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Blog (by JH, no AI)

Thoughts on Psychotherapy

Blog | Dr. Jamey Hecht | Beverly Hills, CA
 
Posts in Indifelity
Addiction, or No?

A habit merits the term “addiction” when it costs you more than it’s worth; when you try to stop it, but find you can only put it “on pause” for a short while; and when you find your thinking (especially your judgment) is distorted by the high priority you place on repeating the habit. Another criterion is perhaps less important because it’s outside you, but it can be very important indeed: when multiple neutral or friendly people tell you they think you have a problem—especially if they haven’t spoken to each other about it beforehand. 

In an excellent book called In the Realm of Hungry Ghosts: Close Encounters with Addiction (2010), Gabor Mate argued that addictions have their roots in early trauma. He tells the story of the thousands of American soldiers who fought in the war in Vietnam, which at that time was part of the “golden triangle,” a geographical area that produced a large share of the world’s heroin supply. U.S. troops coped with horrific levels of combat trauma, including guilt/moral-injury; anxiety, uncertainty, and fear; bereavement and loss; the shock of seeing so much injury and death; and the various physical wounds, ruined health, lost limbs, and so on. Many became habitual heroin users. But when they came home, it turned out that for the most part, the soldiers who remained stuck in heroin addiction were those who had suffered childhood trauma, long before the war. The others were able to drop the habit, though heroin is perhaps the most addictive substance on Earth. 

Not every addict has a trauma background. But most do, and when you meet one who apparently does not, you can’t be certain they have (or have shared) a full knowledge of their own relevant personal history. While many different kinds of trauma can happen to a kid, the CDC lists a few of the big ones in its online material about Adverse Childhood Experiences (or “ACEs”):

Experiencing violence, abuse, or neglect.

Witnessing violence in the home or community.

Having a family member attempt or die by suicide.

Substance use problems.

Mental health problems.

Instability due to parental separation.

Instability due to household members being in jail or prison.

They add “not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination.”

This painful picture of deep human suffering should not be taken as a portrait of an “average addict,” since there’s no such entity. And what amounts to trauma is not actually the stuff that happens to somebody, but how it’s experienced. The mystery of resilience has to do with the kid’s temperament, circumstances, culture, and especially the interpersonal supports that did or did not keep the situation from being even worse. There are people who endured every ACE listed here, who have never been addicted to anything. And there are others who had only one or two of these to deal with, and in adolescence or adulthood became dependent on one or more substances or behavioral habits that cost them dearly. 

The difference is not a moral one, and there is no rational calculus about who had it worse, or who went on to put up the best fight against addiction or depression or anxiety. These pseudo-questions involve impossible apples-and-oranges comparisons and fictitious quantifications of how bad different childhoods were. The feelings are most important; the facts matter, too; but the measurements of them are largely illusory. The reality of trauma has to do with what happened inside the child: what the bad stuff meant to him or her. If parents are neglectful or abusive, a kid will infer that young person in the mirror is deeply flawed, and deserved the bad experiences. But if the same kid also has a benevolent art teacher, a well grounded mentor, a kind and wholesome uncle who is reliable and interested, sane and warm—the kid may be protected from drawing that toxic conclusion about the self, and grow up less susceptible to addiction, to cults, to swindles, to sadomasochistic attachments, and so on.

The trauma theory of addiction is the profound claim that we mammals, we primates, we human beings, have universal evolutionary needs for nurturance and protection, and when these go unmet, or are met with harm mixed in, addiction often results. The person seeks out whatever will soothe away the pain of neglect and/or abuse from long ago. Usually, it’s pain from very long ago: infancy is the first love relationship we ever have, the mother-baby dyad that sets the emotional foundation for the whole lifespan. Even if things don’t go relatively wrong until later in childhood, it’s the inner baby part-of-self within the older kid that’s most overwhelmed. Freud taught that each of us is all the ages he or she has ever been, so the baby who craves a substitute for the warm and milky breast is actually still active inside the active addict, running the show—which is why the addicted adult can be found making such poor decisions. A brilliant, short book by Abraham Twersky, Addictive Thinking (1997), spells out what that kind of cognitive distortion can sound, look, and feel like. 

But acute or chronic trauma need not be the only reason for addiction, and often there is a very useful significance to the person’s particular “drug of no choice,” as it’s sometimes called in twelve step culture. For example, with or without the expectable ACEs, people who have uncontrolled habits of excessive sexuality may be trying to prove to themselves that they are indeed attractive sexual beings, capable of evoking erotic participation from others. Boys who were repeatedly rejected by the girls they hoped to kiss—and that’s most boys, who mature more slowly than girls tend to do—can grow up with a lot to prove. Many spend their late teens, twenties, and even their thirties struggling to establish that they are not icky “involuntary celibates” who will never find a mate (even if the guy himself is now the only person who sees him that way). If they can do this without deception, and without heaps of gender-based resentment, and without excessive risks to physical and mental health, they may manage to accumulate enough sexual experience to falsify their own worry about it. They can be fortunate enough to realize one day that they have indeed established what they were so desperate to establish. Now they are free to let go of the pattern that looked like, or really was, “sex addiction.”

Shopping addiction can be like that, too. I’ve said “people with uncontrolled habits of excessive sexuality may be trying to prove to themselves that they are indeed attractive sexual beings.” Well, people with uncontrolled habits of excessive consumerism may be trying to prove to themselves that they are indeed successful participants in the world of consumption, including the spells cast by advertising. Ads comprise a powerful technology of conscious and unconscious persuasion that links people’s self-esteem to their capacity to get hold of whatever product or service is being defined as beautiful, validating, and necessary. If I succumb to this, my identity will be bound up with my ownership of the bag, the boots, the car, the designer version of whatever I’ve been convinced I need.

Insofar as this is true of somebody in particular, that person’s sobriety will have a lot to do with identity: achieve an internal locus of value, and you can also build up an internal locus of control that defeats the addiction. When a person suddenly comes into a sum of money, a lot can be learned by watching how they spend it: the speed of the spending, but more importantly, the buying choices they make. If you are making large purchases of “designer stuff,” you might be an erudite connoisseur of fine handbags and their nuanced history since the year 1588. But it’s more likely you are buying an Hermes bag for $9,850 because that is what the surrounding culture told you was important, valuable, and above all, validating for the identity of the buyer. It is, ultimately… a bag.

A designer purse like that “says” plenty, but just what it says depends on the wisdom of the beholder. The message can range from “look, I am successful, you would be fortunate to share sex, love, friendship, or business with me” to “look, I cannot think for myself, and remain profoundly naive about the available better uses to which money can be put.” Those uses include appropriately limited altruism, where you get good feelings by helping others who need help; buying experiences (especially travel, but also course-taking, conference-going, skill-building, etc.) rather than things; connecting to the past and to the globe by acquiring works of art that speak to you; funding ambitious projects that you find fascinating and beneficial to the communities of which you count yourself a part; and so on.

I know brilliant, beautiful, accomplished people who collect high-end designer handbags. I see it as an expression of their aesthetic enjoyment of these exquisite objects. I also see it as a mechanism of compensation for early experiences of having to do without the goods that other kids had. If your peers in elementary school and middle school and high school all wore flashy stuff and drove expensive bikes, while you wore hand-me-downs and walked to school without wheels, you might well benefit from disproving the worry that they are blessed and deserving while you are deprived and unworthy. And the collectors I’m thinking of are at least as psychologically sophisticated as I am; they know all about their own formerly unconscious motivations for spending “real money” on glam and bling. But they do it anyway, and apparently it serves them well. Rather than judging anybody for buying or selling luxury goods, I am commenting on some of the common underlying dynamics that contribute to habitual choices which can come to feel quite unfree.

And that’s the issue with therapy for troublesome habits: is the habit a free and informed choice? Is it an addiction, or would we get better results framing it as a mere habit that needs tending? The more it costs you—in money, time, opportunity, relationships, access, etc.—to continue with the habit, the easier it is to decide that you must stop. The less it costs you, the more reluctant you or I will be to use the term “addiction,” or recommend 12-step programs, or insist that only abstinence will constitute recovery. Mild addictions to substances or behaviors can be addressed with a commitment to “harm reduction.” Someone who drinks a few times a week but does not lie about it, nor have blackouts, nor have a Jekyll-and-Hyde personality change when they’re intoxicated, is probably a person who can reduce drinking by, say, 65% without too much struggle. But if it turns out to be a big struggle, then the language of addiction might be very useful for getting hold of the habit and changing it.

If you’re dealing with repeated behaviors that you suspect are costing you too much in money, time, peace of mind, or otherwise, consider booking a session with me. We can join forces to help you figure out your relationship to the habit in question, and find the best ways to change for the better—guided by your values and goals.

Email me through the contact form on this website, or call 917-873-0292.

Marriage and Freedom

Preoccupied with freedom, we can miss out on the full possession of whatever it is we have already chosen, or might choose now.

Keeping open as many future choices as possible is a great way to wind up with nothing.

Married men can cheat themselves out of a lot of wellbeing and self-respect by over-associating masculinity with novel erotic adventure, with an unrevised ideal of “fun,” with youth and its open horizon. It makes them underestimate how much wellbeing and self-respect can be had by freely choosing to love the person they have already chosen. Resentment blocks this process, so it’s an important early step in therapy to check for resentment. If there isn’t much of it there to obstruct the flow of feelings, then the man may be relatively free to make a new use of his freedom: namely, choosing afresh the same person he chose in the past, but this time making the choice as the more mature fellow he has become in the meantime. Suppose I first made the commitment when I was 27, and now I’m 41. My forty-one year old self has (and needs, and deserves) his own chance to make the choice on his own terms, for current reasons: to stay or to go.

Why stay? The fact that you promised to stay should be one reason, but it can’t be the only reason, or the promise is a prison. It is your exercise of your own liberty that liberates you, but it’s a common mistake to suppose that only a break-up would be an exercise of free will, an action, a difference-making choice. There are at least two other choices. One is to stagnate, to resent and to sulk, to withhold affection and sex and boycott the marriage without changing or ending it: choosing not to choose. Such a marriage is kept just-good-enough to be tolerable, but no better and no worse. The third choice is to opt for renewal and flourishing, despite uncertainty about just how best to go about it, and just what you can reasonably hope for by trying.

The goal is to open your heart. There is a better life waiting, though from where you now stand it may be invisible to you. Inside an attempt at an enduring monogamous commitment, a couple builds a small relational micro-culture in their home, that defines the norms of what they can expect from each other. How much verbal affection? How much sex? How much gift-giving, and on what occasions? Is it ok to yell? To use demeaning language, and call it “just a joke”? How much emotional safety is it reasonable to require? How much information about plans and spending and schedules is supposed to be shared in advance, to make the other feel included and facilitate collaborative problem-solving? How much of my time and attention should I expect to share with this person, and is it acceptable for one or both of us to be staring into a cell phone during that time?

The answers to all of those questions can be changed, but it takes deliberate effort. The ends will illuminate the means for achieving them. To find out what you need to do to improve things, envision the kind of relationship you actually want—the one that’s good enough that you could freely decide to stick with it despite your spouse’s limitations, and yours. Some of those aren’t going to change, but what might well change is how much that stuff actually matters to you. If she really can’t sing, she might sing anyway, but not well. If your husband has poor proprioception so that he never knows where his elbows and knees are, that’s unlikely to go away. Rarely does a person start to move like a gazelle who never resembled one before. People can learn to manage their A.D.D., but some of it may be intractable, and the chronically late person might never be consistently on time.

But what empowers us to look past those foibles is the much larger, more important open field of shared loving trust, joy, kindness, humor, help, reminiscence, learning, encouragement, celebration, and sex. Besides all those good things, the experience of shared suffering—getting through difficulty together—is a big contributor to bonded intimacy. And compared with the sum of these, a few human faults might not amount to much. I was going to add, “the signal-to-noise ratio is what matters,” but that metaphor won’t do, because exercising your freedom to improve your marriage doesn’t just make the music of love more clearly audible, it also makes it better music.

All of this assumes that becoming more invested and relationally ambitious is going to be appreciated and, at least somewhat, matched. If it’s not, and you’ve spent the past six months being more thoughtful than before, more firmly-but-gently assertive, more decisive-but-cooperative, more affectionate, more vulnerable, and more present—but your wife or husband has not changed at all, nor acknowledged it, nor made some similar changes to validate and reinforce yours, then you have to consider new options. Couple’s therapy can be a way to figure out how to stay together, or whether to stay together, or how to break up. It can be used to improve a good marriage or a bad one. It can also be a way of finding out whether the thing can be saved or not; if not, you can leave with the confidence that you tried your best. Or it can be a venue for discovering in greater detail just how to go about consistently making each other happier, perhaps even happier than you had thought possible.

With or without the help of a therapist, people in committed relationships who find themselves preoccupied with freedom will benefit from remembering that freedom is useless unless you make use of it. That can be done in ways that are immediately easy to observe, but some of the most consequential and wise uses of freedom are inward shifts that can bring to bloom enormous changes in due course. Among the best of these is the free decision to open the faucet in your chest from which love can flow when you dare to allow it.

For those whose marriages are dormant but good enough, and potentially very good indeed, it’s well to take a leaf from Homer’s Odyssey and reflect: you may find yourself sometimes fantasizing about Circe and Calypso, and that’s fine. But Penelope is the truth.

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Sessions are available in-office in Park Slope, Brooklyn, and remotely in NY, NJ, TX, and CA.

Infidelity

Infidelity is always happening somewhere, and it always involves at least three people; a cheater (let’s call that person Delta), a cheated-on (call this one Epsilon), and a third person, who comes from outside. Couple’s therapy rarely includes that one, so we’ll only discuss those two genderless Greek-lettered persons. The concept of infidelity only has meaning in the context of an attempt at a monogamous commitment, so the world of polyamory and other alternative arrangements is respectfully set aside for the purposes of this discussion.

Most people have either cheated or been cheated on, at least once in their romantic lives; many have been in each position at one time or another. The pains of guilt or betrayal are extreme when we’re young and naive, full of huge feelings without the wisdom of experience. Disillusion can be embittering. But if we endure infidelity early in life, we get to enjoy plenty of future decades with those lessons already installed. Big mistakes and betrayals are always possible, but people who have learned from experience can successfully make such crises extremely unlikely. Cheating on your boo in high school can put a guilty wretch in your mirror, and getting jilted in eleventh grade hurts plenty—but it’s much worse when it happens ten years into a marriage, especially if the couple has to tell their kids about it.

Cheating is: a mistake. Like most mistakes, it does not have to define you. It might forever define you in the eyes of the one you betray, but if you stop cheating, you can reinvent yourself—with or without that injured partner, by yourself, or with someone new. You may be Delta this time around, but you need never be in that awful role again. You can use the ordeal as a schoolhouse whose central lesson is that the price of cheating is extremely high, whether you get caught or not, so that almost no circumstances make cheating a good enough option to be worth it. You may be Epsilon (cheated on) this time, but you can turn this disaster to good account by distilling from it the knowledge necessary to avoid any future repetitions and Never. Be. Cheated. On. Again. Since this lesson is a bit more subtle and complicated than Delta’s lesson, let’s discuss it further.

Most cheaters aren’t sociopaths; some are. Other personality disorders, in particular narcissistic and borderline pathologies, can resemble sociopathy in this striking capacity for deception. Persons thus afflicted can lie well, all the time, to anybody, uninhibited by conscience or principle, with a skill that makes their deceptions very hard to detect. They lack the inner psychic structure that would otherwise generate inconvenient compassion for those they deceive. The missing psychic structure leaves plenty of room for a frictionless compartmentalization that gives them remarkably little trouble. They can smoothly escalate from withholding important information to outright lying. Unlike ordinary liars, sociopaths don’t just blunder forward in hasty improvisations, hoping for the best. They actively manipulate their partners, implementing strategic webs of bad data and false signals whose exquisite architecture is their own delicious secret. Some even lead truly double lives, with whole families that don’t know about each other’s existence. But these people are quite rare, with antisocial personality disorder (the current term for sociopathy) occurring in 2% to 4% of the general population. If you find yourself with such a person, your task is to end the relationship; to discover why you chose such a person; to develop criteria for screening out similar people in the future; and to heal from any underlying masochism that might have influenced your choice. Again, it’s very rare that the problem is a genuine sociopathy, so let’s set those cases aside at this point and consider infidelity dynamics that are much more common.

Most people who cheat have, by the time they bring their sexual and/or emotional needs outside the relationship, already sulked for months or years before they become sufficiently despairing about the relationship to go ahead and ruin it. They start by sending signals that they’re unhappy, the biggest of which is emotional withdrawal. If Delta’s signals of unhappiness don’t get through, it’s generally because Epsilon is too busy idealizing the relationship to consider Delta’s new and troublesome information. Idealization isn’t always a happy state. Its main feature is avoidance of reality, either by pretending that the relationship is rosy and trouble-free (“other people have to work at marriage, but lucky us, we don’t”), or by pretending that the relationship may be troubled, but is somehow uniquely indestructible.

The error—Epsilon’s blindness to Delta’s unhappiness signals—is of course a distorted perception, a misapprehension of the other person’s state of mind. But it is also (and perhaps more profoundly) rooted in an identity issue: one says to oneself, “I am someone who has married well, would never get cheated on, will never become divorced—that bad stuff only happens to other people.” Such self-deception is only human, but it is hubristic. Your partner is not an angel, and neither are you. This fact need not, must not, ruin anything—except the idealization, which began as a valuable element of falling in love, but must sooner or later be outgrown, replaced by a deeper, more mellow form of enduring esteem.

The lesson that will protect you from being cheated on in the future is: signals of unhappiness must be taken seriously, without procrastination, even if it makes you feel less lucky, or successful, or safe, than you are used to feeling. Have the necessary conversations about how each of you is doing, what hurts, what’s boring, what’s missing—what aspects of the relationship are giving each of you trouble of various kinds. If you’re too scared to have those conversations, or if they aren’t going well, get the help you need. Couple’s therapy can do ten times more good for your relationship before infidelity than it can do after it. Idealization blocks you off from the possibility of seeking couple’s therapy. But once you get started, it can facilitate a warm, good-faith, emotionally connected critique that is more humane and wholesome than the idealization.

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Sessions are available in-office in Park Slope, Brooklyn, and remotely in NY, NJ, TX, and CA.

A Note on Deprivation, Character, and Therapy

People cheat when they feel cheated. They lie when they feel lied to, and they steal when they feel robbed. Some of that springs from a need for cosmic balance, where I pay-forward whatever I suffered that should not have been my fate. But some of it is a communication, where my behavior is meant to inscribe on the walls of the universe: this thing I do to others, is what was done to me.

Compulsive shoplifting, for example, can be a kind of broadcast to the world, silently announcing that I have been deprived of my due. Typically, the stolen good was not a material object but a form of experience, some crucial, human relational need that I now despair of ever meeting. Why the despair? Because of too many failed attempts to get hold of that primal good, and because the critical period has passed, in which the needful thing could have found its mark, by meaning just what I needed it to mean: that I am a good-enough person, in a good-enough world. If I can believe this belief, then a good-enough life-of-my-own can feel both permissible (fate will allow it) and feasible (I can manage it). If I doubt my own goodness and/or the goodness of people in general, it will be much harder for me to build an ongoing good experience of being myself. So, whence comes this necessary faith in the human good?

According to Heinz Kohut, what children need are parents who can supply two crucial developmental resources: first, a mother (figure) who mirrors our childhood grandiosity and affirms it for us, and second, a father (figure) whom we can idealize and look up to, identifying with him in an aspirational way. Kohut saw these two needs as ordered, both chronologically and in their relative importance. He also saw childhood and youth as eras that often afford us second chances to get what we need, or, if things go poorly, a new round of trauma (from deprivation or other emotional injury). A step-parent, say, can step in and make things much better, or much worse.

In the 1970’s, psychologist Urie Brofenbrenner made an observation which has often been quoted, and deserves even more notice today: “In order to develop normally, a child requires progressively more complex joint activity with one or more adults who have an irrational emotional relationship with the child. Somebody’s got to be crazy about that kid.” This Somebody need not be the original parent (biological or adoptive) or a step-parent; it can be, say, a relative, a guidance counselor, or a teacher — often an art teacher, perhaps because art is nearer to the emotions than most other subject areas taught in schools. But the changes in institutional culture of the past two decades have made it more risky and difficult for teachers to show special interest in troubled students who may need it. Among the religious, clergy can be well placed to show this kind of individualized interest, but they, too, have become understandably risk-averse as the stakes of being misunderstood have sharply risen. Librarians sometimes took on this kind of role in children’s lives, with often wonderful results, but smartphones and the internet have so fully replaced books that librarians are fading from view.

If a community is in sufficiently rough shape, an idealistic nonprofit might come along and offer a program that pairs at-risk youth with ethically ambitious adults who help them along in caring ways. But those programs don’t always appear, and not all childhood neglect or abuse happens in poorer cities and towns that are in obvious trouble. Much of American literature is about the family traumas of the middle class, and even the wealthy are often very desperate people — in part because they already have the money that everyone else assumes is the solution to every problem, yet their pain continues. “Spoiled,” remember, does not just mean “pampered.” It means a kid has been given everything except what’s most important: wholesome loving care. It is, after all, a metaphor about rancid milk — because material abundance paired with emotional scarcity can spoil a person’s capacity to believe that real love (which psychoanalytic language symbolizes as the breast milk of a loving Mother) exists anywhere.

Some kids who are deprived of one or more of Kohut’s two essential relational supplies (a mirroring mother figure and an idealizable father figure) become hyper-competent, fiercely independent adolescents. Later in life, they can have trouble coupling-up, because romance involves giving what they never received, and because the offer of love feels strange and dangerous to them. By contrast, some other deprived kids remain dependent for decades, relentlessly hoping the caregivers they need will come along, or indeed, that their own feelings and behaviors will eventually transform the attachment figures they do have into the wise and generous ones they still crave. Then there are those who combine elements of each, presenting as adults with impressive professional success while remaining lonely and emotionally entangled with their withholding parents. These people are ahead of their peers in the outside world, but behind them on the inside.

Much trouble can be avoided if several afflicted kids find each other in time to form a group, where they can do their best to raise one another. But this is hard, because independent kids are reluctant to depend on anyone, including peers; dependent kids may welcome fellowship, but their resentments can get displaced and wreck the very friendships they have loaded with meaning and value. An adolescent friend group, with its intense attachments, passions, and impulses, can work wonders or exacerbate personal trouble, depending which personality elements get validated within it, and how the larger world responds. Plenty of movies are about the various storylines that such a group can be found living through, though it’s rare that a clique of teenagers manages to learn, from a film, how to avoid the pitfalls in its path. Art might seem to promise lessons of useful prudence, but it mainly offers us a deeper understanding of those losses and mistakes we’ve already endured.

The benefits of therapy derive from insight on the one hand, and the therapeutic relationship on the other. Between the two, it’s usually the relationship that does the most good — but it’s a relationship built on a series of conversations whose main ingredients are the patient’s stories of the past and the recent past, expressions of feelings in the present, and interpretations that come from the therapist or from the patient (in other words, insight). Some of what gets illuminated and reframed is the experience of not-getting what we needed. It might seem like a waste of painful effort, to recount what you already know about old yearnings and losses. But it often turns out that the telling is itself a healing process, when someone is listening with consistently reliable respect and empathy. The teller and the listener can then reshape what the story means, shifting control of that meaning from the outside world of the past into the inner world of the present.