Julie Miller's Mental Health Blog

Archive for June 2010

Relationships.

Humans require relationships.  Perhaps some cultures are better at them than we are in America.  Perhaps some individuals are better at them than the mainstream in the United States.

Divorce rate now around 50%, right?  There are websites by the thousands purporting to help keep relationships together, or help you make a good choice for a mate.  There are opinions everywhere about why the divorce/break up rate is so high.  (If we count break ups where the two individuals aren’t married, would that make the rate higher or lower?)

Are we getting worse at relationships in America?  This culture moves so quickly, it’s hard to tell what, if anything, might be the cause, if indeed we are getting worse at it.

I can tell you one thing that will definitely make a relationship rocky – attachment issues.  If I wasn’t attached securely as an infant/toddler/child, then I will struggle with it as an adult.  And successful relationships require attachment.

Haven’t you heard?  We marry our mother/father/significant caregivers when we grow up.  Well, you know what I mean.  If my heart doesn’t go “pitty pat” when I’m dating someone, I am not interested, right?  And if my heart does go “pitty pat,” you can rest assured that there are some significant shared dynamics between the man/woman of my dreams and my mother/father/significant caregiver from childhood.

Just look at your own relationship.  What are the positives about your childhood caregivers?  The negatives?

Now, make a list of those same characteristics (+ and -) about your boyfriend/girlfriend/lover/partner/husband/wife/etc.  Circle the similar dynamics.  Take your time and be honest with yourself.

It’s not like it’s a BAD thing; it’s just how it is.  This is how humans work.  Like we have a choice.

There’s no point in looking for “Mr./Ms. Right.”  Sure, you can maybe find someone who reminds you of your caregiver who has a job as opposed to one who doesn’t, but the underlying dynamics will remain similar.  “Trading up,” is what we call that.

Given that it is what is, use the insight to grow, to improve yourself.  Since there’s no “Mr./Ms. Right” out there, become “Mr. or Ms. Right” for yourself.

Public diagnosis without genuine assessment is an example of quack psychology, It is  unethical and a disservice to society.  It exploits the vulnerable individuals who are struggling in their lives who are on the receiving end of this kind of quackery.

I listen (occasionally only) to some of the psychologists and therapists on TV talk shows, either with their own show or commenting on some subject on someone else’s show.  Don’t even get me started on Dr. Laura.  Generally speaking, I find the information from these individuals is overly simplistic or too black & white.  Issues people are struggling with are hardly ever cut and dried, and a 2-minute soliloquy is hardly even helpful to the person with the problem or someone listening who can relate .

I think it’s irresponsible to offer a glib opinion in this manner.  And, is doing psychotherapy on TV really an ethical practice?  Maybe we can’t call what we see on some psychologist’s talk shows actually “psychotherapy,” but wow – give me a break.  These one-hour “fix it” shows can leave one with the impression that all you really need to fix your problem is to get some bossy know-it-all to read you the riot act and you’ll clean up your act.  Yes, sir, with a salute, and all is hunky dory.

Not so much.

Quirk.  Qualm.  Quaint.  Quality.  Quick. Quack.

Nothing in the DSM-IV begins with a “Q.”  I can’t even think of a good “Q” word that has much interest (at least for me) in the mental health field.  I won’t do the “queer” thing, or “queen.”

“Quirk” could mean eccentric, and possibly schizoid, but that’s a stretch.

“Qualm” related to fear or doubts could be a topic, but again a stretch.

“Quaint.”  Come on.

“Quality.”  “Quick.”  Nah.

“Quack.”  Ah, now this is something interesting.  Are there quacks in the mental health field?  Why, sure there are.  If a quack is “an untrained person who pretends to be a physician and who dispenses medical advice” (wordnetweb.princeton.edu/perl/webwn), a mental health quack would be an untrained counselor or therapist practicing mental health treatment .  To practice independently in the State of Arizona, a mental health professional must be licensed at the independent level:  LPC (licensed professional counselor, LCSW (licensed clinical social worker), LMFT (licensed marriage and family therapist), or LISAC (licensed independent substance abuse counselor).

An individual with LAC, LMSW, LASAC, or LAMFT after their names are licensed only at an associate level, and must be supervised by a qualified supervisor with an independent license from the State.

In addition, the individual must practice within the scope of their license.  Mental health professionals seem confused about scope of license.  I have witnessed licensed independent substance abuse counselors introducing themselves as Certified Eating Disorder Specialists, and yet they do not practice under the supervision of a qualified clinical supervisor licensed at the independent level.  I have met an individual with a LISAC providing relationship counseling.  I have met an individual with a LISAC providing counseling to children and adults with attachment issues.  None of these individuals are practicing within the scope of their license.

These individuals are conscientious and hard-working, and yet they chose to practice outside the substance abuse field.  Eating disorders and relationship issues, including “codependence,” are not substance abuse issues.  Even problem gambling is not a substance abuse issue.

These individuals may be well-trained and experienced; however, their license restricts them to working with certain issues.  I don’t say this out of a sense of superiority or in an effort to put down someone’s license status.  I have a LISAC, but I also have a LPC, which allows me to work with any issue in which I am trained related to behavioral health issues.

Licensure is in place in the State of Arizona to protect the public.  To protect the public from quacks.  Those practicing outside the scope of their licenses are not quacks, but they have not gone through the training and testing that required of a LPC or LCSW.

When you talk with a counselor or therapist for the first time, always ask for their qualifications.  What is their licensure?  Who is their supervisor, if they are not independently licensed?  What is the scope of their practice?

Oh, and stay away from those TV psychologists – they’re often not licensed anywhere at all!

Passive aggressive behavior does not mean someone has passive aggressive personality disorder, maybe traits or features, if there is a pattern.

I don’t have much of a pattern, but I have two stories from my own life which I believe demonstrate passive aggressive behaviors.  I hesitate to share them because I know out there somewhere these poor people involved in this will be saying “SEE!  I TOLD YOU SO!” if they read it.  The chances of that are unlikely, I admit, but I must say these are not shining examples of my past behavior.  Anyway…

Many (and I mean many) years ago, I was engaged to a man who had moved in with me.  Well, naturally things went south and we broke up.  Actually, I broke up with him first, but agreed to give it another shot and go to couples counseling.  He then broke up with me in the therapist’s office.  I must say I was very highly peeved.  This seemed like a passive aggressive behavior on his part.  Within a few days, he asked to borrow my garden hose, to which I agreed.  I was meeting him to exchange some stuff.  Well, of course I “forgot” the garden hose.  I did not make a conscious choice to do so, but in retrospect, I can see I was angry with him and didn’t want to continue the engagement of his having my stuff and then having to get it back from him.  It was a convenient way to get what I wanted, and to say “NO” without seeming to be mean or petty.  Big deal?  No, but I didn’t feel good about myself.

Also many (many) years ago, I was asked by an acquaintance to meet with her regularly to talk about recovery in 12-step programs for relationship issues, like a sponsor.  I did not want to do this; I felt a little coerced by another person who wanted me to do it, and I did not stand up for myself.  Instead of saying “NO” and risking looking bad, I said yes.  I was late or “forgot” almost every one of those early morning meetings at a local restaurant.  I remember awakening to her phone call from the restaurant and just beating myself up time after time.  Finally, I realized I didn’t want to do it, and I was wasting her time and mine by continuing to agree.  I got honest, she expressed a worse opinion of me than if I’d just been honest from the beginning, and at last I could sleep past 7 am guilt-free.

Lesson learned.  If I’m not honest in saying NO when I mean it, I’ll find some way to say it indirectly.  So even though it’s sometimes difficult to say no, knowing it may hurt another’s feelings or disappoint them, I still know I must do it.  Otherwise, we’ll both be paying the price.

“He’s/She’s so passive aggressive…”

A pervasive pattern of negativistic attitudes and passive resistance to demands for social and occupational performance, beginning by early adulthood.  The DSM describes this as a condition requiring further research, but I’m guessing most of us have interacted with someone who displays these characteristics at some time in our lives, or maybe BEEN one of these folks.

The DSM-III (p. 733) goes on to describe the individuals as those who resent, resist, and oppose demands to function at a certain level.  This can include procrastination, forgetfulness, stubbornness, and intentional inefficiency, especially in response to tasks assigned by authority figures (or frankly, anyone willing to make a “demand”).

Remember, this is a PATTERN of these behaviors.  A way to say NO without really saying no.  It’s like being a wolf in sheep’s clothing – I look so nice and docile on the outside, but underneath it all, I’ll show you.  And I’ll get my way,…

Obsessive Compulsive Disorder (OCD).  Obsessive Compulsive Personality Disorder (OCPD).  These two are different.  Often I hear folks on the street saying something like “I’m so OCD” but I watch them for a few moments, and it’s pretty clear they are not OCD, but OCPD.

What’s the difference?  It’s kind of like this:

When I was a kid, my father owned Miller Redi-Mix, a concrete company that mixed, delivered, and poured concrete, that grey stuff that lines the streets, as gutters or sidewalks.  The grey stuff that makes up freeways and bridges.  Now, many people, even educated folks on national TV news, will call that grey stuff “cement.”  Holy cow.  That made my Dad’s neck hairs stand on end.  “CONCRETE!” he’d say emphatically, correcting the otherwise erudite speaker.  “Cement,” he’d say,” is the stuff that makes the sand and gravel stick together to make CONCRETE.”

Oh, and the other thing.  If a nice painting is hanging on the wall, that a PICTURE, not pitcher.  A pitcher is that glass thing from which you pour iced tea or lemonade on the porch during a hot day.

Oh, and one more thing.  It’s NUCLEAR, not nuculer.

So my Dad demonstrates a perfectionism and rigidity (sorry Dad) common for OCPD, not OCD.  OCD is characterized by ritual, counting, cleaning, etc.  OCPD is characterized by a chronic pattern of detail-oriented and rigidly focused perfectionist behaviors.

Since I’ve confessed here my family history of OCPD (probably just traits or fearures, not a full-blown personality disorder, although my coworkers and supervisees from the past may not agree), I can admit to being concerned about symmetry when multiple photos or PICTURES (nod to Dad) are hung on a wall.  I don’t have to get up to straighten the frames any more (thank you thousands of dollars in therapy), but I do notice when they are not straight or not symmetrically arranged.

I correct others (usually in my head, but sometimes aloud) when someone uses the word “dependency” when talking about chemical “dependence.”  A “dependency” is a colony, or a geographical area politically controlled by a distant country (thank you Sandra, my internship supervisor from many years ago).

Also, an ape is not a monkey.  An orangutan is an ape, not a monkey.  A chimpanzee is an ape, not a monkey.  A gorilla is an ape, not a monkey.

See what I mean?

OCPD is about detail, and things being just right, in one form or another.  While it makes my supervisors happy because I’m highly observant and detail oriented, it drives supervisees a little wild.  Fortunately, they have always indulged me.

What about OCD?  What’s your experience with it?