“How Difficult This Job Can Be”

A colleague of mine posted this on his Facebook page and I thought it was very poignant and something I could easily relate to, so I am reposting it.

“I’ve really liked my job as a psychotherapist, trying to help people with their deepest, darkest, toughest fears and problems.  Sometimes people are full of despair or even suicidal, and I worry that I could say or do the wrong thing and make the situation worse.  Imagine how horrible a misstep would be!  Pressure, right?

I am surprised at how difficult the job can be.  I thought it would be easier.  Before I decided to devote my professional life to this, shouldn’t somebody, you know, have warned me?”



Should you be a Psychotherapist?

An old patient called me the other day. It seems as she had changed careers and was now in graduate school studying counseling. She was given an assignment to ask a professional some questions and she emailed me to ask if I would help. I was glad to hear from her, thought about it and said I would see if I could help, and scheduled a phone time. Some of the questions she asked got me to thinking.

Her first question was “How do you take care of yourself?” I could answer it personally or as a professional and so I chose the latter as I was pretty sure that was really what she needed for her assignment. I believe by that she meant “how do I keep my professionalism without losing myself in the emotional connection and attachment with a patient?” I explained that having been a therapist for over 35 years and I kind of do this naturally, but at the beginning it was not so easy not continually to worry about my patients and stop thinking about them at the end of a day. I explained that it is not that I don’t care about the problems they face, but it’s just that I can separate myself from my work when I need to. I likened it to being an actor. Not that I am an actor, but an actor can live the role but still maintain that part of him/herself that is them. I am myself and very real in my work but I also know that I am an observer and a helper

I understand connecting and am totally ‘there’ yet I also have a separate view and can analyze. I am apart and yet very much with the person. I also said to her that not everyone is able to connect and empathize, and you need to know who you are and what you care about, and whether this work is for you. A therapist or counselor has to be themselves but also be able to use their skills and understanding to help but not get lost in the process. I said that it is not for everyone.   I do not think that a therapist who is aloof and distant, no matter how brilliant, can give a patient what they need. It takes a certain kind of person who is empathic, connected and interested in others, as well as someone who has the training and skills to be a psychotherapist. She said she thought she had what it takes and would love the work.

She then asked if there were people who annoyed me or who I would not work with or if there were any experiences that scared me. I explained that there are certain kinds of pathology that I know I could not deal with.  I would have a hard time with mandated sex offenders in my role as a therapist- ‘mandated’ being the key word – or psychopaths. But I also explained that I have changed in my ability to deal with certain kinds of problems. As I grow and change as a human being, so has my understanding of issues such as illness, aging, bereavement and the like.

When she asked me if I had ever been confronted with a difficult situation, I told her of one when I worked a long time ago at a psychiatric aftercare facility. A man came into my office and after sitting for a while, he looked at me and said “you look like the man who killed my mother”. Then he began getting out of his chair and was moving towards me. Luckily there were security guards and a buzzer. I was behind a desk and security took him away.

Another incident which I did not tell her about, was when I was newly in private practice, a man came in to my office and began telling me about himself. It was about ten minutes into the session before I realized that he had unzipped his pants, taken out his penis and had begun masturbating. It was a dilemma as to how to handle it but I asked him to zip up and leave. I might have handled it differently today but this was also a long time ago.

Another question she asked was whether the problems people come to see me about have changed over time. I explained that basically the underlying emotions that people experience and need to deal with have remained pretty much the same, but that the externals or presenting problems can look very different and how people approach things and what they look for in the way of solutions has changed. I also mentioned that people are more open in talking about certain things in therapy such as sexual issues, drug and alcohol problems, and are more open about sexual identity and preference.  Thankfully there is less that is taboo.  There has also been a major shift in how people communicate with all the technological changes, but when all is said and done, people are still people.  There is much more openness and talk and media coverage, but little is new when it comes to the human condition.  We just have more of it and more is in the open.

We ended with her thanking me and me wishing her good luck. I thought if I could ever get my book published, it might help a few people. But I’ve been told I need a ‘media platform’. A blog is not enough.


Looking for Love in All the Wrong Places

All throughout my practice and over the years, for both couples and individuals, I see many who find themselves in difficult if not downright abusive relationships.  That has often been an ongoing pattern in their past relationships and their current relationship may continue and mirror those problems.  Also there are many who are still looking for just the ‘right’ person but haven’t a clue as to what makes a relationship ‘right’.  Now sometimes relationships become abusive after time and it can be because two people are not right for each other so that conflict and anger become part of the dynamic.  Or sometimes stresses destroy what was once good.  But more often it is a pattern.  Someone once said to me about her friend “I can always tell which kind of guy she will gravitate to.  She always goes for the one with a certain ‘attitude’ and of course good looking.  It is those guys who are really womanizers”.

More often it is women who find themselves with angry or emotionally unavailable men who take out their frustrations on their partners, but I have also worked with men who find themselves with cold, derisive, and ‘bitchy’ women who offer little warmth or love and mistreat them.  Now relationships don’t  normally start out that way.  People usually fancy themselves ‘in love’.  But the chemistry and that mystery we call ‘attraction’ can fade pretty quickly with the reality of life’s stressors.

There are many who repeat past patterns of abuse whether it stems from original family dynamics or from past relationships.  One person I worked with had a cold, distant, alcoholic mother, and every woman he ends up with has an addiction problem of some sort.  He takes care of them and does his best to offer them the love he feels in the hopes that it will change them.  I often feel that people have a certain kind of radar that puts them in the same situation over and over again.  The key to change is understanding the behavior and the willingness to stop trying again and again to accomplish what may be impossible.  Easier said than done!



“Is There Anything Worse Than Being Ordinary”

Someone said this to me recently and in a way it made my heart ache.  In my opinion, being ordinary is much underrated.  It is what most of us are and if you are your own brand of  ‘ordinary’ you are ahead of the game.  you don’t have to be famous or fabulous or extraordinary to be special and wonderful.  Trying to be the best, the smartest, the prettiest, most talented, most creative, – the ‘most’ of anything is a recipe for disappointment, self criticism, self-hatred and low self-esteem.  If you are always comparing yourself to others you will always fall short in some way.  To be the best that you can be is quite enough, even though that is a cliché.  Labeling yourself as ‘ordinary’ in a pejorative way is so very sad.  All we have to do is look around to know that fame, fortune, success, and talent does not guarantee happiness. 

















Psychotherapy & Sex

Someone asked me if I worked with sexual problems as there is no mention of sexual issues on my website or in my blog.  This was someone who had been married for many years and whose sexual life had become non-existent.

Sexual issues are such a basic topic of focus in both couple & individual therapy that it never occurred to me to write about it.  Duh!  That being said, of course I have seen many couples and individuals where intimacy, sexual & otherwise, is a very important issue.  Unless there are obvious physical problems, I usually view sexual intimacy or lack thereof as a combination of various psychological factors.  For couples, lack of sex can be a direct outcome of what is happening in the relationship as a whole.  Sex can be a barometer of the relationship and sex is often one of the first things that go when people are unhappy with each other or even with themselves.  I usually see it as a symptom of problems and not a cause.  That is not always the case.  Sometimes the opposite is true, because feelings of love and desirability for some people are often based on sexual attention.  Rejection feeds relationship problems and insecurities, which in turn makes it difficult for people to approach one another, and you can develop a dynamic which exacerbates and repeats dysfunction.  If the communication and the relationship improve, often the sexual relationship gets better.

Feeling loving and trusting towards each other can stimulate sexual desire.  In couple’s therapy I almost always ask about the sexual relationship.  It is also a good idea to check out each person’s idea of how often they should be having sex.  It  is amazing how couples can differ – from at least once daily to maybe monthly or less.  Libidos are different and can change over time and circumstance.   But resentments, feelings of rejection and undesirability can be a consequence of lack of sex.  “You make me feel unwanted” or ” I am tired of being turned down” are feelings that get expressed a lot.

Body image can be a major obstacle to a satisfying relationship.  “I don’t want to be seen naked” or “I feel fat & ugly” are reasons that I hear expressed regularly and which interfere with desire.  Other common complaints that interfere with sexual intimacy are lack of romance or foreplay.  Timing can be all important and some couples have opposite clocks.  Other reasons for sexual avoidance I hear are “I don’t want to beg for sex” or “You just want to get off & then roll over & go to sleep”.

I am not a sex therapist, but there are many physical problems that can lead to lack of sex, such as erectile dysfunction, premature ejaculation, vaginal dryness, medication reactions, hormone imbalance, menopause, low testosterone – just to name a few.  There are many actions people can take to improve or alleviate these issues – both medical & technical.  But if feelings of resentment and rejection have been going on for some time, taking even the first tentative steps can be difficult.  If there is a physical problem a supportive partner is a huge help.   A supportive partner is a huge help in any circumstance.

Then there are the psychological problems that compound whatever physical problems there might be.  And of course there don’t have to be physical problems to cause sexual dysfunction.  Past sexual abuse is a major factor as are feelings of inadequacy, feeling used and abused, and family history.  Religious upbringing and familial attitudes towards sex can easily interfere with sexual enjoyment.  All in all, a healthy sex life is a blessing!

But before I conclude, I want to point out that diminishing sexual activity or even the lack of it does not necessarily mean that a relationship is not loving or healthy.  Love itself flourishes without sex – and considering the human condition, it would have to.  Every relationship is different and people have different needs.  We all age and our physical selves are fragile.  It is wonderful that love is greater than sex.









Technology’s Influence on Psychotherapy

The age of technology is amazing.  From when I first started as a psychotherapist, it is a different world as regards information and communication.  I am definitely a fan of technology. However, as it is used in certain situations, it has a significant downside.

The internet offers a wealth of information on all sorts of issues related to mental health.  It gives people a better understanding of psychological problems from theoretical points of view.  You can also find tons of ‘how to’ literature on techniques to approach symptoms, solve and resolve problems.

But from my perspective there can be major problems with people jumping to conclusions from this information.  Like with medicine, they read and think they know what’s wrong.  They self-diagnose and may put off seeing someone until things have gotten much worse.

One of the most alarming outcomes of technology (in my opinion) is the use of social media – texting, tweeting & email etc., as a major means of interpersonal communication.  That is not to say that these communication methods don’t have their place.  For factual information such as when & where, it is great. But many use this instead of face to face interaction for more complex communication.

When you talk via text or email, there is no ability to get a ‘read’ on the other person.  There is no access to the nuances of body language such as eye contact or emotions that enhance communication in so many ways when you are face to face. For some this is helpful.  Many feel they can communicate better via the written word.  But mostly this leaves way too much room for miscommunication and misunderstanding.  It also prevents the experience of re-framing in the moment.  The internet doesn’t listen and is not a substitute for live interaction.

For very isolated people it can offer a means of contact and communication that they would otherwise not have.  I do not downplay the benefit for those who have difficulty communicating in interactive situations.  But it also can reinforce this avoidance.  People can manage their communications like they were writing a term paper.

Communication via the internet is intrinsically sterile.  When you think of children in institutions who have no one interacting with them physically and then compare that with parents who are always holding and playing & engaging in eye contact, the difference is monumental.  In institutions, the result can be a failure for the baby to thrive.

When I see people who get together but somehow always manage to spend time on their devices, I groan.  Think of a TV commercial – I think it’s for online gambling – where conversation is quickly replaced by individual game playing.  This is very different from interactive games and appears to be a new cultural trend.  Why is it necessary to always have the device handy?  I often feel it’s a subtle means of diluting the actual experience with friend, family or significant others.   Its effect is to interrupt the flow of the relationship.

In therapy, there are no devices and most turn them off unless there is an extraordinary circumstance.  The communication between therapist & patient is much more immediate and that lends itself to deeper understanding.  I see the person and can gain greater insight that way.  We have a relationship that can’t be duplicated online.   I hope that in the rest of life technology is not causing us to lose the gift of human presence.

Although the internet offers wonderful things, unfortunately it also offers new opportunities to indulge in addictions of all sorts.  It can be its own addiction.  It enables avoidance of the world and real life and real problems.  Just as with TV it can offer a respite from the stresses of life.  Great!  But it’s abuse tempts us all.

The internet has dramatically changed how people find medical & mental health providers.   You can look up anyone’s credentials and check out their reviews. That is amazing.  However it used to be that people got  personal recommendations.  Now I am not sure which is actually better.  But the internet as well as insurance companies have made finding a provider a much more anonymous endeavor.

Then there are the online support groups which I actually think of as pseudo-support.  They are anonymous, but unlike AA and similar groups, there is no actual emotional or even physical touching.  You don’t get to deal with trauma in person.  You may get lots of information & helpful hints, but the methodology itself reinforces the interpersonal disconnect.

In actual therapy sessions, and even as regards the reasons people seek treatment, I can’t say I have noticed that technology has affected much of what goes on or the problems people come in with.  What I have noticed is that different addictions are ‘easier’ to accommodate.  Infidelity is easier to hide and more and more people are looking for a mate using internet dating sites.  That has both up & down sides. In any case, the issues that confront couples and what makes relationship difficult are still the same.

I have concerns about how the younger generation is learning to relate or have relationships.  Technology is an essential part of children’s lives.  They see adults using devices and are growing up with them.  Hopefully they are also learning to relate in a more personal way.  I would hate to think we are losing something as important and valuable as human bonding which has always occurred naturally and without the interface of whatever new device comes down the pike.






Addiction & Social Anxiety Disorder

Over the years I have worked with many people who suffer from addictions of all sorts –drugs, alcohol, food, sex – you name it.  Most were/are in recovery or have attempted to deal with their addictions in other ways.  But one thing I’ve noticed that they have in common is that most have Social Anxiety Disorder as an underlying problem.  That is not to say that all addicts have this.  But when you think about it, for many it makes sense.  Addictions mask emotions and help with symptomatology.   They initially make things easier – brighter if you will.  Drugs & alcohol lower inhibition and can help ease the way for social interaction.  For most, alcohol lightens the mood and lowers inhibitions and may make things more pleasant.  But social discomfort is major problem for those with Social Anxiety Disorder.  People can shake, stutter, withdraw, become mute and can’t make contact even in the seemingly most benign circumstances.  Think of Rojesh from TV’s “Big Bang Theory”.   He is a caricature for sure, but not so far from hitting the nail on the head.  The powerful underlying truth of what many with Social Anxiety Disorder deal with is that their discomfort is so great, they can’t connect.  Or they suffer greatly when trying to interact.  Drugs or alcohol can produce a major shift for them.  It is self-medicating, and many even forget what is lurking underneath – especially if they become chronic users.  But when sobriety is achieved it is there – just as it was from the beginning.  The trick is to find other ways of dealing that might bring about some real change.