Mixed Nuts: or What I’ve Learned Practicing Psychotherapy
TABLE OF CONTENTS
The Title 3
Opening Parable 8
HOW DID I WIND UP HERE? 16
The Journey Toward Licensing 19
Time to Go to Work 49
WHO’S AFRAID OF ANXIETY? 64
My Train Trestle Story 64
Fun with Controllers! 69
TACKLING ANXIETY 82
Specific Phobias 82
Social Phobia 92
Panic Disorder 94
Obsessive-Compulsive Disorder 99
Generalized Anxiety Disorder 109
Oh…Loosen UP! 111
NO FUN TREATING PTSD 114
“VKD Lite” 124
VKD Technique 128
The Reality of Working with Trauma 130
“DEPRESSED? …JUST CHEER UP!” 137
OTHER ASSORTED NUTS 146
Bipolar Disorder 146
Borderline Personality Disorder 161
Substance Abuse 168
Feeling is Healing: The Truth about Emotions 173
You Wanna Talk ANGER? 177
Cruise Control 185
RELATIONSHIPS: SEA-WORTHY OR SINKING? 189
What Goes Wrong In Some Relationships? 189
Abusive Relationships 192
Why Do I Keep Choosing The Worst Possible Partner? 200
How Do I Know If He or She Loves Me? 204
Relationship Counseling Cases 207
The Key to Successful Relationships 212
Keeping Romance Alive 214
Learning To Be Married 217
THE THERAPY BIZ 220
Psychotherapeutic Style 220
Psychotherapeutic Methods 232
Dual Relationships with Clients 240
Psychotherapeutic Reality 242
QUESTIONS AND ANSWERS 249
Closing Parable 297
Excerpt: Meeting Hannibal Wrecktor
During my internship at the hospital, I treated only one patient who really scared me. Not only was Hannibal Wrecktor on a locked ward, but he was also locked in his room! This was quite unusual.
This was Hannibal’s 42nd hospitalization. He suffered from severe Bipolar Disorder and enjoyed hitting people when he lost his temper. He was here because, while arguing with his 18-year-old daughter, he punched her so hard in the stomach that it had aborted her pregnancy. I was asked to meet with him to determine whether he was a good candidate for individual therapy.
One of the staff unlocked his door and told me to knock when I was ready to leave. I wondered how long it would be before someone heard me knock or scream.
Hannibal sat on his bed. He appeared middle-aged, disheveled, and sluggish, with one seriously mean-looking face. I offered my hand and said, “Hi! I’m Rick Cormier.” Instead of shaking my hand, he looked at it as if it were a dead rat. I sat on the empty bed across from him.
“So, how are you?” I asked.
Hannibal just sat there staring at me. I wondered how long it would take for him to jump up from his bed and kill me.
“Do you think you might want to work with someone on a one-on-one basis?”
He just glared at me. I wondered how long it would take for me to get to the door and break it down with my fists.
“Well, Hannibal, it’s been a pleasure meeting you!” I lied.
I went to his door and knocked. Thankfully, I soon heard the sweet sound of the door unlocking.
I headed back to Dr. Ahmed’s office, with the intention of telling him that this guy was definitely not a candidate for individual therapy. Dr. Ahmed was busy on one of the wards. No problem. I’d tell him tomorrow.
That evening, I had a class in clinical work with Dr. John Twomey. I told him and the class about my experience with Hannibal. My classmates were horrified! Most of them treated clients who suffered from disorders such as Acute Disappointments, Chronic Dissatisfaction, and Unmet Expectation Disorder. The idea of treating actual crazy people was entirely foreign to most of them.
Dr. Twomey listened to my story and asked if I planned to see Hannibal again.
“No way! He’s not ready for individual treatment!”
“I want you to do me a favor,” he said. “See him just one more time. But, this time, don’t feel pressured to draw him out. Say hi, but then just sit there and wait for him to talk. I promise you won’t have to wait even 30 seconds before he says something.”
I was torn between relief that I would never have to see Hannibal again and my admiration for Dr. Twomey, who was the most intuitive therapist I’ve ever known. He was known for making predictions like that in class, and he was always right. I so wanted to be as good as John Twomey.
So I agreed.
The door was unlocked, and I was led into Hannibal’s lair once again. I said, “Hi.” and sat on the empty bed. …and waited.
After about 20 seconds of awkward silence (though it seemed like much longer) Hannibal frowned and said, “So, how are you doing?”
Two weeks later, his door was unlocked for the last time. He and I began having our sessions while walking the hospital grounds twice a week. Thanks to the medication regimen and his new anger management skills, he was calm and stable enough to be released several months later. I have never been afraid of another patient or client since.
From the chapter, “Cruise Control”:
There are three major differences between you and me. Three things that make you who you are and me who I am: Genetics, Nurturance, and Choices.
Genetics has determined my height and my hair and skin color, my resistance or susceptibility to some illnesses and conditions, etc. Nothing too profound here and not much I can do about it.
Nurturance is a bigger deal. How I was raised determines much of my personality, tastes, habits, joys, neuroses, and fears. A huge part of who we are was formed during our childhood.
As a result, many of us grow up blaming our parents and our childhood for our baggage. And, while it may be true that our baggage originated in our childhood, it avoids the question of why we still drag it around as adults.
That brings us to Choices. During our childhood and teen years, we began to have choices independent of our parents. We made good choices and bad. We learned from them, paid the consequences of those choices, or enjoyed the benefits of them.
When we become adults, no one tells us that we can choose to remake ourselves. Most of us approach life with the belief that we are the result of our upbringing, for better or worse. It’s convenient because my flaws and poor choices become someone else’s fault. If I’m shy or overbearing or quick to anger, it was how I was raised. Deal with it.
I call this “cruise control.”
Cruise control is who I am by default, the person my upbringing created, the person who is still reacting to my childhood experiences, reacting out of habit, the person who is still trying to please mommy or daddy or rebel against them. If I put no effort or thought into the way I interact, I’m in cruise control.
We don’t have to be.
We can make adult choices that result in the type of person we want to be. We can make choices based on what sort of person, friend, worker, spouse, or parent we would choose to be.
I’ll give you a personal example. As a dad, my father was marginal. He worked every day and put food on the table, but I have no childhood memories of him talking with me or playing with me. Ever. He took no interest whatsoever in anything going on in our lives. He just worked in a factory, drank a few beers at the VFW, came home, and lived in a private bubble. Spending time with my dad meant sitting in the same room with him while he watched a ball game on TV. And be invisible. Don’t talk, even during commercials.
When my son was old enough to play with toys, he would say, “Daddy, wanna play cars?” The first thought that automatically came to my mind was, “Why in the hell would I want to get down on the floor and play with stupid little Matchbox cars?” That was my cruise control. That was the voice of my dad, the voice of my childhood.
But I didn’t want to be my dad. I was determined to be a better husband and father than he was. I couldn’t change my father or my childhood, but I could be the sort of father that my son deserved.
How would that father have responded?
The response my son grew up with was, “Sure, Buddy!”
I got down on the floor and chose a tiny car. At first, this felt silly and awkward. As a child, I pretty much played alone. My brother was ten years older than me. Before long, the awkwardness faded, and I was engaged in playing with my son.
My son grew up with the dad I chose to be, not the one I was trained to be.
As for my dad, I learned that his father had been an abusive alcoholic. My dad’s bubble was for his emotional protection. It was for keeping him safe, not keeping us out. It also kept him from becoming abusive. He refused to be like his dad.
Just like I refuse to live in a bubble.
All of our neurotic behaviors happen in cruise control, without thought or intention. We need to train ourselves to delay those automatic reactions long enough to ask ourselves, “What sort of spouse/ parent/ sibling/ friend/ professional/ employee/person do I want to be? Can I react in a way that makes me feel good about myself?”
We can be whatever kind of person we choose to be. We just have to begin making conscious choices. It’s hard at first. Cruise control kicks in automatically and feels as natural as breathing. Cruise control is comfortable because we don’t have to question our own actions or their consequences. Expect to catch yourself screwing up just after you’ve done it. When that happens often enough, you may start catching yourself while you are screwing up. Your ultimate goal is to catch yourself before you screw up.
Your life and the person you are is the result of every choice you have ever made. When we learn to slow our reactions and ask ourselves what sort of people we would choose to be and start making choices with that in mind, we can create our healthy adulthood.