<![CDATA[Aleta Edwards, Psy.D. - Blog]]>Thu, 23 May 2013 07:26:54 -0800Weebly<![CDATA[Never Give Up]]>Thu, 02 Aug 2012 18:01:43 GMThttp://www.aletaedwards.com/1/post/2012/08/never-give-up.htmlI don’t know when things began to be so misunderstood, but our cultures clearly contribute to perfectionism, shame, low self-esteem and a general dissatisfaction with the self.  Children learn young that they are supposed to be the “best,” and that involves as many people as possible not doing as well as they do.  We are supposed to build close relationships at the same time our “success” involves those around us not doing well.  This seems to me a sick system, but we are raised in it.  As a therapist who has treated numerous people who did manage to be the supposed best—even though they were intensely unhappy—as well as those who did not, I see what this does to people.  I have always told my clients that it is good to know what they are “good” at and what they are not.  When I started out, I remember being shocked that people had a hard time with this idea, that it was too loaded to be matter-of-fact.  And yet, people pour into therapy complaining of having low self-esteem.  What is self-esteem really but seeing ourselves as compared to others and coming out favorably or unfavorably?  Far too often people compare the act others put on to their own real feelings.  That is like comparing how you look as soon as you wake up to someone dressed for an event.
The things we are strong in then, as compared to others, form the basis for our so-called self-esteem.  I’d like to trade in self-esteem for self-love, but culturally this is a very hard sell.  Being happy with your actions and how you treat others, being tolerant and understanding, having compassion for others, being mindful of real feelings, both “positive” and “negative,” seeing how you affect others and why you react the way you do; these are all qualities that will lead to genuine contentment with one’s own self.  But having more or being better or stronger than others will not provide this contentment, and yet we just keep on striving for these.  How tragic, especially given that the people who play this game and win it still have no more “self-esteem” than anyone else—often less.  Now that they have “won” they know they are no good.  Why, they are exactly as they were before! 

I can’t tell you how sad it is when apparently successful people come for therapy in mid-life having a giant panic attack saying they have never done anything meaningful for anyone—for people, animals, the planet, science.  They are not only depressed and in crisis because of an emptiness and a fear of wasting life, but because of what they call low self-esteem. And if we want to be honest, the qualities mentioned above are valued by a relative few.  Raising my daughter, I don’t remember other mothers bragging about their children having a kind character or seeing a sense of connectedness, but they talked plenty about their grades and how they did in sports.  It was bad enough going through this junk in life and in my practice, a specific part of my life; I could not go through this anymore with the other mothers.  One “hot dog day” when I was volunteering and one mother kept pressing me, I had to tell her and a few others that different things were important to me and that I saw things differently and that it would be better if I were not in the conversation.  I kept thinking of the generations of this that would be produced.

Family conditions of course can create a shame-based, perfectionistic personality Not only do neglect, abuse, and creating fear for real or imagined mistakes all produce excessive shame and perfectionism, but so do the parents who buy into the culture as discussed above.  Many are shamed for anything less than excellence on a competitive standard.  Even when the parents do not buy in, the children very often develop shame-based personalities.  When the family has significant dysfunction, the child has little chance to be otherwise. 

People have forgotten that doing one’s best means doing one’s reasonable best, while allowing for life to keep happening.  I don’t know how many times I have told adult clients that doing their best on a job means doing the best they can while still maintaining a life.  There are work cultures now where people ignore the end of the day, ignore dinnertime, and at 11 or 12 at night one brave soul makes some excuse.  They raised the bar on themselves because the “best” for someone putting in 24 hours is more than someone working 8.  Then, sadly, some people, fearing they won’t measure up to a standard they have bought into, do not try hard at all, do not put in enough effort, so that they can say they didn’t make it because they didn’t try.  They tried to outwit the system they internalized but really were following it just the same.  It works on values and beliefs and feelings, not just behaviors.  The executives must love this dynamic.  Adults working till midnight to do their “best” and children crying because they did not make cheerleader—where has this gotten us? 

The “never give up” or “don’t be a quitter” value has placed numerous people, particularly the perfectionistic type, in sad and even dangerous situations.  We have all known people who say over and over they are going to do this or that, and we learn that they will never do any of it and simply let them talk.  But is the only way to not be that way to stick with a mistake, a bad situation, something that is wrong, or that we hate?  A good friend of mine and wonderful therapist told me years ago that he started college majoring in engineering.  I was shocked and couldn’t even picture him doing that.  He said that he got Ds and Fs and went to the counselor to see about tutoring.  The wise counselor told him that he could do that and would no doubt do better, but asked him why he would want to do this, since it was clearly not his calling.  After some tests and some questioning, he said he would like to be a social worker and ended up an outstanding therapist.  Why stay with a mistaken field?  Another client, a highly intelligent young woman, dated someone several times who was exhibiting troubling behavior, and she wanted to get out of it.  His words echoed her father’s: “You are just going to quit?  You are going to give up?”  She was miserable and had already cycled through a few tantrums of his and did not want to be with someone with that degree of rage.  She felt like a “quitter” and he knew how to manipulate that.  I’ve had clients where their parents even sided with the person mistreating their child.  The only way to get free is to face the whole thing.  So many times I have asked my clients, “Do what you want.  Who do you have to answer to?”

There are times when leaving the track we are on is the only sane thing to do.  It doesn’t mean that you give up the first time you have to study and put forth an effort.  But the black-and-white thinking that often goes with perfectionism does not allow for degrees.  A lot of people in abusive relationships have at the core the “never-give-up” philosophy, and this is tragic.  When whole cultures seem to have lost common sense, though, how can we expect children to grow into adults who can apply a common sense standard to what has been ingrained in them over and over?  What would happen if we decided not to buy into this thinking and help each other?  What if, after making a mistake or a bad decision, we said we would give it up?

I have seen too many perfectionists manipulated by people who have them convinced they are “bad” somehow for not wanting to be taken advantage of, and people who try to quiet the inner voice of shame in ways that will not work.  People turn now to mindfulness for a solution, and it is so important to know and remember that this path involves self-awareness. You can’t become mindful and ignore your true self.       

After 20 years of practicing, I am glad to do what I do.  I always want to help people with shame and accompanying issues.  I am still indignant for them, whether they suffered abuse in the family or the culture.  They will gain insight and self-compassion and will come to realize that their value to me is not based on the same system.  With each person it is a new journey.  It’s so hard for them, my brave clients, because just admitting they even have issues means they are not perfect.  People have told me that the first session was hard because it meant they have a problem, forgetting in their pain that we all have problems.  I spend year after year telling very bright and talented people that changing their major, divorcing an abusive person, leaving a horrible job, does not mean they do not keep promises.  I never lose patience with them but I get frustrated with a system that keeps doing the same thing over and over when it doesn’t work.  My supervisor when I was an intern told me once, “It is really only very little that we can do, but sometimes that very little is enough, and then becomes very big.”  I always want to keep doing this very little, and as he said, sometimes it is enough to result in genuine healing and awareness and authenticity.  It’s funny, but in my advertisement where I list issues I deal with I checked off self-esteem.  What else can I do really?  I do address what they are calling self-esteem but can’t in a short advertisement explain everything I’ve said above, so I guess I enter the system enough to be able to work with people who need this kind of help.  It really does fill me with wonder in a terrible way to see how, collectively, we keep banging our heads against the same wall, over and over and over.  It feels like I’m doing very little working with one person at a time who has been damaged, but I accepted long ago that we all can do what we can do, how we do it.  I accepted the “very little” my wise supervisor taught me about.        
]]><![CDATA[Forgiveness]]>Mon, 31 Oct 2011 22:52:45 GMThttp://www.aletaedwards.com/1/post/2011/10/forgiveness.htmlA lot has been written about forgiveness and much more can be written.   I think there is so much false forgiveness in our culture, it does more harm than good.  There are people who say they have never experienced any anger, and when you get to know them, you see many acts of passive-aggression, showing that they do in fact have anger.  But people think it is a spiritual stance not to have any anger, and I have known many people in the spiritual communities who are extremely angry.  I also think that people are judged for feeling angry in our culture.  I think the people who are angry judge others who openly express their anger and then feel one up.  There are people who have been horribly wronged—of course they are angry!  It’s interesting that our culture has so little tolerance for genuine and righteous anger, and yet we have such an angry culture.  All we have to do is look at all the spiritual one-upmanship that abounds to know how much anger is around. I am of the belief that to really forgive, whatever one means by it, there needs to be some understanding and acknowledgment of the anger and hurt felt, and what was felt by the perpetrator.  I do not think there is a “should” with forgiveness, but who wants to feel pain forever because there is an ongoing passionate hatred for someone, whether they deserved it or not?

In this blog I will write of a young woman who came first to genuine compassion and empathy and then forgiveness, and how she spread it around.  I think this is someone who walked the walk, not just talked the talk.
When I taught Child Development at ColumbiaCollege many years ago, I of  course had many young adults.  Many of my students had been abused and been in  foster care and many had experienced other hardships.  As we covered psychological development, many students shared their stories with either me or the whole class, and many would cry, as they saw themselves in the context of bigger dynamics.  It gave names to their feelings and drew them strongly into the human fold. While the class was not group therapy, I think it ended up serving some therapeutic purposes.

At one point in the class, I was teaching about projection and projective identification.  Briefly, projectionis when you attribute a feeling of yours to someone else.  You feel stupid and you think someone else thinks you’re stupid and you get offended.  Projective identification is complicated and has different forms, but for the sake of this blog, it is when someone has a terrible feeling and  has a need to replay it, hoping all the while things will be different.  So, someone who feels always taken advantage of will always offer a lot and then get fed up and angry after giving more than intended.  Someone who feels irresponsible will behave in a way that induces the other to get mad over the irresponsibility.  Projective identification is a manipulation of someone else and the someone else feels it…and minds it.  Let me give a personal example here to make it clear.

When I was in college as a freshman, my roommate was telling me one terrible thing after another about a female friend, pretty serious things.  Finally, I said that this sounded like a horrible person and  asked her why she didn't stay away from her.  She responded with, “You’re horrible!  How can you say that about someone else?” Now I didn’t know psychology as a freshman in college, but I felt this all right.  I told my roommate that she made me feel all indignant about how this person wronged her over and over and then blamed me for the feeling she made me feel.  When someone does this a lot, it means something that is not so good regarding their mental health.  But the sad truth is, we have all done it and only by being committed to being aware of our own dynamics do we stop.  It is one of our least noble behaviors, I think, but happens all the time.  Imagine how hard it is to do couple’s therapy—no kidding! It is like unraveling a necklace with a lot of knots when both people do this.

Anyway, a young woman in my class at Columbia shared a lot with the class.  She had been raised hard, and said that she had bruises behind her knees from her punishment and got a little teary once, although she still had a relationship with her parents and they loved each other. She lived in a different town than they did now.  She also told us she had a roommate who was not paying her bills, doing her share of the cleaning, and not giving her her messages.  She said angrily that her roommate was making her feel no control whatsoever and that she felt like hitting her, that she hated her, and that they had been having words.  Shortly after I taught about projection and projective identification, she came to class with a story to share.  She said that she had spoken to her roommate and that she realized she had her own issue of never feeling in control, that it wasn’t the roommate’s fault or intention or fault that she felt that way, that she carried that feeling with her and interpreted her roommate according to this feeling, maybe provoked here and there. She shared with the roommate and both cried.  The roommate said that her family always called her irresponsible and that she could see that she was setting things up so that her roommate (my student) would see her as irresponsible, but instead my student was thinking her roommate was attacking her control.  They both laughed and cried and saw that each fed into the other’s scenario and that no one could win.  They made a decision not to feed in.  As my friend Simone Cross pointed out, whether this was or was not forgiveness, learning some human dynamics gave my student and her roommate some compassion and acceptance for what had been going on, and the results were extremely powerful for both.  My student said in a wondering way how she has been doing this her whole life and how she realized she could never really see anyone other than as an extension of her own internal issues.  She was extremely moved.  I do not know if this was forgiveness, but it was  certainly an expression of compassion and empathy. 

The forgiveness that then came was with my student’s mother.  She went out of town to visit her family and spoke to her mother about how she used to hit her, leaving welts, and how her mother thought she was deliberately trying to drive her crazy when she was just being a child.  She and her mother cried and her mother apologized, saying that she did in fact interpret her child’s behavior according to her own dynamics, and she was so sorry she had done this.  My student said that her three siblings were visiting and they all talked about this, and that they felt a new-found closeness.  She did not want all the adult children verbally attacking the mother, and felt overwhelmed by a feeling of protectiveness, of love and gentleness. She said she learned how her mother got that way from her childhood, and that she forgave her mother a million times, and that she was just so sorry for the hurt her mother had experienced in her life, which had been significant. 
  
This was true forgiveness—not done to please society or to show she was a superior person, but the real thing. She learned about human dynamics, observed things in herself, saw the advantages this new awareness brought, and spread the word.  When her mother responded as she did, her heart poured out love.

Sadly, not everyone gets an apology or even an admission, and that is certainly much harder to forgive.  Maybe the highest form of forgiveness then is to just let go and move on with life, but this young woman was lucky in many ways.  Whether you think of forgiveness as an outpouring of love or just letting go and moving on, understanding some things about human dynamics in order to better understand yourself and others is a powerful tool that aids in forgiveness. The forgiveness in this example was as authentic as the anger itself.  While this is not the path of everyone, I think any kind of forgiveness, by any definition, relates to understanding that underlying the other person’s cruelty is pain, and that our interpretation of events will mix our own issues into it. 

This young woman’s mother had visited her in Chicago and came to class with her.  I met her… a sincere and hardworking woman.  We talked after class and they shared a lot with me.  At another time her fiancé came to visit, and he, too, came to class and we chatted.  We joked about how she could end up with lots of psychologists in her family.  She gave me a hug and kiss and a beautiful card the last day of class.  I loved it.  What I really loved is that this was the real thing, not a judgmental, smiling, secretly angry person pretending to forgive, but someone who was truly in touch with her feelings, making her much more amenable to growth than someone with layers of insincerity.  Many years have gone by, but the last I heard this young woman was married and a mother, and was able to laugh as she told how she kept an eye on herself and how easy it was to contribute negativity.  She became a person younger people came to for guidance.  I think of her sometimes.  I remember her telling me while still in her 20s that she felt old, referring to her wisdom. I remembering thinking this young woman would be a wonderful therapist, but when I asked her once if she had ever thought about it, she said she would “go crazy” pointing things out to people all the time, over and over and over, and that she would hate that job, reminding me that aptitude and a calling are not the same.
]]><![CDATA[The Gift]]>Sun, 28 Aug 2011 23:53:15 GMThttp://www.aletaedwards.com/1/post/2011/08/the-gift.htmlI think shame and a feeling of being bad or unacceptable come after learning we are separate.  We all have to learn this, like it or not. Then, if we are accepted in our separateness, we have a chance to not be filled with shame and a longing to be better in some vague way.  People who had miserable, abusive childhoods were obviously not given this and in fact are given multiple messages that they are bad.  That is the essence of shame, that we are somehow bad in a core kind of way. Yet, there are non-abusive homes in which the parents do not know how to let their children know that they are okay in their being different from them.  But some special parents do not need their children to be identical to them, to mirror how they wish they were.  My mother was such a person.  She never studied psychology but knew in her heart in a truly wise way.
I have early, preschool memories.  I always have.  I might have trouble remembering dates of everything important to me, or times, or names, but I remember some early things and I remember issues.  When I was very young, my mother didn’t work or drive and we would walk everywhere.  One day we walked to get ice cream cones, as was our custom.  My mother, ordering for us, asked for two vanilla cones.  I was very young.  I was gripped in an intense anxiety and asked her why she always got vanilla, as I burst out crying.  My heart was pounding and this was a significant development for me.  My mother, knowing what I was feeling, said, “Oh! I should have asked you.  Do you want something else?  Do you want chocolate?”  Crying, I said I  did.  My mother went on and said that we loved each other and that it was okay to not like the same things, that people can love each other a lot and like different things and that this had nothing to do with love.  She said she did not need me to like what she liked to know I loved her or to love me.  The anxiety started to leave me.  My mother then went on to say I was growing older and that she should have realized it was time to change the habit of just ordering for me.  She went on to say people were not good or bad because of a food preference.  

A short time later we took a walk to the drugstore, back in the day when you could eat lunch there and have a fountain drink.  We lived in Jacksonville, Florida, at the time.  My mother ordered two hot dogs, and added "No mayonnaise."  I asked her what mayonnaise was, and she said it was "the white stuff I use when I make tuna fish."  I said I loved that, and she asked if I wanted it on mine.  At this place, they used to put everything on hot dogs – mustard, ketchup, mayonnaise, and relish.  I told her I did want it, and it was fantastic!  I asked her if this was like the ice cream, and she laughed and said it was.  She said to always remind her of what I wanted, because she got used to my not knowing things and might forget and just order for me.  I was so happy because chocolate and mayonnaise entered my world, and more importantly, I was okay, and good, and free to explore my feelings and preferences without guilt or shame.  I have remembered this all my life and I am sixty now.

Several years ago I complimented my client Cindi’s hair.  It was short and spiky with a purplish streak, and she looked great and I loved it.  She burst out crying, and when I asked why, she said her mother never approved of her hair and she finally thought she may as well do it the way she wanted and have some fun with it, since she never liked it anyway.  But the act of freedom and trying to have some fun with her style was not what she had hoped.  She admitted to feeling bad and ugly and also guilty, and avoided seeing her mother.  I could give you hundreds of examples of people even in their 30s who had a hairstyle or other thing the mother didn’t like.  People oppose their parents and then think they are horrible people.  They go into therapy because they are in their 30s and can’t find what they want to do in life.  It’s no wonder!  They were not allowed to even be, let alone be someone with some self-expression. It is amazing the kinds of details that make people feel filled with shame and badness.  
 
When I told Cindi what my mother had told me, she began to sob, and I told her my mother could share this with her as well.  Of course, we had more  work, but the goal of this work was to help her internalize what was so freely given to me at the time it needed to be.  Some people really feel they are bad people because they didn’t clean their apartment, wash their dishes, do laundry on schedule, watched television instead of learning something that evening. I could go on forever.  I finally came up with the phrase “morally neutral” for my clients, to refer to these things that are neither good nor bad.  

As I have said, I have had my own path to walk and sometimes it has been very long, but that is not the purpose of this blog.  I have never doubted my essential goodness and decency as a person.  I have never measured myself or others by achievements. I have always known that I am not my achievements, my things, my likes and dislikes.  I had never thought about this until I met so very many people who did not get the gift I was given, and I have had the honor of working with so many with these issues.  
 
For my mother’s birthday, I want to thank her, to let her know that this gift, in the context of ice cream and a hot dog, was one of the greatest gifts a parent can give a child. I want her to know how her wisdom is freely given to those in need.  Until I worked with people therapeutically and saw how a majority had these painful issues of shame and not being good enough, I never knew I was rich.  I am sixty now and I put things together better than before, and when my mind tends to worry about different things or to feel bad about aspects of life that hurt, I remember that pearl sitting in my heart that my mother gave me – all the more valuable because she responded quickly and without intellectually knowing, just knowing.  I pray that my mother is with the angels in a wonderful place, soothing, healing, making people laugh, as she did in this life, and I thank her with all my heart.  I will always care about shame and related issues and reach out to help people, and I will never forget my brush  with those feelings.
]]><![CDATA[Diagnostic Labels: the Downside]]>Fri, 22 Jul 2011 01:42:20 GMThttp://www.aletaedwards.com/1/post/2011/07/diagnostic-labels-the-downside.htmlPsychologists and other mental health professionals talk a lot about labels.  There are reasons, of course:  We all know what it means when someone is depressed, for example.  We can understand it as a state of mind aside from it being a diagnostic label.  We know that if someone is schizophrenic, it is a very sad situation.  Labels exist so people can communicate without needing a long explanation each time.  I get that, of course.  In my profession, we also say that to provide the right treatment, we need the right diagnosis; while there is leeway in the treatments that may be provided, there is truth also in the belief that the right diagnosis shapes the treatment options we consider.  To continue with the same example, you would not treat someone depressed in the same way you would someone with a psychosis; however, I would hope that many things would be the same—the caring, the respect, and the remembering that both are human beings with feelings.  It is this last point that I have been thinking about for a long time—for years really.
Those of us who believe that childhood influences who we are can be called psychoanalytic, psychodynamic, at times humanistic or existential.  We also call ourselves holistic, because we are not treating symptoms but trying to help people with the reasons for their unhappiness.  People who have had bad childhoods are well aware of the influence childhood events had and already understand this all too well.  Yet, mental health professionals sometimes forget about the person, his or her issues, and the life experience that brought the person to the point of having a label.  

For example, we all know what depression is and I have had numerous clients come in, self-diagnosed–correctly—with depression.  But what did it mean for these people?  And who was the person who was depressed?  I have had clients who have been through a painful experience, and one that would not end quickly, who were sad all the time and had trouble facing each new day; they were not self-blamers.  But I've also had clients who were depressed because they had very strong, shame-based personalities, and when something happened in life that triggered that shame or perfectionism, they fell into a deep depression.  Both types of client are depressed and need and deserve help, but they are not the same.  I have treated many people who suffered for years with depression who even had the chronic nature of it addressed, but not the issues that lie underneath. They could never measure up to their own beliefs of what they should be and therefore disliked themselves, and one painful symptom perpetuated the other. 

Others would come in and say that they suddenly developed panic attacks and had never had them, and that there was no reason they could think of.  The reason always lay in an aspect of their personality that was now triggered by life circumstances.  I cannot tell you how many young adults I have seen who faced a career choice that was not what the parents favored, and to them, it brought back all the shame and feeling of being disappointing they had when younger.  When this was simply clarified, the relief was significant.  Sometimes people had had their symptoms treated elsewhere and their stories had never been addressed.  We had to go back in time to determine what the trigger was and what came before, who the person was whom the life circumstance happened to.  When these issues are addressed with true compassion and empathy, and the person gains insight, not only the label can go away but more painful traits that make the person so vulnerable.

I remember a woman with agoraphobia, who had suffered from it for several years before coming in.  (I must stress that this example is a composite of many people, as all too many women had a similar story.)  I received a letter from her psychiatrist saying she needed behavioral therapy.  The woman said she was hopeless.  No one had ever asked her why, in her adult years, she developed a fear of leaving her home, or what had happened to cause this.  What was being treated was the agoraphobia, not this whole person with a whole life story.  As it turned out, she had been in an abusive relationship and, like so very many others, had been abused as a child.  She felt extreme shame because of the abuse she suffered, and it was underscored by her abusive husband.  She no longer lived with the abuser, but he still supported her and came around; this, too, is unfortunately very common.  By the time she developed agoraphobia, she felt like everyone could look at her and see that she was no good and was filled with shame.  As a secondary gain, she did not want to go out with her husband and deal with his advances and his insults.  When she gained insight, she was not only not agoraphobic but got a career, became independent, and had a very active social life.  .

What was so sad and frustrating to me was that issues of shame and perfectionism and the many other issues that go with them had been left unaddressed.  People were left thinking they had anxiety disorders, panic disorders, chronic depression, and agoraphobia, for example, without having had their issues addressed.  I cannot tell you how many women I have seen who fit the above description or how many cases of depression caused by people beating themselves up with shame, thinking they are filled with badness, and having panic attacks because they could not stand up for themselves.  After all, they already thought they were selfish and unworthy people.  Those of us who are holistic believe that the whole person matters more than the symptom, even though one does need to cope and get through things.  Those of us with this orientation like to look at and treat the whole person.  But I think all too often well-intentioned people do lose the person behind the label.  They treat the depression, the agoraphobia, the anxiety, the panic and almost forget the person.  What does this symptom or problem mean for this person?  I think sometimes we forget that the person has a life experience and a very important narrative.

So many women have these issues, along with gay people, cultural-ethnic minorities, those who were abused—and the list goes on.  I can’t tell you how many women I alone have treated who had agoraphobia who had been in abusive marriages, and before those relationships, ones with abusive parents; likewise, the number of people suffering depression and anxiety because of shame-based feelings that have become traits in their personalities.  There are tools for coping with depression and anxiety—and those are important to get through the day or night—but when it is time to facilitate healing, we really must remember the whole person sitting across from us who is in pain.  We don’t want to add to the pain by failing to see them or understand.  A know of a man diagnosed with a bipolar illness who wanted to tell his therapist about a dream he had been having, and he dismissed the client by telling him, “That’s just your bipolar illness.”  What was “just” the illness?  The dream?  This man felt erased by treatment and by his label.

While I understand the ways and occasions when labels can be appropriate and what they can convey, I do not have to like them, even though they have their place.  Truthfully, a schizophrenic does not have the same chances as a depressed person, but can we still not remember that some schizophrenics have a sense of humor and some don’t; some are considerate and some are not, and that they are people after all.  No matter how serious a label is, we can remember that the label is not the person.  The label is something the person has, not what the person is, and having and being are not the same.  A label can imply a long, tough course, a hard path; but still, we don’t have to discount it if the person has a pet peeve, gets angry like everyone else, or has certain issues.  I think at all times we need to remember that we treat people, not cases or labels.  We treat people, for certain issues, problems, and maybe sometimes labels, but we treat people.  The person’s problems are not the person, just what a person has.

In my book Fear of the Abyss: Healing the Wounds of Shame and Perfectionism, I discuss issues.  I chose these particular issues because in my eighteen years of practice these are the issues I usually see, regardless of the diagnostic label.  People fell into groups that seemed artificial, and I think those who share issues have much more in common.  Everyone has issues, and many are the same; regardless of the level of severity, people share certain ones.  I hope we can remember how very important it is to treat whole people with respect and empathy, rather than getting stuck on labels. 

I will end with a memory from when I was in graduate school doing a placement in a psychiatric hospital.  Some halfway houses had come to interview several patients who were about to be discharged, and one young man had not been accepted at the halfway house he interviewed for.  He was crying and felt humiliated and rejected.  I mentioned this to the psychiatrist, who laughed, saying that a neurotic, like any of us, would feel ashamed and rejected, but this man was after all psychotic and did not have those feelings.  I was a student and there wasn’t much I could do.  But the patient told me he felt rejected and stupid.  He told me he felt that way, and it is the kind of thinking displayed by the psychiatrist, dismissing what a person is or says because of a label, that makes me dislike them. 
]]><![CDATA[Parents and Self-Esteem]]>Sun, 22 May 2011 23:31:19 GMThttp://www.aletaedwards.com/1/post/2011/05/parents-and-self-esteem.htmlParents are the major influence on the self-esteem of  their children, and yet sometimes get so wrapped up in wanting them to do well  or to be the “best” at something, they forget the effect they are having.  I think it is helpful to look at what not to do.  When my daughter was five and a half, we adopted her from South America.  She went to preschool for a time and then Kindergarten.  I speak Spanish but she learned English very quickly.

When she was in Kindergarten, she took a standardized test and scored in the 97th percentile in language skills.  When I picked her up from school and we were walking to the car, I said it was amazing that she did so well, especially as she was still learning English.  We got to the car, and seconds afterwards a classmate and his mother were getting to their car.  The mother was screaming at this child, whom I will call Chuck.  She yelled, “You just did AVERAGE!  AVERAGE!  How do you think that makes me feel?” and she went on to berate him as he got into the car with his head down.  I didn’t say  anything to her, because this kind of emotional abuse is not illegal and I feared making things worse for the little boy.  My daughter said to me, “I guess  Chuck’s mom isn’t so happy with him.”  She asked me why the mother was so angry, and I tried my best to answer her.
The narcissism of this mother was  blatant.  She said outright that it was her own feelings she was concerned about with her child’s scores, as if his very existence had nothing to do with anything outside of making her feel good about herself.  I do not think it was well-intentioned, but she might not have meant to be as devastating as she was.  My daughter is 26 now and this happened in Kindergarten, but I have never forgotten this little boy.  I wondered if one of my colleagues sees him as a client now.  This was one incident, but it is hard to imagine he was ever given the message that he was good enough the way he was.

This is a strong example, but many teachers who have been clients have told me about parents coming to them and wanting – demanding really – that their children come out at the very top on standardized testing.  Teachers have told me they feel pressured to teach to the test.  Parents everywhere push their children to get straight As, to be perfect.  I have known children who were not gifted who were pushed into gifted classes, but were nervous wrecks.

 I think to raise a child with good self-esteem the parent needs to understand that we are not meant to be perfect and are very imperfect.  People have different gifts, and what they do with them is what counts.  What about character?  Have we forgotten about people who are kind and helpful?  What message are children being given when they have to be better than everyone else?  What does this teach them about themselves in relation to others?  I remember explaining to my daughter how having a gift makes certain things easier and provides opportunities, just as we would sometimes laugh together about how she hated math, telling her none of us had that as our strongest point, although her father was respectable in it.  Why are people proud of gifts given by nature instead of making good, decent choices?  Maybe pride is not the way to go, and there is too much of it  already. 

Yes, we are concerned about children having choices in the future, and they have to study and ideally should do their best, but we have gone far beyond that. Do we praise or even respect effort and diligence, or helping others?  Overly-pressured children do not have good self-esteem and I have seen many of them as adults, all the more confused because as they struggled with sometimes crippling anxiety related to perfectionism and shame, they would say their parents wanted the best for them and they were never abused.  It is not the function of children to live out the fantasy of the parent.  I can’t tell you how many adult clients felt depressed and anxious because they did not want to choose the career their parents wanted.  That is not their function, but many have been raised to think it is.  I knew a young woman who was an artist, born into a family of doctors; she told me she was the family idiot.  This happens more often than we want to admit, and people who would never abuse and are horrified by it, are making children extremely depressed and anxious – children who later don’t even know why they are struggling.

I think parents who do not feel good enough themselves need to work on themselves instead of making their children accomplish what they themselves could not. Children are not dreams; their function is not to live out the fantasy life of the parent.  I understand that there is sometimes a tension between confidence and competence, but I think we are seeing a lot of cases in which the parents thought for some reason that their child would somehow live up to the impossible standard they themselves never could.  I think we need to remember to respond to our children in ways that show we value their positive traits, which may or may not be the most prestigious ones. I think children need to be loved for themselves and not for how much they make the parent feel raised up.  In order to teach children self-love and love for others, we need to be  able to experience it ourselves.
]]><![CDATA["She"]]>Tue, 05 Apr 2011 22:32:01 GMThttp://www.aletaedwards.com/1/post/2011/04/she.htmlShe was about 80 and didn't consider herself old.  She lived in a nursing home with her husband, who usually didn't know who she was.  She couldn't hear, so doing therapy with her meant you had to write her notes, and very quickly.  She was also extremely intelligent, probably gifted, but then in her era most people didn't care if a woman was gifted, and she was pushed to get married and have children.  She got dialysis a few times a week, and I hadn't known how brutal a process this is, involving sitting up for hours and having huge bruises to show for it.  She had one leg as her diabetes necessitated an amputation.

I never knew anyone as grateful for life as she was.  She once told me that she knew I would cry for her when she died, but that she would be living in glory, happy as can be in a better place.  Yet she was human.  A doctor once talked down to her and she was understandably very angry.  She was very religious and said that people with their egos made her sick.  In mid-session she started to laugh and said, "Look at me!  I'm not much better than he is or I wouldn't be so upset!"  We talked about how it is easier to not involve the ego so much when not challenged by someone who is really stuck there and how quickly we can fall.  She often said she loved me, and told me I was not a pompous ass.  I would tell her sometimes in my field you end up being therapist to someone superior to you and you keep learning from them.  She smiled.  
She told me of her hard life, but said she was always close to her Creator and that this made her happy.She got around pretty well with one leg in her wheelchair.  Even though she couldn't hear, she could talk, and others loved and respected her as a brilliant woman of much compassion.  She was learning to use a prosthesis and explained to me how very painful it was, something I had not thought of before.  But she said "Onward, onward," and how exciting it was, that it would be like having two legs, and she would be able to walk again.  Then she got an infection on her foot.  She was in the hospital a long time and did not heal.  The infection spread and she ended up having her second leg amputated.  I never saw such agony.  Staff people were crying, and it was terrible. 

She told me how she was about to use the prosthesis and now had no legs.  The amputations were high and she literally had half a body.  We talked about her spirituality and living from the mind, but it was awful for her.  I would sit with her in her agony; grief is not a strong enough word.  And then she would light up and say she was with her Creator and that she was happy. She said it doesn't matter how long one lives really, that you just transition, and that she doubted it was a big transition.  

She said she knew I loved her, and of course she was right.  She made a time to cry and a time to be angry, and then she and her Creator were together.  She would talk about her wisdom, her children, her ideas about why she went through the things she did, and how she would become aware of how brief all of those experiences really were.  She told me to stop feeling so bad for her, that suffering didn't matter because she knew who she was and that all of life was a spiritual experience.  Once, asked if she was depressed, she shouted, "Never!"  She said her grief was like waves and that she always liked the water.  

She was exceptional.  She made me search inside myself for that certain something that would enable me to endure what she had with such grace and even times of joy.  I am still searching.  She is a highly evolved soul and I honor her now.  She was in my life as my patient, but was really a great gift.  I honor her and wish her a million blessings.      
]]><![CDATA[Being Upbeat...]]>Sat, 12 Feb 2011 15:31:29 GMThttp://www.aletaedwards.com/1/post/2011/02/being-upbeat.htmlA lot of well-meaning people often say to psychologists that we deal with “depressing things” and are always concerned with emotional pain.  A lot of people think that talking or writing about painful topics is somehow “negative,” and I would like to address this issue, as well as the “upbeat” part of the psychotherapist’s work.

In all fairness, anyone concerned with healing is concerned with the disease process in the physical realm, and emotional pain in the psychological.  (This article does not address the mind-body-spirit connection, which is also very important.)  It is very hard to change or to facilitate the healing process without addressing the issues.  As a professor of mine once said, “No one goes to a psychologist to say that life has been great, or because they just wanted to be nice to psychologists.”  This is true.  People come in because they are experiencing pretty extreme emotional unease.  Those who have had therapy come in recognizing that they have done some of the work and want to do more. 
The initiated have a different starting point; others come in and just want the pain or discomfort to end.  As one business-oriented person said to me, “Just give me the bottom line.  I don’t want to discuss anything, but I’ll do anything you say to get rid of this panic and sweaty hands.”  He had had that problem for about a year and had been to other therapists, and when he did do the work, he stopped denying how desperately unhappy he was and made changes to his life.  The stage where he acknowledged his unhappiness was very painful, but his panic stopped at that point.  Ironically, he said he found it interesting looking at his issues as he progressed.  It is a hard sell for sure telling people that their panic or anxiety will end when they face feelings they would rather not—and that those will not be happy feelings.  But it is the truth.

But the “upbeat” part for us lies in the human capacity to change.  People have the ability to step aside, look at themselves, and reach a deeper level of honesty and courage, and to stop behaviors aimed at blocking unwanted feelings (even though the behaviors are unwanted, too).  True, change is difficult and we do it in little steps.  It is also true that when people are in pain they do not really believe that looking into themselves will provide solace, but they do have the ability to change, and working with someone and seeing their courage, honesty, and determination is, to me and probably my colleagues, the most rewarding thing one can do.  True, psychologists think a lot about the hard aspects of life and the many facets of relationships.  But we think a lot about how to make wonderful changes and what it is like watching someone become more and more empowered.  To us, emotional pain is not “negative” but the mark of an honest and brave person who wants help; they are just human issues.  To us, pretending those issues don’t exist does not solve anything.  To us, those issues are very clean and sincere.

In the course of my work I have seen people come in traumatized and in crisis because of long-standing abuse by a partner that ended in a huge betrayal.  I have seen them evolve into people who said they knew those partners had big problems but they thought they would make them feel mentally healthier or superior, and that they were in a way using the person.  They discovered a very important truth—that when you acknowledge your own role in a painful interaction, you feel less of a victim and are in fact less of a victim.  When people discover this, sharing their joy and power is an incredible feeling.  It takes a while.  As someone once told me, “I understand what you are saying, but I’m not there yet.”  He did get there and the pain transformed into wisdom and compassion, for himself and others.   I have seen people with a rigid and anxious perfectionism turn it into an awareness of strengths and weaknesses and humor.  I have seen numerous people develop genuine self-respect by looking inward, doing the work, walking the walk.   To us, it is very spiritual to look at issues, which everyone has, not to deny them and pretend, and the work is extremely hard and extremely uplifting.

In summary, we cannot talk about healing without talking about healing from WHAT.  The way we become more positive is to face that which we don’t like, and the outcome is genuine.  Next time someone asks if a psychologist’s or psychotherapist’s job is sad or depressing, I want to think of a way to tell them how very meaningful it has to see the very best in human beings and to be a facilitator in the process.     
]]><![CDATA[The Beginning of Emotional Issues...]]>Mon, 31 Jan 2011 16:07:37 GMThttp://www.aletaedwards.com/1/post/2011/01/the-beginning-of-emotional-issues.htmlOne of the painful things about being a psychotherapist is sometimes seeing problems as they are developing in children, and being unable to change the circumstances that foster these problems.  In the past I did many psychological evaluations of children, and would sometimes see them periodically over the course of years.  There is certainly much mistreatment of children that never reaches the attention of the authorities, but evaluating these children, who were in foster care year after year, taught me a lot about our system and about the human condition.  I remembered again some of these children as I wrote my book, and was thinking recently about how many of the issues I often see now in my adult clients, like obsessive-compulsive disorder, were born during childhoods not so different from those of the children I used to see.  I'd like to tell you about "Elena," one of the children I evaluated, to illustrate how our experiences as children mold and shape our personalities.

Elena was four years old when I first saw her.  She was physically and sexually abused by one of her mother’s boyfriends, and her mother said she did not believe her.  When Elena began to act out with others, the authorities became involved.  Her mother belittled her often, and did it in front of others.  The current boyfriend cursed at her, called her names, and would go into alcoholic rages that were unpredictable.  He had been physically abusive, but when he began to sexually abuse her Elena became even more frightened all the time.  She remained at home for several years while services were provided to the mother and the boyfriend moved out, but there were other boyfriends and she was often left alone in the house, without food or support of any kind.  Elena had therapy, but the result was minimal as her mother was uncooperative.  When Elena would cry or tell her mother she was afraid of the dark and afraid to be in her room, her mother would laugh and make fun of her.
When Elena was six, I was asked to evaluate her again.  She was in foster care now.  She was bossing other children at school, sexually acting out, and tried to control everyone, including the teacher.  In the home, the foster mother made fun of her fears, and while the foster father was not physically abusive, he would fly into rages during which he would tell Elena she was a horrible child and destroyed whatever little self-love she might have had left.  There were older sons in the home, and because she was afraid of being sexually molested again, she behaved in a provocative manner with them, to at least have the abuse occur when she expected it and thus to feel some control.  She had no friends because she was too bossy, and the foster parents would tell her no one liked her because she was so bad.  She began to hit her head on the wall, and cry and beg for comfort from the foster mother, who, like her mother, made fun of her behavior.  No matter how great her anxiety or pain, there was no mercy or solace for Elena.  

Having Elena placed in a better foster home did not seem like it would happen, and the mother engaged in services just enough to not have her parental rights terminated.  Meanwhile, Elena was a very difficult child.  She had different therapists she liked and who tried to help her, but nothing seemed to really have an impact.  When I evaluated her at this age, she was able to cry and say she wished she had a mother.  Her mother would schedule visits; Elena would get dressed and be transported to the child welfare agency, and the mother would invariably fail to show up.  Over and over and over again she got her hopes up, only to be disappointed and humiliated, because others witnessed her repeated rejections.  She tried to refuse going to these visits that rarely happened, but being a young child, she had no choice.  Her caseworkers felt badly, but said the mother would attend a few therapy sessions once in a while, seem to be invested, and then disappear once more, and the law was such that she had to be totally uninvolved for a certain length of time before parental rights could be terminated.  Elena learned that what she wanted and how she felt did not matter.  When she did see her mother, her mother and male friend would speak in front of Elena as if she were an adult, and Elena learned that she was not worthy of respect.  She was still able to cry and grieve and say that, no matter what she did, she got yelled at and punished and made fun of, and was able to discuss her sadness.

I was last asked to re-evaluate Elena when she was eight years old.  This time she did not run up and hug me and did not act happy to see me—with good reason, really, as she figured out that these evaluations were not changing her life, even though from the beginning I tried.  She acted very grown up and formal.  Her foster parents said that she became very nice and well-behaved.  I brought out crayons, and she put all of them in color groups, laying them neatly on the table.  When one rolled a little bit, she put it back.  She did this for a very long time, but was unable to draw anything; asked why, she said she did not draw well.  I had a portable dollhouse I offered her.  She took all the characters out of the house, laid them down in a row, and said everyone was sleeping.  She refused candy she was offered, saying it could make crumbs and was dirty.  On the intelligence testing she would not guess but would only answer easy items she was certain of.  At her break to use the bathroom, she took a long time.  When I went to look for her she was washing her hands repeatedly.  

I spent a couple hours with her, told her it was nice to see her again, that I was so sorry her life had been so hard and so unfair.  She smiled and said it was all ok, that she was safe now.  She confided to me that she would arrange her knick knacks on her bureau a certain way at bedtime, and that no one could hurt her or surprise her because of this; if she forgot to do this, she would get hurt.  She told me her foster mother, who knew she liked to know things ahead of time, would never tell her when they were going shopping or out to eat and would tell her at the last minute.  The foster mother would then tell her she looked dirty, had messy hair, and was not dressed well enough to go out.  She said none of this mattered anymore because she had her secret.  She knew she would be criticized, knew she was ugly, stupid, bad, and bossy, but knew she could go through the motions of everything and still be safe.  She now had friends and expressed empathy for some other children she knew.  

Elena had, with only one ritual, a mild form of OCD that I call PCS (perfectionism, control issues, shame) in my book.  She was not dominated by rituals but was in severe emotional pain.  This did not have to happen.  More grief, anxiety and painful experiences interacting with the world awaited her, as her issues would get in the way.  What is sad is that her emotional issues were probably the highest adaptation any little child could have had under the circumstances.  She had stopped acting out sexually, cared about others (she chose to share some of her secrets with me), and was a very decent person.  She did not go crazy or become violent or cruel.  It is appalling to me that this excruciating outcome is the best that could happen—an outcome only a strong person can manage, and it is still so very painful.
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