extremes and middle grounds, feeding our babies and kids, etc. When you think about that, you have to really look at yourself and see how much you unconsciously on a daily basis participate in these fixations…
14. making assumptions about people too quickly. Learning to go back to the child’s curiosity and scientific investigation of everything you encounter through every one of your senses…
15. I can’t end at 14 as I have a crazy preoccupation with odd numbers. For alarms to wake up I have to set the time at an odd number, 8:01, not 8 for example, so I can’t end this post with only 14 topics. I guess the 15th is also about indeciciveness and making choices.
16. Uh oh I just remembered another. Noticing in your relationships with others, do you have some conflicts that could just be reduced to having totally opposing types of coping skills? This is so common in couples as opposites do attract.
17. “Look before you leap” versus “He who hesitates is lost.” The dilemma of the extremes around decision making and reactivity, ie. the person who spends too much time with a pros and cons list versus the person who can’t tolerate being in the “I can’t decide, I don’t know” zone and goes in the direction of acting on impulses and quickly…
18. The use of dollmaking in art therapy.
19. Systems theory explained simply: we all have many parts inside ourselves and we can get to know them better to help them work together. Often extreme crisis, even psychosis happens when all your parts of your psyche are at war or shouting at you at once. Hearing voices could be related to hearing from your parts… (look at “The Beautiful Mind” as example.)

Ok. I am sure I have a hundred more topics but at least I got some of them out there as things I want to investigate. Usually I veer towards making decisions too quickly, but I guess blog writing is helping me slow down, notice my mind’s chaos and speed and curiosity, wanting to connect many ideas and actually having a hard time making a decision!

The Altered Book: A Great Project for In Session Art Therapy

When I was in graduate school for art therapy, I had never heard of an altered book or seen one, and certainly it did not come up in my “Materials” class. We did not get assigned any kind of Altered Book in any class, whereas now I am hearing from grad students that in some class or other, one of their assignments involves an altered book, which is usually assigned to do outside of class.

I think my first experience of an altered book may have been at the Outsider Art Fair. I distinctly remember going to this Fair years ago when it was always in the lovely Puck Building, which is still there, located on Lafayette near Houston St. in Soho, downtown NYC. In fact years before that, I had some of my graduate art therapy classes in the Puck Building and we organized the student art show on one of the floors of this building. It is certainly a beautiful building. The last time I was there for an art event was the comic book graphic novel fair a few years ago when I met one of my favorite graphic novel authors/artists, Lynda Barry. It must have been back in 2008 when she had just published this beautiful book about her art making process, called “What It Is”. Anyway I think I saw an altered book years before that encounter in the same building. It was made by a female outsider artist and I remember the book being very thick and beautiful and having a lot of glue on all the pages. It was very inspiring and I wish I could remember the artist and find a photo of it.

I made my first “altered book” years before that without knowing it was an “altered book”. It was not quite what we tend to think of these days when thinking of Altered Books. I took all the pages out of this strange pretty bad dramatic novel I did not read and altered the cover completely to the point where it was not recognizable as having been a book. I put a lot of plaster of paris on it and then mod podged tissue paper collage. Then I somehow found part of a cardboard box and attached the book to it so the top opened up as the cover. I think I used the pages to rip up and glue inside the box. I will take a photo of it. Strangely it was a gift for a close friend, but she was a close enough friend that she told me she found the box to be too disturbing to use or look at, so I took it to my studio, where it has been more appreciated! It inspired one person to make something like it with me, and she ended up taking a dislike to the project and left it with me when she left town after we went through her art that she had done in art therapy with me. I still have that rejeccted box in my studio as well. (It inspires me to write a whole post about “ugly” and “rejected” art work and how it is therapeutic in art therapy!)

More recently, a few years ago I stumbled on an online class about altered books, and in fact I have now taken 3 online classes about it, each class covering different aspects of the art making process involved in altering books. I have been making them with patients for a while now, and by making, I really mean inviting patients to try it out and see if they like it. The first part of the process involves the explanation of what it involves, which is, basically, you choose a book and then you can start anywhere in the book or with the cover or back cover and start picking art materials to use on the book. The first steps also often involve ripping out pages from the book, either to use in the book or to throw out. It is usually good to do this at the beginning as a way to give yourself permission to “alter” the book. We all have pretty fixed notions about the sacredness of books, which I think still exists despite the internet, reading on tablets and other devices, or perhaps, the tablets have made books seem even more precious. Jumping in to starting an altered book project requires a certain amount of adventurousness, ability to tolerate anxiety about the unkonwn and anxiety about trespassing a boundary and destroying something in some way in order to create something completely new. It also involves changing ones mind in framing the idea of that book, from something to be read and kept intact, to an object just like any other “found object” to transform and make your own through your own creative expression.

There are many different aspects to altered books as part of the art therapy session that are quite fascinating, so this post will only touch on the first part, the beginning. Once invited the interested patient will next be introduced to the random assortment of books I have to choose from and pick something that speaks to them to alter. Usually Hardback books are more inviting as it is easier to treat the cover like a canvas, but lately I have seen a few people pick soft cover books, becasue I have a few that are an interesting size, kind of square and with a lot of photos, and a cover that is more sturdy than the usual paperback. So far, nobody has decided to go home and pick out one of their own books. Part of this I think is the therapeutic value of taking a book that’s in my studio already taking up space as a book waiting to be chosen, so the process of accepting this odd art project is made easier as you are not “ruining” one of your own books. And I really have a strange random assortment of everything from dictionaries/thesauruses to cookbooks to spiritual meditation type books. Included is a thick hard back Italian novel and some other random novels as well as several books with pictures about fashion or the styles of certain decades. I have a travel guide. I had a guide for artists about materials and how to use them.

This aspect of rejection of the project that began when I made my own rejected “too intense” book box and then an “ugly” book box with a patient is a part of the altered book project. I have had a few people pick out a book and start altering it and then by the next session ask to shelve the project until “I’m in the mood for it. It’s too daunting right now.” The Altered Book will either be seen as a great container that is continually inviting or sometimes it represents being overwhelmed and unable to make any decisions about what to do, resulting in the project getting “shelved”. One of my patients started a first session very excited about all the varied materials I had, wanting to jump right into art therapy and got going very creatively with some book that she even worked on for the first few sessions. At some point I think she started cutting pieces out of the book to create a kind of box within the book, maybe even using an exacto knife. Then in the next session she declared she no longer wanted to work on it, was not in that “headspace” anymore and went to other forms of art making. She made great use of art therapy but never went back to the book until we were terminating and she fondly remembered it as her introduction to me and our work and I think decided to take it with her. The book project just functioned as a jumping in point.

Why do some people get excited to do an altered book in the first one or two sessions of trying it out and then run away from it, shelve it, reject it? Maybe when this happens it is because I, the art therapist, am actually more excited about it than the patient and have high expectations for it being a great kind of project for long term therapy. Perhaps for some people, there is too much commitment too early and they are not really ready for it.

The other interesting thing about doing Altered Books is when people do get invested in them and go back to them every session. Lately that has been happening, probably because a few people in my supervision group randomly chose to work on altered books without my prompting them. Two people have left the group with unfinished books they have taken with them. One person brought her own book to the group to alter with materials from the studio. So that energy of the altered book I really believe was “percolating” for a while in the studio. I had another rejected altered book started about a year ago in one session and then put aside. For a while I was not really focusing on altered books in the studio, just taking these classes and thinking once in a while about it, and learning more ways to approach the Altered Book.

At this moment, my studio feels filled with Altered Books! Like anything that grows in a garden on its own, it feels like this altered book contagion has just sprung up naturally. Just this week I introduced the altered book as an option to 2 patients who got excited about it, chose their books and jumped right in using different media. Last week I had started my own altered book project in the supervision group I facilitate, thinking that now that I have so many patients working on them, I want to do one at the same time. So I chose a book that is a guide to artist’s materials for artists. It was very exciting to imagine taking this book that divides up all the materials and methods and painstakingly describes how to achieve certain effects, and how to “properly” use the different materials and media and rip up the pages and paint on it and collage ripped pieces on to the pages to start the process of making it into a book I hope will be hard to guess exactly what it was even called or to have a vague sense when looking through my book that there are a lot of pictures of how to make art and art materials terms but nothing much else kept from the original book. Synchronicity abounds in doing altered books. For me it came when I opened the book and realized it had belonged to the friend who rejected my first book box project and returned the gift to me. Of course I ripped her name out of the book first.

Anyway, at this moment there are at least 8 altered book projects that have been just begun or are in the mid stages of alteration. If I actually count how many patients have started altered books recently, excluding the person from last year who has not expressed interest in going back to the project, it would be 7, so my guess was not far from wrong, as I am the 8th and then there are one or two people in supervision doing them.

The next post would raise the question: What helps a person stay with an altered book project and continue working on it regularly? and What is it about Altered Books that some people become “blocked” or lose interest after jumping in excitedly.

The one thing true of everyone is that the beginning, that first session of being invited to make one, choosing the book and jumping into it or onto the cover and starting right away to alter it is universally exciting and stimulating. I have only seen people be intrigued and excited when they begin this process. Some express having a weird feeling about “destroying” a book but when encouraged get past that feeling. The fascinating part of the Altered Book is after the initial excitement and embarking on this without a doubt long-term project, there is a moment of remaining with it and committing to it further through getting inside the book and getting going with paint, collage, mixed media, ripping out pages and getting one’s hands dirty. It seems to require about 3-4 sessions at least to determine if one is going to get “turned off” of the project and too overwhelmed, or further jumping in and committing more and more to it. Those who find it to be a kind of safe container stay with it. Leaving it with me in the studio is a big part of that process. I will hold on to their book until they come back to it, so they don’t have to see it for a week. It is very different to work on a long term art project whether it is because the work is very large and will take a long time to finish no matter what or the project by its very nature requires time invested. It is hard to work on a lot of pages at once, especially if you are using any kind of paint or ink. Anyway, leaving the book with me allows the creator to take a break from it and not have to look at it in between sessions. This seems to help the project to become a safe container and holding environment. Even with my own altered book, I decided to try out at first just working on it during the supervision group and leaving it alone, so I also take a week off from it, in order to further get into the experience of my patients and supervisees doing this kind of project…

To be continued…

Here are some photos from my own altered book which I have worked on in different situations, first started it in the supervision group I facilitate, then worked on it alongside several patients who are doing altered books as well as in my studio the other day when I added a kind if nest into the book…

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The Pregnant Therapist, Continued: The “Recognition” Session

Finding Out About The Pregnancy: “Intrusion” in the Therapeutic Space
This post got so longwinded, I’m not sure what to do with it, so I will edit a few paragraphs, and save the rest for another post continuing this longwinded “pregnant” topic! At least it won’t take 9 months to write about it…
You are pregnant and in your office with your patient. There are now 3 heartbeats in the room.  Now, jump ahead to your fifth month. If your patients haven’t “guessed” yet about your pregnancy, this is the time in which you will have a lot of “pregnancy recognition” sessions and a few sessions where you might actually inform your patient about the pregnancy and help him/her prepare for the upcoming changes, such as your maternity leave.
In one of the books I mentioned in my last post, the authors remarked that there are many ways your patient may let you know that they have become aware of your pregnancy besides direct verbal comments asking if you are pregnant, including dreams and images, even discussion of the patient wanting or not wanting to have his or her own baby.
Sometimes a patient, usually a woman, will wait a few sessions to see if your belly is getting bigger, as many women are sensitive to body image and don’t want to make a big “mistake” and find out you have gained weight for some reason and are not pregnant. I’m sure this happens sometimes, as I’ve had a few patients tell me they get asked if they are pregnant, sometimes by strangers, and are not. (Not always people who are overweight, but nonetheless, an odd unpleasant experience no matter what you look like…) Of course this can be very wounding to a person and most of our patients are very careful not to hurt our feelings, especially if they already know what it feels like…
(Confidentiality note: these “stories” are made to be not identifiable, as I do not supply any identifying information beyond gender of the patient. In some cases where the gender is not important, I have changed that, but given the nature of pregnancy, often the reactions are different in women versus men, as well as children, teenagers, adults, older adults, etc…)
So by around five months into my pregnancy, I had to have the inevitable “Recognition” session with each patient. Each person reacted completely differently.
One person had discussed noticing it with another patient, a friend of his whom he saw once in a while, and the two discussed it and decided the one who noticed would say something so he did. I don’t remember much of that session as he was fairly honest about his feelings and reactions. Then the friend came for her own session and got distracted by focusing on feeling bad that she didn’t notice, and her friend did. This may have been a convenient way to avoid the real topic, but I pointed out that I actually saw her “not noticing” as a good sign. Given certain issues around boundaries she was grappling with, I observed that it was great she was able to be so focused on herself.
One patient had a very interesting reaction. As a woman with mother issues (just like the rest of us, who doesn’t have mother issues!) that were unresolved. ambivalent and complicated, she was overly sensitive to my being pregnant and told me she was very concerned that her own negative energy would “hurt” both me and the “baby”,even though I reassured her that this was not the case. She simply did not believe it and was convinced she was right. While I was on my leave, she communicated to me that she could not come back to therapy knowing I was a new mother and explained as thoroughly as possible the issues this knowledge was triggering and not wanting to process them with me despite encouragement…This is an example of a patient who cannot be comfortable during but also after the pregnancy, as opposed to the majority of patients who do return to therapy with their now mother therapist. Quite a few young female patients openly admitted to feeling a discomfort in the sessions and being very aware of my body changing from week to week. One person expressed this through chronic lateness to the sessions and had no interest in exploring the connection to my pregnancy… Of course I supported all reactions, and once I knew the discomfort caused by my actual body changing, I was more sensitive than usual about checking in with people a few times in the session to see how they were feeling about it.
This reaction is related to the conscious and unconscious feeling many patients have that the now pregnant therapist is and will become more and more sel preoccupied and unable to be present and focused in the patient. Most children feel this way and show it non verbally. Having a younger sibling does not always mean a child is more comfortable with the therapist having a baby. The therapeutic space belongs to him or her and many children feel the therapist is going to be inattentive and absent. This reaction at any age can be very real in many ways. The pregnancy is a very real intrusion as well as a big or little distraction for both therapist and patient.
For me, as I contined to view my work with patients, despite the changes of pregnancy, I continued to see my work as a good distraction for me from focusing on the pregnancy and the inevitable birth of the child and shock of now having a real human to take care of… I could not avoid talking about it at relevant moments and accepting that it was very disturbing for some. Even the people who ignored it completely, were nonetheless deeply affected by the change in the therapeutic space, however, they ndicating that it was easier for them to “forget” about this intrusion and sort of get rid of the belly in order to avoid some kind of discomfort. Other therapists that I’ve talked to during their pregnancy have expressed that it was increasingly difficult to focus on and care about their patients, especially therapists at very difficult often traumatizing jobs, so this concern is very natural and needs to be addressed even if the therapist or especially if the therapist is colluding with those patients to try to ignore the inevitable change, that the therapist will be taking a leave, some short, some longer, and the patient has no control over the timing of it in their own life’s journey and their own progress/process in therapy. The return of the therapist is also not in the patients’ control. In private practice, there is usually trust that if the therapist says she will return in two months or three, she actually will; however, I have known a lot of therapists in all kinds of jobs who have been unsure of whether having the baby will cause them to decide not to return to their job, or to return briefly and terminate. In short term settings, the pregnant therapist usually has more emotionally laden issues with the rest of the staff, rather than the patients who may be at the site, such as a hospital, very briefly. These patients tend to be the least affected by the therapist’s pregnancy, although in many cases, people still have strong reactions and transference towards the pregnant therapist, more related to their own particular feelings about mothers and mothering… Thus, short term sites can actually allow for some interesting issues to emerge in therapy and art therapy groups when the pregnancy is addressed in a less personalized way. Discussions that would not normally occur may happen due to the pregnancy bringing up a lot of issues and feelings…
There is much more to say about the topic of “Recognition” and lack of it (thus the therapist’s inevitable “Announcement”. When in the session to tell the patient and how are another interesting focus to be further explored, as there are going to be people who simply do not say anything and even admit to waiting for you to tell them, as well as those mentioned above who probably are avoiding it altogether…
To be continued…

Making Your Art Work Versus Showing It, A Common Struggle!

I just wrote this post and it vanished, so I’ll start again. This is another short post just to bring up some topics and questions, especially for artists and art therapists and those who identify as both.

Do you exhibit your work? If so, is it very sporadic or often? Where do you exhibit it? If you don’t, why not? Do you have gallery representation? Do you want to have your art out in the public eye? Do you sell your art work? Do you enjoy selling it? Are you attached to any of your art work, such that if you exhibited it, you would mark it as Not For Sale? Are you easily discouraged by the competition? Do you find yourself making lots of work as a way to procrastinate trying to show it? Do you every get blocks where it is hard to get yourself to make art? These questions are not easy to wrestle with for any artist, and often more frought with inner turmoil for us artists/art therapists…

For me, I’ve been an artist for way longer than an art therapist, even though I didn’t go to “art school” or major in Art. However, although my artist resume has a long list of exhibitions at various types of venues that I have shown my work, I find that in the last two years, I have not really exhibited it, beyond having it out for public view during the Tribeca studio tour: (http://www.toastartwalk.com/toastartwalk/Natasha_Shapiro.html)

I don’t have issues with getting attached to any of my art work, so that is not a road block for me. I admit that I get easily discouraged by rejection, and find it hard to hussle and market myself as an artist. I am currently working on these very issues, by writing about it here, and by actively trying to look for galleries and opportunities to show my work, that I normally don’t get out of my comfort zone to do… I have always been lucky in that I have no problem with blocks around making art. While I may have a block on a specific piece or idea, I always have two or three other things I’m working on, so I don’t notice getting blocked. However, I confess that I too find it very easy to procrastinate the marketing and selling end of things. For example, I got invited to be an artist on a great website called “Artiscle”, and it took me about a month to make a profile and get some work on it. I still need to post a lot more work on the site, as it is a great opportunity to not only sell work but rent it out.

I find myself making myself promises I do not keep. So it’s time to get on it, and work through all the things that get in the way of trying to succeed more as an artist! Share your struggles and triumphs in comments please!

Musing on Relationships, Culled from Marilyn Monroe’s Writings…

I am reading “Fragments” by Marilyn Monroe, which constitutes notes, poems, musings, diary entries, etc. I have long been fascinated by her for many reasons, psychological reasons being the obvious focus for this blog.
In publishing these fragments of writings in 2010, the editors and publishers wanted to show a very different side of this very complicated person, and they succeed. One of the interesting things about the photos in this book is that they show a lot of photos of Marilyn reading all kinds of books, and she was actually a voracious reader who tackled Dostoevsky and James Joyce’s Ulysses. It is even stated in the book that she liked having pictures taken of herself reading. This was no Sarah Palin pretending to read a newspaper. Those who were close to her knew she had a sharp curious mind and loved reading. Seeing these photos did make me reflect on present day actors as well as past ones. I couldn’t think of any who especially liked to be pictured reading. There is something interesting about a photo of a woman reading a book, especially this woman who was so in touch with the camera. In most photos of her she is looking at the camera, but in these she is dressed fashionably but casually and seen sitting or standing in a casual position in a homey looking environment, and her eyes are on the book, so there are two subjects to the picture. There is the mystery also of what page she might be on and what words age might be reading when the photo was taken!

Anyway, it is quite interesting to read her fragments, many of which are poetic and quite beautiful, while others are filled with insecurity, loneliness and the desire to improve herself. Some are even directly related to her being in psychoanalysis. I’ve been looking through the book for something to quote somewhere and finally found something for this blog rated to a recent post I wrote about relationships. It is very thought provoking and both sad, realistic and somehow hopeful, which is a curious combination, but not so strange when touching on the subject of childhood and attachment. So here it is; please react and comment if you are moved to do so…

“(page 131) re relationships

Everyone’s childhood plays itself out
No wonder no one knows the other or can completely understand. By this I don’t know if I’m just giving up with this conclusion or resigning myself-or maybe for the first time connecting with reality-

how do we know the pain of another’s earlier years let alone all that he drags with him since along the way at best a lot of lee-way is needed for the other-yet how much is unhealthy for one to bear.

I think to love bravely is the best and accept-as much as one can bear”
(words underlined in this passage: plays, much, unhealthy)

Quick reactions. I found this to be very truthful and really focused on relationships that are very mature and/or deep, those moments when people become unsure and unsettled by what they observe in themselves and their partner. It raises some interesting questions for couples who are examining their relationship or in couple’s therapy: “what are the parts of your partner that you do not know or want to know better but seem buried under a lot of pain?” ” Do you think you can share your own childhood painful parts with your partner, and if so, can you use this to better understand your child selves within the relationship?” “Do you give “lee way” to each other for all that emotional baggage you still carry?” “How much can you each bear of this part of yourself and of her/him?” “Are you afraid of it and avoiding it, or are you bearing too much of it to the point that either of you can recognize it is unhealthy?” “Or, are you asking too much of your partner and wanting ir demanding him/her to bear an unhealthy amount of this early pain in the relationship as it is right now?” “Do you feel that you love bravely and strive to accept what you can reasonably bear in each other?” “What does it mean for you to love bravely?” “Have you ever done it or do you shy away from it?”

As a side nite the word “lee-way” is quite interesting, with origins in the concrete meaning of a sideways drift if a boat or plane. The best definition I came across that seems to fit her use of the word was “leeway – a permissible difference; allowing some freedom to move within limits.” Just thinking about this word and this definition, well, what a perfect word to encapsulate a bug part if intimate relationships: the balance between acceptance and tolerance of difficult aspects of the other while at the same time having reasonable limits, thus capturing the combination of surrendering as well as separating/having boundaries… Real food for thought in just a few short sentences…

Relationships: Wiping the Slate Clean!

This blog post is dedicated to my very wonderful friend who is getting married today! May you both enjoy a lifetime of love, confusion, and many moments of joy, as well as the ability to let go of the unpleasant moments as quickly as possible! A fight or misunderstanding is like a sudden thunderstorm, very violent and loud, often, scary, but at some point, it will be over, and, if you can find the rainbow at the end of the storm, you will weather them all and remain close, no matter what comes your way…

A while ago, I heard an interesting story about a friend’s relationship. She got in some kind of unpleasant argument and disagreement with her partner. I’m not sure if it would constitute a fight or not. Anyway she went to bed with a not so great unresolved feeling. The next morning she woke up cheerful and had no recollection of the unpleasant end to the night before. Later in the day, she was talking to a friend about some random topic and suddenly remembered the events of the night before. She was pleasantly surprised to realize that she had conveniently forgotten the unpleasant argument of the night before until that very moment and later told her partner how refreshing it was to have let go of it so easily. They agreed that it was a good thing and that they would remember it for the future, so they could remind each other to “forget” about negative incidents or fights, if one or both of them were to hang on to resentments too long…

This story struck me as a very interesting aspect to our romantic relationships with significant others. It seemed to show that the key to a good relationship is the ability to “let go” of the bad moments when our demons come out and battle each other, as they will do if you are with someone long enough. Nobody fights fair all the time, and we all have our repertoire of venom and nastiness, no matter how sweet people think we are. Close relationships are inherently difficult and stressful at times. Having one or more child with someone will add extra stress to the most loving of relationships….

While we prize the ability to remember events and be able to repeat conversations verbatim, there is a lot to be said for the ability to “wipe the slate clean” and “forget” the dispute, whether it lasts one unpleasant evening or gets prolonged into a week or two of stress and strife with one’s partner. Especially at times when you feel like you are constantly at odds, to be able to call a “time out” and agree to forget the past unpleasant days and “start over”, by “wiping the slate clean” and moving on. Rather than dwell on the past unpleasantness or obsess about future wounds, we always have the choice to be in the here and now and let go of negative predictions..,

In most people’s close relationships, certain conflicts, disagreements, and arguments often get repeated. It is not unusual for couples to report that they have variations on the same themes in their disagreements, and even that it seems to go round in circles without coming to a resolution. I remember a long time ago hearing a radio interview with a couples therapist who said that resolving issues as they come up is actually not the key to a healthy relationship, but actually being able to let go of conflicts and agree to disagree and move on or simply to stop talking about the subject without a resolution is more of what constitutes healthy relating, even if the topics of conflict get brought up repeatedly. So basically, some kind of “forgetting” is involved in letting go and moving on. The idea that you can just leave some tangled mess alone without untangling it is a good skill for being in a relationship with another human!

Love relationships are really often quite primitive and not reasonable at all. We repeat attachments from early on. Humans are not much built to live alone for the most part. I’ve seen total loners who are most comfortable reading a book, or on their computers, end up getting together with someone quite the opposite, who has very intimate close friendships. These two types can love and live together, but they do not speak the same language when it comes to intimacy. Opposites attract. I see couples where one person is soft hearted, almost gullible, looking at people as good unless proven otherwise, pair up with a complete cranky, cynical, untrusting curmudgeon. Rarely do two people with the same attachment style and outlook on others get together. Finishing each other’s sentences? More like- two different sentences next to each other that make no sense. Now that’s a couple bound to spend a life together!

Nobody wants to fall in love with someone who reminds them of themselves. There is a great episode of the show “How I Met Your Mother”, in which several of the characters realize they are dating their mother or father. In various situations, the characters become disgusted when they suddenly see their actual parent interacting with them when they are with their partner. Yes, we are with a weird mixture both parents if we have two, or one of our parents; whatever the family situation, your earliest most primitive attachment will be lying next to you one day in the body of your love partner…

Of course, our partners are more than just a repetition of our early caretakers, but to understand what the crazy is about when you feel like things are getting crazy, as they do in long relationships, it’s time to look at your attachment style. Fights aren’t always about what you’re fighting about. Sometimes it’s just two people thinking, “who are you and how did I end up with you? I don’t even know you right now; do you still love me? I’m going to withdraw now and go to another corner and be with myself. I’m too afraid to reach out to you. I’m too needy, you won’t really want to be with me when you see how needy I am…” “I want you to reassure me but I can’t ask you to. I’m supposed to be the strong one.” Suddenly someone is being mean and scary and someone else is being passive aggressive and crazy. You seem to have metamorphosed into two very different monsters. Don’t touch me. You hear this, so you run away. What is this? The dance of intimacy. Where are you? You’re not on the dance floor. You are in a demon dialogue where nothing makes sense and you’re very scared or very hurt and mad; either way you’re feeling lonelier than you’ve ever felt and you may very well be with the love of your life, or one of them, or your soul mate.

Distance and closeness, aloneness abd togetherness with the same person. Yes it is completely possible, and highly abnormal if you do not experience that with your partner. Love ebbs and flows and we show our babyish selves. Then you may even have a baby together and things will get even more complicated. In my view of many couples, it seems often that one person is the “baby” and the other is the “parentified adult”. If things work out well, the baby will get a chance to prove s/he is capable of taking on the “adult” role, and the parentified adult is allowed to be a baby and get taken care of.

This is a complex topic that long books don’t even exhaust, so as usual, being in the form of a blog post, it is not comprehensive.

The main message I wanted to convey is, gang in there through those bad storms, and if you get a chance to take off your monster costume, push the reset button and remind each other to “forget” what was and re engage in being close again. Remember the best version of yourself that your partner fell in love with, and remember the best version of your partner that you fell in love with! That person is still there in each of you, and you can access it when you let go of the transient ebb and flow of daily petty disagreements. So wipe the slate clean each morning! It’s a new day to let go and be loving again!

Money and Therapy; A Very Confusing Topic

I just wrote a long draft for this post, and it disappeared, so I am very frustrated. I will try a shortened version of what I had in mind.

I started by describing a lot of potential scenarios (in private practice as opposed to clinics or training institutes or agencies) for therapists and patients to raise questions such as the following:
1. What is it about the exchange of money for therapy that directly affects the therapy?
2. With insurance companies often paying the bulk of your therapists fee, does your copay to your therapist hold any meaning for you or your therapist?
3. Is there such a thing as too low or too high a fee?
4. What does it mean for the therapy for a patient to be paying a very low fee over a long period if time due to real financial hardship?
5. Is the therapy compromised or changed when an outside party such as a parent or friend pays for all the therapy?
6. What is it like as a therapist to be mistakenly seen as very wealthy by your patients due to some misconceptions about therapists in private practice and their incomes?
7. What is it like for a therapist to have a patient who makes over twice the therapist’s income?
8. Is it wrong for a therapist to let a patient who has money problems and is paying a low fee get very far back in payments to the therapist and owe months of therapy? Who should bring up the topic?
9. Is there something strange about this scenario: therapist goes to a supervision group and pays a monthly fee 30$ more than the fee s/he charges her own supervises in the supervision group she runs.
10. What makes most therapists say no to bi-weekly (2 times per month) instead of weekly sessions and what makes a few therapists accept this scenario as well as a low fee due to the patients’ financial hardship?

In the world of many therapists the whole topic of the fee and sliding scale and how to handle the negotiations of it is hotly debated. Some say if you don’t pay attention to the fee and how it is paid you are avoiding a lot of important issues. Others have a philosophy of really using the sliding scale fee and accommodating people other therapists would never work with. I confess I fall in the category of those, the ones who lower their fee to accommodate patients with little money and at times I accept a patient coming only twice a month. In most cases it is a patient who has been coming weekly for a long time but not always. There are other reasons I have accepted this type of patient besides money issues though I agree with most therapists’ opinion that much more can be accomplished with the regularity and structure of weekly sessions. I also would never run a supervision group that did not meet weekly as I think the group process works with weekly meetings and consistency and keeps the group functioning for support as well as clinical issues.

Many years ago I read in the New York Times magazine a profile of a British therapist. I don’t remember his name or why the article was on him but I do remember him saying, ” I strongly believe that therapy should not cost more than (don’t remember the amount but it was equivalent to about $80 which these days might be around $120 as this was written around ten years ago)…” anyway I was really struck by his point. He actually thought there was a limit to a decent fair fee for his services despite his education, training and experience. Sort of like saying an ice cream cone from a truck shouldn’t cost more than 3$. This was and is very unusual in our profession to actually say that it’s indecent to charge more than a typical amount such as $100-$120 per session as your highest rate. Putting a limit on the value of therapy. Most therapist’s focus much more on the difficult issue of, can this particular patient afford to pay my highest fee and if not what can they afford. On the patient’s side, I have seen people say I don’t want to pay you less than such and such as I don’t want you to feel disrespected so this is what I could afford to pay you.

I admit I had a conversation with someone about couples therapy and how insurance companies often pay too little for it. Yes, some therapists charge more for couples than individuals. The reasoning is that couples therapy is much more difficult to do, which I think is definitely true. In addition, most couples don’t stay in therapy that long with some exceptions. While it is not unusual to have a patient in therapy for five years or more, the average couple dies not remain in therapy that long. I could diverge into a discussion of couples therapy but that is for another post. I will add that it’s not unusual for a couple to go to a couples therapist and end up with one partner continuing with the therapist individually and thus stopping their couples sessions. It is one way people kind of accidentally find a therapist they like for individual…

Back to money. The idea of going to someone’s office to share intimate details of your life and expose your self in various verbal and nonverbal ways is hard for some people to wrap their head around. Usually the boundaries of not knowing much about your therapist helps with this scenario and makes the whole money transaction make more sense to most patients. I am going to a doctor of the mental, emotional and spiritual body so of course I am paying as I would for a doctor of the “physical” body. This is how I would explain the process to a curious and puzzled Martian.

People may notice they are sometimes treating their therapist like their mother (transference) but it helps to have the distance and strangeness of the personal information mostly flowing one way, from the patient to the therapist.

I admit or confess to sometimes wracking up a large bill with a patient who is on a low fee and having a very hard time confronting the patient about it. It certainly would be easier if the patient brought up the topic. Confronting someone who has a job they work hard at and are paid little for who has loyally stayed my patient when s/he could have found someone in network on their limited health plan and now owes me for quite a few months if therapy is not easy. I also have a patient who left therapy suddenly owing me about $300. She has paid off most of it but still owes enough that I need to chase after her every once in a while.

The majority of my patients not using their insurance pay me some fee lower than my regular fee and pay it on time.

The one insurance company I am in network with pays me a little more than half my regular fee. What does this mean? Probably that the insurance company undervalues my work in a much more insulting way than any patient is capable of doing. It says with your license, level of training and experience we agree to pay you almost half your fee. If course experience usually doesn’t mean much to the insurance companies nor do they raise your fee according to inflation and cost if living.

Raising your fee is another big topic which a lot of therapist’s struggle with.

Money and therapy: big topic to be continued in the next post!

A Calling or A Choice?

I had grand plans last week to do a post on motherhood or on the onset of mental illness and the difficult journey of learning to accept that one has a mental illness, which many of the books I wrote about cover. Both big serious topics. But then at the end of a session with a new patient I got to thinking of the idea of a “calling”, as this patient had asked, when leaving my studio about seeing my art on the walls and did I go to art school or some such question. I briefly explained some of my circuitous road to becoming a visual artist as the patient was leaving.

Anyway some other topics I’ve been thinking about got me thinking about the idea of the identity of an artist. Many artists knew from early on that they “were” artists or “wanted to become an artist”; these people as adults often report that their teachers and art teachers and sometimes also parents saw their talent early on and recognized and encouraged it. These were the people who in grade school and high school were known as something like, “S/he can draw and draws really well…” I’ve met many artists and art therapists who have this kind of history. lThey had the coolest notebooks with great graffiti-like doodles and lettering

However, there are certainly other roads to becoming an artist. Mine was a complicated or maybe actually simple one. But the main question I’m asking in this post is: “Do you decide that you ‘want to become an artist’ or do you figure out that “I am an artist.” These are two very different concepts. For example, most people say they did not decide about their sexuality, whatever it is; they found out about it. It was not a choice. Some others in the minority argue it was a choice. Most transgendered people report that they came to a realization that “I may have the body of a boy or girl but I’m actually not a boy, I am a girl, or I am not actually a girl, I am a boy. No matter what form of body one arrives here in, one does not choose one’s gender, even if the outside body turns out to be the wrong one. And of course there are people who say they are neither a man in a woman’s body nor a woman in a man’s body and believe gender is much less clear than that. That’s a whole other topic. I hope these statements aren’t too controversial. I find them to be an example of basic “identity”; ie. what do you think when you see or hear the question, “Who are you?” versus “What do you want to be?”

As a child, one is subjected to adults constantly asking one, “What do you want to be when you grow up?” As a child, I did not like this question. I knew that I was excited to be a grown up for the obvious reason that then nobody could tell me what to do and I could, in my child mind, basically do whatever I wanted, which mostly involved the idea of eating ice cream for dinner. I also had a vague sense about going on business trips alone and staying in hotel rooms, which I thought would be very glamourous. But I had no ambitions to be a business owner or businesswoman. In fact, when asked what I wanted to be when I grew up, my usual answer was, “I don’t want to be a lawyer.” It seemed to be needed as a statement as the only career I saw growing up was my dad’s as a lawyer and I knew that my mom had met my dad at law school. For some reason, I was dead set on the idea that no way would I be a lawyer, even though the only person I knew who went on frequent business trips was my father, who was one. When pressed to say what I did want to be, I always got grumpy and said, “Nothing. There’s nothing I want to do.”

For a brief period maybe in third grade, my friend and I decided that we were going to go to the Ringling Brothers Clown School and become clowns in the circus. We knew this school actually existed and were partly excited to go together there and be clowns together. After this clown idea wore off, I was back to my set answer, “Nothing. I don’t know.” You like to be in plays do you want to be an actor? No, definitely not. And so on with other professions. I went off to college with a vague idea that I might want to study film making and learn to make movies. I had a brief bout in high school of being interested in photography, but of course had no idea I could become a photographer and probably didn’t want to be one anyway. Soon after I arrived at college, I tried to sign up for the beginning film class and as they only took about ten people or less, I was rejected. Gone went my interest in trying out filmmaking. It was too much darn work to get to college and once I was there, I had no intention of fighting my way into any class, as I thought I deserved to be allowed to take it easy and be allowed to take whatever damn class I felt like. I chose my “concentration” (same thing as “major”) pretty much by checking out which ones required you to write a thesis. I knew a thesis was a long paper, and though I was good at writing papers, the length of a paper was directly proportional to my stress and fears about it, and I was not about to write something longer than 25 pages while at college if I could manage it. It turned out I could pick Russian Language and Literature and was not required to write a thesis, so it was a no brainer, as I liked both. Then the questions turned into ” What is your major? Oh, do you want to teach or become a professor, or do you want to work for the UN?” The question seemed weird to me. I had no desire to use my knowledge of Russian language and its poetry and novels to do anything. Four years of college seemed like a long time, and I still thought I could float along, staying interested in the kinds of things that are the least practical career wise and avoid this big decision.

I did not choose to have a crappy beginning of my sophomore year. Suffice it to say, without much thought, I decided to take an Introduction to Drawing class taught by DeCredico, a visiting artist from Rhode Island School of Art and Design. By then, choosing classes not in my “concentration” had a sort of impulsive feel. There were two intro drawing teachers there, and they were opposites. I watched my roommate freshman year suffer through an awful drawing class where she sat for hours trying to draw a bagel to look perfectly like a bagel. What an awful mean teacher she had. He was ruthlessly critical and liked nothing. It seemed like hell. Some friends of mine had taken the other cooky drawing class and reported that it was really fun, I should try it out, more like someone urging you to try a new drug or something than a class. I won’t go on and on about this class, but it was a pivotal event in my life. I walked in with no idea that I could make drawings or other art, not really sure what I was doing there except that I was sick of the typical classes involving words, papers and exams. I entered an alternate universe where we were told to find 10 sticks and put them together and bring them to the next class. In the next class, big paper and dark black ink was passed around and we were instructed to make drawings using our sticks creations as the “brushes”. Wow. I had no idea this was something you could spend a couple of hours doing at an Ivy League University where everything seemed to involve competition and way too much thinking. The class was like an art therapy experience for me. I had no idea what was going on or what I was doing or even why, but I was really enjoying it and something in me seemed to be awakened.

Suffice it to say that I ended that class with encouragement from the teacher and one of the teacher’s helpers, he must have been a grad student, and he actually knew my name. The teacher did not know anyone’s name as the class was big, but he would make a big sweeping gesture and point to a couple of images with a lot of ink or whatever on them and say “Why do I like these?” and point to some others and say the opposite. The ones he didn’t like were often the tightly drawn well drafter drawings that my poor roommate’s teacher would have loved!Often enough one of my images was up there. I never had the feeling before of someone looking at a picture I made and saying that. Probably it happened when I was 4 or 5, but I have no memory of that. The class ended, the summer came, and off I went to take my year off from college, toting a sketchbook everywhere with me and making lots of awful garish drawings in them among other typical “youthful” poems about suffering and loneliness.

Anyway I started my senior year in college thinking, “Am I an artist or a writer?” Or maybe I was thinking, “Which do I want to be, an artist or a writer?” I don’t remember how I formulated the question. The Russian stuff was now on the side as something I had to do to graduate, while I used my precious “electives” on a creative writing class and a painting class. They were both pretty difficult, not as fun as that drawing class, but the painting class changed for me after I figured out how to do my first painting. Go to the studio when nobody is there to compare yourself to and judge theirs as better than yours and work on it then. It was a a still life. I remember having an interesting awakening moment in the big empty studio when I walked around the room and looked at the work of my classmates, and it was as though someone had taken off a pair of glasses I had been wearing where I’d look at one and think, “Oh no. This person is doing such a perfect precise picture. It’s so great. Mine’s a mess, etc.” During this aha moment, I circled the easels and looked at the other paintings and suddenly those glasses were off, and I was thinking, “Oh this is just this person’s idea of this still life. It’s not that great or that bad either. It’s just different from mine. It doesn’t mean mine is bad.” And then the real awakening came when I looked at my painting and thought, “Wow. I like this. It’s really good.” Not a familiar state of mind for me in this unchartered area of image making…

Maybe at that moment knew I was an artist, maybe not. I continued to struggle with a Kafkaesqe short story in writing class and I definutitely liked the plot and ideas but it  seemed like too much work to keep editing it, and rich oil colors beckoned me.

College ended and life went on, but from that point forth I was an artist and did not really question it. I just kept on making a lot of art as much and as often as possible.It helped that I by chance had a tiny studio of my own right after graduation. It was the size of a closet, but it was a dream come true.  The more I went up there and painted, or stayed in the apartment and drew all sorts of things, all sorts of sizes and always carried caried decorated journal scketcook around with me, the more I got involved with the real difficult questions around a creative career of any kind. In this case it was, “What do I want to pant/draw, or is anything telling me to paint something. I stumbled around in the dark going in all sorts of directions, but it was still wonderful. I had been liberated from the complex depressing world of words and could no inhabit a magic land of textures and shapes and colors.

When I think about it now, it seems like I was covered in some kind of layer of some material that needed to be removed and underneath it, the artist had been hiding all along throughout my life, just waiting for me to need it enough to let it out. I continue to need it and I continue to be it. For me there is no choice… What about for you?

Separation Anxiety

Separation anxiety is normal in extremely young children up to around 14 months old. As the child gets older s/he can tolerate periods of separation from caregivers. Obvious signals that your child is too anxious about separation includes crying and inability to be soothed after separation, nightmares about separation, excessive obsessive “checking” that parent is there and clinging, constant temper tantrums at separation and reuniting, even bed wetting.

Often a child will pick up on an adult’s anxiety, and sometimes changes in the caregiver’s behaviors can go a long way towards easing the anxiety of the child.

What happens when these issues don’t get addressed? What behaviors linger on into adulthood?

“I notice that I get very anxious when I know the time I’m spending with a friend or on a date is running out and we are about to say goodbye. I know it’s an overreaction but I still feel this anticipatory anxiety and after we part ways I feel immediately a lot of sadness, loneliness and fears of being alone.” At other times this person is fine with being alone.

Another interesting scenario: “I seem to keep getting into long distance romantic relationships. Reuniting is always so dramatic and intense but then when one of us has to leave, it feels almost as bad as if we’re breaking up, and the depression lingers for a few days. During that time I’m excessively calling, texting, chatting online with him/her. Then for a while I feel fine and then it’s time for another visit and the whole pattern starts all over again”

“I hate the beginning of the therapy session. I always feel really uncomfortable. And at the end of the session it’s hard to leave. The worst is when you announce a vacation…”

Some people express their anxiety through needing to control the session, wanting to be the one who alerts their therapist that the session is over every time.

Of course as therapists we constantly see different styles of attachment. Aloof and avoidant: this may be the patient who can only tolerate bi-weekly sessions and/or “misses” sessions often through forgetfulness. It can be very challenging to work with a patient with this attachment style as they have a hard time staying in therapy. They may need to control things so much that they become the patient who suddenly leaves therapy when the therapist is noticing that s/he is finally starting to open up and trust. Next minute the patient leaves with no warning or notice. S/he may be able to send an abrupt text or email saying s/he needs a break from therapy, but in some cases this is the elusive patient who just stops coming to sessions and avoids any contact with the therapist. In these cases I have found it is still a good idea to contact the patient and leave a message voicing concern about this behavior, demonstrating to your patient that you have noticed their disappearance and are concerned about it. Often the “parentified adult”, used to the role of caretaker of absent, unstable or anxious even alcoholic parent is very accustomed to their role and has a hard time being in therapy and admitting they need care and attention.

The “ambivalent” attachment style can be expressed quite differently. This may be the patient who opens up very quickly in therapy, demonstrates many shifts in and dramatic affect states, even starts a fight with the therapist. This person needs a lot of contact but feels conflicted about needing it and how to express that need. The consistency and firm boundaries of the therapist with this type of person can be very effective.

The very neglected child can be very consistent as a patient and respond well to individual psychotherapy. S/he is often punctual and gets a lot out of the consistency and holding support of the therapeutic relationship. While this person may take a long time to trust the therapist, I have found patients like these to be very self aware even if their awareness includes a lack of connection to their feeling states and a lot of intellectualization. The goals of therapy are as clear as the patient is eager to work on his/her self…

Many people oscillate between different attachment styles and feeling states about separation depending on the stressors in their lives.

Personally I have oscillated a lot in my life between feeling overly needy and clingy to feeling overly detached, uninterested in connection with others and when under too much emotional stress, reacting very differently as a teenager versus young adult versus older adult. Most of us have a variety of experiences with separation.

I also find it interesting that having a pet dog or cat can help a person heal from whatever childhood separation anxiety they may have experienced. The unconditional consistency of a dog cannot be matched by a human. While this leads probably to a big topic for another post, I find it fascinating how our relationships with our pets can help repair early anxiety and trauma. Of course there is the other side to this, when people get overly attached to their pets and it affects their relationships with people…