Category Archives: Meandering

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So how much can you care? Boundaries are a difficult thing to explain. It’s simple to define them as where I end and you begin, or a fence to keep me in and you out. I don’t know if that’s enough. Freudian analysts kept a clear distance and always worried about transference and counter-transference. Some west coast therapists in the 70s thought that there were no boundaries and sex was a great way to help patients. Some psychiatrists now act like family practice MDs with only 15-minute medication visits. They see so many patients that they have trouble remembering their names. Some family practice docs act like psychiatrists and that is both good and bad. They can offer real warmth and interest, but often times they can RX the wrong med or advice.

There have been countless books on boundaries and co-dependence and there will probably be countless more. Therapy presents some unique issues with boundaries. Whenever someone comes for “help”, they are automatically in a vulnerable position- but so is the therapist. I got to the point that I didn’t think I could work with someone if I couldn’t find something to like. Usually I could find something. Virginia Satir was great at this. She once told the wife of an ax murderer that he was only trying to make contact with her when he tried to kill her and this showed how much he really cared. Now I couldn’t do that. I did refer out a particularly nasty man with narcissistic personality disorder. I just got tired of the way he talked about the women he was abusing. He was also trying to build a case against his ex employer and filing for psychiatric disability. I just got to the point that I couldn’t stand to listen to him.

Now I know that this isn’t the way it is supposed to be. It’s hard enough to make a decision to go for help, and now what happens if your therapist doesn’t want to work with you ? Carl Whitaker ,one of the founders of family therapy, once said “I care very easily, but you have to make me care”. It didn’t take much. I think all I asked was for a person to make a reasonable effort to take some responsibility to change . As long as I could see that , or see where someone was trying to even get to that point, I would be fine. This does get back to the question of how much to care. The problem is always if you care more than they do. Sometimes you can care too much. I think that is the danger of being swallowed up in someone else’s life. It is a very fine line to walk. Robert Frost wrote about his neighbor saying “Good Fences Make Good Neighbors”, but he wonders about that. Before he would build a wall he wants to know what he is walling in and what he is walling out. If you build stone walls you have to be careful because they can crack. If you have no walls you are at the mercy of everyone’s emotions and crises. What price do you pay for this?

“Burn Out”, “ “Compassion Fatigue”, “Vicarious Traumatization” or whatever words are now being used for being overwhelmed with work. I have had lots of people ask how I could hear other people’s problems all day long. Did it ever affect me? Of course it did. Most days I would be able to leave ,get in my car, start blasting the Rolling Stones,and let it all go. However some days I wouldn’t be able to. I think as I got older and more experienced those days got fewer, but my family might disagree. I know that by the end of the week I was tired. Usually I would have Friday off. My wife would go to work and I might sit in a chair and read. The windows would be closed with the curtains drawn. It wasn’t that I liked the dark , it was just that I wanted privacy with no other distractions. I would rationalize this as my own recovery time. Exercise helped this too. If I ran or did some other strenuous exercise, I could focus on that and not on work. By the time my wife got home I was usually better. The rest of the weekend would fly by and before I knew it, I was back at work. I think the clinic was a good place where wonderful work was done. I also think that because of the work, I would get so caught up in the process and the very number of patients, that I didn’t  realize what was happening to me. I think the importance of focusing on self care is often neglected. The less I took care of myself, the worse my own boundaries were. I could always tell when I was getting to the edge when I would argue with a patient or get in a “power struggle” because they weren’t listening to me. The reality was I wasn’t listening to them.

Retirement is still strange. It’s like I put my instrument in the closet and haven’t taken it out for two years. I can try it on my wife and family, but I don’t think they want to hear that kind of music from me. One of the changes now is that the curtains are always open in our house. Sometimes I still want the dark, but I am getting used to the light and still working on new music- and new walls. I need to work on gates and maybe learn about picket fences that you can see thru and lean on and sometimes reach across. I think I am at least getting more ready to try.

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The dream world is so strange. Freud had so much fun trying to explain it. Dreams have had such a mixed set of explanations. It wasn’t only Freud that focused on them. In the Old Testament Joseph and his Amazing Technicolor Dream Coat was just one example. All cultures have stories about dreams and their hidden meanings. In the late 1980s and early 1990s, a new theory trying to disprove this as all just chemical reactions within the brain came out. Supposedly you only dream in black and white. If you begin dreaming in color, your synapses are overly stimulated. If you ate a pepperoni pizza late at night and had a vivid dream, it was because of the chemicals you ingested. Fever, chemical ingestion/withdrawal, extreme stress can all produce intense dreams. Some of our patients in detox had very vivid dreams.

Some people would say they never dream. They do, they just don’t remember. Freud would have his patients keep dream journals by the side of their bed so they could write down the dreams immediately upon waking. Otherwise dreams can be forgotten almost immediately. Repeating dreams or dreams that you cant forget are important. I would be asked, “What does it mean”, and the standard answer was “What do you think it means?” The subjective meaning we place on our dreams can help open up our understanding of ourselves.

So anyhow yesterday I dreamed that I was going back to work on a part time basis in two different agencies. The one agency had mostly teen-agers and God knows I NEVER want to work with teen-agers again. They seemed to like me and a friend of mine ran the agency, but teens change quickly. One of the things about working with them is you have to be ready for their intensity and rapid mood changes. You can be their hero one moment and the worst villain on earth the next. It is always about being an idealized parent or a very evil and misunderstanding one. I always respected people who could make a career of that kind of work. I would work with their parents in family therapy and help them find ways to work thru problems with their kids. This dream agency seemed like I was going to have to work with just the teens.

The other job was just a standard agency that I seemed to be a consultant in. The strange thing was I was bringing my own couch (a small love seat) to each agency. I was really getting ticked off in that I had it in my car and I had to bring it to each place each time I worked. It didn’t have any cushions and that was strange. I don’t remember sitting in it or any one else sitting in it. Now what does this mean? Got me. I am not analytically oriented as much as I am structurally. I don’t ever remember having a patient where we would spend the time analyzing a dream. Usually I would offer support and confirm their own analysis and move on to other issues.

So what do I think? I think a part of me still misses being a therapist, but I need to think about the burden that it was. It wasn’t unbearable (the love seat had no cushions and I was able to carry it), but it was still a burden. The fact that one of the agencies had mostly teen-agers might mean that despite my ambivalence about retiring there are still limits in what I would want to do.

I really did have an interesting job. I met amazing people from all walks of life. I tried to listen to their stories and help them make sense of their past and make plans for their present. I wouldn’t give up a minute of it—–but I am starting to understand how it did affect me. I would get so focused on helping others that I would often forget about myself. I think this time now is still one of discovery. What will I find out ? I remember when Sammy Sosa played for the White Sox ( yes he did Cub fans!). He was a very streaky hitter. When he was on he was a miraculous ball player who could do anything. When he wasn’t he was terrible. One of the announcers was talking about him during one of his terrible times. He didn’t want Sammy to change and wanted him to just keep swinging “because sooner or later he’ll hit something”. I think that is what I am trying to do. If I just keep at it maybe I will come to a deeper level of understanding. We’ll see.

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So today it is still cold and grey and so am I. What keeps us going and alive?

I just read an article about the many faces we have inside us. The author wrote about how many religions have saints or saint like beings who really represent the different aspects we all have. A few years ago I heard a sermon at our church from a visiting archbishop. He spoke about exorcism in the Old and New Testament. In those times demons were ways of explaining problematic changes in behavior. He then began to talk about the modern demons of addictions and mental health issues.   When I thought about it I could see the relationship.

Sometimes our demons seem overwhelming and totally unexplainable. The thought of even trying to change is too difficult to even consider. Other days it’s not that big a deal. When I am busy and active I don’t feel so “stuck”. When I have large chunks of time with no real plan to do anything, my own demons surface. William Buckley’s quote again comes to mind about industry being the enemy of melancholy. However what kind of industry? I have a friend with multiple hobbies. If he gets bored with one activity, he tries another. I don’t think I have the ability to do that. If I start something I need to finish it.

My life was divided into these neat fifty-minute segments. I would see people for 45-50 minutes, do a progress note, and prepare for my next patient. When the kids were young and in school, I could come home and get involved in their activities as much as possible. Now that is gone. I still think about work and wonder if I left too soon. The thing is I left on my own terms. I wasn’t walked out like one of my colleagues was. I think I could still be an effective therapist, I’m just not sure I want to do it again. The first time I had a pager I couldn’t even sleep for fear of missing it going off. Sometimes I still reach for it and feel undressed when it’s not there. I don’t want to have that responsibility right now.

My one brother-in-law has been retired for seven years. He is four years older than I am. When he first retired he was very active. He would play sports, go bike riding and try many activities. He talked about one of his friends who said you could tell a guy had hit the wall of retirement when he was still in his pajamas at three in the afternoon. He said that would never happen to him until one day it did. This became more pronounced as my sister’s illness progressed. His life became very focused around her. She has been gone now for four years. He has children scattered across the country, but still seems lost. One of the things people don’t talk much about in retirement is losing people. Death is a lot more present in my life than it used to be, and you know maybe that is a good thing. Little Feat had a song with the line “And You Know That You’re Over the Hill When Your Mind Makes a Promise That Your Body Can’t Fill”. I can complain about my aches and pains and etc.,but I just have to be grateful that I can still do something and don’t spend all day in my pajamas. If I do maybe I need to think about Hugh Hefner. He is 88 and his wife is 28. I bet he doesn’t have many boring days.

Hey, I think I’ve found a magic cure. I just have to start chasing my wife. It still seems to work!!!

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I’m still trying to get this retirement thing down. We had two of my wife’s relatives over for breakfast this weekend. The husband is in his early 80s and has been retired for many years. The wife is in her mid to late 70s. They travel a lot, go to the gym, go to church, and maintain regular contact with their children and grandchildren. Basically they do what we have been doing. So I wonder is this retirement? I don’t know if I am ready to say that yet.

I still get excited about new ideas and I still get urges to be a therapist. It comes and it goes, but my patient load right now is often concentrated on my own family and that is NOT a good thing. Some of the guys I know can talk about their old jobs and the way they were treated by their bosses, or how their companies were taken over by larger corporations. They still have interest in the business of what they did. My job was people, so it’s not quite the same thing.

The winter may be also contributing to this. It is grey and cold and snow covered. Good day to stay inside and read. Sometimes that is OK and sometimes not so much. I recently heard that an old friend began stocking at Target “just to keep busy”. Another colleague of mine told me she didn’t retire, she just resigned from one job and is now in a very limited practice near her home. She has four grandchildren and is very involved in a number of other activities. She still gets bored and often works until she almost collapses. This chapter of my life-the working full time, being on call etc, is over, but the book is not done. I am still trying to write the next section. I remember I once had the husband of a patient tell me that you don’t retire from something, you retire to something. I do think that is good advice, but it is a difficult question to answer. Is just keeping busy enough ?

I want more than that, but not so much as to work full time or again begin to assume responsibility for a caseload. I guess I just have to keep searching.

I was touched by David Carr’s death. He seemed like a good guy. He was an excellent writer and he had been in recovery for many years. His book “Night of the Gun” details his first recovery. He relapsed after 14 years, drank for couple of years, and then got back into sobriety. An interesting man who was very passionate about his profession. I think the idea of passion is what I am missing. Victor Frankl used to ask his patients “What stops you from Suicide?” as an opening to his interviews. For me it’s not that so much as “What else is there?”

When I was working I would see a real difference between Women’s Therapy Groups and Men’s Therapy groups. No matter what they were there for, women would always talk about their relationships (or lack there of) as contributing to their problems. Men would talk about their jobs in the same way. Now I know that is a generalization and may be related to the demographic I was working with. Yet something of that still rings with me. Maybe I need to therapize myself, or maybe I just need spring. I guess I will see what April brings