countertransferancve

Transference and countertransference
I have already talked about intersubjectivity.  Remember?  Intersubjectivity is how I feel about you and how you feel about me.  But it also includes my sharing with you what my experience is of how I feel about you.  Countertransference, on the other hand, is also how I feel about you but it is not something I would share!
Transference is the idea that a client will transfer their feelings, either positive or negative, about other people including their mother or father, on to the therapist.  When we recognize that a client is attributing some attribute to you which is clearly incorrect, then we can work on why a client may be misidentifying other people's responses to them.
For example, I was working with a kid in foster care.  We were playing catch and at one point, because I have no athletic skill whatsoever, I  accidentally hit him.  We were playing with a very soft ball because I have no athletic skill whatsoever!  However, he cringed and said, " Please don't hit me!".  I said, "Don't you know that I would never hit you?"  He said, "Well , I am 99% sure."  This is countertransference.  The kid was transferring his idea that all adults will hit him on to me.  I am 100% sure I would never hit him, and even though he felt pretty safe and comfortable with me, he just couldn't imagine that there could be an adult who would not hit him since that was what he experienced with his parents.
Now, countertransference is a whole other ball game.  Countertransference can either be useful or it can be very detrimental to the client relationship and the therapy.  I think this is especially useful when working with kids, because I can always ask myself, "What would it be like to live with this child seven days a week?"  There are many kids who elicits a desire to throw them right out the window!  I have not had very many clients who I have disliked.  When I do dislike them, I know this is something about them that needs to be addressed.  That is eliciting behavior.  The client is eliciting this by their behavior.
But sometimes the countertransference is something that I am transferring on to a client's and this is not useful for the therapy.
When I was working at LifeLink and had just been diagnosed with MS, this became a much more powerful issue for me.  I had many clients, the parents of the foster children, who were attempting to recover from drug addiction.  Something like 80% of kids in foster care, and least in Chicago, were placed there because their parents were addicted to drugs.  I had many parents who were attempting to recover from heroin addiction.  Heroin withdrawal is especially painful, and I would have many women say to me that they couldn't stand the pain and had to relapse.  This made me crazy because it was very hard for me to think that they were having any harder time than I was, and I didn't need to be on heroin!
Of course this is a very false analogy, and I knew that it wasn't fair of me at all to suggest that are situations where similar in any way. Most of these women were from the south side and the projects and had no education or even opportunities for education.  They were in the cycle of poverty and had been brought up in, at the very least, unsupportive families and at the worst, abusive families.  Most of them could tell me about horrors they experience when they were young, including physical and sexual abuse, homelessness, parents being addicted to drugs, you name it.  Did you ever see the movie, Precious?  As horrific as the experiences depicted in this movie seem, they are not far from the truth.  Most of the time, when working with parents who had been through these experiences, I had a lot of compassion.  After the MS, it was more of a struggle.
Okay, now that I've gotten all intense, I want to keep writing about countertransference, but with the idea of letting you know that kinds of things that therapists think, that they will never share with you.
But that will be a topic for another blog.

Fatigue

Before I start, let me just say that another reason I know that I am not a writer is by the frequency that I put off completing started projects.  I have lots of ideas and first lines,  but  getting them  to some kind of fruition remains somewhat futile!
Now that I've said that, let me talk about today's topic which is fatigue.  You may think that fatigue is only feeling tired and needing to go to bed or take a nap.  However, fatigue includes muscle fatigue or even mental fatigue.
Did you know that most people will have to quit working because of MS actually do so because of the fatigue.  I always thought I was pretty lucky that I don't have seriously excessive tiredness. I do have to go to bed early and sometimes would like to take a nap in midafternoon, but I generally am functional during daytime hours.  However, I am actually greatly impacted by muscles fatigue.  It really doesn't take much. In the morning when I go to work out, I can walk in relatively quickly and park my cane while I use the  weightlifting equipment.  At least two to three times a week I get on the elliptical machine.  I actually think it's kind of fun because, as I have said before, this is not a movement I can do in real life.  It's as close as I can get to running!  My goal is usually at least three quarters of a mile.  If I'm feeling pretty good after that, I will continue on for a whole mile.  I can tell when it is time to get off the machine when my knees start to knock together and a have to use more hip muscles to get my legs to move the pedals. I am not winded.  I am not breathing heavy or sweating.  I would love to be able to stay on for half an hour or longer, but I also like to be able to walk to my car.
 Even on the days where I don't get on the elliptical machine and only do weightlifting, it is still a struggle to get to my car without tripping.  Once the car door is open, I literally cannot lift my leg high enough to put it into the car.  I have to just sit down and then lift our legs physically with my arms.
This is the kind of muscle fatigue that is pretty debilitating. People who have jobs where they have to stand or do physical labor or  lift things, it makes continuing to work an actual impossibility.  For professionals such as myself, the need to stand is limited.  They need to lift is limited.  And, apart from picking up toys, there is just not much physical labor involved in what I do.  This is why I have been able to go close to 18 years with multiple sclerosis and still work.  And until I got laid off, I was actually working two jobs the entire time that I have had MS, because I have always maintained a private practice.  Now that I only have one job,  I absolutely remain ambivalent about not working.  I probably over identify with my role as a therapist.  Because I am not a real writer, the writing life does not seem to be a viable option for something else to do, and I really do love the work. But I am tired and they are days where I think I am shortchanging my clients because I am so not with it.  Even when I use tricks like trying to space out my clients, I just lack motivation and energy.
Despite my ambivalence about stopping working, it is a real frustration that I am not viewed as someone who is  not handicapped enough.  I guess just because at any moment I might trip and fall, or because I might fall asleep in a client session (this has actually happened), the Disability Administration does not consider me someone who deserves to benefit from guaranteed health care or financial security.  I know I sound a little whiny and bitter and petty today.  But really I am not angry.  I am just very confused about the definition of disability and am not sure what someone has to endure to receive some benefit. I am not trying to say that I want  to be one of those "takers".   I'm just fatigued and tired of wondering when I'll HAVE to stop working.  I guess in a world where I have no control, I would like to feel a little control over my career, and being able to know that my insurance will not be at risk, will let me be a little bit more in control of my destiny.

rewriting

I accidently deleted a blog I spent all morning writing!  That is the kind of thing that I do it makes me so incredibly angry! 
It wasn't saying anything spectacularly wonderful but I still don't want to have to re-write the entire thing and now I am wondering whether what was saying was  anything worthwhile anyway.  The ironic thing is that I was writing about depression and being able to override the anhedonia (or lack of enjoyment in life), and the feeling of being so unmotivated.  The other ironic thing is that anger is very motivating and energizing so I will try again to write about depression and try to say something worthwhile.

Did you know that 41% of people with multiple sclerosis suffer from some form of depression.  This is partially because the having the illness and dealing with all of the struggles.  It is also partially because of physiological changes in the brain.  Due to the plaques and the scarring the brain is less able to produce serotonin or to transmit serotonin between neurons.  Physiological depression is more difficult to override than situational depression.
Therapy and mental illness are highly misunderstood.  When I meet new people and I tell them what I do I frequently have people say something to me like "I'd better watch what I say to you"!  The fact that people say that at all is actually diagnosable, but I generally don't spend a lot of time thinking about other people's mental or emotional difficulties if they aren't in therapy with me.
Actually, I think that everyone could benefit from going to therapy at least a few times.  No matter how healthy you think you are, there are always things that shaped our behavior.  We all have our memes, or entrenched belief systems that may or may not be accurate in therapy can help you to uncover these things and be more present in your life.
Depression is a continuum.  The depression that I struggle with is very mild.  The kid that I write about on this blog sometimes is not on the far end of the continuum on the other side, believe it or not.  He functions.  He goes to work and is able to get out of bed in the morning and do what he needs to do.  People with the most severe depression can't even get out of bed in the morning.  They are overwhelmed by sadness and hopelessness. They see suicide is a viable option to end the sadness and pain.  These are the people who need medications the most!  Most people with depression fall somewhere in the middle.  These are the people who can benefit the most from therapy and who may or may not benefit from medications. These are the people who need to learn how to think different thoughts and change behaviors in order to keep from being overwhelmed by negativity.

I started this blog in order to feel that I can give  people some insight into what it's like to have MS.  I also started it in order to battle the very things that sometimes keep me from doing it! This blog keeps me feeling that I remain relevant, and this keep me from feeling overwhelmed by thoughts that I am worthless because I can do what I used to do.  So here is my blog.  Well written or not, it is as much for me and my sanity as it is for imparting any knowledge.

I started the blog that I deleted with this thought.  I am not a real writer.  Real writers write.  They see a blank page and they want to fill it with their thoughts.  They know how to share those thoughts encrypted in wonderful prose or in poetry.  They know how to arrange the words into pleasing sentences in such a way as to grab the reader's attention and convey their messages  so that people will want to read them.  I am trying to arrange my words and my thoughts on the page so that you will want to read them.
I hope that you will continue to read it and that I won't delete any more of them on accident!

Have you ever been fired from a job?
I actually have been fired three times and that doesn't count being laid off from my last job!
 The first time I was fired was when I was in graduate school.  I was working at a group home for developmentally delayed adults as basically a house parent.  The agency was fairly new and had some administrative issues, to put it gracefully.  When I first started, there was a very good house manager who tried really hard to stay on  top of things. She would  make sure that the home was well maintained that she had good communication with the line staff.  I don't know why she quit, but when she did, things sort of went downhill.  We went through a couple of relatively decent House managers in the short time that I worked there.  The fact that they didn't stay  was probably a pretty good clue about what was going on with the higher administration.  The last guy they hired while I worked there (because he was the one who fired me), tried to take charge  without really knowing the  residents.  We had an older man whose hygiene was n ot his main priority.  Some of the residents were clearly severely delayed.  But some of them were higher functioning.  The gentleman in question was one of the higher functioning residents.  He could even read a little bit at very lower-level.  The new house manager told me that I was to make the man take a bath, physically, scrubbing him myself if I needed to.  I tried to reason with him and explain to him why having a young woman physically give a bath to an older man may not be the best idea.  He  said "if you refuse to bathe him, you are being insubordinate and you are fired.".   I refused to bathe the man and that was it.  My first firing experience. 
My second firing experience was much more traumatic.  It was my third full-time job after graduate school.  My first job at the Center for Children's Services in Danville was a wonderful experience.  I loved the people there, my supervisor, and my clients.  But I left to move to Chicago to get married.  My first job in Chicago was at the Jewish Children's Bureau.  I loved my supervisor and the people I worked with.  I loved my clients, too.  But I hated the casework that I was doing.  So it got another job at therapeutic day school called Learning House.
The Learning House was the privately owned for-profit day school for troubled adolescents.  At first glance it seemed lovely place to work.  The kids were great, and I liked the teachers.  My supervisor seemed clinically astute so I thought I could learn something from him.  But there were troubles that began  soon after beginning there.  The owners/managers of the school had some real issues!
Codependence is a fairly well known topic.  Most people think of codependence as assisting an alcoholic in remaining an alcoholic  without meaning to.  But codependence is actually a way of interacting with someone to keep them from or acting in certain ways.  Everyone at that school had a codependent relationship with the owner, Mark.  We all tiptoed around him to keep him from exploding or being angry about some slight.  He would yell at the staff for something that was done unintentionally.  When there was an issue, a simple directive stated in a polite way would have sufficed.  But Mark's response was to yell and call people names.
The firing didn't happen all at once as it did in the first circumstance.  I was unhappy there and felt that no matter what, I could not make Mark happy.  My supervisor had arranged for us to have an intern from the University of Chicago.  She was in the social work program and since my supervisor was not a licensed clinical social worker, I had to supervisor.  She was wonderful.  Very smart and capable.  But it was evident to her that this was a somewhat toxic environment.  Much of supervision with her was spent discussing how to navigate the politics and keep Mark happy.  During that time, I actually got a new job.  My dad knew how unhappy I was. He had me call someone he knew at Lifelink Corporation.  They were looking for licensed clinicians for a new program in foster care.  So I went to the interviews and I was hired! Hooray!  Unfortunately, this meant that I would be leaving my poor intern fend for herself and without a social worker to supervise her.  When I told her I was leaving, she said she didn't want to stay there without me.  She spoke with her advisor at school and told him about the situation.  She requested to change internships.  When I told my supervisor that I was leaving, I also told him that the intern would be leaving as well.
I should've seen it coming.  Mark was furious that I had told her that I was leaving before I told him.  He was also furious that she was leaving and blamed it on me.  He basically threatens to take my license saying that this was unethical.  I'm pretty sure it's not.  He made life very uncomfortable for me for the next week or so.  He finally told me I was fired.  This really was an incident where I could've said "you can't fire me!  I quit!"  He didn't give me any opportunity to say goodbye to any of my clients, and in fact canceled an appointment I had without telling me.  I sat around and waited for the client, and when I called her, she said she was confused because market already canceled the appointment for me.  Awkward!
I later found out that he told the kids that they could write the letters to say goodbye and he would send them.  I never received any letters.  He told them I had to be fired because of unethical behavior.  I really wish I could sue his ass for defamation of character!
A couple of months later, my husband and I bought a new car.  I had to verify my work experience for the last year.  I had just started at LifeLink so not enough time had passed.  I gave them the number of the learning house and they called Mark.    A car salesman told me that Mark had told him not to sell me a car and that I was a bad risk.  This is  highly illegal.  Nevertheless, we did get the car.  Despite knowing that I had actually quit, the experience of being "fired" was uncomfortable for a very long time.
The last time, and hopefully the final time, that I was fired was recently from a side gig I had.  I was doing professional presentations for Aetna.  They would send me to various locations and I were present on a variety of topics including cultural sensitivity, stress management, positive communication, things like that.  They would send me the materials including handouts and the PowerPoint and I would just present.  I would try to add some material if it was appropriate.  The last couple of times I was not well received.  People didn't like that I went off script and they didn't like that I talked about my own experiences sometimes.  So the company called and told me that I got some bad reviews.  They gave me one final gig after that.  I'm pretty sure the company that I was presenting to may have been told that I was being tested out.  I was met with stony silence.  No one participated in any discussion or activities.  They didn't laugh at any jokes or ask any questions.  Try to have a conversation sometime with someone who is paying any attention to you.  It is a lesson in futility!
Now I am in business for myself and it is unlikely that I will fire myself.  Clients fire you all the time, and I am able to keep this from feeling personal in most cases.
It is funny how your idea of what is really awful morphs when you are fighting a chronic illness.  Being fired from the Learning House seemed to be shameful and embarrassing event.  But when I look at it now, not only was it pretty meaningless in the grand scheme of things, but it's laughable that I could see that as any kind of a challenge.
Trying to put my pants on in the morning...That's a challengw!

Relationships

My very depressed client asked me why relationships were important Before I could answer he told me that I probably would say something about passing the time until we die.  I told you he was very depressed!  But my answer had nothing to do with what he thought.  I had to contemplate my answer for a little while before I told him.
He talked before about intersubjectivity and how important it is see ourselves as others see us in order le to get a clear view of who we actually are.  So that was part of my answer.  But the other part was that in order to know how connected we are one another we must have relationships which continued through time and space.  He told me that he felt that relationships just came and went and therefore they were purposeless to him.  He said that he saw all of his friends from high school go off into the world.  Some he had never seen again.  Some he saw again, but they felt changed, like they weren't even the same person.  The truth of the matter is that none of us are the same people year after year.  Our experiences, thoughts and feelings, heck, our even underwear change day to day. ( I guess I don't really change just because of my underwear....)  But my friendships change and come and go.  Sometimes I choose to end relationships for a variety of reasons.  Sometimes they end because of circumstances or logistics.  And sometimes they just fade away.  But no matter what the friendships always matter in making me who I am.
I told my clients that friendships are like layers in making us who we are.  No matter who I am still in contact with, the fact that we interacted and talked and loved one another or hated one another or had only a shared experience, creates a layer in my heart and soul that never changes.  I think we sort of download ourselves into each other's psyches.
In order to know that we are connected to the universe, to one another, to the tacos and the skyscrapers and the lawnmower... we need to be with other beings.
By sharing our hearts and minds, either one-on-one or in a community, we become larger than ourselves.  We are able to stand with solidarity with other people have empathy for their experiences, good or bad.  This is one of the things I like best about being a therapist.
That young man, so depressed and lost and lonely, comes every week like clockwork.  I think the relationship in therapy is a bright spot for him in a world that looks so bleak.  I think I am the only person listening in an honest effort to really feel what it's like to be in his body and his world.  I feel very privileged  that he lets me try.
Whenever we think we are alone, whether we believe in God are power in the universe beyond ourselves, you're never alone because everyone who's ever touched our lives remains in our hearts and our souls.  The more people we connect with, the more we grow.  Maybe that is the answer to gun violence.  People who feel connected to the world than to others could never choose to take someone else's life for any purpose. The answer really isn't making new laws.  It's strengthening the connections between each other.  It's recognizing that we are the same.

feelings

No, this isn't a blog about a dumb 80s song!
I promise this is my final blog about the grieving process.  My house is finally painted it looks great but it's still not really put together.  I don't do well when the things around me are so topsy-turvy.  Dealing with change  and chaos  is part of the grieving process.  It's why you actually have a lot of different feelings during that time.
Feelings are what happen after you're done being in denial.  Once again, the feelings during the grieving process come and go.  They often don't come just one time and go away.  They come again, sometimes together, sometimes separately, and sometimes at odd times when you least expect them.
Feelings you might have during grieving process are anger, fear, excitement, depression, and of course, I've already talked about the guilt.  There are no right or wrong feelings and no right or wrong way to deal with them.  They all have a purpose.
Anger happens when we realized that we are forced to do things differently  due to whatever change has occurred.  We'd like to make her own decisions about what to change, not be forced into it!  Anger's purpose is to energize us.  It makes us want to do something.  It is no accident that the acronym for mothers against drunk driving is MADD.  Candy Lightner founded mothers against drunk driving after her daughter was killed by a drunk driver.  She used anger she felt to do something rather than feel powerless.
So use anger you feel to become energized to do something to manage the change.
You feel the fear for the same reason as anger.  It comes when you realize that things are going to change and you must change, also.  Fear and panic are energizing as well.  Panic attacks are no fun, so they force you into making the internal changes you need to make in in order to see how you must be different.  Anger is more about recognizing and managing external changes.  Fear is about internal changes.
Believe it or not, this can also be exciting.  Sometimes people feel guilty for recognizing that they are excited about the changes that will occur, but remember that all feelings are just energy passing through us.  It's what we do with the energy that we can actually make choices about.
Depression is the real work of grief.  Sometimes we just need to let ourselves feel sad.
My journey through life with multiple sclerosis has given the opportunity to feel all of those feelings!
I was working with this kid yesterday.  He is very interesting because he doesn't want to feel depressed, but he doesn't want anyone to tell him something about himself is something to change.  He wants people to accept him exactly as he is.  Even though he hates it, he sees his Depression as part of himself.  In an odd way, I see having MS as part of who I am now.  I would give it up in a minute, but after 20 years, it would be a change and I would probably go through the grieving process about letting go.
The trick is making something part of you without getting stuck in one of the feelings.  That kid has gotten stuck in feeling bad about himself and the world and now sees it as part of who he is.  You can get stuck in anger and become bitter or get stuck in the fear and become a recluse or get stuck in the Depression or the guilt and become just a regular Downer Debbie!
One thing about grief, is that it doesn't last forever.  I think I am done with the grieving process. I just remember not having MS with a mild sadness and wistfulness.  I think I am now walking down a different street and can usually avoid the holes! 
Now that the painting is finished, we are getting new carpeting.  Believe it or not, as much as I want new carpeting, I have a little wistful sadness about it.  This was the carpeting  we got when Eli was first born and we paid for it with a gift from my grandfather.  It's bittersweet to watch your child grow up and move away and my grandfather has been dead for many years and I still miss him.  So saying goodbye to carpeting, as saying goodbye to the past.
That's a little maudlin, I know.  I usually just think of getting rid of the carpeting is getting rid of whatever has been smeared on it by the dog dragging his butt on it!

Grief 2

So did you think you are done with the grieving process? I'm just getting started. 
Kubler Ross said that the grieving process consisted of five stage:  denial, anger, bargaining, depression, and acceptance.  As I said yesterday, this model gives the false impression that grief is a neat package of steps, when it is really a messy roadmap.  Since Kubler Ross there have been other proposed ideas about the stages of grief and it is becoming a little closer to what actually happens.  There is one thing consistent about grief and that  is that you always go back into denial between the working parts of the stages.
The stages each have a purpose as well.  Denial is so that you won't go crazy and can continue to function while you do the work of grief.  The other stages are more fluid, too, and they each have their own purpose.  I want to talk about guilt today because it seems so maligned and misunderstood. 
Even if you have no reason to feel guilty, guilt can give you a sense of control over the situation.
Now I don't know about you, but I like to think that I have some control over my destiny.  A diagnosis of multiple sclerosis takes a lot of the control out of my hands.  I know that there is nothing that I could've done to foresee or stop the diagnosis from happening.  There is very little known about where MS originates.  Scientists keep going back to the idea that it is a virus gone crazy.  So perhaps if I would've been more aware of viruses since I was a small child, I could've kept myself from getting sick... not very likely.  But I have had my own guilt about not taking care of myself or not recognizing the symptoms soon enough,  or just not getting onto the medications soon enough.  Denial is useful in helping you get through the day, but it's not useful when it keeps you from getting the treatment that you need!  I could've gone to one of disease modifying drugs about a year earlier, but I just didn't feel like I needed it, and I kept hoping that maybe I just had benign MS and that I would still be able to have a nice normal life.  So I get to have some guilt about waiting so long to go on the medication, because really, the control that I have, is over how I manage my MS. And control is a good thing.
People think that guilt is a bad thing.  Guilt is actually okay.  You should feel guilty about some things!  If you do something wrong you should feel little guilty.  I was at Michael's one day and I was buying some little wooden beads for a project.  When I got to the checkout I couldn't find the little bag of beads anywhere!  I figured I must've dropped them somewhere in a store and it wasn't worth going back for a $.99 package of beads.  When I got to my car and looked for my keys in my purse, lo and behold, there was a little package of beads!  I stole them!  So I should've just take them back into the store, but I didn't.  So I have a wee bit of guilt about that.  Guilt comes with bad behavior.  Do I think that I am a bad person because I stole a $.99 package of beads on accident?  No, but it wasn't very nice behavior.  If I thought I was bad person, that wouldn't be guilt, it would be shame.  Shame is a bad feeling about yourself and guilt is a bad feeling about your behavior.  Your behavior you can change because it's just a choice.  Misplaced guilt can become shame and shame is never useful.
It would be easy to be ashamed of the diagnosis of MS.  It would be easy to feel that needing help was a weakness.  It would be easy to feel that some of the things my body does separate from me, are shameful things.  But shame only serves to make me feel terrible about myself, while guilt and make me have second thoughts about my behaviors and the  way I am managing things.
So if you feel guilty about something that really you have nothing to do with, recognize that you need to feel in control and find places where you do have control.  Control hjelps you feel you can still be in charge of your life!
On a lighter note, I wore my Rocker shoes all day yesterday!  I wanted to find a place where needed to walk a little bit longer in order to test them out.  So I went to the thrift store, and got two really nice sweaters and didn't feel all worn out afterwards!  Next time I am trying the mall!