Wednesday, December 29, 2010

Infidelity and Marital Therapy

(This article ran in the Winter, 2010, Cappstone, the newsletter of the Chicago Assn. for Psychoanalytic Psychology.)

Keith Richards is the co-founder and lead guitarist of the Rolling Stones. Early in his rollicking autobiography, "Life," he tells a story of music, marriage and infidelity from the life of his grandparents, Gus and Emma, during World War II, when they had several children and London was under air attack.

“Why was my grandmother long-suffering? Apart from being in various states of pregnancy for twenty-three years? Gus’s great delight was to play violin while Emma played piano. But during the war she caught him bonking an ARP warden in a blackout, caught him up to the usual. On the piano too. Even worse. And she never played piano for him again. That was the price...” (p.44).

This anecdote--which I found laugh-out-loud funny when I first read it--though a female colleague to whom I read it was not at all amused, for some reason--gives us a lot of psychological meaning to unpack. Gus and Emma are married, and Gus is sexually unfaithful, not for the first or last time. Gus’ infidelities are somehow external to his commitment to his marriage, in his own mind. Emma remains with him--accepting, at some level, that Gus’s view of commitment is different from hers--but she expresses her own hurt, anger, and integrity, by refusing to play piano with Gus, ever again. The ARP (Air Raid Precautions) warden is somehow less than a complete person in this narrative, identified only by her gender and job title.

Marriage and infidelity are among the most ubiquitous human behaviors, expressing the powerful conflicting evolutionary drives of monogamous and multiple mating. The U.S. Centers for Disease Control reports a 2009 marriage rate of 6.8 per 1000 population, and a divorce rate exactly half that, at 3.4 per 1000 population ( Reliable metrics on infidelity seem impossible to find, but it’s a good guess that many of the marriages that end in divorce, and some that don’t, experience infidelity. Certainly, many couples in marital therapy present infidelity among their critical issues.

Typically, the infidelity will have different meanings for each partner, and working through those meanings for the “unfaithful” partner and the “hurt” partner--as Janis Abrahms Spring labels them, in After The Affair--is a big part of marital therapy. Infidelity often reflects problems in the marital relationship, as well as issues that each spouse brings to it. Spouses often enter into marriage with some reservations, usually not expressed and often at least partly unconscious. The romantic power of early intimacy will, sooner or later, need to be supplemented by conscious work on intimacy, including communication, values, and conflict resolution. But that often doesn’t happen, and intimacy can become complacency without anyone realizing it. Then unexpressed and/or unconscious needs and drives can make themselves known; living as we do in a Darwinian world in which there are interesting and attractive people in our various networks, with whom “one thing can lead to another.”

I’ve often been impressed by how lightly and unthinkingly unfaithful spouses allowed themselves to live their way into adulterous relationships, as if infidelity were somehow not likely to have a huge and potentially life-changing impact on everyone involved. Perhaps our society’s lack of appreciation of the deeper levels of commitment and relationship in marriage, together with its preoccupation with the superficialities of sexuality and mating, partly acculturates and partly hypnotizes us into expecting that casual sexual intimacy can be indulged with little consequence. By the time I hear about it, of course, the couple is in marriage therapy, things are desperate, and the future of their marriage--and often, their family--is in the balance. Or it may be one of the three parties--the unfaithful spouse, the hurt spouse, or the extramarital sexual partner--in individual therapy with a broken, or at least very badly bruised, heart.

The term “bonking,” which Keith Richards uses to describe his grandfather Gus’ relationship with the ARP warden, indicates a view of sexual intimacy as more or less impersonal and inconsequential. From a certain purely logical perspective, as long as pregnancy and sexually transmitted diseases were prevented, there would be no reason for anyone not to “bonk” away. The catch, of course--which entirely disqualifies such mechanistic logic--is that the natural human instinct and need for attachment often gets involved in sexual intimacy. The yearning for attachment is often an unconscious factor in unfaithful spouses living their way into infidelities, and it is always a risk, even when a sexual pair gets together for “just a good time.”

Biological anthropologist Helen Fisher has researched three phases in loving attachment, each mediated through a different primary neurochemical. The first phase is primarily sexual, mediated primarily through testosterone, in both men and women. This leads to a romantic phase, mediated primarily through dopamine, which in turn leads to a bonding phase, mediated primarily through oxytocin. Oxytocin is stimulated by orgasm, and orgasm, as Desmond Morris tells us in Intimate Behavior, is stimulated by loving sexual intimacy. So one thing can certainly lead to another, even if that’s not what the unfaithful spouse, or even the extramarital partner, intended.

Morris is aware of the deep attachment in a genuine love relationship: “To say that ‘marriage is a partnership,‘ as is so often done, is to insult it, and to completely misunderstand the true nature of a bond of love...” Morris‘ human ethological review of the “typical sequence” of steps of intimacy is illuminating: “eye to body...eye to eye...voice to voice...hand to hand...arm to shoulder...arm to waist...mouth to mouth...hand to head... hand to body...mouth to breast...hand to genitals...genitals to genitals...twelve typical stages in the pair-formation process...Each stage will have served to have tightened the bond of attachment a little more...” (p 72-78). Of course, there are personal and cultural variations on this typical pattern, but the work of Morris and Fisher can help us to see how “one thing can lead to another.”

So “bonking” can lead to potentially life-changing consequences, pretty quickly and quite unexpectedly, because of the potential of sexual intimacy to create powerful attachment, even if unintended.

Sometimes these attachments persist unconsciously long after the relationship is over. I’ve treated clients whose unconscious attachment to lovers long since out of their lives has interfered with their ability to form successful new attachments ever since. These clients were still, unconsciously, holding their former lovers close, even though they consciously had relinquished them entirely. Sometimes new partners were unconsciously selected in part because they did not threaten the special place in the client’s heart of the closely held former (and still, unconsciously, current) beloved.

Every marriage is unique, and so is every infidelity, although patterns do tend to emerge. Like Gus, the unfaithful partner may commit infidelity with no intent to harm the marriage, and like Emma, the hurt partner may remain in the marriage even while deeply, and perhaps permanently, hurt. Sometimes the extramarital partner hardly seems to exist at all--like the ARP warden in grandpa Gus’ story--while at other times the extramarital partner is a very real person. Infidelity can be a reaching out for love and erotic connection that has been too long missing from the marriage, or an avoidance of issues in the relationship that the unfaithful and/or hurt partner have been needing to step up to. It can express self-efficacy, a determination to be true to oneself and not allow oneself be mistreated or neglected beyond a certain point, while not intending to end the marriage, or it can instantiate some sort of deficiency in self-awareness, integrity, and capacity for relationship. If unfaithful partners can’t find the intimacy they need in their marriages, it might be because they aren’t looking in the right way--perhaps because they lack the self-awareness and/or a skill set to know how to reach out to the other person around certain issues. There is an anthropological piece to some of the work of marital therapy, because American society and typical family life leave a lot out in cultivating self-knowledge and relational skills. Conflicts of values, which may derive from religion or personal philosophy, may need to be unpacked and explored. Some marriages were created with major issues left unaddressed--sort of like the way slavery was ignored when the United States of America was founded--which can emerge later on, turbulently. Perhaps either or both spouses have stopped paying attention, are taking the marriage for granted, or are distracted by issues of career, self, other family members, or health. Often, a partner’s infidelity can be a wake-up call to both spouses, and a springboard to the revitalization of the marriage. Sometimes it’s a symptom of a marriage whose romance, whatever it may have been, has run its course; a marriage whose love has expired and is essentially dead on arrival in the therapist’s office. Sometimes unfaithful spouses meet their “true” partners through infidelity. Infidelity can be self-fulfilling, self-defeating, or both; like marriage. A marriage reflects the dynamics of the individual spouses and their relationship, and some of those dynamics have more potential for regeneration and longevity than others. Whatever the background, infidelity raises the question of whether a couple can rise to the occasion and regenerate their relationship together. That is where the marital therapist meets them.

Marital therapy takes place within a network of relationships; like individual therapy does, but exponentially multiplied. There is the relationship between the therapist and the couple, the relationship between the therapist and the hurt spouse, the relationship between the therapist and the unfaithful spouse, and the relationship between the spouses; all of which are going on simultaneously in the therapeutic process. If the couple has children, there is the relationship of each spouse with each child, the relationship with each spouse and the children as a sibship, the relationship of the couple as a couple with each child, and the relationship of the couple with the children as a sibship. And, in addition to the relationship between each spouse and her or his immediate family, there is the relationship of each spouse with their in-laws, individually and collectively, and the relationship of the couple, as a couple, with both sets of parents, and perhaps grandparents. Often there are also relationships between each spouse and the other spouse’s friends and/or professional colleagues. Sometimes either or both spouses are in individual therapy, in which case I recommend that the therapists consult, occasionally or as needed, which means that the clients have to authorize that. The web of networks gets pretty complex.

And, of course, each member of the couple brings her and his own complexity to the therapy. Tendencies or habits of perception and interpretation of oneself and the intimate other that spouses bring to their marriages may need to be identified and “unpacked” in order for fresh perceptions and new possibilities of understanding, perception and relationship to occur. Sometimes the therapist has to work “bottom up,” connecting directly with the emotion in one or both spouses and “thin-slicing” it, as Sue Johnson says, to make it more accessible for therapeutic work. Sometimes the therapist works in a more “top down” way, teaching the couple about their communications and interactions, as John Gottman does, or making psychodynamic interpretations, which can be about the individuals and about the couple. Of course, there is a good deal of overlap among these various approaches, which are not, in practice, as separate as they are described here.

“Life,” Harold Balikov used to say, “is not user-friendly,” and co-creating a healthy marriage isn’t easy. A cartoon by Steve Kelly, originally in the New Orleans Times-Picayune, reprinted in The New York Times, shows a middle aged couple seated on their living room couch. The husband is reading a large document entitled: “Study: MARRIAGE OBSOLETE?” and says, “Well, I, for one, enjoy being in a committed, monotonous relationship.” “Monogamous,” his wife says. (11/28/10, Week in Review, p 2)

As I write this, I’m looking forward to doing two presentations on infidelity in marital therapy. The first will be a consideration of psychodynamic aspects of working with infidelity in marital therapy for CAPP, planned for Friday, March 11th, 2011, from 2:30--4:00 PM, in Evanston. For further information, visit the CAPP website at, or contact me at or 847.212.3259. The second presentation will be part of the Clinical Treatment of Couples series presented by the Illinois Psychological Association. That entire program takes place over six daylong workshops at the Chicago School of Professional Psychology, 325 N. Wells, Chicago, and my presentation will be one of four workshops on April 8th. For further information, visit the IPA website at

Jay Einhorn is Chair of Peer Study Groups for CAPP and a Council member of the Illinois Psychological Assn. ©Jay Einhorn, 2010

Thursday, December 16, 2010

Keith Richard's "Life"

I’ve just read Keith Richards’ “Life,” with great enjoyment. Richards is the co-founder, co-leader, and lead guitarist of the Rolling Stones, and author or co-author of many of their songs. Notwithstanding the outrageousness of his life, the addictions and extreme partying--and there is a great deal of that in "Life"--Richards emerges as an unexpectedly dependable and reflective person, and I find myself resonating with his insights into friendship and leadership. In addition to being a rollicking good read across one of the definitive lives of our times, “Life” offers some key insights into human nature, as well as delightful observations about characters he’s come across.

Richards’ was always about the music, and his relationship with the fans is about maintaining the quality of the music at all stages of the process: writing, recording, performing. Notwithstanding all the craziness--the sex, drugs, and rock-n-roll--his commitment to the integrity of the music, and to providing musical and entertainment value for fans, is extraordinary. It is through that commitment that he helped form and maintain the huge musical, entertainment and business entity know as the Rolling Stones. And he has appreciated and collaborated with some of the greats in the music business, known and unknown.

Richards is unrepentant about his dependency on drugs, drinking, and assistants to fetch drugs for him and look after him, which have been cited as objections by some colleagues and friends to whom I've mentioned my appreciation of his autobiography. Speaking with Andrew Marr, in an interview posted on YouTube, Richards commented on the relationship between drug use and fame. "In its own weird way, that's how heroin, all this stuff, helped me, because it kept my feet in the gutter, not just on the ground. Fame is probably a bigger killer than drugs in my game..." One of the things that I find interesting about Richards is that he coped at all with the huge fame that he experienced as a young man; when, for example, after a Stones concert filled with hysterical female fans, the janitor commented that it must have been a good concert because there wasn't a dry seat in the house. This level of fame stopped the Beatles from touring and killed Elvis Presley, but Richards has managed to ride the wave, damaged but still himself, and with a very good memory for what happened; "episodic memory," as psychologists call it. In addition to his career success, he seems to have a successful second marriage, close family relationships, and a number of significant long-term as well as new friendships. It's because Richards cares so much and so consistently about music and relationships that his journey through sex, drugs, and rock-n-roll is so interesting.

He was a natural leader, who says that, if he’d gone into the army, “I’d probably be a general by now. There’s no way to stop a primate. If I’m in, I’m in. When they got me in the (boy) scouts, I was a patrol leader in three months. I clearly like to run guys about... I like to motivate guys, and that’s what came in handy with the Stones... It’s not a matter of cracking the whip, it’s a matter of just sticking around and doing it, so they know you’re in there, leading from the front and not from behind.”

Richards connects his outrageous partying to changes in states of consciousness. “Some of my most outrageous nights I can only believe actually happened because of corroborating evidence. No wonder I’m famous for partying! The ultimate party, if it’s any good, you can’t remember it... It’s very hard to explain all that excessive partying. You didn’t say, OK, we’re going to have a party tonight. It just happened. It was a search for oblivion, I suppose, though not intentionally... I can improvise when I’m unconscious. This is one of my amazing tricks, apparently. I try and stay in contact with the Keith Richards I know. But I do know there’s another one that lurks, occasionally, about. Some of the best stories about me relate to when I’m not actually there, or at least not consciously so...”

Here's a one-liner that I think will be around for a long time: “It’s impossible not to end up being a parody of what you thought you were.”

Having lived in Jamaica and hung out and played with Rastafarians, Richards places Rastafarianism in a cultural context. “Rastafarianism was a religion, but it was a smoker’s religion. Their principle was, ‘ignore their world,‘ live without society. Of course they didn’t or couldn’t--Rastafarianism is a forlorn hope. But at the same time it’s such a beautiful forlorn hope. When the grid and the iron and the bars closed in on societies everywhere, and they got tighter and tighter, the Rastafarians loosened themselves from it. These guys just figured out their little way of being spiritual about it and at the same time not joining in. They would not accept intimidation. Even if they had to die. And some of them did. They refused to work within the economic system. They’re not going to work for Babylon; they’re not going to work for the government. For them that was being taken into slavery. They just wanted to have their space. If you get into their theology, you can get a little lost. ‘We’re the lost tribe of Judah.‘ OK, anything you say. But why this bunch of black Jamaicans consider themselves to be Jewish is a question. There was a spare tribe that had to be filled and that one would do. I have the feeling it was like that. And then they found a spare deity in the unreal medieval figure of Haile Selassie, with all his biblical titles. The Lion of Judah, Selassie, I. If there was a clap of thunder and lightning, “Jah!” everybody got up, “Give thanks and praises.” It was a sign that God was working. They knew their Bible back to front--they could quote phrase after phrase of the Old Testament. I loved their fire about it, because whatever the religious ins and outs, they were living on the edge. All they had was their pride. And what they were engaged in was not, in the end, religion. It was one last stand against Babylon...What really turned me on is there’s no you and me, there’s just I and I. So you’ve broken down the difference between who you are and who I am. We could never talk, but I and I can talk. We are one. Beautiful.”

Richards has some pithy observations about cultural events and people. Here's Richards referring to Ken Kesey in the context of remembering founding Stones member Brian Jones, who later drowned in his own swimming pool. Taking LSD “made Brian feel like he was one of an elite. Like the Acid Test...Brian saw it as a sort of Congressional Medal of Honor. And then he’d come on like, 'You wouldn’t know, man. I’ve been tripping...' It was the typical drug thing, that they think they’re somebody special. It’s the head club. You’d meet people who’d say, “Are you a head?” as if it conferred some special status. People who were stoned on something you hadn’t taken. Their elitism was total bullshit. Ken Kesey’s got a lot to answer for.”

On the emergence of the punk bands, Richards notes “a certain sense of renewal” in the Stones when they felt “we’ve got to out-punk the punks. Because they can’t play, and we can. All they can do is be punks... I love every band that comes along. That’s why I’m here, to encourage guys to play and get bands together. But when they’re not playing anything, they’re just spitting on people, now come on, we can do better than that.”

About pop art: “I liked the energy that was going into it rather than necessarily everything that was being done--that feeling in the air that anything was possible. Otherwise, the stunning overblown pretentiousness of the art world made my skin crawl cold turkey, and I wasn’t even using the stuff."

About Allen Ginsberg: "Allen Ginsberg was staying at Mick’s place in London once, and I spent an evening listening to the old gasbag pontificating on everything. It was the period when Ginsberg sat around playing concertina badly and making ommmm sounds, pretending he was oblivious to his socialite surroundings.”

Richards' instinct for co-creating friendships that combine his intensive love of music, musical enterprise, and enjoyment of life--the latter of which does seem to have meant different things at different times--is on view throughout "Life." He comments: “Most guys I know are assholes, I have some great asshole friends, but that’s not the point. Friendship has got nothing to do with that. It’s can you hang, can you talk about this without any feeling of distance between you? Friendship is a diminishing of distance between people. That’s what friendship is, and to me it’s one of the most important things in the world...”

Tuesday, November 30, 2010

"Thank You For Counseling!"

I was delighted when a counseling/coaching client told me his wife's Thanksgiving prayer: "Thank you for my husband, thank you for my children, thank you for counseling!"


Saturday, November 20, 2010

A Mother Wonders

A colleague asks:

A therapist, writing on a listserve for therapists, asks for suggestions on behalf of a client whose concerns about her 3 year old son have to do with what she describes as social/behavioral issues. This mother wonders about some unusual behaviors in her son, including that he often doesn’t seem to perceive or respond to body language. He often doesn’t look at his mother in the eyes, sometimes walks with his head cocked and, when walking, often doesn’t look up and around to make sure that he won’t run into things. In addition, he often doesn’t smile at people who smile at him, holds his hands in unusual positions, and likes to walk in circles and spin. Her pediatrician seems inclined to disregard her concerns.

Dr. Einhorn replies:

Your client does well to notice her son’s behaviors. There aren’t really any tests to determine whether a 3 year old with these behavioral signs does or doesn’t have a diagnosable issue. A professional who is experienced in working with children, particularly those on the autistic spectrum, might be able to identify some signs or tendencies in that direction, if they are present. If issues were identified, the interventions would be social: helping the family encourage more socially responsive behavior in this child, helping them to communicate more effectively with him (if that’s an issue), helping him to self-regulate more effectively, finding a preschool program where these interventions could be implemented to some degree.

Pediatricians often disregard subtle behavioral signs in children which are of concern to parents, and they are usually right to do so; most of the time, parents are overly concerned and/or the kids grow out of whatever behaviors their parents are concerned about. However, in my work with children with learning disorders, it has often been the case that pediatricians dismissed signs that parents, usually mothers, identified early on that actually turned out to be of real concern as the child grew up and did not grow out of them.

A behavioral assessment of the child would involve meeting with his parents first, then observing him at home and perhaps elsewhere (playgrounds, preschool if he goes to one, etc.). A psychologist with experience in working with children on the autistic spectrum, and their families, could provide this. Occupational therapists who are experienced in working with children on developmental delays and on the autistic spectrum can also contribute to the evaluation and treatment as well.

Tuesday, October 19, 2010

Two Couples

("Two Couples" was printed in the fall, 2010 "Illinois Psychologist," the newsletter of the Illinois Psychological Association)

As the year anniversary of their marital therapy approached, the couple and I reviewed how far they’d come. At the beginning, it wasn’t at all certain that one spouse, acutely suicidal, would survive the year, or that their severely troubled marriage would. Neither the suicidal spouse nor the troubled marriage is safe for certain, but both are much better now.

During the year, I have at various times accepted, supported, and challenged the narrative of self and history presented by each or both spouses. I have used “bottom-up” emotion-focused therapy (learned from Sue Johnson), behavioral interventions, and “top-down” psychodynamic interpretations. One spouse had to go through what seemed like a volcano of rage and pain, sometimes abusing the other spouse, and I had to simultaneously endorse the feelings and experiences that led to that state while helping to stop the abuse and leading that spouse toward a higher level of self-integration. I have offered understanding and support for the other spouse’s distancing and disengagement while challenging that spouse to take steps of risk toward being more authentically available. I have, at various times, included in our talk therapy, or supplemented it, with mindfulness, hypnotherapy, spiritual counseling, humor and metaphor. I have consulted with each partner’s individual therapist.

This couple came to me after having seen a marital therapist on their insurance plan who thought she could fix them in twelve sessions, or something like that. The suicidal partner had been seen by an individual therapist working on the same lines. One of the first things I had to do was find an individual therapist for that partner who would allow that partner’s feelings and experience to actually enter the room.

This couple are not even bothering to submit their marital therapy bills to their insurance company. And if I had been asked, on a pre-authorization, to submit a treatment plan describing how I planned to work with them over a finite number of sessions, I don’t see how I could have done it.

Another couple is brand new to me and marital therapy. Brought to the brink of divorce by an infidelity, they are emotionally all over the place. The betrayed partner started a recent session by forcefully asserting that the marriage was over, and ended it by almost whispering that marital repair was the goal. The unfaithful partner, full of guilt and remorse, is challenged to make sense out of behavior that was more lived than reflected on when it was happening. Both partners, full of pain, have to understand their own contributions to what happened, even as they revise their individual and shared narratives of their marriage. Both yearn for stability which neither is able to commit to, right now, and I have to help them accept that uncertainty as they work through the issues that have suddenly become the most important in their lives.

This couple does intend to use their insurance, and I will be asked to complete a treatment plan. How about if I say: “I will empathize with each partner in such a way as to understand that partner’s experience of their relationship and the impact of the other partner’s behavior on them, and convey that in intensive conversation with both partners together in such a way as to help them integrate these perspectives into their conscious reconstruction of their relationship, supporting them in the meanwhile through a period of intensive uncertainty while encouraging each partner to discover and acknowledge what is authentically his or her truest wish for their relationship.”

What do you think the insurance company will make of that?

Monday, September 20, 2010

Coaching Versus Therapy

(posted on a listserve for psychotherapists, as a contribution to a discussion about the differences between coaching and therapy):

As I've read, with interest, the dialog about coaching vs. therapy, it seems to me that the distinction, at least in my practice, has to do with the coach-client and therapist-client contract. I don't mean a written contract, but the mutual understanding about what we're doing and why.

Some of my coaching clients are in therapy when they come for coaching, so I can say things like, "This is what you need to do to take a step toward achieving your goal. If you have feelings that interfere with your taking this step, you can talk with your therapist about them." Other coaching clients have come for help making a career change, or for doing what they're doing better--for example, improving employee selection and retention procedures, improving relationships with colleagues at work, or coping with a difficult supervisor. The coaching contract is action-oriented, goal-focused, and not about a mental health or emotional problem. Feelings are a part of it but not the main part, and if they begin to become the main part, that begins to look like therapy to me. The action agenda can certainly be modified to take emotional issues into account; for example, a very anxious client who wants help with job-seeking skills, including modifying her expressions of anxiety in job interviews, may need to move more slowly than an executive with a successful career history now ready for a job change. If I help her learn to relax, it's so she can pass a job interview; not primarily to help her be less anxious 24/7, although it may have that effect.

Now, I don't know about the overlap between the kind of coaching I'm describing and the "life coaching" I've seen advertised on the web--"You, too, can become a life coach, get rich, help everybody..."--which is much more like the old-fashioned mix of self-improvement and hucksterism that is so quintessentially American. I suppose that the people who are really better at life coaching will eventually develop referral networks based on their competence, like therapists--or any other professionals--tend to do; and "caveat emptor" will be the rule for clients. For that matter, to the extent that "life coaching" really is about improving one's life in general, I'm not sure that mental health professionals, as a group, have the advantage over any other professional group on being prepared to be good at that.

Sunday, September 12, 2010

When Is Therapy Done?

(This article printed in the Fall, 2010, Cappstone, the newsletter of the Chicago Assn. for Psychoanalytic Psychology)

Susan C asks: “When is therapy done?”

One of the most important contributions of psychoanalytic psychology is the perspective that each person, and each client-therapist dyad, is unique. Susan has asked a general question, rather like one might ask a medical question: “When is antibiotic treatment done?,” or an educational question, “When is a course of study done?,” or even a plumbing question, “When will the furnace be installed?” If we are talking about people in therapy, we have to rephrase the question, to something like, “When is who’s therapy done, with whom?”

Generally speaking, people come into therapy with a acute problems which tend to improve after awhile, often within several months. Along with that improvement comes the perception that the client is vulnerable to react to certain stressors in certain ways; such vulnerability and reactions having contributed to the acute problem in the first place. Some people feel, once the acute problem has been relieved, that therapy has done its work, and that’s one way of looking at it. Others feel that it’s important to continue to work on the underlying vulnerabilities so that the problem is less likely to repeat itself. Here are a couple of cases that illustrate the situation of therapy that could be approaching completion, or could go on substantially longer.

An elementary school child who has developed some OCD type symptoms in response to various stresses is making good progress, and has become substantially freer of compulsive behaviors that used to complicate eating and bathing. He doesn’t especially like the idea of being in therapy, and he hopes that by checking off the list of ways in which he’s being compulsive, he’ll be able to stop. That’s alright by me; if the desire to be done with therapy provides the motivation to resolve his compulsive behaviors, then I can work with that. His mother, however, is concerned about his vulnerability to the stresses that he’ll encounter as he enters a new grade in school, and becomes a year older among his peers. She thinks he ought to use therapy to become socially more adept and personally more resilient. That makes sense to me, too, since his history demonstrates that he is vulnerable to developing OCD symptoms under stress. So he has a rationale for stopping soon, his mother has a rationale for continuing, and I can support both rationales.

Another client is a bright high school senior with a learning disability and family stress issues, both affecting his self-concept and self-esteem, which came to a head in a suicidal episode that brought him into therapy. In mainly individual therapy, with some family sessions, he’s worked on a number of difficult issues. He is doing much better, is no longer at substantial risk for suicidal behavior, and is on track to begin college this fall. However, his reactions to his learning issues and family stresses are still problematic, if no longer life-threatening, and significant gaps in his understand about himself and others make him vulnerable to getting into very stressful situations that he may have difficulty finding his way out of. These vulnerabilities put him at risk if some combination of stressors--such as he’s likely to encounter when he starts college--occur simultaneously and interact to become more intense. Again, there’s a rationale for stopping, and also for continuing.

When I’ve been on the receiving side of therapeutic conversation, it’s been pretty clear whether it’s helpful or not. If my therapist or consultant is trustworthy, listens carefully, and helps me to understand how I’ve been perceiving and reacting to various situations and how I could do better, that’s adding value to my life. When therapy or consultation is no longer making much difference in my quality of life, I can use my time and money in other ways.

Of course, therapy or consultation is an economic relationship, partly. Like any other service, it is selected and paid for because it is deemed to be of sufficient value, and ended when it’s value priority decreases relative to other priorities. This holds true whether the payor is the client, an insurance company, a not-for-profit agency, or the government.

Another client is an adult with a pervasive developmental disorder who came into therapy with a serious depression. On a scale of 1 to 10, where 1 is totally depressed and 10 totally happy, he rated himself a 2 or a 3. Several months later, he rates himself a 5 or 6. He’s dealt with some issues and his social life has improved. He still has issues, and could usefully work on them, but he’s also lost his job. His mother is supporting his therapy but anticipates a time when she may have to support his basic living expenses. Is therapy done or should it continue?

One thing that therapy should not do is cultivate dependency. The therapeutic dyad should be engaged around issues of importance in the client’s life, in ways that sustain and enrich her life, in a way that a careful observer, who can take the time to learn the details of the client’s life and needs, and to see how her therapy is working, ought to be able to recognize. There should always be that imaginary “third person” in the therapy room, someone who only has the client’s best interests at heart and in mind, who will know whether this particular therapeutic experience is adding value to the client. Maybe we can call her the Therapy Angel.

So, the response to Susan C’s question is, “What would the Therapy Angel say?” Clear-eyed and loving-hearted, she’d (or he’d, EOE) know when therapy’s done. And would know that “done” means different things for different people. For one person, “done” means the presenting acute symptoms have abated. For another, “done” means, beyond resolving acute symptoms, that the client has become a wiser and more resilient person. For another, “done” means that the client has benefitted more or less as much as possible from this particular therapeutic dyad. For another, “done” means that therapy, as an economic priority, has decreased compared with other economic priorities.

One last word about economics, though. I’ve found that therapy can often help people economically, either by helping them to maintain employment or earning power that otherwise might be compromised by psychological stress and dysfunction, or by helping them to recognize and take advantage of new opportunities in life--including business or professional life--and partnering. As one of my teachers used to say, “When therapy is working, it is very good value!”

Friday, September 3, 2010

Canned Training

An executive coaching client asked my opinion on a certain brand of management training seminars. I replied:

I'm not familiar with these particular seminars. My attitude about canned training is that, in general, most of it doesn't apply to specific needs, but if you take an idea or two away from a seminar that you can plug into your work back at the ranch, that's probably pretty good. There can be a problem with being told to work in ways that actually won't work in your particular organizational milieu, market niche, or for your personality. So there's a sorting out responsibility that one has to do for oneself. Looking at the seminar descriptions, I found myself put off by what seem to me to be hyperbole in the titles and short descriptions, but then I became more interested when I looked into the details. I'm generally wary of hyperbole, and wonder how much of that will get into the presentations themselves, as a kind of hypnotic suggestion or propaganda wavelength. It's possible to leave training seminars feeling like one has been handed a jewel, but then find, afterward, that one's hand is really empty after all!

So, the bottom line is, yes, do go, bringing both your notebook and your skepticism with you, and be prepared to have to work, after the seminar is over, at sorting out what was potentially valuable from what wasn't. I'll look forward to hearing about it, and maybe that's where I'll be able to provide some value for you, in the sorting out process.

Thursday, August 19, 2010

Stenhouse on Curriculum

As the new school year begins, I picked up my old copy of "An Introduction to Curriculum Research and Development," by the Scottish educational thinker and teacher Lawrence Stenhouse (1975), and found some good old thoughts about curriculum.

Stenhouse saw curriculum as both what a school (or teacher) intends to do, and what it actually does.  He takes it as given that there will always be a gap between intent and delivery, so understanding a given curriculum requires awareness of both what we're setting out to do and what we're actually doing. He thought teachers should be studying this, both on their own and together. 

Stenhouse saw curriculum as composed of three broad domains:
-- content (information to be learned, which you can pre-specify and test with a multiple choice test),
--skills (recognizing letters and words, writing a three-paragraph essay, solving mathematical problems, which you can also pre-specify),
--knowledge (using what you've learned to solve problems or meet challenges in some unexpected way that can't be fully prespecified; an essay question at it's best, a scientific, artistic or community project).

He thought that educational thinking and theory often fell short by confusing content and skills, which can be prespecified, with knowledge, which cannot. He saw the teacher as being at the center of education, contrary to the trend to see teachers as deliverers of pre-packaged curricula.

35 years after his "Introduction to Curriculum Research and Development," Stenhouse's thinking holds up very well indeed. The only substantial addition that I'd suggest is about the way teaching methods relate to the more recent knowledge about learning and the brain; for example, strategies designed to engage the left and right hemisphere, frontal lobes and attention, and the domain of social-emotional learning (individual and group strategies, etc.).

In these times, when education is so often about making sure that children can simply read and define words, do math, or pass pre-specified tests at such and such a level, Stenhouse can help us to remember that there are domains of education that connect with potentialities of human nature that lie far beyond these meager models of what learning and knowledge are about.

Wednesday, August 4, 2010

Latent Tension

"Dorothy" comments: "My dad came to visit and we had a pretty good time, but there was all this latent tension that he never noticed."

Dr. Einhorn comments: The implications that there is latent tension sometimes and not others, or that when there is latent tension we usually discuss it, are interesting, because they don't seem to reflect reality very well. It seems to me that there's always latent tension, or almost always, and we are always mostly ignoring it. Our lives and relationships are always moving, changing, bumping into one another, influencing each other. We are all--individuals, families, relationship networks of various kinds--part of this vast Darwinian humanity that is evolving, with huge fits and starts (wars, economic bubbles and crashes, dislocations of various kinds) into a planetary culture. Think of all the kinds of tension there are: status/authority, closeness/intimacy, economic, sexual, religious/spiritual (though I wonder if there can be real conflict once we are actually in the realm of the spiritual), etc. Not to mention the "latent tensions" within our own minds, between various impulses, urges, thoughts, feelings, values, allegiances, states, etc. These "latent tensions: are always going on; it's part of the environment that we live in. The questions that interest me are, which parts of the latent tensions going on at any particular time and in any particular relationships do we want to give attention to, and how do we want to do that. And, of course, that brings in the questions of how perceptive we are, how honest we are, and how much we are prepared to risk in being honest.

A lot of therapeutic work focuses on latent tension in the life of the client. It can also usefully focus on latent tensions in the relationship between client and therapist, if the therapist can use that skillfully and the client can enter into that level of dialog about their relationship.

A lot of art is about expressing the interaction between latent tensions in some way, especially (it seems to me) poetry and poetic musical lyrics, and storytelling in its various forms (novels, plays, etc.). Music itself is a way of creating harmony out of elements that are in a tension relationship, both in the music that is played and also in the instruments that make it. I remember the guitar being described as something that can hardly exist because all of its elements are in a state of tension with one another, the wood trying to collapse, the strings trying reduce their stretch tension. And of course that's what makes the beauty of the sound, when the tensions are just right and a harmony is created.

Rumi talks about the way that things apparently opposed can be working together, as in the handclap being created by the apparent "opposition" of the two hands, which we might see as the "tension between" them. The movement of the two hands through the air might seem "latent" in slo-mo, until they met one another and produced the clap.

It generally takes a lot of self-work to be able to talk about the latent tensions in any relationship, because the ability doesn't come naturally. You have to start the conversation, and then you have to stay in it, according to how the other person responds. Here, Dorothy doesn't say that she tried to raise any issues with her dad, although noticing them herself was a start. The implication is that he should have taken the initiative to raise issues with her, in which case I wonder if their pattern is that he's done that in the past, or perhaps that she wishes he had but he mostly hasn't. If she wants to take the risk of raising some issues involving latent tension with her dad, she'll have the opportunity to see what might come of that. It does take a certain amount of courage.

Wednesday, July 21, 2010

Songwriting and Psychotherapy

(This essay is in the Summer 2010 issue of The Illinois Psychologist, the newsletter of the Illinois Psychological Association)

I’m a singer-songwriter, and I subscribe to a folk music listserve on which a singer-songwriter posted this question: “How do you separate ‘songwriting’ from ‘performance’ when listening to a song that you wish to evaluate for it’s merit?” He continued: “There are some aspects of the performance of a song that you can think of as purely ‘writing’ (clever use of metaphor), and some that are purely ‘performance’ (great voice). But some of the finer points of a song include ‘phrasing,’ ‘dynamics,’ and ‘emotional connection.’ Are these related to writing or performance?”

This question sparked a lively discussion, capped by this comment from another singer-songwriter, just returned from a major folk festival: “Having just witnessed many outstanding singer/songwriters, I truly believe that you can’t separate the performance from the song.”

It seems to me that the question of the quality of a song compared to how it is performed is similar to the question of the quality of a therapy compared to how it is actually done.

Take Gestalt Therapy. Fritz Perls cleverly selected aspects of psychoanalytic theory and practice, Gestalt psychology, Zen meditation and philosophy, psychodrama, and existential humanism, and amalgamated them into a form of therapy which, when he did it, was often very powerful. People who’d been in other forms of therapy for years suddenly found themselves having insights and making breakthroughs. Perls thought he was creating a new form of therapy which would create a kind of revolution in therapeutic practice, but it hasn’t really caught on.

Why hasn’t it? Perhaps because its practitioners haven’t enjoyed the same success that Perls did. And why not? The answer seems to be that, in addition to the structure or form of Gestalt Therapy--the empty chair, the free-floating and focusing of attention, the role playing, and the view of human nature--there was Perls‘ own personality, his therapeutic skills honed over a lifetime of intensive questing and practice, including his fluency at catching and using patient imagery and transference. There was also the special mileau that evolved around him at Esalen, the growth center in California where he did much of the work which he is most famous for, which facilitated a self-organizing population of patients who were mostly well prepared to work with him.

I like Gestalt Therapy, and continue to find it useful with some patients at some times, but it has not become the presence in the therapeutic marketplace that Perls hoped for. There is the “songwriting” of Gestalt Therapy, and the “performance” of it, and no one “played” it like Perls.

The metaphor of the “song as written” and the “song as performed” applies across forms of psychotherapy. I recently read (and wrote a continuing education test on) “Cognitive Behavior Therapy and Eating Disorders,” by Christopher G. Fairburn, in which Fairburn discusses a form of therapy that he calls ““enhanced cognitive behavior therapy,” or “CBT-E.” Describing the steps of CBT-E, which is expected to resolve eating disorders in most patients within 20 weeks, Fairburn emphasizes that “Engaging the patient is the top priority.” To achieve engagement, he recommends that therapists “Be empathic and engaging in manner; Ask the patient what name he or she would like you to use and state your name; Be professional but not intimidating; Actively involve the patient in the assessment process; Instill hope; Avoid being controlling or paternalistic; Repeatedly...check back that the patient is ‘on board’...(and) “Enquire about any concerns that the patient might have.” Clearly, before even getting to the steps of CBT-E, Fairburn is focusing on therapist “performance” here. It is as if he were saying, “My song will work for you as well as it works for me if you sing it the same way I do.”

Psychologist Jonathan Shedler, giving the keynote address at the recent Division 39 (Psychoanalytic Psychology) conference in Chicago, referred to research indicating that most of the effectiveness of psychotherapy is due to the alliance between patient and therapist. Looking at the work of Perls and Fairburn, we see two therapists who are expert at establishing a relationship in which patients feel hopeful, encouraged and engaged with a person and a method that can help them transcend their emotional suffering and behavioral pitfalls and get on with their lives in a better way. Yet the therapies practiced by Perls and Fairburn could hardly be more different.

If we can’t really separate the “song” from the “performance,” the form of a therapy from how each therapist practices it, then every therapist is, in a way, co-creating, or at least modifying, the form of therapy, every time she or he does it, with every patient.

How about that!

Monday, May 31, 2010

Truth and Turf in the Psychotherapy Wars: Two Hands Clapping?

(This essay was originally published in the Winter, 2010, CAPPSTONE, the newsletter of the Chicago Assn. for Psychoanalytic Pychology, and subsequently in the Winter, 2010, PSYCHOLOGIST-PSYCHOANALYST, the newsletter of Division 39 of the American Psychological Assn., Psychoanalytic Psychology. Shedler's article was subsequently published in AMERICAN PSYCHOLOGIST)

The history of psychotherapy is, in part, the story of a long struggle among people and schools between searching for truth and staking out turf. Of course, that’s true of a lot of professions, but it might be more intense in psychotherapy, where the issues are about who owns the rights to understanding human nature and its treatment.

Jonathan Shedler, a psychologist at the University of Colorado-Denver, has written a monograph that advances accurate description of psychodynamic psychotherapy. “That Was Then, This is Now, Psychoanalytic Psychotherapy for the Rest of Us,” describes it in commonsense, non-jargon language that will be accessible to most readers. ( Shedler avoids the morass of claiming turf, in the name of theory pronounced as received wisdom, that is so characteristic in the history of psychoanalysis. The psychodynamic method, practiced well, is more important and more powerful than the ability of any theory to explain it. Psychodynamic psychotherapy is better explained as a method, with the minimum of theorizing, and better understood, as much as possible, through models of neuroactivity, as Allan Schore is developing. This brings us closer to the truth about psychotherapy.

A new attack in the therapeutic turf wars was launched from Psychological Science in the Public Interest, the journal of the Association for Psychological Science, in the form of an article by Timothy Baker, Richard McFall, and Varda Shoham (from the University of Wisconsin-Madison, Indiana University, and University of Arizona, respectively), entitled, “Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care.” ( ) This is the article which, reported as truth in Newsweek, prompted so much discussion; including a flurry of comments on the Illinois Psychological Association listserve, and a rebuttal by Katherine Nordal, APA’s director for professional practice, as quoted in the November/December The National Psychologist (“Psychology gets slap in the face”). Its authors, implicitly defining randomized clinical trials (RCT) as science in psychology, explicitly define evidenced-based treatments as those which have been validated by RCT studies, and consign all other methods of therapy to the garbage pail of superstition and uninformed personal preference.

There’s a lot at stake here, including how clinical psychologists should be trained, how graduate schools should be accredited, and how third party payers should select treatments to recognize, all of which Baker, McFall and Shoham assert should be reserved for RCT-based programs and methods. The stakes were highlighted when I spoke with a psychologist who is an executive at a managed care company. “It’s all about the evidence,” he said, adding that psychodynamic therapy might enrich people’s lives but lacks evidence of efficacy as a treatment.

Of course, that raises the question of what the evidence is. Shedler, in an article entitled “The Efficacy of Psychodynamic Psychotherapy,” which has been accepted by American Psychologist (a draft is posted on his website), reviews an impressive list of studies showing efficacy for psychodynamic psychotherapy. I don’t know how our managed care executive colleague would react, although I expect that he would find a way to disregard it. Perhaps there’s some selectivity here about what evidence to include.

But the argument about which evidence is real evidence obscures the larger issues. I often tell couples whom I see in therapy that each one is probably the world’s best expert on the other’s shortcomings, and something like that situation applies in the opposition between the radical empiricist and psychodynamic traditions. The radical empiricists are right in characterizing much of what psychoanalytic therapists have believed about human nature and its treatment over the years as utterly without factual support. Much psychoanalytic theory is based on the Authoritative Pronouncement of some alpha analyst or other, a tradition begun by Freud and still rife in psychoanalytic culture. There is nothing scientific about it, and the claim of scientific validity for theoretical pronouncements given without a shred of evidence (even liberally defined) to support them is justly characterized by radical empiricists as ludicrous.

On the other hand, reducing human nature in order to fit it into the scientific method available at the time has ever been the problem of behaviorism’s search for scientific respectability in psychology. While the radical empiricists are right in asserting that merely claiming that what one is doing is scientific doesn’t make it so, this applies to their own position of defining science as equal to RCT as well; that’s a philosophy of science, not science itself. In fact, most of what we know about human nature, and particularly brain structure and function, has come about through autopsy studies of people with brain injuries, by neuropsychological and imaging studies of brain-injured people, by animal studies, and by imaging studies of normal people; not by RCT studies, although of course they have made a contribution. I expect that the most valuable research in therapy in future will be neuroimaging studies, once the technology improves enough to measure changes in volume and interconnectivity of parts of the brain. I expect those studies to show improvements in frontal lobe density (especially right frontal lobe), frontal-limbic interconnection, and interhemispheric connectivity, as a result of longer-term, conversational, reflective, relational therapy, when it is successful.

The truth is that, “Life,” as Chicago therapist and teacher Harold Balikov used to say, “is not user friendly,” and emotional pain and behavioral problems in living are part of being human and living life. DSM diagnosis is not the same as physical diagnosis, and therapy is often more like education--in which there are lots of different schools and methods of teaching, and students may have to find the ones that work best for them--than medical treatment, which at least aims for an expert consensus of recognized best practice for any disorder. Truth in marketing mental health treatment would be something like: ”If you need mental health treatment, you may find that therapy, medication, or a combination, may work best for you, and you may have to learn about the mental health treatment choices available, and search for awhile, before you identify the practitioners and the methods which are right for your needs at this time.” Instead, the marketing that we see takes a bit of truth and spins it into deception: ”If you’re depressed, take our clinically proven pill;” to which the radical empiricists would add, “our clinically proven treatment!”

The truth is that different methods and treatment relationships may work better for different people, or for the same person at different times. Twenty sessions of cognitive-behavioral therapy will work better for some people, five years of analytic therapy for others; or maybe both will work better for the same person, at different times in his or her life.

And the truth is that both psychoanalysis and radical empiricism have their roots in traditions in which the dedicated search for some kinds of truth and the dedicated gathering of turf evolved side-by-side. Both traditions offer keen insights into human nature and its treatment, both obfuscate the truth about it as well; most especially by claiming that their method is better than the other, when in fact it is better for some people at some times when practiced by some practitioners.

If this leads to problems about how to authorize and pay for therapy, how to monitor it’s effectiveness and how to do second opinions, then those are issues that psychotherapy, like any mature profession, must develop effective solutions for.

Meanwhile, I’m reminded of the reflection of the poet and teacher Jalaluddin Rumi, that things that appear to be opposed may really be working together; as when the “opposition” of two hands produces a handclap. Perhaps the opposition of the psychodynamic and radical empiricist traditions will produce an effect that will lead many therapists (and maybe even reporters, if they take the trouble to study up on it) to a more inclusive and commonsense mainstream understanding of what therapy is and how it works. Shedler moves in this direction when he acknowledges the overlap between cognitive-behavioral and psychodynamic therapy while respecting their differences. Maybe, even, the opposition between truth-seeking and turf-gathering, even when done by the same people, can help the rest of us, through observation, to learn to sort out the one from the other; leading to a more inclusive perspective that we can ground our work in, train students in, and communicate to the public. Wouldn’t that be a step forward for psychotherapy!

Sunday, May 30, 2010

How Much Therapy is Needed?

An out-of-state Mom, whose son attends a local school, called to discuss the possibility of my working with him, which I appreciated. During our conversation, she identified several issues that he's struggling with, including relationships with a roommate and a girlfriend, and asked how much therapy might be needed to deal with those issues.

My reply was that the length of therapy is not so much about the issues that the person has as about the person having them. On reflection, I'd add, "and the people he's having issues with."

When it comes down to it, just about all therapy is about relationships, whether it takes one session or a thousand. There's an enormous variation in how much time and help people need; including, at the beginning of therapy, what they know and can learn, what they do and can change, and how quickly they can get to work on their perceptions, emotions and behaviors in order to make things better. And who the roommate and girlfriend are, in this case, could be as important as who the client is.

Sunday, May 2, 2010

Which Divorce "Camp" Are You In?

“Becky” asks:

I am in the process of getting divorced, and I respect your opinion, experience and level head, so am hoping you will tackle a question I have. My husband decided to leave me, which apparently he’d been thinking about for a long time but not sharing with anyone, and it came as quite a shock. I have been reading copious amounts of studies, and opinions, on divorced families. Summarized briefly there seems to be an "If the parents are okay the kids will be okay" camp, and an "it doesn't matter what the parent's marriage was like (except in cases of violence), kids do better with their parents together" camp. Of course there are variations on this theme and a number of 'camps' in the middle. Do you have an opinion about this?

One aspect I am trying to work through is how to keep my kids’ lives as 'normal' as possible, especially my 14 year old son, who is beginning to show signs of 'feeling left,’ which of course I feel as well. He seems to “feel left” even by me, though I am here, because of course I am not 'here' the same way I was before. I guess I am looking for a validation of "if we are fine the kids will be fine", but I don't really believe it. What do you think? And what is your hourly rate for phone session, btw?

Dr. Einhorn replies:

Hi Becky,

Thanks for your compliments, and I hope my reply lives up to them!

Every situation and every person is different, so I'm not so sure that there is a rule of thumb about divorce.  Kids will tend to take their cues from their parents, but each child might be sensitive to different cues, and there's also the impact on each child's relationship with her or his parents, which can vary from child to child within the same family.  So I guess I'm not camping in any "camp."  I'm all about the particular people in their particular situations.  In your son's case, what matters is what happened to this child within this family.  

Keeping things “normal” is good, but the very definition of what’s normal is changing in your family. It used to be normal for the family to live together, now the parents live separately, and perhaps have relationships with other people who are now coming into their children’s lives. Even the definition of what used to be normal is changing, because it now has become obvious that one parent had private thoughts and feelings that culminated in a separation and divorce for quite some time.  

So, for those who “got left,” reinterpreting where you were may be part of being able to move ahead from where you are.  

It makes sense to suppose that, in at least some respects, your son probably did "get left," and in a somewhat different way by each parent; Dad left with little or no warning, and Mom was probably freaking out--however quietly and self-containedly and trying to keep the children protected. So if your son didn't feel “left” he'd be pretty oblivious, wouldn’t he?  

What he does with that feeling is another thing.  Of course, I'm a fan of therapy, because I think talking about stuff like that with someone who can listen and help us think it through is a very good thing for our brains and our lives.  Some kids are open to the idea, some not. Have you raised the possibility with him?     

Contact me privately for rates for telephone consults. Be aware that such consults are not diagnosis or psychotherapy and can’t be submitted for insurance reimbursement.

Best wishes to you and your family,
Dr. Einhorn

Wednesday, March 10, 2010

Mother In Law

“Julia” writes:

I’ve had an issue with my MIL not letting go of her son since before we got engaged.  She wants to be the center of his attention constantly and makes nasty remarks (which my husband will NEVER recognize as nasty or says he didn't hear it) to me.

I'm of Hispanic descent and over breakfast she told her little grandson (my blonde, blue eyed nephew) that he should never ever date dark haired women, only blondes...and if they are dark haired, then they'd better highlight their hair blonde.  As a Latina, we are very proud of being "brown" and having dark hair (some of us...since we come in a rainbow).
This is about the 20th incident in the past year where she has made some type of dumb/insensitive remark.  My husband sat silently as usual, and when I brought it up later, he got very defensive of her as he always does...she can do no wrong.
Any advice?

Dr. Einhorn replies:

Well, it might mean something that he didn't marry someone like his mother!

“Julia’s” question raises a couple of interesting questions: How do we know what we’re getting ourselves into? And, How do we deal with prejudice?

Disappointment, as Idries Shah points out, occurs because we have an expectation. We can’t always know what the expectation was, but we can sometimes discover it by tracing back our disappointment.

Julia says that her MIL hasn’t wanted to let go of her son since before they got engaged, and her son thinks she can do no wrong, so she certainly had information about what she was getting into. I wonder if Julia expected that her MIL and son would change after they got married, and if so, why she would assume that?

Now, prejudice, as I said at the National Fair Housing Conference of the Department of Housing and Urban Development in 1994, is a natural function of how the brain works. The efficiency of mind is that it categorizes everything and then we can recognize and respond very quickly and with minimal effort to what we have categorized. Perception itself is prejudiced, one might say, in that we pre-judge everything, noticing very little about what we actually see, hear, and so on. That makes life efficient, because we can concentrate on what we need to, instead of having to re-learn about everything we see. The problem with the system is that stupid prejudices develop, and we don’t naturally differentiate between the efficient prejudices and the stupid ones. That takes work. As Edward de Bono points out, the brain forms perceptions of patterns as it goes forward, and then those patterns become perceptual habits, and it does that very efficiently. Once patterns are formed, however, changing them requires special effort and methods.

So--taking Julia’s report at face value, and remembering that there is always more than meets the eye and more than is contained in the initial report--Julia is faced with the prejudice of the MIL and the habit of relationship between the MIL and her son, Julia’s husband. Now that Julia’s expectations that her MIL will come around and that her husband will stand up for her on his own have been pretty well disconfirmed, what are some of the choices she has in this situation?

It seems to me that she can choose one or both of two paths; she can try to directly discuss the issues with her MIL and husband, or she can try to engage with them emotionally and relationally to change their minds and behavior. We might call them the straightforward path and the sneaky path.

The straightforward path involves having direct conversations with her MIL and her husband about the fact that her MIL is making racist comments about her in the presence of their nephew/grandson. It sounds like Julia hasn’t really had a conversation with her MIL about it. Widening the focus, Julia might open up the conversation to include her impression that her MIL has never really welcomed her into her son’s life, or her own. She might emphasize that she really loves her son and wants to be a part of the family, and she might remind her MIL that many families today include people of different backgrounds and ethnicities; and are the richer for it, as long as everyone has a place at the table.

Julia might also have a straightforward conversation with her husband about his not standing up for her. It sounds like she does mention it to him, but then he makes some excuse and that’s where their conversation stops. She might tell him that the conversation doesn’t stop there as far as she is concerned, and that this is something that very much concerns and hurts and frustrates her and that she expects him to recognize that and wonders why he doesn’t, and why he allows it to continue to happen without stepping up to speak with his mother about it.

Those are straightforward verbal conversations Julia might have. There’s a section on “Difficult Conversations” elsewhere in this blog with some information about having them more effectively and avoiding some of the pitfalls that difficult conversations can fall into.

Then there’s the indirect approaches; which, from a brain function point of view, might actually be more direct, because they go directly for the prejudicial and habitual behavior processes themselves. The key here is that that the way to respond to emotionally off-putting behavior from MIL is to engage positively with her around it. Here’s a couple of ideas about how to do that, offered constructively and somewhat tongue-in-cheek, and I hereby disclaim all responsibility if you try them and they blow up in your face!

Humor can sometimes be more effective than straightforward verbal discourse. For example, when MIL makes denigrating comments about dark-haired people, you can point out that all humanity seems to have emerged from Africa, and the light-haired ones just went further north and got pale to get more Vitamin D from sunlight (I don’t know about that last part, just made it up). Say it with good humor, and never mind if she doesn’t respond or shrugs it off. It might have the effect of disconcerting her for a moment, during which some fresh air might get into her mental stereotypes and prejudices. Collect a bunch of comments like that, good-humoredly showing how dark-haired people are better, or came first, or have advantages, which might not be noticed at first by lighter complexioned folks, and just keep bringing them up when she makes prejudicial comments, as kind of throwaway remarks. It’s a more indirect way of responding to her prejudice, that might facilitate some change over time.

Although it’s politically incorrect to suggest it nowadays, you might consider engaging relationally by responding in kind; although you'd have to do it in a better-natured way than she is, teaching by demonstration, by raising the bar higher. "Oh, there you go, those light-haired people, always thinking that they're better!" Or, "You can always tell a light-haired person, but you can't tell her much!" But you have to really do it in a good natured way, not in an implicitly resentful one.

These remarks focus more or your MIL than your husband. Maybe it's time to think about marital therapy to work on this lack of communication in your relationship, and the obstacle that his relationship with his mother presents?

Here’s the ultimate manipulation, which I take absolutely no responsibility for if you decide to go ahead and do it: get pregnant and give Grandma another grandchild. She’ll probably fall in love with it and then you’ll rise up in her esteem. Except, with your luck, it’ll probably have your husband’s light features and you’ll still be in the doghouse. Asi es la vida.

Julia replied:

Thanks so much - this is such an insightful response! To answer your question...when he is defensive of her, I immediately get aggressive and not nice because it hurts me that he is "choosing" her over me yet again. It also angers/hurts me that he doesn't take the time to recognize that this is a real issue...I certainly thought about the repercussions of marrying into a non-Latino family, I don't think he did. I'm expected to "blend", and we sweep these types of things under the rug instead of settling them.

Ay, yay, yay - well, thanks again, I really do appreciate it!

Dr. Einhorn reflects:

Julia's problem is of particular psychological interest because it shines a light on two usually hidden sources of unnecessary suffering. The first is the activity of prejudice itself, and I think the cure for prejudice is not to try to eliminate it--because if prejudice is a natural product of brain activity, it can't be eliminated--but to make a human connection with people so that they can realize, through that human connection, that their prejudice was mistaken. The second is Julia's own unconscious assumptions that somehow time and marriage would cure her MIL of her prejudice, and her husband of his non-critical attachment--I'm trying to use neutral language here--to his mother.

P.S.: A reader sends this youtube link:

Tuesday, March 9, 2010

Couldn't Say It Better

A client said:

"You just kind of get locked into your own deal. I needed your help to step outside."

Dumbed-Down Parables

David Gergen, a political commentator who worked for several presidents including Ronald Reagan, writes approvingly about Reagan’s ability to communicate with the public through stories that were, effectively, parables (in “Eyewitness to Power”).

I agree with Gergen’s analysis of Reagan as a talented and skilled story-teller, which contributed in no small part to his becoming known as “The Great Communicator.” However, I think that Reagan often used dumbed-down parables that would be easily accepted and responded to by the electorate, rather than giving them the parables that actually described the situations they were in and what should be done about them.

Such parables are like junk food; cheap to make, buy, and eat, and they may make you feel good going down, but later on you get digestive problems, like diabetes, obesity, hypertension, and cardiovascular problems, especially if you make a steady diet of them.

I’m all for parables, analogies, metaphors--which are both expressions of how we think, and food for thought--but they need to be ones which help the receiving mind adjust to the reality of its situation, not pretend to adjust while really avoiding it.

Of course, adjusting to reality may make us feel worse, at first, even though it’s better in the long run, while settling for a pretense will make us feel better at first, and worse later. I wrote a song about that, called “I Must Be Getting Better ‘Cause I Think I’m Getting Worse.” It’ll be on the CD I’m completing work on now.

Saturday, February 20, 2010

Worship and Body Image

I’m reading some interesting articles by Bucknell psychologist Chris Boyatzis on the relationship between women's body image and religion and spirituality. One of the take-away points is that “Research has confirmed a healthy link between young adults’ religiosity and body image.” Now, why would that be?

I have often observed that nearly everyone worships something, although the object of their worship may not be immediately apparent. In the case of women’s body image, women with eating disorders are often striving for a “perfect” physical self. Now, perfection is one of the attributes of divinity, and for people of faith, one doesn’t have to be perfect because divinity is. People can participate in aspects of divine perfection, but perfection itself belongs to divinity. Thus, living a healthy life, a balanced life, a life of service, etc., are ways to approach participating in various aspects of divine perfection. If one is without faith in an object higher than oneself, living in a materialist world in which there is no higher power and no higher order than everyday life, then the self may become the embodiment of perfection--we are certainly bombarded with a certain version of feminine beauty--and, in the world of appearances, physical appearance can become the pinnacle of perfection. Thus follows disordered body-image and self-concept, with eating disorders and the other problems that accompany them.

For religious naturalists, a concept of divinity isn’t necessary to have a relationship with something higher than the self. Constructs such as nature as a whole, humanity as a whole, evolution, the genetic code, and the universe, will suffice to call one to relationship with a higher order of life in which one’s healthy self-image and lifestyle are important parts of that relationship.

Monday, February 8, 2010

Knowing It All

There’s a lot of talk today about addictions of various kinds: to substances, gambling, sex, video gaming, etc. There’s some controversy about what constitutes an addiction and whether all of these behaviors really qualify as addictions. Whatever they are called, one characteristic that I’ve found among people with such fixations is a know-it-all attitude. You can’t tell them anything that will help them to change their behavior, minds and lives for the better, because they know it already.

It’s interesting to reflect on how this connects modern psychological and traditional spiritual values. What would be considered to be a kind of ego defense, in psychoanalytic terms, or cognitive rigidity, in cognitive behavioral psychology, equates pretty well to what would be regarded as arrogance in spiritual terms; meaning simply that the person thinks that she knows things that she doesn’t, and therefore doesn’t have important learning to do, including thinking about what is being said to her by someone whom might be saying something useful if listened to. Two qualities that are missing in such people are humility (without humiliation) and spiritual motivation (motivation for experience of relationship with divinity, higher power, higher purpose, etc.). Interestingly, these qualities are directly cultivated by 12-step programs.

It’s all about brain chemistry, at some level. Substance addiction alters brain chemistry directly, while compulsive gambling, sex, and video gaming alter it more subtly, as research as indicated. But so does humility and a proper kind of motivation for higher or deeper experience, even if we haven’t been able to measure that yet.

Paradoxically, we can know more by sincerely thinking that we know less, and identifying, with humility, with a higher power or purpose; although that involves a different kind of "knowing." It's interesting, to me, that such identification connects the individual brain with the brainwork, the thought and lives, of very many people, past and present; and, who knows, maybe future as well.

Saturday, January 23, 2010

Notes on Borderline Personality

Here are the notes I sent to a colleague who asked me for some help in understanding another colleague who has borderline characteristics. I wasn’t trying to be definitive, or to address the issues and controversies surrounding this diagnosis, just to give some practical advice. Perhaps others may find it useful.

While the borderline personality style can present in different ways, one of the most frequently encountered is the person who has genuine skills in both productive work and relationships, but whose attachment dynamics have been severely compromised at a young age, such that she (or, of course, he) cannot really attach in a trusting and trustworthy way on a long term basis aside from being on either side of a very clear dependency relationship; up or down.  The individual's unconscious (and it is unconscious) formula for attachment survival is to divide others so that her alliance with key supporters is attained by their alliance with her in rejecting another or others; this is the "splitting,” “triangulating” dynamic.  A borderline patient on an inpatient unit famously splits the unit by allying some staff with her against other staff, and sometimes it takes lots of work to unravel the knot the borderline person has created.

Such people can't really be wholehearted members of teams, because they can't trust colleagues; but they can be members of productive teams in which specified tasks are done by various people in order to come together into a result.  However, their relational pattern as team members will still be to split, even at the expense of the success of the team, so that both their work and their tendency to split will have to be managed by the team leader.  

There are different hypotheses about how borderline personality disorders come about.  Barbara Oakley attributes it mainly to genetics, in "Evil Genes."  Psychoanalytically oriented theorists look to early childhood experiences, in which the patient was alternately seduced (in one way or another) and rejected by a powerful parent, usually with the other parent being too weak to make a difference.  As in most things psychological, probably it’s a combination of nature and nurture.

There are lots of nuances of this, of course. As a therapist, I often see patients with family histories in which a parent allied a child with himself or herself at the expense of other family members, who are rejected. Sometimes my patient is the child who was seduced, sometimes the one who was rejected. Sometimes the seduction-rejection behavior cycles, such that the parent seduced (not necessarily sexually, but emotionally) the child and treated her as very special, then rejected her and treated her as a bad person or a non-person, then cycled that treatment again and again.  

The result is that the borderline tends to have a "good object/bad object" attitude toward others in his life, alternately feeling beloved and betrayed.  So, those who have been "good objects" and thought they had a trustworthy and dependable interlocutor suddenly find themselves excoriated and vilified, and wonder what hit them.  Of course, the cycle can turn the other way as well, so that the person who was opposed and undermined can suddenly become the special and perfect and desired one.  The seduction/betrayal dynamic repeats, and people who relate with people with borderline personality styles have that “walking on eggshells” feeling, of always being about to do something wrong, without knowing it.

Working with such a person means that the working relationship has to be managed, because trust is not really available, especially if you are the person who threatens the borderline and whom he is trying to ally with others against.  Over the run of time, as the borderline becomes more secure, he may alter his focus in terms of whom he tries to split off from whom.  

The key to managing a working relationship with a borderline is in two parts:  1. Keep your productive agenda going, and 2. Deflect splitting by refocusing attacking energy onto productive work; not by taking it personally and rising to the bait.  The splitting behavior is unconsciously strategic, a substitute for healthy attachment, which the borderline person never really had. Therapy for people with borderline personality tendencies aims at establishing secure attachment. Dialectical Behavior Therapy (DBT) is a new therapy that has been developed for helping borderline patients feel a secure sense of attachment within their therapeutic relationship.  

Borderlines typically feel a great deal of apprehension and anxiety, much of which is repressed and projected out onto others.  They are masters at appearing calm while provoking and upsetting others by attacking them, then pointing to those whom they have provoked and saying, "What's wrong with them?"  For this reason, maintaining a low-key emotional tone can be important in dealing with a borderline-type person.   

Few people are severe borderlines all the time; they couldn't function in society if they were.  Lots of people have borderline tendencies, and some people have them more strongly than others.  Such tendencies can be exacerbated by stress that can be brought about by big life changes, even apparently positive ones like starting a new job, entering a new relationship or a more intimate level of relationship, etc.  

Because the person with a borderline personality disorder may seem to be quite normal much of the time, and can be quite charming (remember, the borderline person was often seduced emotionally as a child), the observer may be fooled into thinking that the borderline pattern is over.  The truth is that, without personality change so deep that it affects the foundation of the person's being, the borderline pattern is still there, beneath the surface, just waiting for the right conditions to activate it. It takes insight and wisdom for a borderline personality pattern to change.  

Saturday, January 2, 2010


Discussing fear with a client, we realized that sometimes the fear of death can help us to overcome the fear of life. So many things that we want to do but avoid doing because we are afraid of being uncomfortable, or embarassed, or failing, become possible when we see them with the perspective of a limited amount of time left in which to do or not do them. Fear is essential, of course, when it really is needed to save us from taking risks to our survival. But fear, outside of its use in preserving our safety and well-being, becomes an obstacle to achieving what we were born to achieve; which always involves transcending unnecessary limitations.