October 2010

I’m reading Whitaker and Malone’s 1951 book The Roots of Psychotherapy, an early attempt at a general theory of therapy. Whitaker was a psychiatrist who started working with families in the very early days of the family therapy field. It’s a good book, though not an easy read.

My favorite of his ideas so far is that of the social therapist. He says that since everyone has troubles, and everyone has some capacity to help others through troubles, everyone is a potential “patient” (therapists still called their clients “patients” back then), everyone is a potential “social therapist,” and every interaction between people has the potential to be therapeutic.

What causes a potential “patient” to become an actual “patient,” and go ask a professional therapist for help is a failure of that person’s social-therapy community to help with their troubles. That, and the “patient’s” overcoming their own fear of change and their fear of the stigma our culture places on getting therapy.

Whitaker also tackles the sticky question, “What is a cured patient?” and concludes, “In short, the patient gets access to other human beings and, incidentally, enters the community as an adequate social therapist, no longer so concerned with himself that he cannot get and give therapy to others in a social setting.” (p. 79)

Dear Nathen,

US Airways is an awful company to do business with. Please do not forget this again. Perhaps this post will help.



I’m studying Emotionally Focused Couples Therapy, or EFT, this term in my Couples and Family Therapy master’s program. In her book for therapists, Susan Johnson writes that many people, especially those with histories of trauma, have strong fears about expressing strong emotions. She gives five common examples. These are directly quoted from her book, Emotionally Focused Couples Therapy, p. 73:

We may fear that if emotions are unleashed, they will go on forever.

We may fear that we will be taken over by such emotions and our ability to organize our experience, our very sense of self, will disappear.

We fear that we will lose control and be slaves to the impulses inherent in these emotions, and so we may make things worse or actively harm ourselves or others.

We fear we will not be able to tolerate these emotions and will go “crazy.”

We fear that if we express certain emotions, others will see us as strange and/or unacceptable.

This quote came after a shocking first-person description of what it’s like to work at a casino, mostly ripping off the Social Security and pensions of elderly folks with gambling problems:

“In this politically correct decade, the most horrific politically correct term ever created is the one that the gambling industry has made into an everyday word: Gaming. There is no game here. You pay and you lose; that is the game.”

Addiction Treatment, Van Wormer & Davis, p. 7

I’ve never been a huge fan of Dan Savage. He rubs me the wrong way kind of like Dr. Laura rubs me the wrong way. They both have moral codes so strong that they don’t need to know very much about a person before dishing out copious advice. Of course, they are both in the business of giving advice, so I guess it comes with the territory. I just want anyone with that much power to listen more and be less sure of their moral code. Their supplicants are real people with complex, unique histories, families, confusion, and pain. Advice before understanding is premature–I read that in one of my textbooks and underlined it. True. And if you think you understand someone after they’ve said a few sentences, you are wrong.

But this video makes Dan Savage a hero to me. This is using power for good. So many gay kids kill themselves! It’s a real, ongoing tragedy and shame in the US. Just at the developmental phase where fitting in is the highest priority, these kids are often denied respect and bullied mercilessly. But it gets better:

On 10/9/10, I woke up 6:54 am, vibrating with fear. I said this into my voice recorder. Imagine a super groggy voice. (Warning to the squeamish–I say the F-word and the SH-word, and it’s kind of gruesome, and worst of all I say “like” a lot.)

“Holy crap, what a nightmare… I go to a dentist to get my two fillings… and, uh, they gave me like shot after shot and were doing like brain stimulation stuff [this was the “dentists” shocking my brain through my skull over and over, making large parts of my face numb] and uh… shooting into my gums and eyelids, and drilling into my eyes… and when I left there I realized it was like 7 in the morning. I’d been there… I’d been there all night. I was like, “What the fuck?” and I went back. And I basically killed ‘em…. by banging their heads together… cause I realized—in the dream I was certain of this, though they totally denied it—it was like they hadn’t even drilled my teeth. My teeth felt the same. And I like, I kind of like worked out their scheme. It was like they had given me AIDS and like drilled into my brain. It was really creepy, just really creepy. Holy shit! I don’t want to have dreams like that. That’s fucked up. It started off nice enough, I was just going to the dentist. It was in a big house in the woods, kind of like Vermont….. Also, there were people that I knew in the house downstairs. I passed them on the way out. I forget what they said but when I came back I brought one of them up with me for moral support.”

Yesterday, I got two real fillings. Anticipating them is probably what prompted that nightmare. The dentist was very nice and very competent. The fillings are good ones. And it was brutal. Getting needles stuck deep into your gums to pump fluid in, getting holes drilled into your teeth, with a drill–these are undeniably brutal experiences.

I tried to teach myself something during that process. “Nathen, this is the result of putting off finding a new dentist. If you don’t like this, don’t put that kind of thing off.” My dentist in southern California diagnosed the cavities (the second and third cavities of my life) last December and said they were so small that he wouldn’t have to numb me or drill. Just a little sandblasting and a dab of porcelain. But then he got sick and couldn’t do the work before my term started. I came back up to Eugene and just hated the idea of finding a new dentist. All the dentists up here are way more expensive than mine, and who knows if their work is good? So I waited (Maybe I can make it to my next visit home! I take such good care of my teeth…) and agonized and eventually had my brutal fillings.

One of my definitions of adulthood is the absence of that kind of behavior: An adult is someone who just does what needs to be done. No agonizing, no procrastination. By this measure I am still working on adulthood. Perhaps this lesson will speed up my development.

I kept track of my driving mileage this last year here, and my biking mileage here. I drove (that is, I was the driver of a vehicle) for 5,056.1 miles and bought 152.341 gallons of gasoline. I bicycled 837.52 miles during the same year, almost entirely in just-under-two-mile-each-way commutes to school.

That means, according to the .28 calories per mile per pound of body weight calculation suggested by this site, I burned about 31,658 calories of food by biking this year. That’s about 1,266 medium-sized carrots, or 220 beers. And, according to this site, that is approximately the same number of  calories that are in a gallon of gasoline, so I bought 152 times as much calories of gas to drive my 5,056 miles as I did food energy to bike 837 miles. That makes biking a heck of a lot more efficient! My driving calories could have gotten me about 125,000 miles on a bicycle.

I’d like to do a cost analysis, too, but I’m behind on updating Quicken. Maybe later.

I’m taking a class called Contemporary Issues in Addiction. One of the things we’re learning about is how different clinicians think about addiction. Here are the official diagnostic criteria for substance abuse and dependence, word-for-word from the DSM-IV-TR:

Criteria for Substance Abuse

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:

(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

(b) markedly diminished effect with continued use of the same amount of the substance

(2) withdrawal, as manifested by either of the following:

(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

(b) the same (or a closely related substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

With Physiological Dependence: evidence of tolerance of withdrawal (i.e., either Item 1 or 2 is present)

Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)

Course specifiers (see text [below] for definitions)

Early Full Remission

Early Partial Remission

Sustained Full Remission

Sustained Partial Remission

On Agonist Therapy

In a Controlled Environment

Here are those definitions, from pp. 196-7:

Early Full Remission. This specifier is used it, for at least 1 month, but for less than 12 months, no criteria for Dependence or Abuse have been met.

Early Partial Remission. This specifier is used it, for at least 1 month, but less than 12 months, one or more criteria for Dependence or Abuse have been met (but the full criteria for Dependence have not been met).

Sustained Full Remission. This specifier is used if none of the criteria for Dependence of Abuse have been met at any time during a period of 12 months or longer.

Sustained Partial Remission. This specifier is used if full criteria for Dependence have not been met for a period of 12 months or longer; however, one or more criteria for Dependence or Abuse have been met.

On Agonist Therapy. This specifier is used if the individual is on a prescribed agonist medication such as methadone and no criteria for Dependence or Abuse have been met for that class of medication for at least the past month (except tolerance to, or withdrawal from, the agonist). This category also applies to those being treated for Dependence using a partial agonist or an agonist/antagonist.

In a Controlled Environment. This specifier is used if the individual is in an environment where access to alcohol and controlled substances is restricted, and no criteria for Dependence or Abuse have been met for at least the past month. Examples of these environments are closely supervised and substance-free jails, therapeutic communities, or locked hospital units.