The politics of shoes

Naomi Wolf 's thesis in The Beauty Myth (1991) was that the 'beauty industry' keeps women down by demanding the attention to our appearances that it does. It siphons off physical and mental energy from other pursuits. It drains our purses. Sometimes, as in the case of cosmetic surgery, it kills us. Her book asks questions like:

• What could we accomplish with the 45 minutes we spend every morning doing our hair and putting on makeup if we put that same time and energy into our careers? Or politics?
  
• How many battered women's shelters could we fund with the money we spend on face cream?

Right after Geraldine Ferraro was nominated for Vice President, a shoe company ran an ad in a women's fashion magazine with the tag line, "Every woman needs a platform to speak from," over a picture of an admittedly hot shoe with a three-inch platform. I knew right then that Ferraro was going to lose. A 3-inch heel, be it platform or spike, is, it goes without saying, most emphatically not the sort of platform we needed. The advertiser viciously trivialized the platform Ferraro was running on. The ad's creators overtly sought to channel all our political ambitions into a "suitable" direction for women and girls, and away from real power--as Wolf points out, much in our consumer society does. It's almost as if the shoe guys were saying,

"It's ok girls. You aren't ready for the White House, but here's this cool consolation prize--a pair of shoes you could break your ankle falling off of. Be careful when you walk, but hey. At least you'll look sexy! which is all you girls really want out of life anyway, right? Not to mention that we guys are much more comfortable if you stay in that space, ok?"

Now Dr. Isis has some truly hot shoes in a recent post. I bet she looks spectacular in them. And I am not, repeat not, criticizing her for wearing them. I like them. And given her station in life, they are obviously not the consolation prize. But Dr. Isis and I grew up in very different times. I was just coming of age when the second wave of feminism hit young women of my generation like a tsunami, and that, believe it or not, has a lot to do with how I feel about shoes.

Rape crisis centers and battered women's shelters sprang up everywhere in the '70s, as did self-defense classes for women. And one of the things I learned early on was that high heels are literally crippling. For one thing, they actually damage your feet, legs, and back. No biggie--lots of things we consider fun or fashionable are not good for us. Take chocolate, for example.

But feminists back then equated spike heels in particular with the ancient Chinese practice of foot-binding. If it was hard for a woman to walk, and her activities were thereby severely restricted, it was obviously going to be easier to keep her in her place--to wit, submissive and dependent. And as the women who ran the self-defense classes pointed out, it is damn difficult to run, kick, or fight wearing spikes. (Although removed from the foot, they do make pretty good weapons.)

So to me shoes are important to mobility. If I'm not mobile in them, I won't buy them. These are my office and classroom shoes. They are simply the most stable, comfortable shoes I have ever owned. They are Brooks and you can buy them here (although I got mine cheaper on e-bay). I have two pair (the other pair is tan) and if they ever start making them in purple, Dr. Isis, I shall have a pair of them, too!

Second Life, mainly

I should blog on shoes more often. That one's gotten more hits than anything else I've done--but no comments. Leave some comments about my shoes, ladies!

But. As promised, here are my thoughts on Second Life:

1. I spent about two hours the first night building an avatar. That's two hours of my life I will never get back. So thought number one is that Second Life is (a) time consuming, and (b) consumes time that might be better spent elsewhere (see #6).
2. It was frustrating from the very first, because if I were going to have a Second Life (hereinafter referred to, for the sake of brevity, as SL) I would want it to be a truly mind bending experience. I would want to experience life from a totally different point of view. I would want to really learn something. I would want to be a dog. SL won't let you do that. You can "build" a dog and "script" it to follow you around, but you can't be one. Which makes thought two that people don't really want a Second Life. They want a do-over of the first one.
3. I am not (and cannot be within the limits of SL) satisfied with my avatar. She neither looks like me nor looks like what I might like to look like if I were, say, able-bodied, or simply just better-looking. So thought number three is that other avatars I saw on line are probably imperfect expressions of their owners as well, and therefore SL might not be too effective insofar as it's intended to let people live out a fantasy.
4. The avatars I saw were indeed fantastic. A lot of them looked like fantasy fiction or sci fi characters. Some may have belonged to the kind of people who hang out at medieval festivals--caped and bearded and booted and all that. Although I didn't see any avatars with wings, I understand that you can add them! Thought number four, therefore, is that SL is inhabited by people who are not happy--or at least not fully satisfied--being who they are, where they are, when they are.
5. Some people have businesses and make money on SL. My first thought is that I would open a psychotherapy practice: Some of those people probably still need therapy! So the fifth thought on SL is that people who are happy with their lives will more or less replicate it on SL, which makes it sort of redundant, and therefore unnecessary. Which is why I won't be back after today.
   
6. Or I could open a bookstore. But I make a choice every day to continue to be a psychologist because I like what I do. Thought six, therefore, is that people on SL would rather do something else. Which raises the question, then why don't they? Might not all the effort (and money--you can spend some real bucks "in world") be better spent making your only real life count for something?
7. But here's the real kicker. Research, clinical, and my own experience all tell me that in life (specifically, in group therapy, the transference, the workplace, and the family) people will sooner or later reenact whatever issues they have going on elsewhere. Sure enough, in just a few hours on SL the other night, I saw people rejected, ignored, pestered, and one guy suggested that "everybody get naked". So my final thought on SL is that even if you don't want it to, your personal frustrations and limitations are going to follow you onto "the grid" and you will inevitably find yourself disappointed in the same ways that you are in life (so take the advice offered in #6 and put your energy into working through your issues in the here and now!).

There were 57,646 people logged onto the grid when I got there. That's kind of scary.

The Goddess, hard at work

Shoes

But before I get to Second Life, I just have to weigh in on this shoe thing.

Here are my favorites:

These are so awesomely comfortable that I feel guilty wearing them to work, which undoubtedly limits the range of Hotness I can aspire to on RateMyProfessors.com.

See, to me, the real revolution is when we can wear comfortable shoes (like men do) without being accused of being dumpy, frumpy, dorky, or otherwise not feminine enough.

Second Life

OK. I just discovered Second Life. This is some scary sh-t. More about this later.

Blackout

Just finished reading John Lescroart's Betrayal (at 1 a.m. this morning, but compulsive reading is another subject for another day). In it, a defendant has no memory for the time of the crime. The defense attorney's handling of this problem is a bit muddled.

He hopes to get in Posttraumatic Stress Syndrome (PTSD) as the explanation for the gap in memory. In a preliminary hearing, a psychiatrist with expertise in PTSD testifies that flashback-related blackouts last only a few minutes (pp. 211-217). My quibble with this is that these experiences are not technically "blackouts" at all, but dissociative episodes. The person is fully conscious, but not really present because they are re-experiencing events from another time and another place. Most likely, they will remember the content of the flashback, but not necessarily what they said or did, or what other people said or did, while they were having it. It is in that sense that it is a blackout, in that the information they forgot was never recorded in the first place, and this is why it cannot be recalled.

During the trial, the evidence proffered is that an old head injury is the cause (pp. 274-279). Unfortunately for the defense, a neurologist testifies that brain injuries do not account for extended periods of unconsciousness (after the initial trauma, that is) and the defendant has four days to account for. Not to mention that his blood alcohol at the time of his arrest shows clearly that he'd been wide awake and drinking like a fish for goodly portions of the days in question. Here the problem is that, once again, "blackout" as a term is being used by the attorney to mean one thing, and by the expert to mean another.

The defense attorney recognizes this little problem in mid-testimony and gives up on this witness, when another question or two would have established that "blackout" is not synonymous with "unconsciousness." Indeed, testimony from a VA staffer is available to show that, while still in the hospital, the defendant had experienced an episode during which he was fully awake but thought he was still in Iraq: He remembered nothing of this afterward (pp. 226-228).

And then I must have had some kind of blackout, because I started this blog entry over two months ago and never published it. I found it when I decided to write a little scribble on memory in general, and was checking to see if I'd done that already!

I have no idea any more how I intended to finish it, so here it is, as is. Scary.

This is Io

Io will be accompanying me to the office most days, beginning the first of January. Mr. Wood and I adopted her a few weeks ago from the Atlanta Humane Society. She may be a Flat Coated Retriever mix, although there has been some difference of opinion on that. She is two years old, well-mannered although you could not say "trained," and has the sweetest disposition. She is shy at first, but once she gets to know you, very affectionate.

She is named after the Greek goddess, and it's pronounced "eye-oh".

She and I went by the office today to feed Larry Bird, post yesterday's deposits, and pay this month's tax bill. This was her first visit to the office, and she went straight for the Rescue Dog toy a client had brought in after 9/11 for Rosie. Io loves stuffed-animal-type toys!

From there, we went to the bank and the post office, and as you can see it was a tiring day.

Participated in the biennial ritual of license renewal. It is now legal for me to practice in the state of Georgia in 2009-2010.

It's good to be back.

How I spent my vacation

Claire Potter, over at Tenured Radical, turned me on to Scars of Sweet Paradise: The Life and Times of Janis Joplin, by Alice Echols when I put the word out a couple of weeks ago that I needed someone I could use as a model for my Personality students to follow in writing their papers. I'm about halfway through, and loving it. Janis's debut album, Cheap Thrills, came out when I was 16, and she had a helluva influence on me. Broke my heart when she died.

I anticipated that I would be able to mine her life for some good psychoanalytical stuff for the Theories class, but after that, I worried that there wouldn't be good material. My first surprise was what a hard worker she was: There's some good Trait Theory stuff to be mined there--not only Conscientiousness, but also Neurosis and Openness (to Experience). But the real surprise is the cultural angle: She was a Boomer, of course, so before she was in the thick of things in the Haight, she'd had that whole 50s-suburban-middle-class-nuclear-family-upbringing thing going on. And of course Big Brother was one of the original San Francisco bands, so she was turning pro just as everybody out there was going psychedelic and plugging in. The cultural angle shouldn't be a surprise, but being a late Boomer myself and having come of age in the 60s, I tend to forget what a revolutionary experience that would have been for her.

In other words, to my amazement, I am less than halfway through the book and have three sets of theories I can apply to Janis's life to teach my class

1. how to use theory to explain a real human being,
   
2. how to find relevant empirical literature, and
   
3. how to pull it together for a paper.

And it's such a fun read! Some of the history I knew of course, having lived through it, but some of it was before my time, so the book has been providing some fascinating background to my own adolescence.

Thanks, Dr. Potter!

Dr. Wood on vacation

• Fog drifts through the woods from the river, blanketing my sister's horse pasture in soft, gray light and shadow.
• I woke up during the night to find my bed co-occupied by two cats and a 95-lb. Labrador Retriever.
• Went to the bookstore yesterday to watch my niece work and was thrilled to see three copies of Shreve's book on the shelf!
  

So Whudja Think?

I'm loving the discussions on discussions in the blogosphere of late. Sisyphus (who is actually a cat, but never mind) over at Academic Cog started it. When you get done with that, read Dr. Crazy's response at Reassigned Time.

I am not nearly as intellectual as either of these ladies, so my classroom discussions tend to begin with, "So whudja think?" But like Crazy said in her comment,

"I definitely have an agenda for what I want them to get from the texts that I assign, but I think that the best discussions happen when I'm not terribly controlling in my methods for getting students there."

Before we go anywhere else, I want to find out where the class is at with the assigned reading. Sometimes they have a better idea than I did about where to go with it. Sometimes I find out up front that they didn't even get it, so some explaining is in order before we try to discuss. But I always start with their initial, gut reactions to the thing.

We have to get past that, though. I want them to do in class (and in their reaction papers) more. In ethics, there are, obviously, some clear Rights and Wrongs. You don't have sex with a client. That would be a clear Wrong. But some things are fuzzy, and some things in the ethical code conflict. And some things haven't been sorted out by the experts yet. For example, some say we should never mix the therapeutic and forensic roles. Others say that separation is neither possible nor practical. So how do we as practitioners handle that? I want them to be able to cite cases from licensing board and ethics committee proceedings, the Code itself, and case law to support their arguments. I want them to be able to cite commentators' opinions and research findings when they are available. And finally, I want them to be able to consult with colleagues and document their ultimate decisions as to a course of action.

But Sisyphus complains that "the refusal or just plain inability to dig your fingers into the guts of the text and mush things around is prevalent in my class right now,"and there is some of that in my class as well. Indeed, my students occasionally express frustration that the Code and its commentators don't just tell them what to do! They even accuse people who grapple with ethical issues of the sin of ethical relativism, apparently on the theory that "everybody" already "knows" (or should know) Right from Wrong. I want these folk to come to understand, over the course of the semester, that part of what makes psychology a profession (as opposed to a technical field) is that there isn't just a manual that you can follow, that the work requires sometimes difficult judgments.

I came to teaching in general (and to discussion in particular) with more clinical than academic experience. As I have noted previously, the Georgia School of Professional Psychology was oriented toward clinical practice, not research and teaching. So I never had the opportunity to TA with the professor I most admired, and we had no undergraduate program to practice on either. What I did know how to do was group therapy, and I brought some of those skills (e.g., getting people to talk to each other, not the group leader) to the classroom. And that did give me a good start. It feels natural to me: I don't agonize over it they way I do over my lectures in my Personality classes. (I've never given birth to an infant, but I imagine the process is somewhat similar.)

Classrooms are also similar to groups in that, while you want members of each to be talking to each other more than they do to you, you also must still remain in charge. You have to keep people on task. You can't let someone become a scapegoat for the rest of the group. And as Crazy noted, you can't be afraid of silence. Group therapy is not performance art: Members can't come to group expecting you to 'do them some therapy.' They have to bring something to the table. It is similar with students, at least in ethics class: You can't just lecture people on ethics. That's not how people learn to be ethical. They have to engage with the issues. So if they aren't, you can't be afraid to just sit there until somebody pipes up. I learned a long time ago as a group therapist that nobody can stand it longer than one minute: Try it yourself. Count off 60 seconds in your head next time you find yourself doing all the work and see if somebody doesn't start something before you make it to 60. Works every time.

What I'm still learning is how to be "explicit about how what we do in class... connects to what they do when they read, what I expect of them on writing assignments, and what they do on tests." My Personality classes have been totally at sea on how to use empirical articles to examine a public figure's personality, and my Ethics students tend to write reaction papers that are just that: their reactions. No processing at all.

Crazy's post made me see the obvious: That not only have I got to do this 'make explicit' thing more than I have been in class discussion, but also in instructions for assignments, study guides, and even in my lectures. For next semester's Personality class, I'd already picked one public person (just like they will use for their case study/term paper) to follow all the way through the course, using research and theory to explain her as well as using her to demonstrate theory and research. Before, my choice of examples from one class session to the next was pretty random, and they haven't been 'getting' how to do their papers because of it. Now in addition to using a better class of example, I know I have to lay out for them how to use that example.

On Fairness and Respect

Sister blogger Lesboprof is out protesting California's Proposition 8 this weekend. She explains in today's post that the nationwide protests are about a lot more than "gay marriage":

It is about calling out people's rejection of LGBT people... the idea that you can say you love us individually and vote against us as a group. We are your family members, your teachers, your students, your friends, your neighbors, your partners in faith, your elected officials, and your compatriots. We deserve fairness and respect.

She's right. That vote was an awfully painful slap in the face to LGBT people everywhere, not just in California. The message is that however much it may feel like you are accepted and respected by society, you really aren't. It's all lip service. And when your students, your friends, your neighbors, your family, and your fellow congregants can vote in secret, the truth comes out. A vote like California's serves only to demonstrate straights' hate and disgust and fear. And that is what it is. During the Civil Rights era, you used to always hear "Some of my best friends are Negroes, but..." and then would follow some right or list of rights that Blacks should be denied. Despite what people say about not being racist or homophobic or sexist or whatever, their behaviors say otherwise.

Maybe we ought to reserve the term "marriage" for the religious ceremony that takes place in churches, synagogues, and other houses of worship. Maybe we ought legally to refer to it as "partnership" (with some adjective to distinguish it from a business license) and make it accessible to everybody (adult), everywhere. The official status of what we currently call "marriage" confers not only numerous legal and financial benefits--which there's really no logical reason to deny LGBT people--but also a certain social standing and psychological meaning. When your coupleship is official, it gets much more "glue": Other couples support it, singles respect it (by which I mean it cuts down considerably on "poaching"). A state license grants a personal sense of permanence, stability, and trust in the relationship--that it really means something, that it will be there for you. All of which there's also really no logical reason to deny LGBT people.

When I was growing up, it was illegal for people of different races to pair off, never mind marry each other. It was called "miscegenation," and it was a crime. There were laws against it. (I know I just said the same thing three times, but I'm betting there's young people out there reading this who won't believe me the first time.) That looks so quaint, backwards, racist, and downright silly to us now. Why are we holding on to the same ugliness with regard to LGBT people? It does not become us as a nation. What it says about "the content of our character" is not pretty.

It's time we grew up.

Courtroom Antics

I have two cases going to court in the next couple of weeks, one civil and one criminal. And it's got me to thinking about past forays into the justice system and how weird it can get.

Used to be, we were the only private practice up here for miles around, and we had folks drive from as far north as Dalton and Copper Hill for therapy. As a result, we were occasionally in courtrooms just about anywhere in the Blue Ridge circuit. Judges and attorneys varied wildly in quality. On one memorable occasion, I drove all the way up to Calhoun to testify in a divorce case in which I had already warned both parties that I had nothing to say that would be good for either of them. But one of them subpoenaed me anyway, so off I went at the crack of dawn to the wilds of north Georgia. No sooner had I been sworn in than the judge asked me if I wanted to waive privilege. I said "No," he excused me, and that was that.

Now I am no lawyer, but it is my understanding that, in the first place, the privilege is not mine to waive. It is the client's, and the soon-to-be-ex-wife, by subpoenaing me, had already waived hers. (Not to mention that, under Georgia law at the time, communications with me weren't privileged in the first place.) But whatever. I didn't want to be there so this suited me just fine.

Even some counties close in to Atlanta were pretty back-country when I started my practice. I was in Dallas one day for a child sexual abuse case. This Court liked to assemble all the parties, including witnesses, before beginning trial and was calling roll. The child victim was female, and was accompanied by her mother. The mother had brought her divorce attorney, who was female, as there was also a modification of custody action pending. I'm a woman, of course, as was the pediatrician who was going to testify to some physical evidence. A female police officer was there to testify as well. At about this point in his roll call, the judge, clearly exasperated, turned to the (female) ADA and asked, "Is everybody in this case female?" to which the ADA, straight-faced, replied, "No, Your Honor, the Defendant is a man." The courtroom broke up. Even the bailiff was laughing.

Veterans' Day

For those of you who like to write but are occasionally stumped for a topic, check out The One Minute Writer. Today's prompt, appropriately enough, is "write about a war veteran you have known of, or known personally."

The first vet I ever knew was my Mom's Dad, whom we called Boppa. He was in the infantry in World War I. I don't know much about his service, because he had a repertoire of three funny stories and that's all he would ever say on the subject. My father-in-law was in the Navy (Pacific) in World War II and was reportedly much damaged by the experience.

One of the best clinical supervisors I ever had served two tours in the infantry in Viet Nam before he went to medical school. As a therapist, it has been my honor to work with veterans as well as active duty personnel and military families. Some have seen combat, others have not, Some were officers, others grunts or noncoms.

Today, and every day, I would like to thank them all for their service.

RateMyProfessor.com

One of my students told me today that I already had a good rating on RateMyProfessor. This surprised me, as I have only been back teaching since January. But I went to look tonight, and sure enough, there I was.

There's good news, and bad.

One of the ratings was from 2002: "Awesome. Really knows her stuff, makes it interesting." I got good ratings on helpfulness. Unfortunately, I'm also rated as "easy". (I'm not easy: I flunked somebody last Spring, fer cryin' out loud!) So of course my overall ratings were good.

But the worst part, worse even than being described as "easy", was that I got zeroes on "hotness". Now I realize that at 56 I can't look very hot to most of my students. But zeroes?

Obama wins!

"Change has come to America."

The Mental Status Exam

MDOD has a new post, complete with CT scan, on a fella who came into ER c/o (complaining of) altered mental status. Of course in the outpatient private practice of clinical psychology, one rarely--if ever-- sees such dramatic cases. Nevertheless, it's a good reminder that whenever we do see a really whack MSE (Mental Status Exam) we should always, always have the patient seen by a physician to rule out physical causes before we assume that they are "just" being paranoid, or are schizophrenic or whatever. Talk therapy won't work on tumors.

Mom once lost a friend that way: He'd been in treatment for months for "depression" when what he actually had was a brain tumor. This happened when I was still an undergrad (yeah, yeah, I know--back before the Flood), but it's remained in the forefront of my mind whenever I am doing an initial assessment or when an ongoing patient's status changes. Mom's friend had never been depressed before, even though he was by that time in middle age, and there was no family history of it. Furthermore, there were no apparent environmental causes (e.g., illness or death in the family, work stress, etc.). Which should have been big ol' red flags right there.

In a practice like mine what we are more likely to see is someone who is physically quite ill, but the medical folks, having failed to find the cause, refer them to us for psychotherapy for imaginary or manufactured illness. One such fella I had certainly had an altered mental status--he kept passing out!--but there was no discernible psychosocial causation, no family history of anything remotely similar, and his personality profile from psychological testing was completely inconsistent with any sort of histrionic or psychosomatic disorder. And a friend's son was once referred to a psychiatrist before it was finally discovered that he really was having trouble breathing: The poor kid had tuberculosis!

Point being, I guess, that mistakes get made on both sides of the professional aisle. Medical people should listen to us when we tell them we don't think the problem is psychological, and we must consult with them, too.

Wood's Rules: #2

Rule 2: I never wait for anyone, not even God, for more than 20 minutes.

The Mister and I went to vote this morning. Lines have been long, but Mr. had called ahead and was told that we could go to the front of the line because of my disability. So we turned up promptly at opening time this morning (8 am). It was a madhouse. The parking lot was full and there were lines of cars snaking up and down the aisles looking for a spot. Which of course they weren't going to find because no one had voted yet and therefore no one was leaving. Ever the optimist, Mr. dropped me off at the front door and I went to the front of a very long, very fat line--only to find that handicap voting didn't 't start until 9:30!

But it all got me to thinking again about disability rights, which we talked about in Ethics class on Wednesday. Going to the front of the line is not a privilege. It merely evens up the playing field. I could wait in line all day, and have done (Jimmy Carter's election comes to mind) but a lot of handicapped people can't maintain for that long. So they could not vote the way things are this year. Point is, "privileges" like going to the head of the line enable us to do things we could not otherwise, things the able-bodied take for granted.

The dean of my graduate school told me once that my fellow students envied my special parking space. At the time we were moving through a buffet line: I picked up a carving knife and told him that anyone who wanted one could bend over and I'd qualify 'em for special parking right here, right now. He did not get the message that he had it all backwards. Curb cuts, special parking, wide doors, grab rails, ramps, all that stuff is not a privilege to be resented by TABs (Temporarily Able Bodied people) like him, but assists that we need so that we can attend graduate school, travel, get to a job, go to the store, stay in a hotel, see a movie, and partake in community life in general. His facial expression clearly said that he thought I was the one being inappropriate.

Anyway, to get back to Wood's Rule #2, which is where we started, I wasn't inclined to wait an hour and a half for special voting privileges. Why, if everyone else can start voting at 8, can't we? Mr. and I have things to do this morning, so we came back home. We will try again later. Maybe we will be able to get a parking place.

But it did occur to me that every rule has an exception, and this rule is no exception to that rule. I would wait in line ALL DAY to vote, if necessary. In fact, before I found out about my disability getting me to the head of the line, I had planned to take Tuesday off if standing in line all day today didn't get me to a voting machine before closing. It took all night to vote the year Jimmy won: I went to the polls after I got off work at 4:30, and they closed the doors at 7. There were so many people already inside that gym that it was after 10 before I finished. Boy was I bored! There's only so much you can chat about to the total strangers in line with you, and you can only study your ballot for so long. Somebody had a paper, and we read it about seven times each, then that got old, too. But voting is so important that it was ok. I would have still been standing there at daylight if that's what it took. I'm just glad the pollworkers were willing to keep at it until we had all voted.

Generally speaking, however, I consider my time valuable, and I hate late. If you are my last client of the day and you aren't there by 20 after, I'm gone. If you are meeting me for lunch and you aren't there within 20 minutes of the agreed-upon time, I'm ordering without you. If you're my doc and you aren't ready for me within 20 minutes of my appointment time, I'm leaving. And I tell my classes that if I'm not there within 20 minutes of the scheduled start time, I'm not coming and they are dismissed. I once had a professor whom I never actually met because he was late for every single class the first few weeks of the semester. The fourth time this happened I went to the Registrar's at 20 after and withdrew: I made them give me every penny back, too. No withdrawal fees, or late registration fees for the new class I signed up for either. I felt disrespected, and I worry that, when I'm late, no matter the reason, that I am communicating a disrespect that I don't feel to the person cooling their heels waiting on me.

Why is this such a big issue for me? Possibly because my mother was late everywhere she went. When I was a kid, I don't think I ever saw a movie from front to back. We would arrive late, stumble around in the dark looking for a place to sit, then climb over people in the middle of the movie. I was always so embarrassed! We'd watch the last half of the show, then sit through the previews and the newsreels and the cartoon and watch the first half of the movie. Mom would announce, "This is where we came in," and we would get up and leave, climbing over everybody again and stumbling out of the theatre in the dark. My mother-in-law was the same way: The Dad-in-Law used to always tell her things were starting 45 min. before they actually did in order to get her dressed and out of the house in time, and even that didn't always work. Mr. is prompt, thank heaven, or we never would have made it as a couple.

Part of promoting Rule #2 to patients is that so often they--especially the women--do not hold themselves in high enough esteem. They are willing to be kept waiting endlessly by people who obviously are disrespecting them by making them sit. One of the faculty at the Internship From Hell pulled that on me once, deliberately, and when I left after 20 minutes he went ballistic. (It turned out that he had not arrived for nearly two hours!). In business and politics, apparently, keeping people waiting like that is a deliberate ploy to establish dominance: What made the guy so mad was that I didn't demonstrate the expected subservience. I won't play that game, and don't encourage my patients to, either.

Anyways, that's Rule #2.

Postscript: The second time was the charm. There were no handicapped spaces available, so Mr. had to drop me off, take the car across the street to the drugstore, and walk back, then repeat the process in reverse afterwards to pick me up. But except for that we were in and out with no problems. The guy in front of us, who had come through the regular line, said he'd been there 4-1/4 hours. My hat's off to him and to every one of those other good people so determined to vote. You go, America!

Reassigned Time: On Guiding Students Through the Research Process

A few months ago (geez, has it already been that long?) I posted a whine on teaching senior undergrads to write. Dr. Crazy has tackled this task in a recent post, and does it ever so much better than I did.

For one thing, she's not whining. Read Reassigned Time: On Guiding Students Through the Research Process, and the Comments.

Since my first post, I have had students in my Ethics class turn in four Reaction Papers. The average grade on the first paper (and the mode, too, while we are at it) was the moral equivalent of an "F". (Among other problems, despite most of them having already been through the Research Sequence, they still don't know APA style.) I was horrified, and they were pretty freaked, too.

Slowly, the papers began to improve--gradually at first, then radically between the 3rd and 4th assignments. I suspect that part of this is that now they realize I'm dead serious about the grading (one student admitted to me that he hadn't even opened his style manual since the course began), but the biggest part I think is that they have heard the same things ("You need a thesis statement in your first paragraph. Really. You do.") three times. Now they're gettin' it.

This last crop has actually been fun to read.

The whine, I now believe, was the result of inexperience. I don't feel so bad after reading the posts on Dr. Crazy's blog about teaching writing. In fact, it feels to me now like an appropriate part of my task (as in, "Writing Across the Curriculum"--why not?) and no reason it can't be as fun and productive as arguing about whether psychologists should be working at Guantanamo.

Blogging

Blogging may be good for you.

Read the results of a three-year-old survey (I know, I know) here.

The survey has its flaws, not the least of which is an infinitesimally small response rate coupled with a lack of data about how the respondents might differ from the blogosphere as a whole, but it is interesting nevertheless.

The conclusions, and what others make of the results, do not mean that blogging is actually therapeutic--for that, you'd need some data other than self-report on whether blogging produces change. A literature search of the databases available through the American Psychological Association's website produced 107 hits--and not one empirical study on the therapeutic value of blogging. One fellow wrote an article referencing this survey and calling for research on this potentially fascinating topic, but nobody's responded yet.

All the survey tells us is that therapy is what many people hope for when they blog, and that they feel, afterwards, that it was helpful. This kind of self-report data is highly prone to bias. And there was an article in the New York Times in April questioning whether "name-brand" bloggers were actuallly stressed by the pressure to post, and post well. This refers specifically to information workers, however, not the average blogger.

There is a good bit of research out there on paper-based journaling that does show, especially if (a) it's problem-solving oriented in nature rather than just complaining, and (b) entries are processed in therapy or in a group, that it can be quite helpful. I believe that these results ought to generalize quite nicely to blogging. Studies of blogging following the design of journal-therapy studies would tell us.

Rosie

Gini's Cherokee Rose was my therapy dog for the first six or seven years of her life. She started coming to work with me as soon as she was housebroken, when she was still so small that I could carry her up the stairs to our offices in her puppy crate like I was carrying a purse.

She had a doggie door at home, and so could help herself to the back yard in the mornings. If she was outside when it was time to go to the office, I would holler out the back door, "Time to go to work!" and she would come running. Her favorite day was Tuesday, when her favorite client, "Miss B." had her regularly-scheduled weekly session. Miss B., who had a dog of her own at home, always brought a dog-biscuit for Rosie, but other people brought treats, too: Miss B. was Rosie's favorite for other reasons. At first, I would tell Rosie on Tuesdays that "It's Miss B.'s day today," or "Miss B. is coming today!" but she eventually learned somehow which days were Tuesdays and would be noticeably more excited about going to work those mornings.

Another client, we'll call her Mrs. C., brought in a cartoon once showing a dog, with a little diploma on the wall that said "Pet Therapist," explaining to a new client that the therapy works because "I wag my tail and you feel better." Rosie didn't have more than two inches of tail, if that, but the therapy worked: Mrs. C. used to refer to her treatment schedule as "coming to see the Dog's mother."

Freud's dogs were often present in sessions. He swore that people would tell the dogs things that they wouldn't tell him. The day Miss B.'s dog died, she came in, took Rosie onto her lap, and announced, "She knows. She knows why I'm sad." And Rosie probably did, although I could not tell that she was doing anything different that morning. And she was a great comfort to Miss B. for many sessions afterward. Miss B. once asked, if I died, could she inherit Rosie?

Rosie also went to school. She made several appearances in my Introductory Psychology classes as a demonstrator for the units on behavior modification. In between lecturing, she wandered up and down the aisles between students' desks, sniffing their lunches and stealing Kleenex out of the girls' purses.

At work she liked to leave her toys in other therapists' wastebaskets in exchange for wads of paper which she could shred and scatter like confetti all over the suite. One colleague kept a pair of walking shoes on a shelf in the knee-hole under her desk, with socks stuffed into the toes. Rosie was particularly fond of stealing those.

She was such a fixture at the office that for a while her crate served as my end-table: I even had a lamp on it and could put my coffee-mug there during sessions. A neighbor, not realizing that this was my practice, came for an initial consultation with a colleague. I heard him say as he was leaving, "Wait. I know that dog! Does Ginny Wood work here?" after which he stuck his head in my door to say hi.

When she got older, she got snarly and snappish and I eventually had to "retire" her, but even after she became less friendly with people, Miss B. remained a favorite. Rosie would lie across her lap on the couch throughout the session, and Miss B. would stroke her as we talked. One day, Miss B. was making a series of points. "Number one," she would say, and absently poke Rosie's shoulder. "Number Two," poke. "Number Three," poke. Rosie never batted an eye.

Rosie died the Saturday before Labor Day. She was 14.

Holy Mackerel, George (Bush)! What Were You Thinking??

I see that our government, and some of my fellow psychologists, have (once again) been up to no good.

For evidence, I offer MALINTENT, Homeland Security's cool new airport screening device. Short version, it uses "research on human behavior and psychophysiology" to detect bad guys. Read about it here, then tell me it doesn't leave you speechless, too.

"Yikes" is all I could think of to say.

By Monday, when we discuss the ethics of the pilot study in my Theories of Personality class, perhaps I will have found my tongue.

Wood's Rules

You may have noticed the new name on the banner. Or perhaps not.

You may be wondering what it means. But perhaps not.

I am going to tell you anyway.

There is a pretty good blog out there already with a version of the shrink wrap pun, which confirmed for me my suspicion that I wasn't being very original when I named mine. Wood's Rules, on the other hand, are my own invention, and since what I am offering here is more of the same, to wit, my opinions on nearly everything, "Wood's Rules" makes a better title.

Anyone who has been in therapy (or class, for that matter) with me for any length of time has heard of Wood's Rules. Wood's Rules are little maxims for therapy and for living that I share occasionally, always with the comment, "That's one of Wood's Rules." There are not many--less than a dozen--developed over my last 30 years (most in the first six months, actually) as a therapist, and I will be posting on them over the next few weeks by way of explaining the title further.

For now, they are, simply:

1. Rule 1: Where there's breath, there's life--and the corollary, where there's life, there's hope.
2. Rule 2: I never wait for anyone, not even God, for more than 20 minutes.
   
3. Rule 3: Never be afraid of a fact.
4. Rule 4: If you don't have a problem right now, then for all practical purposes you don't have a problem. (Also, see Rule #5.)
   
5. Rule 5: If there's nothing you can do about it right now, you don't have a problem right now. If you're still convinced you have a problem, refer to Rule #6.
   
6. Rule 6: This, too, shall pass!
7. Rule 7: For the first year after your divorce (or its moral equivalent) becomes final, you are forbidden to say "I love you" to anybody or anything who/that weighs more than 50 lbs.
8. Rule 8: You can (indeed, should) say anything you are thinking or feeling in therapy--this is not, after all, Amy Vanderbilt's Manners Class--but you may not do anything to hurt yourself or me, or to bust up my place.
9. Rule 9: If you come to therapy drunk or drugged, I will not meet with you. And, of course, the corollary: You're not driving yourself home.
10. Rule 10: Never lie to your kid(s).
    

There may be more, but if there are, I can't remember them right now.

A Perfect Day, As Far As I'm Concerned

It started with the rain. It hasn't rained here in at least a month, but last night it started coming down and it hasn't stopped since. It's blessedly cool and the humidity in the house is up to 62%, which feels wonderful compared to living in the Sonora Desert, which is what it's been like around here.

Then I got an e-mail via Facebook from an old friend I've been looking for. We exchanged a couple of quick notes before I had to split for school. I am delighted to be reconnected.

As if that weren't enough to make me happy, as I was packing up my stuff and getting ready to head over to school, I got a phone call. I didn't want to take it as I was in a hurry: Parking is at a premium at KSU, and I am always afraid if I don't get there early I'll wind up late for class.

But I took it, and boy, howdy am I glad I did! A vaguely (very vaguely) familiar voice said, "You'll never guess who this is" and as I was struggling for a polite way to say, ok, so don't make me... just tell me! he identified himself and I nearly fell off my chair.

This is a kid I first saw just before his 16th birthday. He's 43 now, married, kids, the whole enchilada, and doing great. Not anything I did for him, as far as I can tell--I think it was a God thing.

Regardless, he's doing wonderfully and it just made my day to hear from him. I've been grinning ever since.

The funny part was he said he'd been thinking about me lately and wasn't sure why. I had to laugh and tell him it was because I had his genogram up on the board in my Theories of Personality class on Monday! I am sure his ears must have been burning.

Economic Stress

According to the APA, 8 out of 10 of us are stressed about money. Women in particular are taking it on the chin because we are less financially secure to begin with.

The study's author recommends implementing stress-management skills rather than letting yourself continue to suffer the symptoms (headaches, compulsive eating, and so forth). I have joined a gym again, and resumed my meditation practice.

Stupid questions

I always tell my students that there is no such thing as a stupid question. And they don't ask stupid questions. They come prepared, which is to say that they ask questions that expand on or fill in gaps in the assigned readings. There is always something useful to the rest of the class embedded in every question. The worst experience I have with their questions is that sometimes they are ahead of the syllabus and I have to say, "Well, we're gonna address that, so hold that thought."

Then I attend a workshop with my peers and am reminded just how stupid a question can be. I went to one such event yesterday. About halfway through the morning a woman in back piped up with a request that we hold questions 'til the end: She was kinda concerned that everyone would be mad, but a bunch of us cheered.

So apparently I'm not the only one who was seething with impatience over the sheer stupidity of some psychologists. My graduate-school experience was similar in that there were always a few people in every class who were not prepared and would ask questions for which the answers were right there in the assigned reading! I wanted to scream sometimes.

Then there's always the one participant who isn't really asking a question, but who wants to argue with the presenter. Or the one who is actually just seizing an opportunity to show everyone else how knowledgeable they are on the subject at hand. They aren't actually asking questions either, but making speeches--sometimes quite long ones. Somebody oughtta do a study on inappropriate participant behavior. There's grant money in there somewhere, I'm sure.

Yesterday's experience also reminded me about the importance of crowd control. People who present a couple of workshops a year do not learn how to manage a classroom, and yesterday's expert was no exception. As an adjunct I had to learn pretty quick. It's not pretty: Sometimes I resort to yelling, "HEY!" in my command voice. But it gets the job done.

How do psychologists work?

My Dad e-mailed me recently to say that
"it has always been my understanding that real world, the psychiatrist gets the patient to talk talk talk talk until he reveals his own feelings and finds himself.  ...

So the question:  How do shrinks in the real world get the patient to see why they work the way they do?"
That ought to be a relatively easy question to answer after nearly 30 years in the profession, so the difficulty of forming an adequate response surprised me.

Part of the problem is that "how" means more than one thing. If by "how" my Dad means "what are the actual motions we go through" then that's not so difficult. If his "how" is more at "why", as in, "what is the actual process by which change occurs?" then we are getting into the harder stuff.

One answer to the why-does-it-work? part of the question, and the part which I gave Dad, is "I'll be damned if I know. It just does." And that really is true. Why should talking to someone about your problems help? I have no idea. But I know that it does. I have experienced over the last three decades innumerable sessions in which I felt like I didn't do anything and yet the patient leaves feeling so much better. It never ceases to amaze me.

Then, when I thought about it, I got back to the old core of William James's interpersonal theory, which is, in modern lingo, that we are hardwired to live and to experience life in groups: mating pairs, family groups, tribes, and so on. In particular, the human species has the longest period of dependency on parents of any species on earth, and this period of dependency lasts long past sexual maturity--which is true of no other species on earth. So any way you look at it, we are definitely relational down to our very bones.

Looked at that way, it makes sense that what gets injured, or never developed properly, in a relational context might then heal, or grow, in a relational context. Add to that the importance of language in our cognitive and emotional lives, and it only makes sense that talk is the solution to any problem that is not strictly biological.

As to the mechanics of how it works, again, as I told Dad, there are reams and reams of writing on that subject. Not something one boils down into an e-mail or blog entry with any degree of ease. The core, however, I think is the ability of the therapist to create a safe space. I have had clients tell me that the only space that they do not feel alone in, or the only space that they do feel safe in (and sometimes both) is my office. This sense of safe, secure connectedness is the sine qua non of therapy. And everyone who comes to me for help, without exception, either has never had that secure attachment (e.g., with a parent) or has lost it in some way.

Talking it through of course involves much more than just talk. Talk, per se, accomplishes little. Sometimes the issue is that there are feelings that could not be expressed at the time (read Charlie Mike for the perfect explanation why)and so an important part of therapy is that the patient gets a chance to experience those emotions in a supportive environment. We call this a "corrective emotional experience." Especially in the case of childhood issues, a vital part of therapy is the cognitive restructuring that, ideally, follows the re-experiencing. Kids have limited ways to understand what's happening to them, and what gets tucked away in the brain in kidspeak has a tendency to remain conceptualized in child-like ways of thinking. Consequently, in adolescence and adulthood, there are vast pockets of experiencing of the self and of self-in-the-world that get thought about, felt, and acted out behaviorally in immature ways. So we have to re-understand ourselves from the vantage point of adult experience and ways of thinking. As a small example, a person may need to see that she wasn't sexually abused because she was "so sexy"* at age 5 or 6, but because her father was a sexual deviate. This will totally change her outlook on herself and on life, not just on men or sex.

So. To recap, this is how psychologists work:

1. We establish a safe space.
2. We encourage the patient to talk.
3. We listen.
4. We help reframe--if not the experience itself, then the patient's experience of it
   

How it works is:

1. The patient gets to bring up issues in a safe space that they may never have had the chance to talk, think, or feel about before
2. The therapist helps him reframe his experience, or at least his experience of his experience, in a more functional way
3. As a result, the experience loses its power to interfere with his day-to-day lived experience
   

Now THAT'S adjunct abuse!

http://www.insidehighered.com/news/2008/09/11/adjunct

All I need to know I learned by watching tv (not)

My mail carrier once told me that he'd figured out there were only three things you needed to know to be a therapist, and he got this from watching tv.

1. Mm-hmm.
2. Tell me more.
3. How do you feel about that?

I only wish it were that simple.

Unfortunately, business is booming

Just thought I'd share this:

Back in the early 1980s, Minneapolis psychologist Gary Schoener and colleagues wondered if the recession was affecting the mental health of people living in Hennepin County. "We were convinced there was a problem," said Schoener, then chairman of the Council on Mental Health Programs.

How right he was. The study revealed "personal adjustment problems showing up in all kinds of places. It was fairly clear that we were going to be seeing more of those things," he said.

Schoener is, again, seeing more of those things. "We're busier than ever...

We are, too. It would seem odd, given that money is the problem, that people would take on a new expense, like therapy. This is especially true, given that insurance coverage is not as good as it used to be.

Financially challenged companies are cutting back on health insurance coverage, or cutting out coverage completely. Deductibles and copayments are growing, too. "The standard percentage paid by the insurance company used to be 80/20," said licensed social worker Suzanne Harman. "Now it's 70/30 or 60/40."

I will reduce my fee periodically to accommodate a client out of work, and/or go to less-frequent scheduling of sessions, because if someone has lost a job or is teetering on the edge of bankrupty, it's the worst possible time to be out of therapy. But of course eventually that will put me in a bind, too.

And it's not just lower-income families who are affected ... "Families where the main breadwinner is in the mortgage and housing industry are just being killed by this. Therapy is a luxury for every family."

That worries Lesli Kramer, a psychiatrist in private practice in Eden Prairie.

"People, when they're struggling, get more and more immobilized," she said. "It's harder to pick up the phone, especially for those who have never been seen in the mental health system. There's still a stigma. Add economic barriers, and that takes it to another level entirely."

Amen, sistah.

Copyright (c) 2008, Star Tribune, Minneapolis

Distributed by McClatchy-Tribune Information Services.

Mooning gets professor fired

Call me a Pshrinking Violet, but I think I won't try this.

You can read the whole story at Inside Higher Ed
but the gist of it is that the dude got fired for
mooning a room full of students and fellow
professors.

PV

I miss Paula

My PDA beeped me Saturday morning to remind me that her birthday is next week. She spent her last birthday in the hospital, and died a few weeks later. Her office still seems terribly empty to me. And the neighborhood seems terribly empty without her. I can't believe it's already been a year.

We first met back in the early '80s. I don't remember exactly when, probably around '83 or '84, but it wasn't long after her divorce. Her son and mine were the same age, and we lived barely two blocks apart. We didn't really become friends right off, although our sons were in the same first-grade class and hung out a little together.

Friends or not, I admired Paula from the get-go. She had a way about her, which I could never quite put my finger on, that caused people to underestimate both her intelligence and her courage. But she was smart, and she was tough. She was a single Mom raising three kids on her own. Child support was late more often than not, weekend visits with the dad frequently cancelled at the last minute. She worked full time in a pink-collar job for pink-collar wages, drove three hours round-trip several nights a week to complete first her undergraduate degree, then her graduate training, and still found time and money to buy ponies for her kids and schlep them and their tack and gear around the Southeastern horse-show circuit behind "the Skate," that tiny little car not even as big as the pony. And she was strong in her faith.

When she got ready to do her practicum experience for her Masters in counseling, she called to see if she could come to work with me. She did, and stayed for two semesters. She was well-trained in Rogerian therapy and was a serious, hard-working student. She was a joy to supervise. She saw some clients on her own and did some co-therapy with me, and got A's in the course. After she graduated, she wanted to work with us for the Supervised Work Experience she had to have (three years' worth) to get licensed. And after she got licensed, she stayed on as a colleague. I used to joke that I couldn't get rid of her.

All in all, I'd say we'd been together over ten years by the time of her death, and by then she had become a good friend. We walked together some (although she preferred the track and I preferred the neighborhood streets). We swam at the community pool, and we had "Culture Day" once in awhile and went to the museum or to home tours and such. We called each other when there were good birds in the air over our neighborhood ("Go outside! Quick! There's cranes!").

I loved her laugh. I loved that little disgusted spit noise she would make when she was mad.

She'd been sick a long time. It started with some falls that, at the time, did not seem all that unusual. But they got more frequent. Her balance was affected. Her gait was affected. She said her head felt heavy. I don't remember what all else. She visited doctors who said it was this (it wasn't), and it was that (it wasn't) and gave her medications, and changed the prescriptions when they didn't work. But because she had a really crappy HMO, it took months to get an MRI and find the tumor. By the time they did, she could barely walk.

Also possibly because of the crappy HMO, she didn't get a second opinion. I'll always wonder if she should have had radiation or chemo or something instead of the surgery, or to shrink the tumor before surgery. I'll always wonder if, had they caught the tumor sooner, or even if they'd caught the infection sooner, she would have lived. But she didn't, and they didn't, and she was gone in what seemed like the snap of your fingers although she'd been sick for nearly a year and in the hospital over a month.

She was 60 years young. She had children she loved and who loved her. She had grandchildren she adored and who adored her. She had plans, goddammit.

I miss her laugh. I miss that little disgusted spit noise she made when she was mad.

Blonde moment, 33 copies

It never fails. I always leave for a trip knowing I've forgotten something, and it's kind of a relief when I figure out what that something is and it's a minor something, like a toothbrush, rather than some disastrous thing, like forgetting to unplug the iron.

My syllabi are something like that: There's always an error somewhere. This one says that my Ethics students' reaction papers should use their student ID numbers in place of the Running Head as their only identifier---which does me no good at all should the pages of a paper become separated, because the Running Head only appears on the front! I meant to say, "manuscript page header", which appears on every page.

E-mailed everybody and got that straightened out before the first paper is due. Heaved a big sigh of relief.

If that's my only misstatement, we'll be in good shape.

And You Know It's STILL Monday

when at 11:12 p.m. you've spent what seems like forever trying to copy and scan an article from the textbook that didn't get ordered, on the world's possibly slowest home copier/scanner, so your students can read it before Wednesday because you've based almost your whole lesson plan around discussing it and you finally get it ready to upload and then the school's frickin' website won't let you because it's too big so you try to e-mail it but that won't work either because the school's e-mail system has the same 20MB size limit so you send all your students an e-mail saying you give up but you'll try again from the office tomorrow where you have a faster copier/scanner and maybe you can get the article into some other file format that will go.

Maybe.

If you're lucky, and Tuesday goes better than Monday did.

It's Definitely Still Monday If...

• ... you spend 20 minutes circling the parking deck looking for a parking place.
  
• You give up and spend another 20 minutes just trying to get out of the parking deck, which by now is a three-story traffic jam.
• You drive over to the alternative parking lot you used last year and find that it is now closed to faculty.
  
• You finally, in desperation, park illegally and are still five minutes late to class.

You Know It's a Monday When...

1. It's the first day of class, and you can't find your ID--which unfortunately, is also your key to your classroom.
2. You aren't even at your first class yet, and you're already getting e-mails from students saying that the book orders--for both classes, no less--are screwed up.
   

Professors From Hell

I'm really excited about school starting Monday. I love teaching.

When I went back to grad school (for my 2nd masters & my doctorate) my first professor on the first day was John P., Ph.D. John was, without question, one of the best instructors at any level on any subject that I have ever had. Watching him teach was like watching a piece of performance art--every single class, he gave his all. High energy, encyclopedic knowledge, a sense of humor, passion, style--that was John. And one day in class, I remember thinking, "That looks like fun."

My first year out of school, I was lucky if I had six clients in a week, so in order to keep body and soul together, I decided to look for part-time teaching work. As it happened, a local commuter college was looking for someone to take over a course at the last minute, and I got the job. But I had gone to a professional school, and they don't have any interest in teaching teaching, so I graduated without any experience at all. As a result, I was pretty awful. I read a joke to open my first class. But I was right about one thing: This is fun! I loved it from the get-go.

Now, as I wrap up preparations for starting another semester, I think not only about how I wish to teach, which is to say, 'like John', but also about the burden on me how not to teach. Which brings us to the first Professor From Hell. (Further installments to come.)

This gal nearly drove us all crazy. We were beginning a series of three classes about which I was pretty excited as the topic had not received much coverage in my first Masters degree program. I was looking forward to this class. Boy was I disappointed. This instructor was a student of the Dean's from her grad school days at his previous place of employment, and I believe he'd hired her because he liked her rather than for her talents she had as a teacher, since we could never detect that she possessed any.

In preparing for her lectures, she xeroxed the text, then literally cut and pasted sections of it onto legal pad pages and read it to us! Talk about tedious. Hour after hour, she would read. Watching her was more painful than watching grass grow. We asked her not to, but it made no difference. On she read, relentlessly. We complained to the Dean, but it made no difference. She kept on reading. This was back before everybody had cellphones in their pockets or laptops in their backpacks, so we were hard-pressed to find ways to entertain ourselves. Two or three people would fall asleep every class period. Our class clown tried to lighten things up, but after the first few weeks she took him aside during a break and told him if he kept it up all the professors in the department would hate him and it would affect his grades. This reduced him to gloomy silence punctuated by snoring, and left the rest of us to our own devices to stay awake.

I can't say I learned much on the topic in her class, but I did learn something about how not to teach: Every semester I vow that whatever else happens, "I will not be boring!"

Managed Care is Killing Me

The economy is going into free-fall. The cost of consumer goods is up 5.6% this year, the worst it's been in 17 years. Tax collections in our state are down by more than 6%. Population growth has slowed in the 10-county Metro area. Home values are plummeting in the midst of rising foreclosures. Our state's jobless rate is at a 15-year high and expected to get worse. Everywhere you look there's more bad news.

In the meantime, what insurance will pay for our services has remained stagnant--or declined. Psychologists are probably the only professional group that has lost ground in the last few decades. Managed care is killing us.

One way in which it is doing so is by adding significantly to the paperwork/case management burden that we face. Just one small example is this fax memo I received from one company:

Wellness Assessments are to be completed in your office at the time of the initial evaluation and faxed to [insurance company]

A second Wellness Assessment is to be completed in your office during the 3rd, 4th, or 5th session and faxed to [insurance company]

A set of algorithms are applied to all Wellness Assessments designed to identify potential clinical risk

• Some potential risks yield a letter that requires you to determine whether the identified concern has been fully assessed and, if applicable, addressed in the treatment plan. It is strongly recommended that you file the letter and document that the risk is being addressed in treatment or has been ruled out in the course of assessment/treatment
• Potential risks that yield a Care Advocate outreach call require you to complete a brief clinical review

For members who have seen you in the past and return to treatment, representing a new episode of care, the Wellness Assessment should be completed even if the member completed Wellness Assessments during a previous treatment episode.

During the first two quarters of this new initiative, you have seen between one and five new referrals. In all or most cases, a Wellness Assessment was not sent. Please review these requirements to support your implementation of this process.

This is a level of supervision which I have not received since I was in grad school. Let me just say that I don't need an insurance company computer to tell me when a client is at risk or a Care Advocate to tell me--after the fact--what to do about it!

A Wellness Assessment, by the way, asks some very intrusive questions of the client:

• In the past month have you felt you ought to cut down on your drinking/drug use?
• In the past month have you felt annoyed by people criticizing your drinking/drug use?
• In the past month have you felt bad or guilty about your drinking/drug use?
• In the past week, approximately how many drinks of alcohol did you have?
  

This is protected information that is now going to be faxed to... who? A clerk? I certainly don't know. And besides running algorithms on it, what will they do with this information? It's not anonymous: It asks for complete identifying information at the top.

These are actually useful questions, as are the others on this sheet, but they are also questions that competent therapists routinely ask. Why we should have to ask them twice and fax them in for someone to second-guess us (we are, after all, fully licensed to practice psychology independently) is beyond me. Besides which, all this c**p takes time I could be spending with the patient! Actually helping them with these problems!!

Never a dull moment in this job!

Just when you think you've seen it all, the Forest Service brings a handcuffed guy in for an evaluation: Seems he spent the night in a tree overhanging the river that runs through our National Forest, and the Service was concerned about his mental status.

He's still brushing twigs and duff from the forest floor off of his clothes and knocking stuff out of his hair while you're doing the interview.

When you're done, he bows and kisses your hand like a knight of old.

Then the county sheriff handcuffs him and takes him off to the state hospital.

Supervisors From Hell, Part I

Back when I was a lowly practicum student, I was asked to perform an assessment and offer an opinion as to the readiness of a parent for unsupervised visits with her kids. I did the evaluation, wrote up a letter for Child Protective Services, and submitted it for my supervisor's signature.

She hung on to it for a week. I couldn't figure out what the deal was--I mean, just sign it already!

When I finally got it back, I found that she had changed my recommendations so that they were no longer based on data from the evaluation. She had felt free to get it re-typed to suit herself, and to add insult to injury, my letter now contained a summary sentence to the effect that visits were "counter-intricated".

She wouldn't believe me when I told her that the correct term was "contraindicated." She argued that "counter" is a word, right? and "intricate" is a word, right? so if they are both real words, you can hyphenate them, and you have a real (compound) word, right? so what was my problem?

She refused to send it back to the typist: I refused to sign it the way it was.

Standoff.

The client never got her letter.

How I Chose My Major

I was telling this story the other day, and thought it might be worth a re-telling.

I had been to a hoity-toity, liberal-artsy girls' school in the Old South for two years. It was not a good fit for me, as any of you who know me can well imagine. I dropped out my second summer, got an apartment and a job. A year later, I felt ready to go back, but had acquired some expenses and therefore needed to keep the day job. Back in the day, college was for young persons in dorms, not adults with jobs and apartments: There were no night schools.

But as it happened, the civil rights movement had spawned a federal grant to educate police officers, who, back in the day, only had to have high-school diplomas. Police officers work shifts. Ergo, to get the grant money, a college would have to offer day and night courses. And as it happened, a little school in my hometown decided to open a night school, The Urban Center, and make it available to citizens as well as the police. So I applied.

I was working at the time as a pool typist, and later as a Data Entry Operator, for Dun & Bradstreet. I wanted a promotion to Business Reporter, but to do that I needed some business courses. The company would reimburse a portion of my tuition for every course in which I obtained a "B" or better. Sounded good to me. I got accepted, and in due course went over to register.

Yes, children, it is true: Back in the day, you had to register in person. No Internet. Plus, since it was a night school, and registration normally happened during the day, faculty and administrative staff rather than the secretarial/clerical types were handling it after hours in the main office complex. I drew the Dean for an interview, as I was transferring in from another school. We did our thing with the credits and he wrote down my proposed major and then he left me sitting there while he went across the hall to do his thing with the punch cards (I'm really dating myself here, aren't I?)

I love books. When I'm in someone's home or office for the first time, I go straight for the books. The Dean had great books, including Cleckley's Mask of Sanity. Fascinating!

So he comes back, having signed me up for business courses, and I ask, "What did you major in?" He looked at me warily, like "Oh my god this woman is going to be one of those students who changes her major every semester, isn't she?" and answered, "Psychology. I'm a psychologist." And I said, "That's what I want to do!" and we had to do all the paperwork and the punch cards all over again. But I loved it, and still do. It was the smart decision for me.

Credit Card Security

Hello, everybody.

Just a quick post in response to last night's news to reassure everybody that we do not process your credit card transactions over an open network! Don't know what those retailers were thinking. Ours is not only secure, it is secured by a long, complex, randomly-generated WEP code.

Virginia

Kite Runner

No, not that kind. The Swallow-tailed Kite!

Real unusual in our neighborhood, one showed up just north of my office over the weekend. So I left work in the middle of the day to run up the road and look at it. I rationalized that (1) it would be good for my mental health--certainly true--and (2) that anything that is good for my mental health is bound to be good for my clientele--possibly true.

This was unplanned. No scope, no map, didn't even have any extra camera gear (basics, you know, like a tripod?). But off I went. And sure enough, the Kite showed up a few minutes after I did. After soaring near the road for a few minutes and giving us several good views, it disappeared again.

I trudged up and down the road for a few yards in either direction, getting all hot and sweaty in the middle of my work day, no less, while the other birders jumped back in their truck and went on their merry way. Sensible people, that lot. I was just about to give up and go back to work when I saw the Kite pop up from behind some trees again.

I got so excited that I pulled over on the side of the road again and hopped out to try to get a photo. I was alternately looking at the bird through my binocs and trying to snap a shot off with my compact digital camera (never got one--this one was taken by another birder) when I felt something bite my ankle. I looked down and saw that I had been standing in a fire-ant hill for several minutes! So right after the LIFER! Dance, I did the Fire Ant Dance for the entertainment of passing traffic. My right foot had been smack in the middle of a mound the whole time: I was lucky only one of the little bastards had got onto me.

After that, the Kite left again and I did go back to work.

It's a beautiful, graceful bird. Its white is the purest white, its black pure jet. It soars, but then so do a lot of birds. What makes this one stand out to me is the way it swoops on bugs. When it snatches a meal off the top of a tree it does so with such grace and pin-point accuracy that it does not appear that the leaves even stir!

Great way to spend a lunch hour. I may even do it again tomorrow.

Woman on a Mission

Yesterday while surfing I found a great blog, "Made A Difference For That One: A Surgeon's Letters Home From Iraq" at http://madeadifference.blogspot.com/.

I used to carry a hot pink key chain (harder for this ADD therapist to lose!) that said "Woman on a Mission" on it. A colleague asked me one day what the mission was, and I said that it changed from time to time. His reply was a snort and a statement to the effect that 'that isn't much of a mission, then.'

Wrong, boychik. Missions, once accomplished, must be replaced. And even missions in progress, especially if there's any hope of accomplishing them, must be amended as conditions on the ground change. But mine, at bottom, has always been to leave my little corner of the world a little bit nicer than it was when I found it.

At the time of the above conversation, it was "Changing the World, One Woman at a Time" in respect of the fact that my entire caseload was female. I don't know why: In a supervision group I used to attend, we joked about the Gods of Therapy, who knew just what to send you and when. So I just respected that the universe wanted me to work exclusively with women for awhile, and I put my all into it.

One of my earliest clinical supervisors, back when I was working on my first Masters degree, warned me that I could not measure the value of my work by my clients' progress. She said that what I had to do was first, do good work and second, know that I had done a good job. And I have found over the intervening decades that she was to a large extent correct. There are so many times you can do good work and see absolutely no result for the simple reason that personal growth is an inside job. You can't make it happen for the client--the client has to do it. And some days, they just won't.

Days like those, I only know I make a difference by being part of something bigger. As a psychologist, I am one of about 98,000 nationwide. And believe me, 98,000 people, organized, can make one hell of a difference.

On the other hand, there are times when you can make a difference. A tiny difference, but a just noticeable difference nonetheless. And I find that most days--sometimes even on my day off--I can achieve that.

Yesterday a client called as she was planning a relapse. It was my day off, and I had been sleeping in. But of course I got up and made myself a pot of coffee and called her back. We spoke for ten minutes or so, and when we hung up she sounded more centered. All I had done was remind her of coping skills that she already had but had forgotten in a moment of panic, yet when I hung up I could pump my fist and say to myself, "Made a difference to that one!"

That comes from a parable about a woman walking along a beach who finds a starfish stranded above the tide line and throws it back into the sea. Another walker comments that there are so many animals stranded that way every day for miles up and down the beach, why bother? What difference could it possibly make? The woman replies, "It makes a difference to that one." Which tickled me, because I am the dotty old lady who is forever pulling over to the side of the road and gimping out into traffic to move a turtle to safety. (Made a difference to that one!) Or picking up strays and boarding them at my vet's until I can find their owners.

So when I think, What can I do? I come back to 'I can make a difference for somebody, or some thing, somewhere, somehow, today.' And that's my mission these days: "Make a Difference to That One!"