Maybe I’ll be stating the obvious, but those of us in the mental health biz talk a lot about enabling, and the rule, of course is, DON’T.

Don’t make it easy for someone to stay addicted. Don’t bring him a beer, even if he’s your father and that’s what you’ve always done. If your mother’s half in the bag at your graduation, get really mad at her. Create such a fuss that she thinks, Good golly. I have a problem. I messed up. I better change.

If (s)he is your partner, you don’t go with him to the bar. And if (s)he comes…

You know I work with a lot of program people, meaning I hear many stories from people who are working 12-Step programs. And sometimes themes emerge.

Being a therapist with a research background, you look at things differently. You see your work as a series of qualitative interviews and you look for themes that cross lines.

Here’s one I find interesting. I’m sure you’re familiar with it. It’s about the idea that a person in recovery from an addiction is beginning life where life sober left off.

I find this a very sad and difficult concept to have to lay on people,…

Cat writes about recovery and changing sponsors, and it brought up all the issues I have, mainly my own insecurities about telling someone to get another therapist, get another opinion. I’m not the only doc in the sea, and am not for everyone.

It’s so ironic, you know, because the patient (or in AA parl, the sponsee) is afraid of hurting the therapist’s feelings (sometimes), and yet the therapist doesn’t want to add to the patient’s abandonment anxiety, ever.

We don’t want to add to the issue when the issue isn’t resolved.

So for me, it’s all about trying to resolve…

I’m in the car with FD. He’s driving south on 1, we’re heading for the tide pools, and two of our grandsons are kicking at the front seat.

I get a call from one of my sons, a married son with children who lives on the opposite coast. Basically, if I want to see my grandchildren, I get to get on an airplane and fly an hour or four. I’m still working it out three days later. My back is, that is.

Oh, let’s segue. I’m not complaining, although I do look silly in the galley on the plane, doing the physical…

Mother’s Day when someone in the family is addicted.  Mother’s Day when your mother is addicted.  Mother’s Day when your father is addicted.  Mother’s Day when one of the kids is addicted.

The fun never stops.

I’m sorry.  That wasn’t nice.

But people give me those looks when I say, “Well, surely nobody’s going to get wasted on Mother’s Day.”  There’s a Jewish expression, kal v’chomer (rhymes with doll-v’-roh-mare) that can mean, among other things, all the more so.

Looking at the problem with a cognitive approach (drinking/using is behavioral, not in your head), people actually think about the meaning of a person’s drinking on…

I’m so glad you guys found me, you Second Road people.

Because you know I love to talk, but am basically too shy to do that, just talk to people.  So instead I listen for a living, and occasionally, when I have something worth saying, let it roll, the mini-psychoeducational lecture, or the observation about how a person is operating, and maybe suggest, hypnotically of course, a better way.

But blogging, as you who are here well know, allows all of us to talk ad nauseum, and no one is interrupting, and no one necessarily even knows who we are, so we can…

I think that there is a stereotype about this type of family, the alcoholic family, one that is unfortunately well-deserved, if misinformed.   It is by definition a stereotype, a generalization, that alcoholic families tend to be violent.  Just as any generalization about any type of family has to be wrong, this one is too.

Each family is unique, crazy in its own way.

And yet, someone like me sees some people for about seventy seconds before thinking, alcoholic family. Maybe you do this, too.

People in 12-Step programs aptly use words like rage-aholic to describe a population of people who don’t drink,…

Okay, that’s ridiculous, of course. I just had to share this link with you, though, and couldn’t think of a good title for the post. Maybe you’ve all seen these clips before, but I hadn’t.

Check out this blogger. at DryBlog.

therapydoc

Those of you who read me regularly know that I’m from an observant Jewish background, which means that I follow plenty of rules. And I scoff plenty of rules. I’m as good a hypocrite as anyone else, as are all my friends and most people who breathe.

But we try to be better.

And probably like most religions that have teeth to them, there’s plenty of spirituality to back up mine, to make the rigor make sense.

Because a Jew’s life is one for the books, meaning theoretically, ideally, every movement could be a page from a Jewish law book, should be a…

The other day someone said to me, “I think this world, this country (meaning America) should stop drinking.  Americans could beat the economic blues, could win this war on terrorism, if they stopped wasting their brain cells with booze.

No joke.  It’s true.  What’s interesting to me is why people even want to drink, to lose themselves to alcohol the way they do.  Some of us don’t, have no physical craving, no mental “need” or desire to get stupid.  For alcohol, make no mistake, is one of those drugs that slows the central nervous system, retards our critical thinking, makes us…

Most people know that people who abuse or depend upon drugs and alcohol tend to be remiss about  important tasks in life, tasks like: parenting, helping others, being accountable, responsible, keeping promises, participating in a community, respecting time and property, giving one’s best on the job.  Things get dropped when under the influence. Or the next day.

An addict forgets to call.

An addict forgets to be there.

It’s in the nature of the brain, befuddlement of substances.  Alcohol and drugs change a mind that might have half a chance of working fairly well, into a mind that not only forgets, but fools the “self” within the…

I give patients the option of calling me and rambling to my voicemail, no promises that I’ll listen, but usually I do.  I tell them to call me back, after they have talked themselves silly, when they’ve figured out exactly what it is that I need to know.   They’re to mark the one that summarizes it all by saying, “Okay, this is all I what I wanted to say.” Then say it in a couple of sentences.

Strangely enough, the people who use this option tend to be alcoholics in recovery.  They’re in 12 Step programs and know how to use the…

Step 4: “Made a searching and fearless moral inventory of ourselves.”

Sometimes I feel so guilty pontificating about the steps, never having worked an A.A. program. But I feel, as I’ve said before, that so much of the program is steeped in Judeo-Christian thinking, that in a sense I’ve been working one for most of my life.

Skip a little adolescent acting out. Everyone is entitled to an adolescence.

So, Step Four is about looking yourself in the mirror, finding yourself in your past, owning the things you’ve done, and committing to change. Changing you. Did I get that right? It’s like…

Here’s what can and will happen in therapy (and therapy is a microcosm, a miniature world, so some of us like it).  So here’s what can happen in therapy when the doctor puts a person in charge of his or her own drinking and that person wants to be in charge, believes it’s possible, really, to control it— when it probably isn’t.

Let’s take a marital therapy case.  The sober spouse, make it a she, is the one who doesn’t drink to excess or drink at all.  Someone like me, a therapist tells her, “Do not count his drinks. He’ll monitor his own drinking. Let…

It’s a funny relationship.

I remember being about ten and sitting on the sofa watching a baseball game with my father.  I never saw him sit and watch a game with a beer in his hand before.  If anything, we drink seltzer or ginger ale.  Maybe Coke of Fresca.  But that day he had a beer in his hand and he passed it over to me and said, “Do you want to taste it?”

Now you have to understand.  If we drink anything, or eat anything in our family, it is unthinkable not to share.  And in Europe they drank beer when they couldn’t trust the water, so…

I went out of town last week, and as I boarded my plane caught a glimpse of the pilot, an older guy.  And thought, “I sure hope he’s sober.”

I treat pilots, you know.  And flight attendants.  And I’m not trying to discriminate, nor do I mean to disparage a profession, but one of my pilot patients told me, “It’s a party profession, at least on this airline.  We work hard, and after work, we play hard.”

“But you’re sober when you fly, right?” I ask timidly.

“Well, sure.  But a little hung over sometimes.  Not always in the greatest mood.  But I fly…

You know it’s a theme of mine, and it’s not easy to put it down.  Every child has that moment of reckoning, lost innocence, an epiphany that the world isn’t all that safe a place, and it is because they are hurting.

All I ask is that as adults, we put that moment off as long as we can, we protect our children.  I realize that it is virtually impossible, that we aren’t to blame when our children get into trouble.  But if we see them getting dark and cranky, we should get them help somehow.  We shouldn’t assume it will…

If you read my posts at Everyone Needs Therapy, especially the more recent post about Friend Poaching, then you know I go to a lot of weddings.  I’m at the age where the children of my friends are all either married, or they’re getting married.  Not everyone, but enough of them to really give my credit cards a beating.

I’m not complaining.

The last wedding had an open bar.  I personally appreciate this very much.  I like to walk into a shmorg and either get a mixed drink or a glass of wine, because the two go together so well sometimes, appetizers…

A patient sees me and says, “I’ve been trumped by the Third Step.”

Pray tell, what is the Third Step?

He mumbles much jibberish about letting people become your higher power and getting angry and how that is never acceptable but it happens when your ego is first and other people are not. He tells a story, and I’ll change it here, as I always do.  So let me tell you right now. I’ve changed the details of this story so much, if you think you know this person, there is no way.  You don’t. He is pure fiction.  But you’ve heard this story,…

Sometimes I think it’s cheap that I use television shows as teaching examples.  But The Office is never cheap television.  It is an exemplary show that mocks our work culture, the one particular to the office, a place where people have the opportunity to get to know each other very, very well. 

There’s potential for intimacy at the office, too much, sometimes, one of the reasons we why we find it so hilarious.

I liked last week’s show, Moroccan Christmas, for one line, really, the one at the end that illustrates so well how systems operate.  

In the show, Michael (Steve Carell) stages an intervention.   You may…

Here’s where I get stuck with alcoholics. I get stuck in the place that alcoholics stick themselves. It’s that place they get into that’s all about proving how functional they really are. You guys call it denial, and it is that. But it’s that and much, much, more.

The spouse of the alcoholic (or the parent) will cry, “She’s abusing alcohol and drugs! He’s dependent!”

And the user/addict will cry,

“So what?! I function just fine, thank you. Even better a little stoned, if you want to know the truth.”

The addicted spouse will point to the clean house, the folded clothes, the…

You know those holiday movies about Thanksgiving, the ones with all the drama and in the end everything ties up so nicely?

Sheer fantasy.

A couple of Thanksgiving tales from the archives of my brain.  I’ve changed all the demographics, and the plots, but you’ll get the basic idea.  And you’ll probably say, “I know these guys!”

You do, but you don’t.

Scene One:

The parents have come to the children for Thanksgiving dinner.  Dad has a degenerative disease, one that is slowly killing him.  Mom is the insufferable martyr who handles him alone, wants to put him in a residential setting, but he’s on a waiting…

First, apologies for being so slow to respond to the thoughtful comments on the post Work is Your Playground.   This is the link, if you’re interested in that conversation.  

Now for something completely different. 

The Therapeutic Agents of the 12 Steps  

I’m not sure how much real therapy people get when they’re in a 12-Step program prior to a hospital stay, or even after a hospital stay.  And not everyone gets a hospital stay.  

But my guess is that the 12-Step meeting or recovery group becomes the only source of therapy for most people.  And the therapeutic agents of the group experience include:

(a) purging bad experiences by talking about them;

(b)…

Family therapists and addictions therapists tend to part ways when it comes to whether or not to cut off, in the name of not enabling, the “sick” member of the family, the one who steals the silverware to pay for the cocaine, the alcohol, the heroin.  Pick your substance, none of them are free.

Not that we’re naive.  We understand that an addict will do anything to get substances, and will exploit the family, in all kinds of ways, as a coping strategy under stress.  Object?  Get drugs.  Drug seeking. 

But family therapists like to keep the door cracked, the lines of…

Boy, that sounds severe. Especially from someone who thinks of concentration camps, “Work Will Set You Free” propaganda, Hitler’s design to convince Jews to work themselves to death.

But some people who work the Steps tell me that they don’t get five minutes off. No time to play. They’ve played for as many years as they used and abused drugs and alcohol, and want to make up for time lost. The world needs them. People need one another, and as a person, they’ve joined the human race.

So people in recovery work when they work. They don’t cheat the boss, and when…

It’s too late for that, but I do have memories of Mr. Franken running as a joke on Saturday Night Live.   But maybe I’m dreaming.

I have grown children, political creatures, strangely enough, since I tend to be very apolitical. Maybe not so strange.

One of them is also in “the business” which is not a family business at all. The “business” in California is television and movies, and he plays around in this world. The only reason we let him watch so much television growing up was that he swore he would go into the biz.

You can’t deny a…

Sometimes I try to give people who are struggling with addictions a little chizik.  Chizik (rhymes with whiz-ick, hard “ch”) is the Hebrish (Hebrew/Yiddish) word for strength. 

I tell them a quick story a patient told me a long time ago, but the message still works.

I imagine the old-timers in the 12 Step programs tell annecdotes like these over and over again.

An abused teenager cuts school to get high, with or without her friends. She’s severely depressed. At some point her family garbage has worn her down. She used to get good grades. She used to care about people.  No longer.

She’s only 15 and already has a…

OR CAUGHT IN A STAGE OF EMOTIONAL DEVELOPMENT. Which is it? How about both.

It’s been said that people with substance abuse and dependency disorders are stuck in the stage of development they were in when they started using, depending, or both.

And it makes sense, really because when that happens, when a person’s first true love, first reliable source of coping and satisfaction is a drug, then psychological development, something that depends so much upon socialization, meaning, depends upon people and healthy relationships, is going to suffer.

So a therapist gets a good psycho-social addictions history and at some point in the treatment…

I’VE SEEN 28 DAYS, AND TALKED TO ENOUGH PATIENTS WITH ADDICTIONS TO KNOW THAT WHEN THEY’RE IN RECOVERY and can keep a plant alive, it’s a very good sign.  A person who can keep a plant alive is getting better.

And vice versa, if a person is trying to get sober but fails, so will the plant.  A very bad sign.

I think it’s so cool how this works.  A person’s going along, controlling the desire to drink or get high, then it happens, there’s a slip, a binge.

For addicted people, you know, a slip is generally going to be a binge.  People who…

AT THE GATE I EMAIL MY KIDS, ALL ADULTS, TO TELL THEM ABOUT MY TRIP.

Why would I bother texting with thumbs on a cell phone when in only a few hours I’ll be home? The anxiety. It’s the anxiety. Maybe I won’t make it home. Maybe the plane will go down. Who knows? So I email them. I say:

The trip was great, a real vacation. Four days I didn’t make a single meal. People fed me. This is what it must be like to be a child. It is a very good deal. Kids shouldn’t complain so much if there’s food…