the artist

A westerner went to a famous Japanese artist and asked to commision a painting of a rose petal. The artist instructed him to come back in two years. In two years’ time, the westerner journeyed to the artist again, and asked if he might now purchase the painting. “Yes,” said the artist, “Please hand me that canvas.” The man handed him the canvas, whereupon the artist rapidly flew through the brush strokes, creating a beautiful painting of a rose petal. As the man paid for the painting, he asked the artist why he had not done that when they first met. “No, you don’t understand,” said the artist, and led him into the studio. Covering the walls were imperfect practice sketches of the rose petal.

sending the food back

The family of a colleague of mine enjoys dining out, but the elderly matriarch has a habit of sending her food back to the kitchen. The family would become concerned, worried that she was upset, but then my colleague suggested to them that perhaps she enjoyed sending the food back. Perhaps this was when she was most happy–after all, she was getting special attention during the process. Once the family came to realize this, they began to view her complaints in a new light. They could relax in the knowledge that she was doing what she enjoyed. No longer did it ruin the meal.

the psychotherapist in 2010

I want to briefly discuss three important issues to the psychotherapist: Avoiding burn-out, adapting to the current consumer culture, and leveraging time.

Avoiding burn-out. Psychotherapists have one of the best professions, helping people find peace and meaning in their lives. Therapists start out valuing their profession, but may become cynical. I remember in training hearing an experienced therapist say he was not sure if he could stand to hear one more complaining client. I thought about his comment for quite a while, because as a naïve beginning therapist it caught me by surprise. How could I avoid becoming him? Other therapists seemed to focus on continuing to hone their abilities to interpret client problems and select therapeutic responses. Could a key to avoiding burn-out be to continue to look for opportunity for improvement in skills? In Malcolm Gladwell’s Outliers: The Story of Success, he makes a good case for 10,000 hours of experience being a prerequisite to becoming great at something. I feel like I am just starting to get a handle on being a good psychotherapist.

Adapting to current culture. Old-school therapists have fixed schedules and answering services, and an implicit medical model, in which the client shows up at the appointed time and place and humbly accepts advice. Today’s society is of course an on-demand culture of digital video recordings in lieu of scheduled broadcasting, instant information from search engines, every product and service imaginable at our finger-tips, instant communication with anyone: all accessible from a personal digital assistant. Tomorrow’s successful therapist will likely be available via messaging and even web cam when needed. I suspect that people will come to increasingly expect egalitarian relationships between clients and therapists as they do between employees and managers or in the meritocracy of the web.

There is good evidence that the relationship between the client and the therapist is the key to retaining clients, and working in a collaborative manner enhances therapy.

Leveraging time. Being available on-demand in an information-rich culture with lots of user-determined content available dovetails with providing services in a more efficient way, allowing the therapist to do more in less time. One example of this is providing a place for users to exchange information in a moderated blog and other group-interaction settings. Although business models are lacking for much of the new egalitarian culture, therapist reputation, especially within a specialty niche, can be greatly enhanced with the greater degree of exposure that new media allow. Other options include creating residual income from the production of books and testing products, or conducting scalable groups and seminars. Finally, consider service activities as a way to enhance reputation in a personally meaningful and interesting way. Getting more out of your time does not necessarily mean working less. For example, it may make sense to fill therapy hours with selected pro bono cases, Medi-Cal (Medicaid) clients, and lower-paying managed care members prior to being able to fill all slots with better insured and self-paying clients within your preferred specialty area. Having a busy practice is a reputation builder, as is becoming known as the go-to person for a particular issue or disorder.

Viewing psychotherapy as an important and meaningful career should provide the incentive to become a master therapist, to build more responsive relationships with clients, and to adapt to current culture. Success should follow.

thinking out loud

Teaching and conducting psychotherapy are, I guess, a part of the service economy. The skills seem to continue to be in demand, even when manufacturing declines. However, they also involve an incredible amount of time of the teacher or therapist. I feel conflicted about this because, on the one hand, I love engaging in these activities (especially when they “go well”), but on the other hand, there are few tangible products that emerge, such as there are from publishable research. I have research ideas I really want to pursue but have not yet. Obviously there needs to be more of a balance in my life. I want to incoporate more reading, writing, data collection and analysis, not to mention family life, exercise and leisure, travel, learning. Time and again I come back to the time management issue, which is interwoven with financial planning. What a challenge!

thoughts about thoughts and emotions

Today I’m reflecting on some of the problems I see in therapy…. Borderline personality disorder (extreme instability in mood, self-image, and relationships, which often has emerged from early abuse experiences) reminds me of a hormonally driven adolescence: Anguish, self-destructiveness, and desperate behaviors. Thank god that wanes for most of us as we age. We replace it with generalized anxiety and sporadic dysphoria,  but with various coping skills that usually meet the challenges at hand.

A more ubiquitous problem is procrastination and the perceived lack of control over one’s own behavior. Ironic, isn’t it? The one thing people can control, they perceive that they cannot. That then can become a self-fulfilling prophecy, and a rationalization for taking the path of least resistance.

Then there are misjudgments, cognitive errors and distortions, and impulsive decision making. I appreciated a 10-10-10 rule published in Bottom Line recently: A suggestion that before acting we should ask ourselves how something will affect us for the next 10 minutes, the next 10 months, and the next 10 years.  And of course there are the two common questions asked by cognitive therapists: How likely is the event you are worrying about, and how bad would it really be? What’s the book title? Don’t sweat the small stuff, and it’s all small stuff? There are lots of good suggestions on how to stop worrying available online, by the way. Things like learning relaxation techniques, learning to think differently about the pros and cons of worrying, accepting uncertainty, and avoiding cognitive distortions.

happiness

Positive psychologists want to enlighten us with the results of studies that are interpreted to mean that having greater wealth is not associated with happiness, or that what is important is not wealth but wealth relative to that of our neighbors. Do any of us care about these studies? I for one do not; at least, I am not inclined to readjust my goals because researchers tell me I will not be happy getting what I want. If I were inclined to do anything, it would be to scrutinize their measures of wealth and happiness, to see how often their definitions of wealth translate into real, liquid, disposable resources, for example. And I suspect that how happy their study participants purport themselves to be has little bearing on the difference between how I feel when I have needed resources or do not. At least positive psychologists do acknowledge that wealth makes a difference when we are very poor. It is sort of like health, or job security: We do not think about them or care too much until they are gone. We take them for granted. We may generally value what we have, but these things really come into awareness when there are serious deficits. Fortunately, it is true that we adapt to the conditions that we find ourselves in, but that is not a good argument that these things do not matter to our well-being. The subjectivity and relativity of “happiness” do not impress me. Yes, we can make ourselves happy through our perceptions. Big deal. More relevant, and depressing, is the point that this outlook has a lot to do with our inherited genetic tendencies.

Freud really had it right, however, when he pointed to the importance of love and work. Cardiologists and introductory textbooks alike trumpet correlations between being in love, feeling loved, having a confidante, being in an intimate relationship with happiness and health. Similarly, job satisfaction and happiness are highly related, and probably contribute to each other.

tree

I have a huge tree in my backyard. It grows around the telephone wires. It can be seen a long way away because of its height. I had it trimmed this summer and I can now see more of its trunk and branches, with fewer leaves on the low branches to obscure them. It is odd to think of owning it, a live thing, this tree. The grass around it is dying in spots, as it is hard to keep the lawn watered enough, but I guess the tree’s roots go deep, and it thrives.

I sat in my backyard looking at this wonderful tree yesterday, and contemplated the end of summer. Today we have to be back on campus, for meetings. Reports have to be given, syllabi distributed, classes taught. It is always bittersweet to have a long summer away from the classroom, of course. We experienced it as students all those years and now we get to as faculty. One almost forgets how to do it, the classroom thing, over the summers. And so as a student we can show up, still not up to speed, and suffer through half-heartedly at first. As instructors, we have to gear up a little more quickly. And we have to deal with the throng of people wanting to add the course, ask questions, challenge the work or evaluation processes we are imposing.

All of the summer projects that did not get done will now probably remain undone for another 11 weeks, the endless cycle of the quarter system, the blocks of time we live our lives in. Now we have to meet deadlines and get lectures done.

things always look better in the morning

Depression is supposed to be worse in the mornings, but who wants to commit suicide before the first cup of coffee? Okay, bad example. But it does seem that when you are alone late at night, contemplating that you are alone late at night, those are not good times. It is like the difference between having to go to school in the fall, or to work in the morning, as opposed to having to stay in school as spring turns into summer or at work as day turns into night. Being alone is somehow okay in the mornings.

By the way, is it a problem if the person you are in a relationship with says she is not ready for a relationship? What about if someone you are in a relationship with says she is looking for a “real relationship”? These statements beg questions that I did not know I did not know the answers to. Once a student wrote on an evaluation form that I should teach the material, not just review it. That was a good point, but at the time I was confused by it. (For one thing, I had probably made the naive mistake of assuming the students had read the assigned chapters.) And of course people do tell me to learn how to drive, while I am actually driving, so none of these things should be that surprising.

Even therapy relationships can be screwy. One of the best Freudian slips I have heard was when a patient intended to tell me that she wanted to set up an appointment to discuss transference issues and accidentally said she wanted to set up a relationship. And if you say that there is no benefit from therapy but you want to keep coming so you can see the therapist, that is too much like real life. And maybe I am becoming cynical but I have decided that it makes sense to miss the appointment that is scheduled to discuss termination. And sometimes it seems that providing individual therapy is only surpassed by providing couple therapy as a way to facilitate a break up.

What is that citation for the study that showed that depressed people view things more realistically? Was that one ever refuted in this current positive psychology zeitgeist? Why does positive psychology seem silly when one is being negative?

del potro

Juan Martín del Potro did a number on Nadal, shutting him down by allowing only two games a set. I have to admit, though, it was moving to hear the 6′ 6″ Argentine, just shy of turning 21-years-old and now in his first U.S. Open final, indicate this may have been the best moment of his life.

serena

It was remarkable. Kim Clijsters was leading Serena Williams in the U.S. Open Semifinals. She had won the first set 6 games to 4, and was ahead in the second set 6 games to 5. In the last game, Williams was serving and down 15-30. She seemed frustrated at hitting the last two points into the net. On the next point there was some crowd noise, a low-key remark by the chair ump to the crowd regarding quiet, a slight pause, and then she served and it was wide. On her second serve she was called on a foot fault, possibly or probably incorrectly and in any case unusually (though earlier in the tournament it had also been called against her). That put the score at 15-40. She then walked over to the line judge and cussed her out, and apparently telling her she would like to shove the ball down her throat. When it persisted, the chair umpire called the line judge over to ask what Serena said, and this repeated, with Serena re-approaching the line judge and the line judge returning to the ump. The tournament referees came out. It was Serena’s second code violation of the match, because she had smashed a racket on the court at the end of the first set. Now it was match point, and a second code violation costs a point, so she lost the match by default, which she accepted. She walked to Clijsters and shook her hand, patted her shoulder, and exited the court, pausing to once again to make contact with Clijsters briefly. In the postgame interview, Serena indicated she had no regrets, but also that she had not realized she would get the point penalty. Her outburst toward the line judge was extreme, walking up near her and shaking the racket at her, and warranted a default by itself. It reminded me of the degree to which another American abuses umps, though typically via sarcastic questions–Andy Roddick (Serena is from Compton, by the way–near south central L.A.; Roddick is from Austin). Williams provides a strong contrast to the temperament of Nadal, who seems incapable of anger other than at himself. Clijsters will play Wozniaki in the final tomorrow (Sunday) 9-11 p.m. Eastern on ESPN2.

The men’s semifinals are also tomorrow: Nadal will play Juan Martín del Potro first (12-4 EST on ESPN2) and then Roger will play Novak Djokovic (4-7 on CBS). The final will be Monday (on CBS 4-7 Eastern). Del Potro beat Nadal in March in the Rogers Cup on a hard court in Miami, but we can hope for a Nadal-Federer final on Monday. Nadal has been bothered by an abdominal injury (and his knees), but after the rain delay against Gonzalez in the quarterfinals Nadal came back very strong, and I imagine that he will bring his usual physicality to bear on the Fed, and complete his career slam–the U.S. Open his one remaining quest. I for one am rooting hard for the Spaniard. And how about 17-year-old Melanie Oudin, from Marietta, GA, who made it to the quarterfinals?