New York, February 14, 2019

Street Art; Quito, Ecuador

Merry Valentine! The subject of love has been on my mind lately.  I am thinking about love as a force.  I am thinking about love and power dynamics.  Love has the power to hurt, heal and expand our universe.  Culturally, especially on a day like today, most of us associate love with romance and sexuality.  Although there is much to be said about the difficulty, importance and rewarding experience of having strong, healthy romantic relationships, I am also thinking about love as it manifests in therapy, in life, with our friends and family.

As I am preparing my presentation in two weeks at the 50th Anniversary Conference for Association for Women in Psychology, the question of love is much present, since it is the topic of my discussion.  Specifically, how does patient and therapist address the love between them?  Is it spoken, acknowledged?  Or is it implicitly understood?

Having trained psychoanalytically I wouldn’t have imagined ever talking with any of my patients explicitly about the love we share, or more precisely about my feelings for them.  I also wouldn’t have imagined that I would practice therapy, the way I do today.  It was through the countless hours of therapy with patients, day in and day out, that they have taught me differently.

In critical therapy love is central to the process, and it develops over time, through different stages. Love for the patient and with the patient is the ultimate gift of therapy.  Yet, it wasn’t until four years ago, that one of my patients, whom I will call Dora, challenged my understanding of love.  One day, five years into our therapy together, after explicit statements of love (“I love you,” she would say) for me, she confronted me.  “Why don’t you say those three words?” she asked.  “I know you care about me, I know you love me. I just need to hear it. I didn’t grow up hearing the words I love you, so I am not sure why, but I have the desperate need to hear them now.”  And with this simple yet vast encompassing question and proceeding statement from her, she forced me to reflect, think critically, and to explore analytically and theoretically the subject of love in the clinical hour.

Object relations therapists maintain that the therapeutic relationship can be a holding environment for the patient, while attachment theorists see it as a corrective experience.  So, then, I had to ask myself: how do we expect our patients to be comfortable with love, to be vulnerable, to express their emotions, if we don’t practice it with them?  If we hide behind analytic neutrality, are we doing them a favor?  Or, are we playing into the dominant capitalist ideology, where relationships, including the therapeutic relationship, is just another transaction?

As Dora’s therapy with me was coming to an end, and as we dialogued about our experience together, especially on the topic of love, she agreed to work on a case presentation with me.  Together we embarked on long conversations, interviews, about her experience of therapy, particularly about critical therapy with a focus on love.  In one of our interviews, as she reflected on our work, she stated: “When you said I love you to me… it was extremely important to me to hear you say it.  I remember feeling complete in a way, like we came full circle.” My upcoming work in the next couple of months will be on the subject of love in psychotherapy (some will take the form of theory, and some will be comments on my my newly launched Instagram page).  The topic is long overdue.

Dora died two years ago.  Her death, although expected, as she was suffering from an incurable disease, put this work on hold.  I couldn’t bear to listen to her voice, I wanted to mourn her death.  This Valentine’s Day, as I am grateful for all the people in my life (friends, family, patients, co-workers), I am also deeply thankful for Dora, for she has given me the courage to question my theoretical beginnings.  With her in mind, I decided to finish our work together.

Dora has expanded my understanding of therapy, my relationship to love, and ultimately has made me a better therapist.  In a way, all my patients do this work with me, challenge and inspire me, every day.  Today, I am grateful for her and for all the wonderful people who are a part of Critical Therapy, who challenge me, and encourage me to critically think about this work.  To my friends and family, thanks for your ongoing support, I wouldn’t be doing this work without you.   I am deeply humbled by all the love in my life.  Thank you!

 

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This post is part of CTC’s Reflections from our Clinicians series. These series consists of blogs written in the first person narrative, meant to reflect our values of independence while ensuring a broader diversity of topics, styles and opinions.

New York, December 21, 2018

Happy Winter Solstice! Tonight is the longest night of the year in the Northern Hemisphere. How do we celebrate our light? And how do we embrace our darkness? In Latin the word solstice means “to stand still” and tonight may be about embracing darkness and learning to sit still with oneself. In antiquity it was believed that the solstice was the day when the sun died and with the next sunrise came its rebirth.

Being able to sit with things is perhaps the hardest and one of the most important part of therapy and of self-reflection. Learning to accept and also to change those parts of ourselves that cause us pain, or are rooted in trauma is difficult, yet essential to an authentic life, to rebirth, to liberation.

This holiday season I am grateful for all the wonderful people who are part of the Critical Therapy Center. To all of you: patients, colleagues, and friends, I thank you for your continuous support and your faith. To our patients in particular, your courage moves me deeply, and I thank you for allowing us to be a part of your life, to sit with you, to be together. And to my patients, I am grateful for the love we share!

Happy Solstice!

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Now that a famous Hollywood mogul has been exposed and Bill Cosby convicted of sexual assault, will men behave better? The problem with celebrity cases like these is that they are simple, we know how to identify the abuser and the victim. Most of the time, however, unwanted sexual encounters are not as straightforward. As psychotherapists we counsel many women who discuss those awkward dates. They weren’t raped, or even coerced, exactly, however in the final act, they consented to more than they meant to – perhaps to protect the man’s feelings, to avoid name-calling that might come from a man’s wounded ego. Too many of these problematic encounters happen from well-meaning people. Is there a better way to protect women, and men, from non-consensual sex?

Relationships are genuinely complicated. We’ve all misread signals, and when it comes to physical intimacy, our own desires can change in a moment. For men and women to have healthy collaborative sexual encounters, they need to learn how share power with each other and how to stay present in the moment.

Unfortunately our relationships largely follow a script that accepts a model of coercive power, reinforcing the abuse we rail against. This understanding of power and strength leads to inauthentic, mindless and often unwanted sexual interactions. But there is a better way to ensure that men and women engage in consensual sexual relations. It starts by analyzing power dynamics within relationships.

Men are culturally taught to be powerful and pursue women (calling, advancing, proposing), while women are taught to be less powerful and submissive. The #MeToo movement has given women the power to say NO loud and clear. However, while exposing this epidemic, it largely relies on the same outdated conversations about power, in which power is uni-directional, requiring an oppressor and a victim.

Power is not the problem. It exists within every relationship and doesn’t have to be bad. “Coactive power” is a term popularized by Mary Parker Follett, an early 20th century social worker and a management consultant. Her model has been used in community organizing and social justice circles, such as Occupy Wall Street in the U.S., or M15 in Spain, to create communities and spaces of shared power. Coactive power is relational (working together, helping each other out, team-up) and reciprocal. Coactive power considers openness and vulnerability (uncertainly, shame, fear, and expressing emotions) as an asset not a weakness.

From school, to work, to dating advice books, to porn, we have generations of learning that strength comes from coercive power. The problem with this script, adopted by #MeToo, is that it sees power as a hierarchical, static, master/servant model. When men and women engage in sexual activities they default to this coercive-power script, but in order to do so they have to dissociate, to ignore the other, and to be mentally absent.

For men, the dissociation starts when the encounter becomes about power and sex as a reflection of their masculinity. Are you trying to have sex because you like or are incredibly attracted to this woman, and how much of it is also tied with asserting your power and masculinity to yourself? For women this dissociation starts when reluctance sets in. Are you not stopping the act or expressing reluctance for fear of being rejected or shamed by him? Both dissociate, cut off emotional attunement, and instead of focusing on their partner’s messages, they become consumed with the end result. To change this, a few things have to happen.

Both have to learn to practice coactive power, to embrace and celebrate each other’s agency and vulnerability. Both have to understand consent as a process, a dynamic, and not a destination. Men need to delink prowess from personal power, while women have to learn to trust their inner voice. And this has to start outside the bedroom, with practicing sharing power in other, less fraught, domains where everyone has their clothes on.

Parents can start by teaching and practicing a co-active parenting, where they have responsibility for, not power over, children. When deciding on education, parents can enroll them in schools such as Brooklyn Free School, Sudbury Schools, or Queens Paideia School – places where they will learn how to practice non-coercive democratic decision making. Schools can further teach a new kind of sex education, not one that focuses only on making babies, but one that also includes what it means to be in a relationship, when is the right time to have sex. Some schools are doing this, like Beaver Country Day School.

When it comes to work, we can seek alternatives to the current power structure models. Co-operatives or worker-run management structures, as exemplified by Arizmendi Bakery in the Bay Area or the Cooperative Home Care Associates (CHCA) are a good start.

While dating, partners can start by sharing and completing together the Consent Questions complied by Support Zine designed to generate meaningful conversations around consent.

Some might say that the attempt to negotiate power sexually or to be mindful in in bed will destroy desire and power fantasies. Like, if we keep talking about it, will it be sexy? Yes! Studies show how talking about sex, increases desire. Will negotiating power make sex boring? Just ask the BDSM and Kink communities, how much fun they are having, while creating and maintaining consent. As Henkin and Holiday have shown in Consensual Sadomasochism, the foundation of BDSM is about being honest, while playing with power safely, consensually, and non-exploitatively.

Ending sexual assault and coercive sexual practices between men and women, can only happen when we practice sharing power together, outside and inside the bedroom.

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This post is part of CTC’s Reflections from our Clinicians series. These series consists of blogs written in the first person narrative, meant to reflect our values of independence while ensuring a broader diversity of topics, styles and opinions.

 

New York – March 28, 2018

Last Friday, Nicanor Ochisor, a 65-year-old cab driver, was found hanging from a wooden beam in his garage in Queens.  A month earlier, on a Monday morning in February, Douglas Schifter, a 61-year-old cab driver, drove up to the east gate of New York City Hall and shot himself in the head while sitting in his car.  Both men were struggling financially, both felt hopeless.

A few hours before his death, Mr. Schifter posted a virtual suicide note on Facebook.  “Companies do not care how they abuse us just so the executives get their bonuses.  They have not paid us fair rates for some time now. Due to the huge numbers of cars available with desperate drivers trying to feed their families they squeeze rates to below operating costs and force professionals like me out of business. They count their money and we are driven down into the streets we drive becoming homeless and hungry. I will not be a slave working for chump change.”

Mr. Schifter’s note went on to outline how he worked 100 hours a week in order to pay his bills, compared to his 40-hour work week when he started driving professionally, in the 1980s.

As a psychotherapist, like so many clinicians, 90 percent of my work in therapy consists of helping patients achieve healthy interpersonal relationships. Yet, one of the most authoritarian and abusive relationships they experience is at the place they spend most of their time: work.

In order to create a healthy relationship, clinicians advise patients to set boundaries, work towards developing agency, and create relationships in which they feel valued and equal.  Yet, while psychotherapists talk in therapy about building healthy relationships, so many workers today are seriously struggling with toxic work environments. Elizabeth Anderson’s book Private Government: How Employers Rule our Lives (And Why We Don’t Talk about It) offers a chilling look at the state of work today.  Anderson analyzes how issues of domination and power are present in unhealthy ways for most American workers. That’s right: Most.

Many of us are familiar with discussions about mental illness as a chemical imbalance; and have a sense of experience-based mental illness, such as veterans returning from war suffering from PTSD. Yet we fail to recognize how American workers suffer from mental illness because of the treatment they receive at work.

The time has come to acknowledge how American workers are struggling psychologically, due to real factors like: precarious job security, low wages, lack of health care and other key social benefits (e.g., paid parental leave).  These factors have become part of our work experience that for many seem “ordinary”, yet cause very real trauma when experienced repeatedly for years or decades.

Statistics from the Department of Labor reflect that forty-one per cent of workers have unpredictable schedules, with employers asking them to come or leave work at any time. The precarity of work is exemplified not only by cab drivers and wage workers like Mr. Ochisor, or Mr. Schifter, but also managers. One such manager is a patient of mine, who holds a high position within a well-known respected company, yet is fearful that he might be replaced if he disconnects from his work at any time.  He even responds to texts during our psychotherapy sessions.

Mental health issues, oftentimes caused by company policies and treatment of workers, are a growing problem in our society, affecting both personal happiness and economic productivity.   As a psychotherapist for more than 15 years, I have counseled survivors of human trafficking, giving me a unique understanding about the effects of exploitation on the human psyche.  Yet, I never expected to hear similar stories, or see similar symptoms like that of PTSD, from American workers.

Clinically, I would diagnose America’s work epidemic, as acute.   The gatekeepers to services like psychotherapy, insurance companies, negatively contribute to this epidemic, often pushing medication over talk therapy, and limiting the amount of yearly sessions they will cover.

Lack of labor and worker focused laws, as exemplified by the employment at will doctrine, gives companies far greater power over workers.  Under employment at will – the situation of the vast majority of American workers – employers can fire workers at any time for any reason or no reason at all (unless specifically prohibited by law by, for instance, Title VII or FMLA).

Solving this epidemic requires thinking outside the box.  One solution is to embrace co-operatives or worker-run management structures as alternatives to current power structure within the work place.  As Virginie Perotin 2017 study  What do we really know about worker cooperatives?, concludes labor-managed firms, offering workers autonomy and giving them a direct stake in managing production, yield more efficient businesses while making workers happier and healthier.   For successful examples we can look at Arizmendi Bakery in the Bay Area or the Cooperative Home Care Associates (CHCA), the largest in the United States.

We also need a stronger social safety net, which might include a universal basic income, as well as real living wages and meaningful protections for job security. As Katherine Burnmaster and her team’s study:  Impact of a private sector living wage intervention on depressive symptoms among apparel workers in the Dominican Republic: a quasi-experimental study, showed, raising wages has a direct effect on one’s mental health.  Finally, psychotherapists should advocate with workers, and also participate in political discussions and policy decision-making.

In the final acts of their lives, both Mr. Ochisor and Mr. Schifter exposed their daily despair.  They also reminded us that the struggles of workers to be able to live and work, play, and love, to enjoy leisure and community, is at the same time an urgent fight for mental health and well-being.

 

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This post is part of CTC’s Reflections from our Clinicians series. These series consists of blogs written in the first person narrative, meant to reflect our values of independence while ensuring a broader diversity of topics, styles and opinions.

The recent shooting in Texas is generating conversations regarding mental health, gun control and domestic violence. President Trump’s statement about the shooting and his quick link and blame to mental health issues, rather than domestic violence is not surprising from a man who embodies misogyny. Having counseled both domestic violence survivors and abusers, I can say that domestic violence is not a mental health problem, it’s a cultural problem. Men (as in most cases the perpetrators are men) do not abuse women because of some unexplained mental health disorder, but because they are taught through culture, and society, that women are less than them, that women are Objects/property, and that they can and should be controlled. President Trump whose anti-choice pussy-grabbing woman-hater statements are all over the news, is a clear example of this.

It is my hope that the recent tragedy in Texas will facilitate conversations about domestic violence and also about gun control, power and aggression, as well as access to psychotherapy and the problems with managed care. At this time, we know that the shooter (who I consciously chose not to name throughout this essay) had a history of domestic violence, as well as a history of aggression, and that at some point he was receiving some type of mental health services from an institution that he escaped/fled. Based on this current information, it is easy and simple, to blame the incident on mental health issues. However, events such as these are never simple. Researched coupled with my experience as a psychotherapist, shows that folks with mental health issues are not more violent, or more prone to violence than the general population. I caution against correlating mental illness with violence so quickly, as the connection is not apparent or simple. Worse, connecting metal illness with violence further stigmatizes mental illness, and discourages people who need services from acquiring them.

I started in this field by studying Post Traumatic Stress Disorder (PTSD), with a particular interest in torture. Early on in my career this focus was on political and religious persecutions, however with time, I slowly realized that the most horrific atrocities and torture does not occur in the public sphere but in private ones, in our homes. It is easier to understand political and religious motivated torture than personal torture. Psychologically it seems more logical, easier to work through the process and to heal from political or state sanctioned torture, than it is from torture suffered at the hands of a parent or a loved one. As a result, my focus and interests shifted towards issues such as: domestic violence, childhood sexual abuse, and family violence to name but a few.

Terrorism is politically motivated violence meant to control the behavior of others, and domestic violence is motivated violence and manipulation intended to control and scare anOther. Abusers are terrorists in their own homes, lashing out violently against their partners, children and/or other family members systematically and periodically, in order to control them and to exert power over them. This controlling behavior, similar to political torture is motivated by ideology, by rigid ideas such as gender roles, femininity, autonomy and power.

As the recent report released by Everytown.org shows, domestic violence perpetrators share qualities with terrorists, namely: they are willing to die for their beliefs. Further, much in line with terrorists, in 56% of cases of domestic violence related mass murder, the killer committed suicide. These are men (and, yes, mostly men ) who chose their last few moments on earth to be an act of anger, and a display of power and control over people who, at some point, had loved them. These men are also victims of a society that teaches boys to dominate and control and teaches girls that they are the weaker sex. Domestic violence is not inevitable or a mental health problem, it comes from cultural attitudes and messages.

The shooting in Texas, also offers us an opportunity to reflect on mental health issues, since it seems that the shooter also had a history of mental health problems. Although we do not know the shooter’s mental health diagnosis we know that he was receiving some services at some point. This shooting can be a small example of the need for more affordable and comprehensive mental health services. The gatekeepers – insurance companies — are often more eager to cover medication than talk therapy, however we know that medication alone does not work. Worse, in some cases insurance companies decide to terminate payment for treatment based on the amount of session or time, rather than the patient’s well-being. For others, who lack health insurance there are even fewer options if/when they need mental health services but cannot pay for them.

Lastly, we as a nation need to be mindful that the personal will always be political, meaning this tragedy and the shooter is a product of our times. We live in a war culture that promotes violence and competition. Through movies, video games, narratives of war and destruction, our access to weapons, our ideology reflects a discourse of aggression. Whether we publicly talk about hunting terrorists, or claim that we strongly believe in the competition of the market, or that women need to be controlled, we promote discourses of domination and subjugation. Not surprisingly the shooter also at some point joined the military, another institution that adheres to strict rules and admires the powerful. In this world view, one is either attacked or attacks. Although we do not know or understand the shooter’s motives for the shooting, we can see how he is a product of a society that reveres the strong and punishes the weak. The time has come to change this!

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