Author:Paul Gilmartin

Crossing The Line in Therapy: A Guest Blog by Mark Rubinstein M.D.

Crossing the Line in Therapy

Sometimes Rules Are Meant to be Broken

by Mark Rubinstein, M.D.,

Author of Bedlam’s Door

As a practicing psychiatrist, I was treating Alice, a 38-year-old, unmarried artist living in a Manhattan loft. She was depressed about her career and life’s direction. Above all, she was distressed that she’d been unable to sell her oil abstract paintings, although she’d displayed them at shows and at a prestigious gallery. Things had become so dire, she thought she might have to sell her apartment so she could pay for ordinary living expenses, and continue painting.

She was seeing me once every two weeks for supportive sessions. I become somewhat alarmed, when in addition to her lack of career success, a relationship with a man—a fellow artist—fell apart and Alice became despondent.

Over the next few months, her financial status worsened. The real estate market was headed to record lows, and she was desperate for money. Alice took a part-time job as an office temp, but that barely helped pay her bills. Because of her financial plight, I progressively lowered her fee. I had to charge her something for her to maintain a sense of self-respect.

Despite her best efforts, her career did not progress, even though she was a talented artist. She came to such a low point, financially and emotionally, I began considering if there was something I could realistically do to lighten her burden.

I was fully aware of the admonition that a therapist should not enter into the “real” life of a patient. There should be no social relationship; no sexual relationship; and no business dealings with someone in treatment. The therapeutic dynamic required freedom from such real-life interactions which could place the treatment in jeopardy. It’s considered an ethical violation for a therapist to engage a patient outside the office.

But desperate times call for desperate measures.

Alice’s financial situation was by now so precarious she was barely able to pay her co-op maintenance.

I decided the most ethical and caring thing to do was to get involved.

I made arrangements with Alice to bring my wife to her loft studio where we looked over a number of paintings. We purchased three pieces. In essence, I became a “customer” of hers. I realized the potentially difficult—even treacherous—relationship I’d allowed to develop, but felt Alice would probably decompensate emotionally if her travails continued much longer. In so doing, I created a boundary violation (mixing “business” with Alice’s therapy), but felt I was working toward a far greater good.

Fortunately, the money Alice earned from our purchases was enough to tide her over for the next few months, and she soon sold a few paintings. Her fortunes improved over the next two years, as she sold more.

Eventually, Alice sold her loft at a much higher price than she would have received, if she’d disposed of it under the desperate circumstances of a few years earlier.

Fortunately, my breaking the rules helped Alice find her financial and psychic equilibrium.

As a psychiatrist and therapist, it became clear that one should not always stick by arbitrary rules. Yes, sometimes rules can and should be broken.

© Mark Rubinstein, M.D., author of Bedlam’s Door: True Tales of Madness and Hope

About the Author:

Mark Rubinstein, M.D., an award-winning novelist, a physician and psychiatrist, is the author of a non-fiction book, Bedlam’s Door: True Tales of Madness and Hope. For more information, please visit http://www.markrubinstein-author.com/ and follow the author on Facebook and Twitter.

bedlamsdoor

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SarahHaufrect

Sarah Haufrect – My Mom Had BPD

Sarah shares about her mother’s battles with Borderline Personality Disorder, her relationship with such a “beautifully disastrously complicated” woman, Sarah’s own battles with bulimia, anxiety, and co-dependency and the role exercise has played in helping her moods.

This episode is sponsored by Blue Apron.  For your first 3 meals free (with free shipping) go to www.blueapron.com/mental

Follow Sarah on Twitter @Smartypants_Inc  www.twitter.com/smartypants_inc

To read the Salon article she wrote about her mom go to http://www.salon.com/2016/02/28/i_loved_lived_with_and_lost_my_mother_to_borderline_personality_disorder/#

Tickets are still available for LAPodfest.  Go to www.lapodfest.com and use offercode HAPPY for $5 off.

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Mental Illness Portrayed in Film: A guest blog by therapist Paige Zuckerman

Crazy in Celluloid: misrepresentation of mental illness in film

Consider your favorite “crazy” movie character, perhaps you conjure-up the image of a leering Psycho Norman Bates or a charismatically chaotic Joker in The Dark Knight. Whatever image comes to mind, there’s likely to be several common tropes imbedded in it.

Recently I watched the new trailer for the next M. Night Shyamalan film Split, set for release in January 2017. I was deeply conflicted, immediately by the implication of dissociative identity disorder being given that tired title of ‘split personality.’ Furthering my frustration, the lead actor (James McAvoy-a personal favorite) has often performed mentally ill characters with a deft balance of grit and compassion. However, apparently at the hand of a thriller/horror genre director, the film rests upon common problematic narratives of “madness.” I’m aware there’s a typical Shyamalanian ‘twist’ at the end, but does said supernatural edge make amends for the recapitulation of Hollywood’s worst psychological misapprehensions?

There’s more to this issue than my annoyance as someone inside the ‘real world’ of mental health. There’s a larger socio-cultural narrative we craft in our various forms of storytelling. We are existing in an era of pervasively accessible media intersecting with acts of terrorism, authoritarian brutality, racial and gender violence. How are we using our gifts as storytellers to portray those within our population who are in pain? Are we coloring them as malicious and fractured or as troubled fellow humans worthy of empathy and ethical intervention?

In considering numerous films headlined by a character struggling with mental illness, it becomes clear that several misrepresentations pervade. The first and most common is that ‘crazy’ is tantamount to dangerous. Based on this schema, anyone suffering with mental illness is intent upon gruesome violence. This is most commonly depicted via male characters or those who embody traditionally masculine traits. You’re in this camp, M. Night! The next misinformed mechanism is the assumption that people ‘snap’–or that mental illness is often of sudden, sharp onset. The reality–mental health issues are often progressive and insidious….and wholly treatable. A third and especially infuriating ignorance is the narrative that people with mental illness are exploitable and tokenized, often sexually. This is markedly common in portrayals of females with mental health issues. Thus we see sexism and misogyny intersect with the marginalization of people with disabilities. As a Feminist and a therapist, I am troubled by the potential impacts of these messages.

My gripe transcends impoverished depictions of those suffering mental health issues to include those who treat them. Historically, film has been a predictable perpetrator of the narrative of psychiatrists, therapists and support staff being incompetent or even cruel. Perhaps the all-time most hackneyed embodiment of the ‘therapist’ has been as a powerfully transgressive authority figure who sexually exploits clients. This is a threadbare and ignorant take on the very real, yet entirely manageable phenomenon of transference and counter-transference. The truth is that the profound majority of mental health professionals are ethically conscious, collaborative folks who just happen to value creating safe spaces for us to explore our deeply human luggage.

The somewhat positive news is that consultation and collaboration with mental health professionals is gradually becoming an industry practice. Just as the film industry will fact-check their historical references, many producers and directors are seeking assistance to more consciously craft their characterization of emotional pain. I vote we make that a universal standard!

When we take a moment to step-back and examine how ubiquitously psychology is woven into our storytelling, we have an opportunity to create richer narratives that honor the complex tension of it. If those who hold the privilege of publicly telling human stories choose to remain complacent, we’re likely to perpetuate discrimination and hatred of those worthy of our kindness and compassion. We can do better. In an effort to further our consideration of this issue, here’s a few of my recommendations to absorb and deconstruct:

Did it better:

Benny & Joon: a compassionate perspective on the worthiness of people living with occasionally debilitating mental illness and their potential to be creative, loving and contributing to society. Also an apt depiction of the challenges for loved ones and caregivers.

Filth: veering from grandiosity to angst, addiction and impulsivity in the face of losing one’s family and suppressing early childhood trauma is reflected with a beautiful balancing act only Irving Welsh and McAvoy can muster!

Cake: the slow-burn emotional erosion from a major medical trauma and chronic disability are not laid-out with histrionics, just honesty.

Did it worse:

What About Bob: too many issues to mention, from the ridiculous depiction of the mentally ill character to the laughable treatment. If you suspend disbelief entirely it’s only a good laugh, not a total mess.

In Treatment: They could have done right by the therapeutic process here if they hadn’t gone down that old ‘sex with your client’ rabbit hole.

Suckerpunch: traumatized characters are sexualized, infantilized and brutalized and caretakers are criminally unethical and abusive.

 

Paige Zuckerman, CMHC

mental health therapist, contributing writer and fellow human, Salt Lake City, UT

www.therapywithpaige.wordpress.com

IG: ShrinkPaige

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Large1

Maddy F – Learning To Love Yourself

You hear the phrase “love yourself” a lot.  But how do we get there? Maddy’s story is a great example.  She was molested by a relative (and church leader) but didn’t feel safe enough to speak up about it for years.  Then she got help and everything changed.

This episode is sponsored by Casper Mattresses.  To find out more go to www.casper.com/mental

To buy tickets for the In This Together Festival on Nov 13th go to www.ittfest.com

To watch or attend LAPodfest Sept 23-25 go to www.lapodfest.com and use offer code HAPPY

To sign the petition Maddy was talking about that looks to abolish the statute of limitations on childhood sex abuse cases go to

https://www.change.org/p/abolish-the-statute-of-limitations-for-child-sexual-abuse-in-the-state-of-california

 

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StephenTBrophy

Stephen Brophy

The reality TV producer (Somebody’s Gotta Do It) opens up about his depression, social anxiety, history of unrequited love obsessions – especially as a kid, getting sober from prescription opiates and smoking speed thru a broken light bulb!

This episode is sponsored by BlueApron. To get your first three meals free (with FREE shipping) go to www.blueapron.com/mental

This episode is sponsored by SquareSpace for 10% off your first purchase go to www.squarespace.com and use offer code MENTAL

For more on Stephen go to www.stbrophy.com (to buy his books go to the “merch” page on the site)

Follow him on Twitter @STBrophy www.twitter.com/STBrophy

For info on seeing the MIHH podcast at LA Podfest go to www.lapodfest.com

For info on seeing the MIHH podcast at the In This Together Festival in Nov. go to www.ITTFest.com

The post-abortion counseling resources mentioned on the show

www.1in3campaign.org

www.yourbackline.org

www.plannedparenthood.org

 

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Texting Can Actually Help People Who Shut Down: A Guest Blog by listener Paul S.

 

If you’ve ever been rendered non-verbal by any sort of meltdown, shutdown, or panic attack in the presence of other human beings, you know how the actions of well-meaning people can only make matters worse. I imagine that when a relatively normal person sees someone in visible distress, their instincts are to immediately try to comfort you, calm you down—by doing all the wrong things. People start asking you “What’s wrong?” and, when they get no verbal response, sometimes even become even more insistent. They may try to touch your shoulder. I’ve had people try to hug me (note: if you see someone having a meltdown/shutdown/panic attack, that is just about THE WORST thing you can possibly do). All you want to do is flee to a secluded little corner, maybe run to the next room, grab the pillows off the couch and hide behind it while rocking back and forth sucking your thumb, away from the sound and touch of anyone else so you can ride the waves of overwhelming dread until it subsides, but people want to help.

 

I know I can’t speak for everyone, but in these situations, as long as I can get sufficiently far enough away to be sure no one is following me, I can sometimes muster up enough strength to send a text to somebody, who by this point is probably quite alarmed at my strange behavior. If you know the person well, a few words is all it takes for them to understand you need to be left alone in peace for a little while.

 

If you don’t know the person quite as well, however, it takes way too much energy to explain what happened, so why bother?

 

There are a couple of ways I’ve found to get around that second scenario. One is to have a text template saved somewhere on your smartphone, explaining what is happening in your head and instructing them to be gentle, quiet, not to touch you and, if needed, help you find a place to escape to for a little while.

 

More recently, I’ve been using an app called Emergency Chat (Note: This is in no way meant to be an official, commercial endorsement of Emergency Chat. I have nothing to do with its developers or distributors. Besides, it’s free; how would they have the money to pay me anyway?),  which you can get for free for Androids and iPhones. Upon opening the app, it displays a message, which you can customize. (sample screenshot of the one I wrote, slightly modified from the stock template that comes when you first use the app). It’s much faster than trying to find a text file on your phone, and an added bonus is that it actually acts as a sort of texting platform, i.e. you can even hand the phone back and forth exchanging typed messages with the other party without the need to actually speak.

Textpic

 

 

Textpic2

 

I only jumped on the smartphone bandwagon a couple of years ago, and with all the mood trackers, medication reminders, and other apps like the one described above, it has drastically changed and improved the way I record, review, and analyze my moods and lifestyle, in ways that are surprising and often ingenious.

 

 

 

 

 

 

 

 

 

 

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Recovering from Religious Harm

Recovering from Religious Harm

Do you ever wonder about whether religion has had a harmful effect on your life? If you have experience with controlling, authoritarian religious indoctrination, it may very well be true.

I’ve been working with people recovering from religion for over 20 years, and a few years ago, I noticed that some symptoms actually looked a lot like PTSD. I coined the term Religious Trauma Syndrome, or RTS. It refers to the damage done by religion as well as the trauma of leaving religion. Here are some examples:

“I feel angry, powerless, hopeless, and hurt – scars from the madness Christianity once had me suffering in.”

“It took years of overcoming terrific fear as well as self-loathing to emancipate myself from my cult-like upbringing years ago.”

“There is a lot of guilt and I react to most religion with panic attacks and distress, even photos, statues, or TV…. I guess although I was willing it was like brainwashing. It’s very hard to shake… It’s been a nightmare.”

So why is this problem not recognized and discussed? At present, religion is still seen in our society as either helpful or benign. There is no training in psychology programs for treating religious trauma and most therapists do not understand. In fact, therapists sometimes suggest religion to treat psychological problems.

Yet there are serious issues in religious dogma and practice that affect mental health. Fundamentalist Christianity is a good example. I call the two biggest problems “the horror” and “the terror.”

“The horror” refers to the way believers are taught to despise themselves. You are taught to think you are born bad and need of saving – there is no good in you at all and that is why Jesus had to die. Even after you are “saved” you always have to work to be good enough. This is devastating to a healthy sense of self, which is necessary for personal identity and mental health.

“The terror” refers to the overarching fear that is taught – fear about the world, other people, the future, and most of all, eternal damnation in hell. This is the terrifying backdrop of the entire religion, no matter what is said about love. You may hope to escape punishment but you never know for sure and so you always have anxiety. After you leave the religion, this terror can haunt you for years and be debilitating.

Christianity can also cause an existential crisis by creating a false reality and making wild promises. You get told you will have a perfect relationship with God, you will become perfect, God has a perfect plan for your life, you can spend all your time working for a huge cosmic purpose, and eventually, you will live for eternity in a perfect place. Alternatively, you are told there is no other coherent way to think about life; there is no meaning in life outside this framework. Thus when a person leaves the faith, they feel lost and scared. The challenges of ordinary life are exaggerated, and finding new meaning in life seems impossible.

As one person said, “I get depressed and upset. Jesus no longer saves me. God no longer created me. What purpose is there? What am I left with? What do ex-Christians fill the hole with? So we are here for no reason, no divine plan. Reality is harsh. . .it’s like having your entire world turned upside down, no, destroyed.”

 

Added to this is the problem of losing a support system. Church is often a person’s social life and families are often still in the faith. Finding new connections in “the world” can be daunting.

So what is to be done?

  1. The first thing is to understand what you are going through. In addition to the above, you can read about RTS at my website.
  2. Realize that you are not alone. Many people are leaving religion and going through these issues.
  3. Understand on a deep level that what you are going through is NOT YOUR FAULT.
  4. Take time to get informed. Read about the issues and also stories of others who have left the faith. Ex.christian.net is one place.
  5. Realize there is hope. On my website there are “messages of hope” and video testimonials.
  6. Find ways of getting support. This could be individual counseling from someone who understands, a support group, or a retreat. Check online or in your community.
  7. Know that people do get better and it does not have to take a lifetime.

 

Marlene Winell, Ph.D. is a psychologist, retreat leader and author of Leaving the Fold: A Guide for Former Fundamentalist and Others Leaving Their Religion.

Journeyfree.org

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CynthiaPena

Social Worker In Training

28 year-old Cynthia Pena ACSW opens up about her life, experiencing skin tone prejudice within the Hispanic community, being the “good child” who gets forgotten, anxiety, triggers, working in an overloaded county system helping children with severe or persistent mental illnesses and her dream of expanding the role of mental health in athletics.

Follow Cyndi on Twitter @Ms_Cyndi_Pena

For more information on Paul’s appearance at LAPodfest Sept 23-25 go to www.lapodfest.com and use offer code HAPPY for $5 off.

 

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Meth-Induced Psychosis- en Español: Fond Memoirs of an Ex East Oakland Therapist

Meth-Induced Psychosis- en Español: Fond Memoirs of an Ex East Oakland Therapist

The city of Oakland, California is famous as one of the top five most dangerous cities in the United States and is referenced in rap songs, home to the Oakland Raiders with the wildest fans, and has distinctly different neighborhoods, ranging from north Oakland that houses some of the best Ethiopian and Eritrean restaurants- to Rockridge, a neighborhood of rather affluent people and expensive boutiques. In east Oakland, the neighborhood of Fruitvale is heavily populated by Latino immigrants, fruits stand on corners selling tropical fruit topped with hot chile and lime, a lady yelling out all the flavors of cream she can fill your hot churro with, and the “elote” (corn) guy with the horn and bells on his cart that people run outside just to flag down. There is a large amount of poverty, crime, highly stressed households, and low paying jobs. Due to the stressors of living in a dangerous city with frequent gun shots in the distance, robberies at gun point, and lack of mental health services, street drugs serve as the remedy for many to escape from the overwhelming environment and economic struggles.

I worked as a therapist in east Oakland for the last few years and the amount of people complaining of psychotic symptoms seems to have skyrocketed dramatically. Whenever a client reports to me that they are hearing voices, seeing moving shadows, feeling radiation, or having paranoia and delusions, I always check for meth to rule it out. Why? Meth is one of the most commonly used stimulant drugs right now due to its low price, lasting high, and abundant availability. Studies show that the use of methamphetamine can induce a psychotic break and leave someone with a lifetime of symptoms appearing very much like schizophrenia even years after stopping meth use. The majority of folks that start to show psychotic symptoms from an organically occurring psychotic illness is around age 19, give or take a couple years. When I see someone older say they just started hearing voices, I have to investigate.

A gang-affiliated Mexican female who grew up in deep east Oakland once told me in a session “What the fuck, Grace! This is bullshit! I used crystal before and it didn’t make this happen? I can’t stop these creepy ass voices telling me to do nasty shit! It makes me just wanna do it so they shut the fuck up! Then I yell back and them to shut the fuck up and then people think I’m loca.” Some people can use stimulant drugs for years and have no psychotic break but for the unlucky bunch for whom it triggers a break, antipsychotic medication and therapy for coping with psychosis are often required to alleviate symptoms.

Medication compliance can be tricky with folks who are new to taking psych meds and there is often a sense of shame around what it means about oneself to take psychiatric medication. This is particularly common in the monolingual undocumented Spanish speaking community who often report, “Pues Graciela, no me gusta tomar pastillas” (Well Grace, I don’t like taking pills). Culturally, its odd to take pills and natural remedies are preferred, not limited to doing a “limpia,” a cleansing using burning herbs performed by a traditional healer. Some try religion and church to see if they can get relief and “pray away” the radiation from the F.B.I. who, apparently, have been parked outside our therapy session for the last hour.

Methamphetamine, crystal, crank, ice…whatever you call it was referred to as “azucar amarga” (bitter sugar), by a Salvadorian male who developed psychosis after feeling intolerable sadness and abandonment after his girlfriend cheated on him and got pregnant by the other man. He stated that he was saving up for an engagement ring for her and would talk about having children together who could go to college in the U.S. and have the opportunities he didn’t have. He worked a minimum wage construction job where his boss called him a “stupid Mexican,” reminding him of the major cultural tension between his country of origin in Central America and Mexico. “Lo odio cuando me llaman Mexicano” (I hate when they call me Mexican), he commented, triggering his memory of being robbed and pistol-whipped when passing through Mexico on foot in the sweltering heat, trying to make it to California. He would share that he would sometimes hide in the “porta potty” to text her that he loved her and referred to her as “mi reina” (my queen). In Spanish he told me, “I feel like meth is comparable to my ex-girlfriend…they both were beautiful, thrilling, and seductive, but ruined my life and left my mind forever fucked.”

 

If you or anyone you know needs help with meth you can contact,

Crystal Meth Anonymous (CMA) www.crystalmeth.org
Call 211 to ask for local substance abuse treatment resources
Phone your health insurance company to gain a referral

 

Grace Pacheco, MFT is a bilingual psychotherapist with a private practice in Pinole, CA and sees individuals, couples, families, and performs psychological evaluations in collaboration with immigration attorneys. You can learn more about her by visiting her website at www.EastBayAreaTherapy.com

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nakki