O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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Teletherapy–One Year Later

Psychologists help people cope with change in ways that enlarge and nourish them. Perhaps the most important thing we do is witness our clients’ stories by the deceptively simple act of listening and observing. But that simple act became complicated when the COVID-19 pandemic thrust us overnight into the new territory of telemedicine.

The pandemic and quarantine were accompanied last year by unimaginable tectonic shifts in almost every aspect of life. Police violence, civil protests, and political unrest made us rethink our relationships with some of the most fundamental aspects of being human. We went through it all alongside our clients, yet our code of ethics demands keeping such fears to ourselves and keeping self-disclosure to a minimum.

For therapists and clients alike, teletherapy presented an unexpected and steep learning curve. Many patients felt awkward having painful or intimate discussions while being physically separated, sometimes while dealing with technological issues. Behind the scenes, therapists had to master new technology and change our billing and documentation procedures while ensuring the new system was secure and  HIPAA-compliant.

It could be awkward for us too. and I worried about staying attuned to my clients and whether I could still practice deep listening as described by Theodor Reik in his book Listening with the Third Ear.

We are… encouraged to rely on a series of most delicate communications… collecting all our impressions; to extend our feelers, to seize the secret messages that go from one unconscious to another. . . . The student often analyzes the material without considering that it is so much richer, subtler, finer than what can be caught in the net of conscious observation. The small fish that escapes through the mesh is often the most precious.

Nevertheless, we figured it out. Therapists and clients found that we could make deep contact even through a screen once the technology got sorted out. We learned new ways of observing and gaining information, and I was impressed to see my clients’ resilience in using telehealth apps from their cars, in a dark garage, or from a closet. We found ways to see the whole person without needing to see their whole body by listening with the fullness of all our senses.

In my practice, I’ve also observed how the pandemic has allowed more time for hobbies, family life, and other pursuits. Seeing opportunities for growth in the midst of difficulty is an insight with wide application beyond the pandemic. It’s helped me grow in my job as a psychologist; in the words of the Shaker hymn, I’ve found that to “turn, turn will be our delight, / Till by turning, turning we come ’round right.”

That said, it’s important to acknowledge that the terrifying awareness of our tremendous vulnerability and life’s fragility has severely tested our defenses. In our communities and the world, the grief we’ve experienced and witnessed differs from anything we’ve seen before. It’s what Pauline Boss calls “ambiguous loss”—unresolved loss without closure and no end in sight.

We must carry this ambiguous loss for our clients and ourselves, knowing that the way ahead is still dark. Fortunately, our training as psychologists provides us with the clinical foundation to continue to practice in empathic and ethical ways even as we traversed the chthonic underworld along with our clients. Our ability to stay with the depths of despair alongside the knowledge that we can still hope and dream is the stuff of our work and our personal lives. As the poet Theodore Roethke wrote, “In a dark time, the eye begins to see.”

 

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Passion and Sex in Long-Term Relationships

 

It is not uncommon to have romantic fantasies about people other than your partner. It’s not just normal; it can even enhance your marriage—that is, unless those fantasies cross the line, which is what I’ll talk about in this post.

In a long-term marriage, romance can depart, and sex can follow. From the outside, couples might seem to have perfect or near-perfect relationships, partnering well in work, raising kids, entertaining with other couples, and just plain building a life together that to everyone on the outside looks like a perfect or near-perfect relationship. But I can tell you that in my nearly 30 years of seeing couples, one of the biggest issues that get them into therapy is when they have not been having sex and one or the other of them feels neglected, rejected, and regret about years wasted in not having a sexual marriage.

The lack of sex often happens insidiously. It may start to decline as early as after the wedding, or after the first child is born. Maybe it begins when personal stressors take over a person’s psyche. Or it may start as late as after a woman goes through menopause and experiences dryness and pain with sex.

Life is difficult and often draining, taking a toll on our energy.

Once we get overwhelmed with responsibilities we try to use control to keep things together. What does that control look like? It can devolve into being snarky, snappy, or stingy. But admitting this to ourselves is threatening, so we compensate for those resentments or hurt feelings by making everything look more perfect on the outside so no one will guess how empty we feel on the inside.

Now we’re ripe for an effective distraction from having to think about these feelings of discouragement. Enter stage left a coworker, friend, or neighbor who listens to our feelings with rapt attention. With each interaction, new confidences are shared — just as we used to do with our partners when first falling in love, one of the best feelings in the world.  We feel our vitality is coming alive again from that dormant state, that deep freeze it had been in because romance and vitality are intimately tied together. Meanwhile, our partner is oblivious —  or, if they do suspect that a flirtation has progressed to a full-fledged emotional affair, we gaslight them, saying they’re crazy and have nothing to worry about.

Most relationships require that couples discuss and come to mutual agreements about fidelity issues, such as flirtation, porn, or time spent with the others that a spouse may find threatening. . When one partner strays, it’s often because these difficult discussions haven’t happened. Whether out of denial, fear, or just plain self-centeredness, the affair ends up coming like a bolt from the blue to the betrayed partner.

Of course, it’s never okay to violate the fundamental trust of your relationship by having an emotional or sexual affair or committing other indiscretions like visiting a sex-worker or getting a happy-ending massage. But it is each partner’s responsibility to check in with one another about where you’re both at with regard to your sex life, or lack of sex life.

When I’ve seen couples who come in for therapy to repair the damage from an affair, the betrayed partner will often say “I had no idea,”  “They never mentioned they were unhappy,” or ”I assumed we were on the same page.” Other times, the problem is right out in the open, with years of fighting about sex.  As with secrecy, that takes a toll too.

It’s important to get into counseling early—before the damage is done. There’s no doubt that affairs create deep pain. Even so, after the crisis has died down, infidelity can reignite the love you once had for each other. We are all multi-layered beings with complex feelings and needs, and we’re especially vulnerable when it comes to our sexuality. To protect yourself and your relationship, don’t neglect to have those difficult conversations.

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Bittersweet and Everything In Between

Being able to hold opposing emotions is one of the hallmarks of good mental health. Something can be both bitter and sweet, and we tend to feel that we must pick sides. To our confusion, we often can’t stick with one or the other feelings — either getting pulled back and forth, or stuck in one or the other. Getting mired in the bitter side can lead to depression, but the sweet side has its own pitfall, such as denial about problems.

What does it take to hold the tension of the opposites? A willingness to acknowledge that we can be both happy and sad, weak and strong, and that we are in a continual state of change. If we can’t accept that  impermanence underlies life, we can be badly rattled when fortune’s wheel turns for the worse, or overly elated (and sure that things won’t change) when it turns for the better.  We must learn to live in between, alongside the difficult and the pleasant. When we taste only sweetness, then bitterness will not long follow — because nothing lasts forever.

We are living through a historic pandemic that’s made more acute by the daily (or hourly!)  news we get on the ever-present phone in our pockets. Adding to the constant angst is social media, frequently showing a rosy view of other people’s lives— the victory garden that is blooming like crazy, the family game night, Instagram-ready special recipes . All of these are examples of how we have made sweetness of a difficult situation, but they don’t tell the whole story. They can  also serve as stark reminders of all we had intended to do in the weeks of our confinement leading to feelings of loss that, that when combined with daily news of deaths, disease, and economic hardship, are very real reminders of the bitter side of life.

These painful feelings can include missing  our friends, seeing our child deprived of a real graduation ceremony, and worrying about front-line health care providers and essential workers who make other people’s lives easier.  They’re certainly not getting time in their garden or finding creative ways to make a meal.

Holding opposites in tension is  based on an awareness of both good and bad, which are both always present as forces in the world and within us. It takes a great sense of balance to live with this paradox, and it’s rare to remain  in the place of balance for very long. The reason is that our thoughts and emotions will tug at us continually pulling us all along the spectrum from bitter to sweet and back.

When I first started writing this blog, I called it “Creating Well-Being.” That title no longer fits my thinking about suffering and growth. It does not represent the complexity of how we live in a world full of trauma, inequality, and paradox.

In my thirty years as a psychologist I have been seeing clients grapple with the paradoxes in their lives and within themselves. One wants to be good and moral, yet has affairs that he knows would hurt his wife; he’s unable to stop himself, unable even to see that he’s hurting himself too by being pulled apart. Another stays silent about years of sexually abusing a younger friend when they were kids, meanwhile marrying and starting a family with the burden of shame and guilt weighing him down. And often we  externalize these negative and difficult feelings, because it feels safer to blame another person, a job, or our lot in life for all that we don’t want to look at in ourselves. Instead of growing, we’re stuck.

Psychotherapy is about finding the syntheses of opposites. A helpful technique is looking  for what’s left out of a clients’ narrative. Carrying secrets creates turmoil; the omitted truth wants to be heard, on levels that range from the faintest whisper in the back of the mind to a gnawing pain that keeps us tied up in knots.. ; When we ignore our full reality and drive awareness into the unconscious, we perpetuate default patterns that prevent us from becoming whole. It takes courage to open ourselves and allow a fuller view of consciousness to dawn. Expanding of one’s being means an enlargement, and enrichment of the personality and is no easy task —  arduous, but enlightening.  

The archetype of the shadow can be seen in many stories, such as Dr. Jekyll and Mr. Hyde, or in f Frankenstein, written by Mary Shelley in 1812. It struck a huge chord with the public as a profound example of the risks of disowning our dark side. In the story, Dr. Frankenstein is consumed by the needs of his ego to create life out of death. He works tirelessly, manically stitching together the parts of dead bodies to create his masterpiece. Avoiding all human contact for years, he is eventually successful in his ambitions. But on seeing  the creature he made, he recoils, calling it The Monster and abandoning it without a thought. He betrays his own creature, and it catches up to him, finding revenge in destroying the people Dr. Frankenstein loves most.

There is a bit of Dr. Frankenstein in all of us. We pursue our dreams and then when they do not satisfy us in the way we had expected, we abandon our creation — which has its revenge  in keeping us from full aliveness and wholeness. Or, because we’ve all been hurt, betrayed, or abandoned in some way, these unprocessed wounds can create a monster that’s embittered, enraged, and revenge-seeking, even taking the shape of self-harm. 

The poem “As I Walked Out One Evening” by W.H. Auden speaks of a healthy tension of opposites, which acknowledges the contradiction and beauty of human experience: 

‘O look, look in the mirror,

  O look in your distress:

Life remains a blessing

  Although you cannot bless.

‘O stand, stand at the window

  As the tears scald and start;

You shall love your crooked neighbour

  With your crooked heart.’

Personal growth through whole-hearted openness can  heal the split within ourselves, unifying opposites and defeating divisiveness. It is then that we can love our crooked neighbor with our own crooked heart.