let's talk. (about ableism)

"let's talk about the way we practice internalized ableism towards each other": an excellent question that really grabbed my attention.

I see internalized ableism in my practice all the time. Which is to say, I see it in my clients.

My clients frequently express hatred of and disgust toward their bodies. Interestingly, however, more of them express shame that they are not able to work than over the perceived inferiority of their bodies. The men aren't macho enough if they have disabilities, the women not sexy enough. But in a materialist society, apparently, the ultimate failure of the disabled is that we don't make money.

Never mind that discrimination is responsible for the largest portion of the wage-differential between, say, able-bodied white guys at the top and disabled women of color at the bottom--it still feels to us like some kind of character failing on our parts. Never mind that materialism is a rotten way to value people--we still feel like losers.

But how do we practice internalized ableism toward each other? That is harder to see.

• Am I, outside of my awareness, guilty of speaking for my clients?
  
• Are even clients with disabilities of their own making assumptions about my professional abilities based on my physical (dis)ability?
• Do I make a space where other people with disabilities can feel welcome?
  

Please Hold While I Connect Your Call

We had a spirited discussion in supervision last week about what it is exactly that we as therapists do for our patients. Job #1, as I see it, is to make connections.

Our clients are invariably suffering from some form of alienation. Perhaps they are alienated from their feelings: They don't know what they feel. Or they don't know why they feel it. Perhaps they are alienated from their selves: They don't know who they are, or what they want. They don't know why they do the things they do. They see-saw back and forth between contradictory wants, thoughts, feelings, actions, and self-images. Or they might be alienated from others: They can't maintain a relationship.

So what we do is we help them re-connect to alienated, denied, repressed, suppressed, split-off, and projected parts of themselves.

If people are alienated from their feelings, we help them get back in touch with them. Some people are all in their heads, some have split off their feelings and either projected them onto someone else or created alter personalities to handle them. Still others drink and drug to numb their feelings. Some just deny that they have any, and hope that will make it so. Women in my practice are frequently (if not usually) especially alienated from their anger. We might help them make the connection between their abuse of alcohol and drugs and their wish to avoid feeling angry. Or their wish to reduce inhibitions to the point that they can let loose some anger. We help them re-own anger they have split off and projected, be it onto another person or into another personality. We help them look at patterns in their lives and what their anger might mean in response to people, places, and things. Maybe we help them learn to use their anger as valuable information, as signals.

Which brings us to power. Most of my clients are no more or less powerful than the next person. But women in particular tend to believe they are powerless: They have become alienated from their own strength, usually by the same social process that alienated them from their anger. Therapy, therefore, may involve getting women to exercise that particular muscle as well.

Other people are alienated from their reason and ruled by their feelings. These folk need to be re-connected to their rational sides. We can do that, too. Therapy is a whole lot more than getting in touch with your feelings.

Some folk have become alienated from their very selves: Their parents split off experiences that would otherwise be intolerable and projected them onto the patient. Or tried to live vicariously through the patient. Instead of mirroring for the child what the child is actually like, these parents' eyes are as inaccurate as funhouse mirrors: No child looking into them all day ever day is going to grow up with a realistic self-image. Therapists, if we are doing our jobs, help clients look at themselves with their own eyes (through ours) and begin to see themselves as they actually are. They learn what they really want, not what somebody else has been telling them all their lives what they should want. We reconnect them with their own opinions.

And we reconnect them with their voices. Perhaps a child has been told all his life that what he has to say isn't important, or is incorrect, or must not be spoken of at all. This child, as an adult, is alienated from her own voice. We help her re-learn to speak her piece, often by simply listening objectively, without judging her or injecting our own points of view.

As a psychodynamic therapist, of course, I thrive on making connections between peoples' pasts and their presents. Why do they do what they do? Where did they learn that? What impulse/fantasy/wish/fear are they acting out? Where are its roots in the distant past? How does what goes on in the therapy session connect with how they conduct (or fail to conduct) themselves in their "outside" relationships?

The list of possible connections is endless. What is alienated and needs to be brought back into self-awareness varies with each client. Our job is to help them ask the right questions, observe themselves, analyze the data. We listen. We observe. We make connections.

So that's what therapists do. We are the telephone operators of the psyche.

Impostor Syndrome

Back in the late 1970s, there was a draft of Pauline Rose Clance and Suzanne Ament Imes's 1978 paper on the impostor syndrome circulating among female academics and professionals in and around Atlanta. I probably still have my copy somewhere, but with my filing "system" the chances of ever finding it are slim to vanishing.

In it, Clance and Imes proposed that professional women, no matter how accomplished, continued to believe deep down inside that they were and always had been 'faking it' and would soon be unmasked as the impostors that they were. For my generation, which came along after theirs, it is still true. You can't grow up hearing tens of thousands of sentences over the years that begin with "Girls can't. . ." or "Women don't. . ." without coming to believe in your heart of hearts that whatever it is you are doing now, you really shouldn't--and indeed, can't.

In the published paper, the authors described a self-perpetuating cycle in which, because women attribute their successes to luck or other temporary outside forces, they are unable to internalize any success as proof of their very real abilities. So no amount of success can convince them otherwise: Each new level reached in their careers is a mistake and only brings new pressures and fears of being unmasked. Indeed, many of us who read the draft back then were convinced it didn't apply to us because we really were impostors.

This may be in part motivated by the adaptive function such a belief in one's own ineptitude serves: If a woman is not really successful or smart, then she gets to keep her femininity. She's not really a threat to the men in her work group/profession/family. It is the obverse side of sexual discrimination that society "rewards" women (in a manner of speaking) who live out the feminine stereotype, just as it punishes women who do not. Look at the recent flap over Barbara Boxer wanting to be called by her correct courtesty title--not "ma'am", but "Senator." Little girls observe this very early and adjust their behaviors accordingly.

In 1985, Clance published a book about it:

The Impostor Phenomenon: Overcoming the Fear That Haunts Your Success

As for younger generations, I suspect it might still be true at least to some degree. I had a little kid in a session about 20 years ago who wanted to play with those little metal cars and trucks. He was divvying up toy vehicles for us to "drive," and commented that "Girls can't drive dump trucks." He kept that one for himself and gave me a sedan. Women could and did, even then, but it was just not part of his world view. Oddly, this post-Second-Wave child, raised by parents of my generation, was perfectly comfortable with the concept of women astronauts, having seen Sally Ride on the TV--just not women truck drivers. His generation is old enough to be raising kids of their own now. Wanna bet what they're probably teaching them?

But I digress.

Clance and Imes, supposedly feminists, totally missed the root cause of the phenomenon, locating its origins in one of two family dynamics, despite their recognition that it is gendered. Based on their explanation, there would be no reason to expect any more women than men to have the problem. Yet, as the authors recognize, research into attribution theory shows that women by the age of ten are habitually explaining their successes and failures differently than boys. It cannot be coincidence that in a patriarchal society little boys claim credit for their successes, while girls do not.

If Clance and Imes are wrong about the etiology, can they be right about the intervention? Probably not, since if the problem is located at a societal level, then an intra-personal, individual intervention hardly addresses it. Possibly so since, on the other hand, psychologists as agents of change often must start with the individual before us. Clance and Imes begin by recommending group, with which I heartily agree. People can see things in others that they cannot in themselves, and thus group becomes an ideal setting in which women can confront each other's unrealistic self-images. The authors recommend cognitive-behavioral techniques, such has having a woman practice different expectations or eliminate behaviors like compulsive work habits that reinforce the cycle. And they recommend role-playing both sides of a conversation in which she is alternately telling people she's brilliant or telling them that she's really an idiot but has had them all fooled. These are all great as far as they go, but I believe that if a woman is not consciously aware of how her "problem" functions in a social context, she won't be able to hang onto the changes she makes in the protected arena of therapy.

A therapy group is but a tiny raft in a sea of bigotry. If the raft's occupants don't understand the environment in which they are adrift and their relationship to it, they will not survive. Consequently, in my work I believe that it is of core importance that women come to see this as a gendered, social issue. The family is only the agent of society in socializing girls to be women. It is vital that women understand that men, and other women co-opted by patriarchy, will not be comfortable with their new comfort in their own skins and will work to return things to status quo ante. If they don't know this, they won't be prepared to protect their gains in personal growth.

Reference

Clance, P. R. & Imes, S. A. (1978). The impostor phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research and practice (15), 241-

Busted!

A psychiatrist who practices at Peachford has been indicted for sexual exploitation of a patient. Psychologists' ethics specifically forbid sexual relationships with patients, as does Georgia law, and as do most professionals' ethical codes--for good reason. The doctor-patient relationship, whether the doctor is a doctor of medicine or a doctor of psychology, is not an equal relationship and gives the doctor the power to engage the patient in activities that are not in the latter's best interests.

Adult patients who are exploited are usually female, and there has been some argument that such an ethical/legal prohibition is therefore sexist. It has even been said that, male or female, such prohibitions might deny adults their constitutional right to freedom of association. But studies of this issue have consistently found that it is not usually a case of two consenting adults falling in love (or lust) but rather one in which the therapist has serial affairs with patients, acting out her or his own issues in the treatment, much to the detriment of the patients. So I'm gonna go out on a limb here and predict that now that his mug has been on the 6:00 news, there will be more patients coming forward to report that they, too, have been taken advantage of in this fashion.

Often, it is not until someone else files a complaint that a patient realizes that s/he has an unethical therapist. In the first place, some such patients have been abused before (e.g., incest survivors) and have very poor boundaries to begin with. Their idea of what is abnormal is way, way out there, based on their growing-up experiences, and a little kiss or a date with a therapist doesn't even come close to tripping their radar. To them, this is business as usual. Therapists who are sexual predators in this way are no different from child sexual abusers in that they have a well-honed instinct for who is exploitable. Is this client emotionally needy? Does this client lack a good support system? This re-traumatization is an especially awful betrayal of what to my mind is a sacred trust placed in us.

Seduction by a therapist then proceeds in much the same way as an adult/child exploitation: Early inappropriate behaviors are highly deniable and serve as a test of what the therapist can get away with. Test behaviors also serve to 'groom' the victim, as the therapist (like any sexual predator) gradually increases hir demands. The victim is sucked in one small step at a time, and by the point that s/he feels things are badly out of whack here, s/he (a) is too far from the exits to be able to extricate hirself, and (b) has come to feel complicit in what is going on so is too embarrassed and ashamed to tell anyone. Plus, these therapists, like all sexual predators, instill the importance of secrecy in the victim's mind long before reportable, criminal behaviors occur.

In some cases, the therapists told the patient that this was part of their treatment. For example, the therapist may tell the patient that s/he needs the experience of feeling attractive, lovable. Or that sexual inhibitions can be worked out in therapy by having sex. An unsophisticated patient really has no way of knowing any better: S/he trusts the doctor and complies. This is so not a love relationship, people. It is an abuse of power, pure and simple.

This particular psychiatrist has also been charged with inappropriate prescription practices. Reading between the lines, I'm guessing that the drug was part of the exploitation. This can happen in one of two ways: First, the drug impairs the patient's judgment. Second, the patient may become dependent upon the drug, and by extension, the psychiatrist. This is especially an effective trap if no reputable psychiatrist would prescribe the particular drug, or so high a dose of it--the client has become addicted to it and can only get it from her perpetrator. If she reports him she loses her source. See what I mean about power?

Psychologists' ethics do allow for relationships between therapists and former patients under certain conditions and after a certain period of time has elapsed. This, too, is controversial. These rarely (if ever) turn out well because the power imbalance from the original relationship persists. The roots of these relationships are in transference-countertransference manifestations that were never properly worked through in the therapy, but which, instead, are now being enacted outside the therapy. By definition, then, the therapist wasn't doing hir job in the therapy, and the patient by definition got short-changed.

These are the same interpersonal relationship dynamics that probably brought the patient to therapy in the first place: If they caused the patient problems then in hir relationships, they will cause problems in this one. Similarly, the therapist's lack of self-understanding, poor boundaries, and behavioral disinhibitions exhibited during treatment spell disaster for any outside relationships as well, including especially one with a former patient. Two such relationships of which I am aware became physically abusive; in one, the patient wound up killing hir former therapist in self-defense--and went to prison for it. In a third case, the pair got married, the therapist made the former patient hir office manager, and then proceeded to be unfaithful--with patients!

There are cases in which the patient initiates sexual contact. This is no defense of the therapist: Freud long ago recognized that when the patient falls in "love" with the therapist that it is not the therapist the patient loves--and that the therapist would be a fool (not to mention an under-analyzed narcissist) to think so. The patient/victim in some of these types of cases has been previously victimized, and presents with all sorts of sequelae of previous abuse that makes hir more likely to sexualize the therapy relationship than a patient without an abuse history. When such a patient introduces sex into the mix, it is clearly a therapeutic issue and should be analyzed, not acted out. And it is the therapist's responsibility to make sure that this happens. As one of my clients is fond of pointing out, "That is what you are getting paid the big bucks for."

The ethical and legal prohibition against sexual relationships with patients is a sound one. No good can ever come of it, no matter the participants' rationalizations to the contrary. If your therapist has said or done anything even slightly sexual before, during, or after one of your sessions, run like hell in the opposite direction. And please consider filing a report with hir licensing board and/or the Ethics Committee of hir state and national professional associations. The affirmation that your therapist was in the wrong will do you a world of good.

Hypothetically speaking

It is not possible to diagnose someone we have not met and properly evaluated, and by extension it is not ethical to suggest publicly that one can. That is why when the media have a psychological question about a public figure, the experts will only offer hypotheticals.

What we have here, accordingly, is a hypothetical.

If you were to ask me about someone who has tricked out his property like some children's amusement park, names his home after Peter Pan's (a story about a little boy who never grew up), has never had a mature adult sexual relationship (two sham "marriages" do not count), and who invites other people's children for "sleep-overs", I would venture out on a limb and say that there is very high risk that you are dealing with a pedophile.

In fact, I would go so far as to say that you were dealing with the fixated type offender: Adults who inside are still children and identify with the age group from which they choose their victims. This type does not often even see what they are doing as victimization. In the deepest emotional/psychological sense, they see themselves as these kids' peers. As they see it, they are giving and getting "love".

Pedophilia is a highly compulsive behavior, like unto an addiction. The one victim you know about is just that--the one you know about. There are likely to be many, many more. The older the perpetrator, of course, the more likely this is to be true, as s/he usually has been offending since reaching her/his own sexual maturity. If the accused is, for example, 73, then s/he has been at it for 60 years or more. That's a lot of victims. I have had cases in which the perpetrator had more than a dozen victims across three generations within the immediate family alone. One particular fella who comes to mind abused his sisters, his daughters, the children he conceived with his daughters, his grandchildren, his nieces, the children he conceived with his nieces, and his grand-nieces.

What typically happens in any child sexual abuse scenario is this:
(1) It is almost never stranger on stranger. The kid doesn't run home and tell mama and papa. (In fact, the abuser usually is mama and/or papa, but that's for another post.)
(2) Perpetrators know how to single out kids who don't have good parental support/supervision, who are emotionally needy, who are not likely to tell, who are likely to comply with sexual demands, etc. Often these are children who are the offspring of survivors who themselves lack good boundaries or assertiveness skills. Such parents may not be able to spot potential trouble or to act to protect their offspring when trouble occurs.
(3) Because it is not a stranger-on-stranger crime, the non-offending parent(s) is (are) in a bit of a dilemma. Who do you believe? The family friend you love and trust, or your kid? The church VIP or your kid? The perpetrator never would have abused this particular child in the first place if s/he didn't think s/he had very, very good credibility with the family.
(4) That's if the kid says anything at all. Pedophiles have, by the time they get to your kid, had a lot of practice at this. They know how to convince a kid either that this is normal behavior or that the kid needs to keep it a secret, or both.
(5) Pedophiles often have a position of power in the family/community that is virtually unassailable. This is, in fact, how they gain access to children in the first place. Consequently, even a parent who believes her/his child may be loathe to press charges.

Child sexual abuse is damned difficult to prove in a court of law.
(1) It doesn't often leave evidence. Children's skin heals quickly. Bruises and tears and even infections can have a number of other plausible explanations. Rape kits are useless if the parents only learn of the abuse weeks or even months later. Depending on the sexual act performed, there may be no scarring or semen in the first place.
(2) There are no witnesses other than the victim, and children's testimony is problematic. Just for starters, a young child especially may not have the verbal skills to put into words what happened. Children may not be able to give details like dates and times, and an unskilled investigator/prosecutor may not know how to get at that information. Etc.

One often hears that the non-offending parent(s) put the child up to making the accusation and coached the child's testimony either in a custody dispute or to get money from the accused. To that, I would say that it would be damned difficult to coach a child to hold a sufficiently detailed story together over a sufficient length of time to get through an investigation, preliminary hearings, criminal trial and civil suit. Not gonna happen. It'll all fall apart somewhere in that lengthy process.

Emotionally and psychologically speaking, it's a hard way for a child to make a buck. You aren't going to find many genuine victims who are willing to go through it, never mind fake ones.

Are these people for real?

This is from the actual Remarks section of an actual Explanation Obfuscation of Benefits received in the mail today:

Remarks
D214 -- We have reviewed your previously denied claim. We have found you to be eligible and are overturning your denial for that reason. Your claim has been reconsidered and has been denied. . .

There are no battered women,

Image by kalandrakas via Flickr

conceptually speaking; only battering men.

By which I mean that there is no one personality type of woman who gets battered, while men who batter all seem to have gone to the same school.