Treatment models

"Beware of Geeks bearing formulas," Warren Buffet advises. He was speaking of formulas accepted whole hog by bankers, financiers, and mutual fund operators to predict such arcaic outcomes as how high interest rates will rise, when the housing market will bottom out, how to carve up derivative instruments such as asset liability swaps to maximize profits (to the carver) and minimize risk. The problem is such fourmlas have flaws as witnessed by the present financial crisis.
It seems to me that psychotherapists do the same thing. Today most psychological healers claim to be a cognitive therapists. Years ago it was psychoanalysis, client centered therapy, humanistic approaches, Gestalt thereapy, and so on. All of these models, even in the best trained hands, may be helpful but they are not paneceas for emotional health. All have limitations, even those with solid empirical (evidence based) backing. They don't work for every condition or every client. They don't take into account less tangible and measureable factors such the relationship between therapist and client. They are not complete theories of personality (Psychoanalytic models come closest because of developmental concepts that are intrinsic to the model. However they can be used to explain anything by the those who speak the langauage fluently, and therefore have little predictive value.) My point is that these models provide tricks (OK tools) of the trade. They bring some order out of chaos and a comfort level to the therapist. But the most honest of us will admit that there is more going on when outcomes are positive or negative than merely the particular stratgey the therpist believes he is employing. Gabriel Byrne, the Irish actor/therapist, Paul, on HBOs In Treatment, who explains everything in a psychodynamic targeting parents as villains, said it best to his own therapist, Gina, when he lamented that therapists don't cure people, they merely walk with them through their problems for a while. Gina didn't buiy into that idea. We are all more holistic and humanistic than we often care to admit.

Transitions

We usually think of transitions in life as positive-a child learns to walk, the first day of school, graduations, marriage. Each represents the beginning of a new phase in life and brings with it hope for the future. Retirement is also a transition and it has its positives--the end of the daily grind, new opportunities for travel or pursuit of hobbies. Yet there are also negatives since it portends ultimate decline, illness, and death.

This week, at age 76,I celebrated my third retirement at the same time that I was planning for several new ventures. There are some of us who cannot retire without feeling useless and inadequate. We tend to define ourselves by what we do in the marketplace. Most souls are able to give up that false sense of identity. Others cling to it as a source of recognition and purpose. For me being a psychologist who also writes is who I am. So long as I maintain some modicum of health I will continue to play this role. I don't look down on those who do otherwise. Indeed, I
sometimnes envy them. But for me there is no choice. I am leaving a pleasant and comfortable part-time position where I was moderately successful to expland my options for consulting, writing, and doing private practice. For me transitions are a necessity-- a source of optimism, and continued potential for productivity, creativity, and growth. Nostalgia at walking away from friends and colleagues is balanced by new opportunities, challenges, and anticipation of success. It has always been so. For want of a better label I dub myself a "transitionalist." Wish me luck.

The feminizing of psychology

When I was a graduate student in the late 1950s psychology was a masculine dominated discipline. Oh, there were women doing university teaching and research, and even a few clinicians,mostly child psychologists, but the major psychologists on a national level were primarily men. Towering figures develped elegant theories of loearning, perception, memory, and personality. These were grand rational conceptualizations backed by brilliant research. Proponenets of major schools of psychology did battle in learned journals--Hull v. Tolman, Rogers v. Skinner, for example. Emotion was a part of those theories but largely played a secondary role.

Today there seems to be major paradign shift. Practianers increasingly seem to be women, particularly school psychologists. With this feminine shift there seems also to be increased emphasis upon feelings. Yes, cognitive behavioral theory places cognitions first, followed by emotions and behavior. But concern about abuse,trauma, marital problems, disfunctional families, the effects of poverty appears to place more and more emphasis on feelings. Simultaneously conceptualizations appear to be based more emotional than rational. What gets tossed of as thoery would never make the Psych. Review.

Recently I attended a three hour seminar about eating disorders. The speaker, a female university lecturer and clinician shifted seamlesly from anorexia, bulemia, binge eating, and the like to disconnectedness and social isolation as determining factors. She offered a disclaimer that most eating disorders affect women and that her experience at an eating disorder clinic was primarily with women. All theories are basicly the same she added--psychoanalytic, cognitive, behavioral-- they are all coming from the same place. (However, she was quick to add that is cognitive-behavioral in persuasion.) We learn at an early age, she explained, that thin is good and fat bad. That accounts for the cognitive part of her theory.

It seems to me that when I sit and watch the Piladelphia Eagles play the Dallas Cowboys with my male riends and relatives we are all well connected. We bond nonverbally. There is little talk except about football strategy and plays. We can go an entire hour without anyone saying anything but we are still communicating. We may sometimes discuss politics or the stock market or finance but I don't ever remember anyone bringing up feelings or relationships, except for an occasional smutty joke. Oh, did I mention, none of us has an eating disorder?

One last thought. I have been a practicing clinician for over forty years but I can honestly say that never once have I ever asked a client "How did that make you feel?" I would choke over the words.

A state of mind

I never turned on to golf. It's mostly because of my vision. I'm like Weakeyes Yokum in Li'l Abner, I just don't see well. When I manage to hit the ball I can't locate it for the next shot. So Retirement doesn't sit well with me either. This past weekend we did a fast trip to Orlando. Hilton offered us a deal we couldn't refuse. The trip on Air Trans was horrendous but that's another story. Just don't ever willingly fly out of Terminal D in Philadelphia. Things improved once we arrived despite 96 degree temperatures. The quid pro quo was a two hour sales pitch for a Florida Hilton time share. We already are Hilton owners in New York City which allows us to go almost anywhere so why would I need another time share? How many times do I really want to see Disneyworld?

But that takes me back to retirement. I am retiring for the third time in June. Not really retiring, just leaving. I'm going to consult, providing mental health services to schools. They've invited me to a retirement party all the same, so I'll attand and have a good time. So long as I'm healthy, why reire? I like what I do and still do it well. I make my own hours, more or less, and so does my wife. We can go to Orlando or the Big Apple, or Swahillyland if we want to (if we can afford it).

We did retire for six months about half a dozen years ago. After a while we were both talked out. We had nothing new to discuss...so we went back to work and never looked back. It makes life more interesting. I mostly listen anyway but Joyce talks for the both of us.

When Marvin Levi at age 75 was still coaching the Buffalo Bills a reporter asked him when he would retire. "When you start thinking about retirement" he quipped "you're already retired."

Publication Update

After a bad beginning, "Shrink: Odyssey of a Therapist" is now out and available from Eloquentbooks.com. It may also be ordered through Amazon and Barnes and Noble. The original copies sent to friends and relatives had many typos. These have now been corrected. The sequel "Finding Jackson" presents a short (i4,000 word) further adventures of Morrie Schwartz. It will be out in June but copies are now available through PublishAmerica.com. Bronx Lyric is a self-published book of poems about growing up in The Bronx. It is available through CreateSpace.com. I am playing with another idea for Morrie Schwartz but, frankly, I am tired right now and will delay working on it. Instead, I am making some changes in my daytime job for the fall. More about that later. My trials in publishing something that people will actually purchase and read continues to convince me that I had better not abandon my real work as a psychologist.

Schools and self-esteem

Martin Seligman, in his resilience textbook for middle schools, The Optimistic Child," suggests that children shouldn't be praised without some genuine accomplishment.Even my four year old grandchild Julia criticized my wife when she praised her twin brother for being chosen as a line leader in preschool. "Everybody gets to be line leader, grandmom." It is a good point. The opposite side of the coin is that children should not be critizied for lack of accomplishment beyond their control.

Yesteray, I attended grandparents' Day at the private school attended by two other grandchildren, a four and almost six year old. It was an all-morning afffair
which started in the auditorium where five grade levels of children --Early education, Kindergarten, and First through Fourth grade--presented a musical concert. Later we sat in classrooms with each of the two children. It was interesting to note the increasing development, maturity, and self-confidence of the children, progressing from grade to grade. The principal explained that their curriculum required that children learn stage presence in front of an audience. The children differ in the degree to which the children enjoy that experience. Bella, a drama queen, relishes performing. Reagan couldn't care less. There were obvious gender differences. Boys went along with the singing but few of bothered with bodily gestures.

I remembered my own experiences at P.S. 80 in The Bronx. We had weekly assemblies where boys wore white shirts and blue knit ties and girls sported white "middy blouses" and orange ties. Each class rotated in presenting a dramatic performace and the entire school sang each week, including the hymn "Holy, holy, holy," in the days before school and church were separated by law. I was told by the music teacher, at an early age, not to sing. Labeled a "listener," because of my tone deaf monotone, I was instructed merely to move my lips. Now, I don't really know if I was scarred by that experience but certainly the message was that I was incompetent as a singer and could never improve so stop trying and don't ruin the efforts of others.

I assume that teachers at what is now Junior High School 80 in The Bronx are now more psychologically atuned to self-esteem. I talk weekly with high school students, assigned to emotional and learning support classes, about resilience, self-confidence, and the like.

When the kindergarten class at my grandchildren's school sang along with their guiitar-playing teacher, I sang along with them, loudly and with self-confidence.

Catch-up

I've been negligent in maintaining this blog of late for a variety of reasons. "Shrink," my first novel, was published by Eloquent Books and, embarrassingly, and despite my many editings, was launched with dozens of my typos. These are now being corrected and a short sequel titled "Finding Jackson" is being published by PublishAmerica, so far painlessly, on my part. On the other hand, my attempt to self-publish Bronx Lyric, a short book of poetry about growing up in The Bronx, has hit a snag. My terrible computer skills do not enable me to meet the formating dermands of CreateSpace, the publisher. I wasted hours enmeshed in the vaguaries of PDFs, jpgs, and a 6X9 format, without success. All of this is my lame excuse for not maintaining this blog. I read, with some awe an almost daily blog of a writer who documents her writing and reading progress. The author is verbose to a fault, but her ability to grind out words nonethelss impressive. I am a fast write--too fast it seems to detect errors, but I don't have daily blogwrite words and never will. I'll continue to do this blog, mostly with a psychology spin, but not always, and only when I have something to say.