The Rules Of Privacy In Therapy

We were all seated at large round tables enjoying a celebration of a dear friend’s son. We guests went around the table introducing ourselves. A woman across the table stared at me after she announced her name. “You look familiar she said.” I smiled at her. I knew very well how she knew me but I did not want to say. “When I look at you,” she continued, “I get this good feeling.” Her voice trailed off. I discreetly got up and went to the ladies room. Sure enough, she followed me. “You know, don’t you?” she said, looking at me, mystified. “Yes,” I told her, “You came to see me for therapy last year. And I’m glad you didn’t blurt that out at the table!” “Ohhhhh.” She replied, remembering. “I’m glad you had a good feeling,” I kidded. That wasn’t the first or only time there were awkward moments encountering clients in public situations. Generally, I pretend I don’t know the person at all if I am in front of others. Why do I do that? Every kind of therapist has to abide by a code of ethics. And we do. Or should. So, for example, The American Association for Marriage and Family Therapy has a Code of Ethics which reads, in part: “Principle II  Confidentiality Marriage and family therapists have unique confidentiality concerns because the client in a therapeutic relationship may be more than one person. Therapists respect and guard the confidences of each individual client. 2.2 Written Authorization to Release Client Information. Marriage and family therapists do not disclose client confidences except by written authorization or...

It Might Be Trauma

Lilly was ten. When she was in school, she could dig into her work and her mind could entertain itself with whatever the subjects were; she loved school. It was when she came home that the problems began. Her father had a temper that would erupt easily. Lilly could not know what would bring it on. Her mother didn’t know either. Her mother’s response was to beg her father not to hit the little girl. Her father might push her mother out of the way as he came after Lilly. Lilly knew that she could find a hiding place in the back of her closet. Her father would stomp off if he didn’t grab her before she fled into hiding. That’s why, as she got just a little bit older, she found the greatest refuge in school. She could always find some reason to stay late — library research, a team practice, helping a friend. When Lilly reached adulthood she got a very well-paying job on Wall Street. She was pretty happy there until there was a shuffle in her department and a new boss took over. He had a temper. Lilly could not understand for the longest time why his temper would send her home crying and shaking on the railroad. She was ready to quit her job. Was Lilly suffering from trauma? Joe remembers living in a happy family. He, his three brothers and sister got along, played, did their school work, and generally lived uneventfully. At 18, his mother received a scary diagnosis and before the family could gather their wits about them, she died. Things...

When High Standards Become a Weapon

    High standards are good, right? They help you set lofty goals and then you can achieve them, right? Often. But not always. Not when they are used as a whip for not reaching them. Not when they are used as a barrier to keep away people who — oh, no! — have flaws. Especially not when those people who have the flaws have hurt you in the course of being flawed. In other words, high standards can be a great source of self-flagellation and pain. Let’s take Daniel. His parents wanted him to excel at school — and he did. He was lucky that he was smart because if he wasn’t smart enough to get the A’s, he would have heard about it like his sister did. She heard and heard and heard. His parents never let up on her because they wanted to extract the A’s that weren’t forthcoming. In fact, the more they shook her up, the harder it became for her to focus and the worse her grades got. But Daniel learned a powerful lesson from it: He was better than Rosie. Thank God. He worked hard, though. He definitely did not want to ever get to play the role in the family that she played. That would be just awful. He couldn’t imagine it. And it was convenient for him, especially being the younger sibling, not to imagine how she was suffering. It was far more convenient for him to just go along with his parents’ diagnosis: she was lazy, maybe stupid. She didn’t try hard enough. She did it to punish them. All the...

Do You Choose Happiness?

    One time, I was having an argument with the speaker standing in front of a crowded assembly. The argument was taking place in my head rather than out loud as I didn’t quite have the energy to actually engage in a discussion right then. I thought that perhaps it would be an even better idea to present it to you to see what your thoughts would be. The speaker was making a case for happiness and I certainly can’t argue with that. He reminded us that wisdom requires that we be happy. He shared research that happy people get the job done better than unhappy ones and noted that the last decade and a half of research in “positive psychology” has led to many fascinating outcomes supporting this. He argued that people try too hard to get to the next goal and then the next, thinking mistakenly that when they only reach their goal they will be happy. This is not true, he admonished: Happiness comes from the process of living your life, not from getting to a goal. I couldn’t argue with any of that. Then he said that happiness is a choice. Some people choose to be unhappy. And that is where I part company. I could immediately think of two classes of people who are unhappy but not by choice: People who have serious troubles in their lives and people who are stuck in a cage of unhappiness that they don’t know how to get out of. In fact, I completely believe that these two categories cover every single person who is unhappy and that there...

You Can Control Your Emotions!

  I was on the main avenue in my neighborhood a few years ago after I’d moved in looking for a store. Not being from here for very long, I just didn’t know all the shops and where they are located. I crawled along riveting my head from the road to the store numbers when that old familiar, grating noise intruded: beep-beep-BEEP!! And I had that urge that I always get – to rush out to the the beeper and ask, “So…I’m looking for an address and I’m a little confused….How, um, how, exactly, does your beeping help me find my address better so I can get out of your way?” Of course, I never do ask that question. For one thing, I don’t want to be shot because who knows just how irritated and aggravated that person is who is behind that steering wheel? And that really is the second and most important reason why I never have done this and never will: It’s because I know that the beeping comes from the emotional place in the brain and rational questions can’t “reach” an emotionally overwrought person. People use their horns as an expression of emotions that have gone out of rational control. In fact, people often use their mouths as an expression of their emotions when they ought not to. It’s those darn emotions that get in the way of brains that work so very well otherwise. Think about all the emotional things that deter us from living happy lives: Worries over what is beyond our control like someone who is sick, fears of failure when failure really...

Why Bad Things Happen To Good People – Another Thought

I don’t know why bad things happen to good people. Why would a perfectly innocent little child be born into a house where she is put down, beaten, or worse? Not only don’t I know, but this particular problem has brought me to tell people that this is a difficult and painful world. I don’t like saying that. Okay, it’s true. But I still don’t like saying that. I want to believe that this is a good world. I believe people are good. And I believe God is good. So it seems very contradictory to say both God is good and the world is bad. It makes no sense. And I’m tired of being caught in this particular place. Yet it comes up so often in my work that it seems like I ought to have a better answer. That’s what I was thinking recently when this idea hit me. When I look at my own life, the bad that happened in it makes perfect sense to me now because I learned so much. What I learned, I wouldn’t trade for the world. I’m awfully sorry I was such a slow learner, but ’tis what it ’tis; no sense beating myself up over it. Besides, it’s really a good thing that it took me so long because that way I can tell clients, “What are you complaining about? Look how long it took me to learn what I learned.” I can be a wonderful example to them of being slow to “get it” and yet, here I am, having finally made sense of my life and my place in...

Overcoming “Mental Illness”

Overcoming mental illness may be started best by no longer thinking of it as “mental illness.” Or “disease,” or a “sickness.” In the world of marriage and parenting, it’s important to think how you will deal with certain problems. If your spouse or child seems to “have” a mental illness, then please read on. So why do I say that you shouldn’t think of it as mental illness, disease, or sickness? There are three reasons why I’m putting it in these terms. The Concept is Made Up; They Only Describe; They Can’t Ascribe If we look back in history, people who heard voices were thought of as prophets at one time. In a different era, they were considered possessed by the devil. At present, if you compare the European diagnostic code with ours, you learn that the Europeans have fewer categories and ever since World War II are really, really hesitant to put labels on people. In the psychology world today, diagnostics are considered a “construct.” This means that we made up the idea because it seems useful to have it. We constructed it. Unfortunately, putting people into the “correct” diagnostic category is impossible because there is no objective measure of what the correct category would be. Yes, there are many rules as to what sorts of behaviors we are looking for but people don’t actually fall within the neat rules that the panel that composes the series of books on it have arbitrarily created. Unlike diagnosing a broken arm (which takes place with the help of an X-ray) or whether a person hit a D# (which takes place...

Book Review: You Can Feel Good Again (For Depression)

A fellow therapist recommended Richard Carlson’s book, You Can Feel Good Again: Commonsense Strategies For Releasing Unhappiness and Changing Your Life. I had asked her because she is a sex therapist and a couple I was seeing had a particular sexual issue. They did not want to change therapists, so I searched out the best possible advice that I was aware of. Instead of some complicated, family-of-origin work, which is what I expected, she recommended a book which falls into the Cognitive Behavioral approach. Now, here is the interesting part, before I get into the details of this book. The book is really targeted at combating depression and I told a client to read it whose depression didn’t seem to want to leave her. She read it and perkily texted me that she was doing fine and happy. So, whatever negatives I will say about this book — and there was really only one — I recommend it. I recommend it for –obsessive thoughts –depression –self-punishing thoughts –low self-esteem Highlights The author’s premise is that we control our thoughts. Thus, any negative thoughts we have are of our own invention and ought to have zero power over us. That makes complete sense to me and is in line with my work (which says that feelings are within our control because they begin with thoughts. On the other hand one of his points is that if you happen to be depressed, don’t think because that will make things worse. A wonderful point is that we are all capable of healthy thinking. In fact, before being messed up by adults, children...
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