Why I Told My Clients about My Surgery

Years ago, when I was 6 years old, my family was in a massive car accident. That event, which nearly killed my parents, is a nodal life event for me. It is the source of many years of mental suffering, as well as the focus of eventual healing and my interest in psychology.

I was seated behind my father, who was driving, when the drunk driver hit our station wagon head on. The driver’s seat slammed into my knee, and jammed my hip into its socket. For the last 20 years or so, I have gradually lost range of motion in that leg, and felt occasional pain that has kept me in PT steadily for the last 5 years.

I finally decided it was time to find out what was what with my leg. It turns out the joint is destroyed by arthritis, and that there remains nothing more to do for it but replace it. I am going in for surgery next week.

As I have had to plan for a gap in my practice for the 2 weeks my surgeon anticipates I will need to rest and rehab at home, I decided to tell my clients why. I know that most of them would have asked me directly anyway, since we regularly talk about vacations, or trainings, or family obligations that change my practice schedule.

But the primary reason I share my personal health decision with my clients is that appropriately sharing more of myself within our therapeutic relationship is central to the way I believe good therapy works. I bring the whole of myself to our conversations, and that includes general personal information that connects me as a human being to their own lives.

I don’t believe that my clients need to know everything about me. Far from it. After all, therapy is about Them, and the worlds and issues they wrestle with in my presence and with my help. But sharing basic social information, stuff that connects us at a human level, is healing because it builds our connection as well as our equality before one another. My clients know I’m married, something about my hobbies, that I have young adult children, that I worry about how they are doing in their lives, that I have family I visit on vacations. They know I was a parish pastor; some of them have asked me why I left. I have shared some of that deeply personal and difficult journey with them. And we continue to build our relationship, even as we focus on their lives.

I believe what the research describes: that with over 200 or so discrete psychological theories, techniques and perspectives on human change that currently exist, what lies at the center of all of their effectiveness is the relationship between the clinician and the patient. The trusted, caring space between us that I work to sustain.

That is why I have told my clients about my hip surgery. My leg issue is not secret; most of them have noticed my limp. Nearly all of them have wished me well. For me, the old model of a clinically distant, intensely private therapist is less than helpful. As I see it, without trusting me to be human and real, how can my clients be real and human with me?

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When Empathy Goes Awry : Mirror Touch Synesthesia

How do we come to understand another person’s emotions?

Within our brain are a cluster of nerve cells that scientists call “mirror neurons.” These cells and circuits turn on and develop when, as infants and toddlers, our primary caregivers express on their own faces what they sense in us. We are wailing because we are in pain? A caring parent has some of that same suffering in their facial expressions. We laugh and smile when we begin to recognize our mother’s face, and our mother smiles and laughs with us. This is how the human baby begins the long process of understand the self, what s/he is experiencing, and who others are, and what they are experiencing.

Most human beings have adequate care as children; their caregivers give more or less consistent emotional feedback to them day-to-day, and the emotional skills of knowing how we feel and how other might be feeling develop naturally. Those children who suffer early life deprivation (e.g., orphans in mass care settings, like those in China) may never completely catch up with their peers who were raised in small family groups. Others, who may have the terrible fortune to be born to uncaring, chemically addicted or violent parents, will suffer personality changes that will hamper their natural capacity to feel their own emotions and care about others for the rest of their lives. Those early life experiences of caring, love and emotion are that important to normal human development.

But that is the normal or mainstream human experience of noticing emotion in others, understanding what they might be feeling, and sharing human experience. What if those mirror neurons don’t stop developing? What if those experiences of feeling another person’s pain actually become your own body feeling not your own emotions, but those of people you see and feel?

That is the extremely rare and the terrible lost-self experience of those with Mirror Touch Synesthesia. These folks have mirror neuron circuits that in some mysterious way over-developed. Out among people, they “catch” the emotional experiences of others in such deep ways that it is hard for them to know what is their own emotion and not the experience of others. This disorder seems to run in families, and has the capacity to ruin not only individual experience, but the relationships that person tries to maintain.

Want to hear more, including an interview with a woman who suffers from MTS? The new NPR podcast “Invisibilia” just included a story on this phenomenon — here’s the link for the January 29, 2015 broadcast:

http://www.npr.org/podcasts/510307/invisibilia

It’s fascinating, and disturbing. As it turns out, helpful empathy, the kind we want our parents, friends, teachers, chaplains and therapists to cultivate in themselves, has normal limits. None of us, it turns out, wants to so inhabit the emotional lives of others that we don’t know exactly what it is we are feeling. Because what we feel is the center of who we are.

What Every Husband Ought to Know about Marriage Conflict

Nobody likes to hear someone close to them be critical, blaming or shaming. It feels bad. And sometimes scary. It turns out that when women talk like that to their husbands, contrary to popular opinion, most men feel this intense criticism very strongly in their bodies. And because male bodies “rev up” faster than women’s in stress (heart rate, blood pressure, muscle tension, tunnel vision), in order to protect themselves and their relationships from too much emotion, men frequently, readily, as a default, go into Defense mode.

It’s vital for happy, flexible marriages to have partners who know how to manage difficult conversations. There will be many of them over the years.

As I said in my last post, women have to learn how to bring up their complaints softly, gently, and with a caring touch.

Men need to recognize their usual default of Defensiveness, and learn to lower their emotional walls quickly.  If men can do this, while at the same time women practice being more gentle, the best situation for a positive interaction around difficult topics happens.

The most successful couples work on this communication posture change together. Trusting that the other is doing their best to move out of their “automatic” thinking/behavior/posture and tone to a more couple-friendly communication strategy.

Because I talk about these automatic couple missteps every day in my therapy practice, I know this is one of the most common couple problems. No one part of the couple can fix the problem completely on their own : each person in the marriage has a piece of the solution!

What Every Wife Ought to Know about Marriage Conflict

If I had the opportunity to share one essential marital tool with every wife in America, I know exactly what I would say:

Learn to bring up difficult topics with your partner in a calm, quiet and focused voice.

Marital researcher Dr. John Gottman has studied tens of thousands of marital conversations over 30 + years. He has found that there are 4 distinct communication habits that are poison to happy relationships. He calls them the “Four Horsemen,” like the biblical horsemen that bring in the end of times in the book of Revelation.

He has learned that men have a faster body response of adrenaline (increased heart rate, blood flow to the extremities, tunnel focus of attention) than most women to partner conflict. That means that when many women are just getting into the meat of their problem, their partner has become ready to run, fight and defend. It makes it very hard for men to stay focused and listen calmly without enormous effort.

If every woman could develop the personal skill of bringing up difficult discussions with their partner in a calmer way, their male partner is less apt to “flood,” focus and defend. And the conversation is more likely to be productive and problem-solving.

It’s a skill we practice in therapy all the time. Are you able to bring difficult topics up to your partner in a calm, cooperative way? If not, you may want to start working on this skill.

What is it that I wish I could tell every husband in America? Well, that’s for next time.

Men Have Emotions, Too

“Men seem to have a mental file drawer where they can store unpleasant experience. Open it up, drop it in, slam it shut. Done.” One of my friends was talking about her own experience in her marriage, and wondered if I agreed.

Well, it’s complicated. I do think that in western culture, men are expected to be problem solvers: movers, shakers, thinkers. This is what it takes to succeed in a market economy, where competition for work and other resources parallels the competition for food, shelter and safety of our earliest human ancestors. This ability to compartmentalize their lives? I see it as a psychological defense. Men are taught early in life that boys don’t cry, that when in pain they should shake it off, and that they need to be prepared to bring themselves, if not their families, and their communities to the front lines of life’s battles every day. And if their life battle isn’t a literal one, it certainly is core male metaphor.

That old saw, biology is destiny, is rather real. Men don’t bear children; women do. And women’s bodies and brains have for tens of thousands of years shaped women’s experiences of themselves as child bearer, child protector and nurturer. Women’s brains (recent fMRI imaging bears this out) have been primed to first see the world through relationship and emotional perspective. Men have brains that have developed to give a stronger preference to problem solving.

No wonder we can have trouble talking to and with each other. Women complain that their men don’t listen to them; that they simply hear every conversation with their partner as a plea for information, solution or fix. Men complain that they don’t know what their women partners want from them, if it isn’t what they are naturally good at.

I see this difference in my work as a therapist, but I see it as much through a cultural and family lens as I do a biological or neurological one. Yes, human beings have had gendered roles around children and family life as long as we have recorded history. Yes, we inherit strong personality traits from our parents, who themselves have inherited similar traits from their families. Yes, our culture has deep, anxiously held gender meanings for men (witness the current chaos that transgendered or gender-queer youth have when trying to play high school sport of their gender preference, not their biology) and you will begin to understand how hard it is for men to be really comfortable with their emotional lives.

But men, like women, are people. And we human beings all have these biological responses to the world called emotions that give us information and neurological action split seconds BEFORE our brains kick in to gear with thinking. Men are just taught to rush through them to get to their preferred way of being, thinking. Women are encouraged by biology and culture to notice emotion and better integrate it into their thought.

How can we get through this gendered issue to a better, more satisfying way of being with each other? I teach my clients to reach for their emotional reactions first. I ask men to think about looking for their female partner’s emotional experience, to respond to that, before they begin to problem solve. “Empathy first,” I intone, time and time again. And for women, I teach them tolerance for their partner’s (perceived) emotional dismissal, and patience as they must ask time and time again for their husband to listen and understand them first before they tell them what they ought to do.

We are in this together, men and women. We are all emotional beings, whose preferences with those experiences seem to differ fundamentally. But we are also creative, plastic, changeable beings, too. We can learn to better dance together. Couples who have adjusted to one another in this fundamental way can find a continuous, subtle joy in talking with and sharing life with each other.

Long Term Marriages are Different

From Madeleine L’Engle’s Two-Part Invention: The Story of a Marriage: 

Speaking of her 40 year marriage to her husband Hugh Franklin:

“We were not a latter-day Heloise and Abelard, Pelleas and Melisande when we married. For one thing, the Heloises and Abelards, the Pelleases and Melisandes, do not get married and stay married for forty years. A love which depends solely on romance, on the combustion of two attracting chemistries, tends to fizzle out. The famous lovers usually end up dead. A long term marriage has to move beyond chemistry to compatibility, to friendship, to companionship. It is certainly not that passion disappears, but that it is conjoined with other ways of love.

Of course, the culture tends to glorify the passionate whirlwind romance, rather than the steady committed marriage. Anyone fortunate enough to share in the latter, to enjoy true love, realizes how empty is the former.”