When did you realize you needed to see a mental health professional?

I did that as I became a “mental health professional” and it was time to deal with what was PTSD, but back then PTSD was not the in vogue diagnosis that it is now.

I started this work when I was in my early 20s and have been in and out of analytic psychotherapy for the better part of my adult life. I do this as I treat people on the extreme edges of human experience, that is, psychoses and those with borderline personality disorders. Doing this work reaches into the darkest corners of my psyche so I treat myself to work with a therapist I have been working with for over 25 years. I’m not sure I could do this work without being in therapy myself.

I entered into therapy as a result of the ravages of an autoimmune disease that regularly tries to bump me off. So, Staci, you might imagine that living with such a murderous little number might impose on me the necessity of frequently confronting issues of my life and death and continuing loss can impact my emotional availability.

Of course, having to live with such a thing and being in therapy has helped me continue the work I do with people who wonder about their ability to survive; and they often wonder and talk about my obvious health problems and their worry that I will die before they can rise up from the depths of their own madnesses.

The only really good thing about this is that my patients know I’m someone who’s been there, done that. Many patients with severe symptoms of madness also come to realize how resilient all this has made me and they eventually tell me that they came to rely on my resilience.

Additionally, Staci, if you are going to work with the population that I work with, being in therapy is a necessity. I could never continue this without the relationship with my therapist.

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How can I support someone with borderline personality disorder (BPD) in a healthy way?

The answers to this question, Elizabeth, really depends on the reality that borderline conditions are not all alike. Some are high functioning and some medium and low functioning. The presence of acting out, violence, drug abuse, and self-destructive behaviors vary across this diagnostic category.
With these additional caveats, the best thing you can do to support someone struggling with parts or all of the above is to encourage healthy behaviors while urging the person to get into therapy if they aren’t already, and if they are in treatment, counsel them to continue with it when they wish to flee.
The very best thing you can do to be supportive is to take care of yourself. Additionally, you need to keep yourself from being dragged into the person’s madness.
One thing I remind people to do when involved with someone who is severely disturbed is this: Don’t attack, don’t withdraw.
Good luck.

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What’s something a therapist knows that would scare most people?

To live is to suffer, to feel pain, to struggle. There are good moments, too. But most of us need to give up the idea of banning pain and suffering from our lives.

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Do therapists ever feel emotionally vulnerable with clients?

Put it this way, you wouldn’t want to be in therapy with a person unable to be vulnerable to you, your thoughts, feelings, fears, dreams.

It’s an important tenant of process-relational philosophy we must first be vulnerable to the experiences of others, to allow ourselves to be moved before we can move the other.

I work hard, well not as hard as I did 40 years ago, to stay open and tuned to even the smallest flicker of the patient’s emotions and repressed thoughts, feelings and fantasies.

I can’t imagine doing psychoanalytic work with someone while trying to remain emotionally invulnerable as s/he needs much more than that from me. It isn’t unusual for me to belly laugh, and wipe away tears rolling down my face.

If the therapist isn’t fully human or working on it in her/his therapy then that is a crippled therapist who might want to pursue other work.

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Therapists, do you like your clients on a personal level or is it part of the job so they trust and open up to you?

Interesting question, Hayden. At this point in my career, I only work with people I like. If in the initial contact I find an open dislike for a new client I work really hard in that initial session to understand the origin of my dislike. If I can’t do that I will suggest a second exploratory session with that new client. I would then talk with a trusted colleague about my reaction. If I’m still not able to at least understand what is causing my dislike, and it’s not terribly obvious what the client was or wasn’t doing to strike off my dislike, I would then refer the person on to someone else.

It is impossible to fake liking or disliking a client as they rather quickly sense my true feelings. Once long ago I worked with a young woman who after a month or so into our work together I developed a real dislike for her. In consultation, I couldn’t think of any buried reason for my dislike other than when complaining about others, which she did in every session without developing insight into her feelings, she would screw her face into such a mask of hatred I began to feel a real dislike for her. She confronted me about not liking her and after several sessions of being unable to resolve or understand my reaction, with her approval I referred her on to other therapists.

What I soon realized after terminating with her was that she needed me to feel my dislike for her—which matched her own feeling about herself—and hold onto the feeling while also trying to help her confront and maybe change the hatred that poured from her. My countertransference trapped me as her hatred pushed against and made me aware of the hatred living in me that at the time I didn’t want to deal with. But I got into therapy and resolved that nasty little trap.

By the way, there is a wonderful paper by the great British pediatrician and psychoanalyst called “Hate in the Countertransference.” Should be required reading by all therapist, not just we psychoanalytic types.

Interesting question, Hayden. At this point in my career, I only work with people I like. If in the initial contact I find an open dislike for a new client I work really hard in that initial session to understand the origin of my dislike. If I can’t do that I will suggest a second exploratory session with that new client. I would then talk with a trusted colleague about my reaction. If I’m still not able to at least understand what is causing my dislike, and it’s not terribly obvious what the client was or wasn’t doing to strike off my dislike, I would then refer the person on to someone else.

It is impossible to fake liking or disliking a client as they rather quickly sense my true feelings. Once long ago I worked with a young woman who after a month or so into our work together I developed a real dislike for her. In consultation, I couldn’t think of any buried reason for my dislike other than when complaining about others, which she did in every session without developing insight into her feelings, she would screw her face into such a mask of hatred I began to feel a real dislike for her. She confronted me about not liking her and after several sessions of being unable to resolve or understand my reaction, with her approval I referred her on to other therapists.

What I soon realized after terminating with her was that she needed me to feel my dislike for her—which matched her own feeling about herself—and hold onto the feeling while also trying to help her confront and maybe change the hatred that poured from her. My countertransference trapped me as her hatred pushed against and made me aware of the hatred living in me that at the time I didn’t want to deal with. But I got into therapy and resolved that nasty little trap.

By the way, there is a wonderful paper by the great British pediatrician and psychoanalyst called “Hate in the Countertransference.” Should be required reading by all therapist, not just we psychoanalytic types.

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Oranges

ORANGES
For MJM 1946-1995

Felt it coming, I’ll bet, the earth’s
final invitation.

Lying motionless in dry grass
under a leaning tree
you watch a slatted sky pour
the ripened sun.

A steely Santa Anna
furnaces noonday leaves just beyond
your reach.
Light bathed fruit,
like a Hopper still life,
draws your finished thoughts.

A petal crested orange,
like a jeweled pendant,
bobs in sun’s center at the side door
of your vision. Another,
directly overhead, winks into life,
winks out.
You can feel their pulpy flesh
behind your eyes,
little membranes in juice, ruptured,
ebbing…

With ruined breath
and pupils saucerd in
blinding light
you take a final look:
the last oranges hanging,
unpeeled.

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Untitled

I was there, an aqualunged conscript jimmying
through the blue-black abyssal, just one
in a queue, a dupe tossed overboard
one by another, to the
drenched cobalt in a boundless trench, a savage fissure
in the Arctic Furies. The ocean exsanguinous in
adamantine horror surrounds my protector,
my drifting monoquoc.

Yes, I was my vile flesh sinking, sinking
in the oleaginous clutch of gravity’s
grip, frigid, a grasp hostile to my
heart tight against her warm susurration.

A grasp of deceit, a clutch
of ambiguous stories floating in me like schools of
viridescent fish, stories with just the right lick
of imperious irony gnawing
these numb entrails, a scene so virulent
even Poseidon’s Trident offered no protection.

I swam with eyeless fish of luminous jade,
shimmering plankton drifting on brutal currents.
An ancient unicorn belly splayed, galloped in tightening circles
looping iron splinters ‘round my ruptured soul.

I rolled soundlessly with iridescent creatures immune
to the arrival of winter’s tenebrous silence, and me seeking desperately
their fraternity long secluded in unfeasible fissures.

I swam for those star fractured
gates, but gliding closed they rejected
my incipient derangement; turned it in on itself.

Is this the crimson region’s true madness: Onyx
smooth
loneliness drenched in Arctic satin?

It took years to swim against gravities imperative, claw
back to the heaving surface of that Cataleptic
Sea where combers stacked
gunmetal grey end
on end leaning high against the shattered
crystal of my will

But the ocean cold couldn’t calm the seductive
sway of a swivet-suckled mind. Can my scissoring legs
kick me free me from that siren song of satin’s onyx?

Will those gelid currents once again heave aloft that blue-black
menace to strap its undertow beneath my rising
archipelago of serrated sanity? Yes, that post-lucid search
beyond my crippled reach for everything, oh, god, yes, reach
for everything and
nothing at all.

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String Theory by Mark Maginn

STRING THEORY*
http://disqus.com/by/River Styx
Your teeth break
on the body’s grief.
Pain unjoints you, strips
your bones and cracks your ribs.
Loneliness, with its ocean cold,
rides your tides.

You have learned how to suffer.

Your mind, once a pearled matrix,
splits open.
Your ruptured thoughts nova,
collapse like a dark star.
What remains compresses you into
a shrunken space.
Dreams do not protect you.

You have learned how to suffer.

You’d like to ride away on light
from the Big Bang
but gravity bends you back.
No longer a particle floating
on wavelengths,
you are a twist of string,
a filament.
Devolved, a one-dimensional
member
of pain’s empire,
you’ve become a theory.

*A unified theory of the universe wherein the smallest particles of nature
are thought to be theoretical filaments called strings.

Your teeth break
on the body’s grief.
Pain unjoints you, strips
your bones and cracks your ribs.
Loneliness, with its ocean cold,
rides your tides.

You have learned how to suffer.

Your mind, once a pearled matrix,
splits open.
Your ruptured thoughts nova,
collapse like a dark star.
What remains compresses you into
a shrunken space.
Dreams do not protect you.

You have learned how to suffer.

You’d like to ride away on light
from the Big Bang
but gravity bends you back.
No longer a particle floating
on wavelengths,
you are a twist of string,
a filament.
Devolved, a one-dimensional
member
of pain’s empire,
you’ve become a theory.

*A unified theory of the universe wherein the smallest particles of nature
are thought to be theoretical filaments called strings.

Mark Maginn

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What do therapists do during a boring session with a client? From website Quora

It’s not so much what I do with a patient when I find myself bored, it’s, rather, what I do with myself. I have learned over the decades that when boredom starts making me susceptible to all sorts of more comfortable positions gravity has to offer than sitting upright, that I am either closing myself off to whatever is being stirred in me or the patient has stepped out of emotional contact with me; sometimes both as they are reciprocal behaviors and motivations.

As I listen to the patient I am also letting a part of my mind wander over and through me to see if there are any clues sprouting where an unconscious idea is pressing for awareness.

If I find myself being defensive I open myself to what that may be and the best evidence for this lies in whatever story s/he is telling us at any moment. I have found that if I temporarily disconnect it is always for defensive purposes that are surely also related to what is going on in my patient. If I listen closely about some social/psychological interaction the patient had, say at work, wherein the patient felt unheard, dismissed and all under the growing shade of abandonment fears.

I then think that my temporary withdrawal triggered those very same emotions in my patient that s/he had in an earlier encounter with a coworker. I then invite the patient to examine all this more closely, that is after I apologize for my temporary detachment.

I then encourage the patient to tell me whatever fleeting thoughts s/he had when s/he sensed something off with me. I confirm what is accurate about me and wonder with the patient about that which seems on the surface not connected to what had just happened between us.

I help the patient and me identify what each of us consciously and possibly unconsciously contributed to what we enacted between and with each other.

In short, boredom can be a partially open door encouraging us to open it more widely and see what is and isn’t there.

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Can sugar cause schizophrenia?

No, Amy, sugar or other substances don’t cause the psychosis of schizophrenia. This serious disorder is the result of very early and repeated failures between a mothering parent and the child. The dislocations start in infancy and repeat over the maturational years of the child.
Usually this starts in the unconscious of the “mothering” parent and is expressed unknowingly as anger, rejection or any of a number of different things that bedevil us as humans.
These “maternal” attitudes are usually quite unconscious and beyond the parents conscious recognition. In a really true sense, their conscious selves are ruled by the unconscious attitudes that would probably appall the parent if confronted directly with these unconscious feelings and ideas.
However, these destructive unconscious feelings and attitudes can and do fall heavily, usually on one unconsciously chosen child leading to the stagnant or destructive parental attitudes that the child needs to defend him or herself against. Often the defense is the bizarre quality of psychosis as the child tries desperately to deal with the terror engendered by the unconscious feelings and attitudes of the parent that often leave the child believing that there very existence is in mortal jeopardy.
Yes, there may be a genetic weakness that can make a child susceptible to the unconscious machinations of a disturbed parent(s) and thus the development of the more ominous psychopathologies, but the real causes of psychosis lie in the relationships within the family and particularly between parents and vulnerable child.

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