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• What Happens in Psychotherapy
  Courage is necessary to enter therapy. Any inner journey is guarded, usually by pain, often early, or later from emotional trauma. One’s vulnerability is scarred. A mother’s death in childhood leaves a void that can last a lifetime. Attention must be paid. The therapists in the American Academy of Psychotherapists know this importance of attention being paid from their personal experience, both as therapists and as patients. The Academy holds this truth at its core. We dedicate our professional lives to learning the depths of loss, unconscious motivation and the nuances of the shadow side of humanity that run in the blood of each person, no exceptions.
  
  In addition to the rigorous academic demands of our various professions in  psychiatry, clinical and counseling psychology, clinical social work, family therapy, pastoral counseling, and nursing, the Academy mandates specific training in psychotherapy. This training includes one or two years of clinical experience, plus100 hours of supervision and a minimum of 100 hours of personal therapy. Our national meetings each year maintain a focus on the person of the therapist where all emotions are welcomed and in-depth approaches to treatment are discussed. We are dedicated to the truth that psychotherapy can diminish misery and enhance emotional richness. We view ourselves as lifelong patients, students hungering for deeper awareness of life’s unending challenge. We keep journals, record our dreams, and discuss our personal pain, joy and professional challenges with fellow and sister therapists. When the troubles come, we happily return to therapy for consultation and/or further treatment. We endorse the words of psychiatrist Karl Whitaker, former AAP member and a nationally renowned family therapist, who, when asked how he was surviving his own teenaged children, said, “It’s okay; but we (are) not doing this alone. I would not think of living with even one adolescent without family therapy.” He also said that when he caught himself feeling important lecturing a learned audience in his three pieced suit, the image of his farmer father came to his mind, standing at the milk station in his one piece bib overalls, offering calm balance to his glowing self importance.
  
  What follows below are ideas, feelings, vignettes, and reflections from Academy members and others, at times in a stream of consciousness form, that we hope will elicit your thinking and feeling related to your inner life.

• Longing for Father
  The legacy of the innate life long hunger for paternal love is a hidden source of emotional suffering. Like most emotional pain, father wounds are well guarded, denied, ignored. One simple way to begin this journey to your father’s place in your present life is to appreciate how normal and deep is the longing for father.
  
  "Your father is not much of a kisser, now. You go to him and kiss him goodbye." My mother is saying this as she lavishes kisses and hugs on me in the camp parking lot. Duty fights fear as I march to my father sitting in the car. I see the closed door, the rolled-up window, and his head straight, staring. I’ll get by with a wave. I half raise my hand, hoping he does not see me. He turns his head, looks at me through the glass. The look dissolves courage; I feel immobile. I will kiss him through the window. Toe standing, neck reaching, my escape is shattered by the rolling glass curtain. He knows what I am about. He leans his fleshy face toward mine. I aim for cheek, kiss it gently, now steps into the kiss. I am flooded with warmth so powerful that my uneasiness starts to melt.
  
  Then, unlike any movie script, my father straightens his head, looks away from me. I hope he has heard my wish. My tongue is paralyzed. His eyes return to the steering wheel. He speaks. "Richard..," he speaks my full name with such affection that for once it sounds agreeable. A long pause, then he adds, "Don’t you get hurt," still looking at the steering wheel.
  
  I look at him not looking at me. I have so much to say. Nothing comes. I try. "You too, Daddy.” I whisper. As his old car bounces down the camp road, my mother waves. As the car grows smaller, I smell his shaving cream, sweet and medicinal. I make a high wide Wave to my out of sight father and yell loudly, “You, too, Daddy, you, too.”
  I remained in that emotional parking lot with my father for the rest of his life. When he died I was sunk in a grief that has not completely left me. At the final goodbye I bent over his dead body, kiss his cheek, the coldness of flesh shocked. I smelled the shaving cream.

• The Longing
  On those days I was allowed to meet my father at the corner. Excitement so engulfed me my body reacted with singing and skipping. Waiting there looking down Park Street my heart beat faster. When he appeared I would run to him and he would pick me up and throw me in the air, saying my name over and over, “Susan, Suzie, Susan my sweet Susan. I missed you sweetheart.” And he would put his arm on my shoulder. And I would melt with joy all over, my tongue particularly and began to tell him, speedily tell him with that ease totally devoid of self consciousness that loving listening elicits, about me and my day, what we learned in geography, and what Sally said about Marie and how her brother is mean, and so much more. And he would listen, nod his head and look at me with pride bite one corner of his lips together for emphasis. And then we would walk in silence not because we had nothing left to say but to enjoy the fullness of our presence to one another. And I would hear the sound of sand crunching on the sidewalk under our shoes, hand in hand, arms swinging, my daddy and me turning the world pink with pleasure.
  
  This oceanic feeling ended when I was ten. He took me to a fancy restaurant and had a present for me, a silver necklace. He did not seem so happy that night. He said he loved me and did not want to hurt me, but he did not love “your mother”, he called her, any more. He did not want to but he felt he had to leave. He moved out of the house, out of the state, and out of my life. The good times ended, turned into memories as hurtful as the earlier times had been delight. When I hear sand under my shoes I block my ears.
 

• What Were the Precipitating Causes that Led You to Seek Psychotherapy?
  Sterling arrogance fed by a walled off defense system buttressed by a conviction that I knew myself better than most people knew themselves were the traits I brought to marriage. The woman I loved was accepted into a PhD clinical psychology program and entered therapy. This new patient tried valiantly to get past my arrogance; words failed. In exasperation one night she left me in the middle of an argument and went to a movie without me. When she failed to apologize, the arrogance told me to pout. This led to her pouring my can of beer over my head. Enraged I walked around a long wintry block in a beer-soaked cotton tee shirt. Shortly later I went into therapy. My life changed. The marriage got better.
  
  Suggestions: If you are miserable or close to it, ask your spouse for help. Spend time alone in silence thinking about your misery. Read something that makes you think, such as the Book of Psalms, the Torah, or a favorite author, maybe Oscar Wilde, “Only the shallow know themselves.”; “Where there is sorrow there is holy ground.” If no author comes to mind look up one of your dominant feelings in Bartlett’s Quotations, and see what is offered to you.
  
  I know a man who daily uses the Big Book of Alcohol Anonymous for meditation. He is not alcoholic but his best friend is in recovery. He admires this friend a great deal, one of his reasons is that his friend has attended an AA meeting every day for over 25 years. This friend knows the wisdom of one day at a time. He gets by with a little help from his friends.
 

• Commentary after the first episode of the HBO Show Tell Me You Love Me
  Tell Me You Love Me is the first in an HBO TV series about three couples in couples' therapy. The three couples could be any of the hundreds I have seen in my office with relationship issues, communication problems, lack of sexual desire, and infertility consequences. The issues are true-to-form, anyone who is married can resonate with them, and all therapists who see couples will recognize them immediately. I may ask some of the younger couples I see if they watch the program. (This is my way to make a suggestion.) ...
  
  The therapist was a different matter for me. On the positive side, her appearance was professional, her voice calm, confident, and knowing, and the storyline tells us that she, too, is human with glitches in her life. On the negative side, whoever wrote her lines probably did not adhere to their consultant-therapist's suggestions, if they had one. The therapist was not believable to me. She hasn't learned to follow and track, doesn't wait until patients speak their story, gives advice before they recognize their own pain or anxiety. She leads them, and when they say, "No, that isn't it," she doesn't follow their lead or question them further. She judges them by saying "good" when silence might have occasioned better results. Some of her interventions made sense; she told the infertile couple to take one week off from trying to get pregnant and just enjoy sex and each other this week (useful, but not enough information).
  
  I loved the sex scenes. Naked, you could mostly see all the genitalia and they moved well whether they were really having penis-in-vagina sex or not. This was a turn on. That all three couples were young and beautiful had a certain monotonous feel. I got excited and then disappointed when the (older) therapist and her (retired) husband started kissing and she moved down his body toward his penis, then no actual sex was shown. Having used in my (former) workshops, "A Ripple of Time," sex ed film of an older couple having all kinds of amazing sex, I knew the viewing audience would have to guess what this couple did. Their guess may be as filled with ageism as the scene, but I appreciate the initial nod to the fact of sex and aging.
  
  This could be an interesting, relationally instructive, for-couples-to-watch-together series if the writers can get a grip--or a real therapist--to write that character's lines and the director adhere faithfully to them. Other TV therapists have been portrayed worse, granted, and this one isn't so bad that I wince, she's just not a skilled therapist. The series is worth watching, just don't take any professional hints about couples' therapy from their therapist character.
  
  Jeanne Shaw, Ph.D.
  AASECT Certified Diplomate of Sex Therapy
 

• Tell Me You Love Me
  Neither of us has ever watched much TV. In the past 5 or 6 years, we certainly don’t watch much TV together; Elliot needs it so loud and Ann needs it so quiet. So when Ray asked us to review the new program on HBO, Tell Me You Love Me, it seemed ridiculous – and tantalizing. This was a show about therapy and about couples therapy – both of which we do and sometimes do together. So Elliot went out and bought TV Ears so he could actually hear the program and Ann ordered On Demand so we could watch the show when we wanted to and in two weeks, we watched the 10 episodes.
  
  At the beginning, we hated it – Ann more than Elliot. The first episode is filled with sex, a kind of sex we had never seen on a TV show, including frontal nudity and what looked like couples having intercourse although apparently they really weren’t. That certainly was shocking and distracting and seemed to take over the whole show. Furthermore, we did not care about any of the characters. We had wrestled with some of their issues, but we did not like the people. However, we had told Ray we would review the show and we liked sitting on the couch together, so we kept watching.
  
  After about 6 episodes, we still did not like any of the people – except for the therapist and her husband – and still felt the sex was distracting and as Elliot has been known to say “a defense against intimacy.” We did not want to keep watching, but surprisingly, we each found ourselves recommending the show to some of our patients. We realized that we liked our connection in the process of watching and that other couples might also.
  
  We did like the therapy. It seemed real and caring and for the most part full of good therapeutic interventions. We liked that the therapist was a real person with questions and concerns in her life. While a few of our patients told us they did not like to see the therapist in her real life, we did. We liked when she had a personal crisis and still went to work; we liked watching her be distracted by that crisis and not able to be fully there for her patients on that day.
  
  Finally, we liked that the people got better. They each became better able to know themselves and to ask for what they wanted and needed. In that process, they had less sex, at least in front of the camera; in fact, the second to last episode had no sex scenes at all. Perhaps that’s why we liked the last two episodes. Certainly, the characters had become somewhat more likable to us.
  
  So we don’t know if we would watch another run of this show. Probably not. The writers have to write more likable characters. To do that, they will have to write more about them. While patients do come to us with their problems, we discover how they came to have those problems. We learn about their families of origin, their early years, their previous relationships and their joys. We knew almost nothing about each of these characters. Watching this show, we felt awash in their pain and defenses. But without understanding how they got there, we did not connect with them.
  
  We both also found that the sex stopped the narrative. Perhaps we needed to get used to it, but we never did. Ann yearned for a little Grey’s Anatomy where the scene fades when the couple gets into bed.
  
  So we got some good things from this assignment from Ray. We liked watching the therapist work; we like that we now have On Demand; we love our new TV Ears and the fact that maybe we can really accommodate our different need for sound levels. And we did like being together, watching a TV show. Maybe we’ll watch The Wire.
  Ann Reifman and Elliot Blum
 

• Parity for Mental Health Treatment Increasing
  The bias against the mentally ill is ancient and has resisted the proven truths that depression, bi-polar illness and schizophrenia are as much a disease as are diabetes, cancer and heart disease. Insurers and employers have routinely refused to include mental illness in their plans.
  
  The drive to seek parity for mental health services began decades ago. Today some 42 states require equal coverage as does the federal employee’s health benefit program. While this sounds encouraging, 82 million Americans work for employers who self-insure and are thereby exempt from state parity laws. An additional 31 million are in other plans that do not have to offer equal coverage. This September the senate unanimously passes this bill. Its passage in the House looks promising with three major committees voting for its passage. As we urge its passage we need to be reminded that the bias toward mental illness still lives in the minds of many. Bias is lessened on a one to one basis, when diseases of the body and those of the mind are equally welcomed devoid of judgment.

• Film Review
  Lars and the Real Girl is a recently released film about a shy young single man who develops a delusion that an anatomically correct doll purchased over the internet is real. The film is a fable teaching the truth that trauma has the power to distort reality and the cure lies in a little help from friends.
  
  We learn that Lars’ mother died in his birth and his father’s grief turned to depression. The setting is a small town in the mid west full of genuine kind people concerned about others. Containment and understatement are everywhere in this town and so is acceptance and understanding of this good boy with a problem that the town can help cure. A loving sister-in-law helps Lars brother go along with the delusion; the town folks discuss Lars and conclude his delusion is no worse than their oddities. The town doctor, Dagmar, is an excellent therapist to Lars as she skillfully listens to him weekly talk about Bianca and himself. It would be easy to say the film offers an unrealistic view of humanity’s goodness and a very happy ending. How many films show an excess of the evil side of who we are. This film takes a giant step in showing viewers that a slip into unreality is very human and can be cured when others refrain from judging that slip. The cast is superb. Ryan Gosling fills most frames with facial communication and meaningful silence that makes one want to cheer for Lars. And the ending is very happy indeed.