Family Communication Countering Relatives Who Go Off on Tangents

In my blogposts about family metacommunication, one issue I discussed is the tendency of people to change the subject when discussing anything touchy. When a person is afraid to or does not want to go into depth in discussing a particular repetitive interactional pattern with a family member, for whatever reason, a subtle switch from the issue under discussion to some other matter is often a successful strategy for avoiding further dialogue about it.

This is particularly easy to do if there are a whole bunch of similar issues that are all inter-related and intertwined with one another. As I wrote in the previous post: 

Another related misdirection strategy is to mix several separate but highly interconnected issues so that none of them is ever completely discussed. For example, one woman was in a complex family system in which her husband would find ways to distract her from her anger at her parents and vice versa. Whenever she expressed anger at one of her parents, the husband would do annoying things to draw away her anger from her parents towards him Similarly, when she was ready for war with hubby, one of her parents would act out and draw her wrath towards them.


The woman's genogram revealed that the problems in this system were related to gender issues (whether men should take care of women or women should pursue independence), concerns regarding the adequacy of males in the family to take care of their women (her husband felt that he was supposed to protect his wife but felt inadequate to do so and angry about "having" to shoulder the responsibility) and even class (how much money was being brought in).

The discussion would change from one of these aspects of the problem to another at the drop of a hat. Because the aspects were all so interconnected it was indeed difficult to talk about any one of them without talking about the others. For example, when the issue of the husband's adequacy came up, the issue of why he was like that would also arise. Because the subject of any conversation jumped around, however, any conversations about the issue would end up going in circles with nothing being resolved.

In this post, I want to discuss another useful strategy under these circumstances for keeping family metacommunication on track in order to get to the bottom of a single issue. Another way to look at the problem of subject changes is that the mix-up of issues allows people to go off on a tangent that is related to - yet different from - the main theme the metacommunicator is trying to clarify.

The trick here is to remember the definition of a tangent from your old geometry class in high school. Tangents are related to circles, and look like this:

If you go to the tangent line and trace it backwards, it always goes right back to the circle. Analogously in metacommunication, the "circle" is the main theme that ties all the different tangents together.

Any tangent someone goes off on can be thought of as just another example of the main theme - the circle in the diagram.

As an example, let us take a hypothetical situation in which there is a highly conflicted relationship between a mother and a daughter who come from a typical highly dysfunctional family - one characterized by many examples of major gender issues common to many members: the females getting involved with men who are drunk, abusive, and/or cheating; whether or not they should leave relationships with such men; expressing anger at such men; mothers who do not protect their children from abusive men or from witnessing domestic violence; conflicts over being tied down by children leading to neglect and invalidation of them; enabling children who don't take care of themselves; depending financially on either unreliable men or good providers who mistreat women, and so on and so forth.

There are indeed families characterized by all of the above conflicts- over several generations. If there are several sisters, aunts, great aunts and female cousins acting out several of these themes, one can see how easy it would be to subtly avoid focusing in depth on any one theme, or for that matter, on any one relationship.

So what might tie all of these gender-related themes together as they play out in metacommunication about problematic behavior patterns between a mother and her adult daughter who has children of her own?

Here we can make use of the concept described in a previous post: intrapsychic conflict leading to ambivalence leading to mixed and/or contradictory messages. Anything the mother says to her daughter regarding any of the above behaviors can be translated into a message to the daughter to either "act (or relate to the issues) like me" or "do not act (or relate to the issues) like me." Usually both within the very same conversation!

In this case, a good strategy might be for the daughter to express confusion about what the mother is trying to tell her in terms of following or not following mom's example no matter which aspect of the gender dysfunction is brought up. She might say something like, "Gee Mom, sometimes it sounds like you are criticizing me for doing the same things you do, while at other times it sounds like you are criticizing me for not doing them. I'm confused about what you think is the right strategy when, for example, my ex-husband keeps calling me on the phone several times a day."

A typical dysfunctional conversation might go something like this:

Mother: "I told you to block his phone number and stop talking to him."

Daughter: "But you let Dad keep bugging you all the time."

Mom: "Well, I do that for your sake 'cause I know you still care a lot about him, so it's better if we are civil to each other."

Daughter: "But wouldn't that also apply to my sons from my ex?"

Mother: "Well you don't seem to want to be bothered with your kids' feelings half the time anyway."

In this example, the mother has subtly changed the subject from how to handle an ex-husband to the daughter's parenting practices. If the daughter were to engage the mother on that issue, the mother might then talk about how the daughter is still financially dependent on her ex and needs to support herself better so she can get rid of him. Nothing would ever be resolved.

The counter-strategy is to take each tangent the mother goes off on and reconnect it to the circle or main theme. Any criticism the mother makes of the daughter on any of these inter-related subjects can be used as yet another example of how the mothers statements confuse the daughter in regards to whether or not she should follow her mother's example.

If the daughter starts with the statement above describing her confusion about whether or not mother thinks the daughter should emulate her, and the issue of the stalking ex comes up, the daughter would not say, "But you let Dad keep bugging you all the time." She would instead say, "I'm confused when you say that, cause that sounds like you are saying I shouldn't let my ex keep bugging me like you put up with Dad."

If mother then brings up her having put up with Dad for the patient's sake, that of course contradicts mom's initial advise for the daughter to cut off her ex when there's a child involved there. The daughter might then bring up that seemingly contradictory advice as a way to get back to the circle once again. 

The daughter would be ill-advised to come right out and accuse her mother of being hypocritical, as that would usually lead to the mother becoming defensive. Instead, she could blame her own confusion about what the mother is trying to say:

"Well I'm again kinda confused now. Are you saying I should handle it like you did for the sake of my sons, or that I should do the opposite of what you did and cut off my ex?"

Of course, this strategy could have good results, but it could also backfire.

The mother might at that point be struck by how she is giving the daughter double messages, which might then allow her to take pause and start to discuss why she herself might be confused on these issues - a good result. On the other hand, the strategy might also make her feel guilty and want to change the subject yet again. 

Mom might try the strategy of saying that her situation with the daughter's father is somehow different than the daughter's situation with her ex. Naturally, in some ways every situation is somewhat different, but in doing this she would be ignoring all the ways in which their situations are similar.

Figuring out the next move on the daughter's part would probably require the services and advice of a knowledgeable therapist. A therapist can tailor a counter-move for the daughter, using his or her knowledge of several different things: 

Knowledge of the mother and daughter's prior interactions; the therapist's own experience successfully countering the daughter's having done the very same thing to the therapist as her mother does to her within the context of psychotherapy; and information from the genogram about the source of the mother's ambivalence that can be use to empathically advance their conversations toward problem resolution.

Clinical Wisdom – Who Needs It

In the March/April Issue of the Psychotherapy Networker, the question of whether clinical wisdom - knowledge and intuition that a therapist gains over years of experience - has any place in today’s culture. As the magazine’s editor, Richard Simon, puts it: “The search for wisdom is out of sync with our entire culture, which much of the time is one of hurry and distraction, shallow questions and quick answers, short attention spans, and chronic restlessness.” 

He adds that the pioneers in the field of psychotherapy knew that good therapists were not just technique dispensing machines. They knew that being a good therapist required genuine insight into what it means to be a human being. Today, however, the emphasis is on quick fixes, and “short term, empirically supported manualized and medicalized therapy,” not to mention a pill for every ill. And too often, the “empirically supported” therapy treatments are based on poorly constructed, symptom counting studies that neglect underlying personality. Not to mention our relationships!

People who dismiss all widespread clinical experience and wisdom as "anecdotal" probably think it necessary to devise a scientific experiment to actually prove that the sky appears blue to the human eye at noon local time on a cloudless sunny day on the equator.

Simon comments that for therapists there are marketing plans to revise, website statistics to crunch, and referral sources to cultivate. Who has time to be wise?

This is a horrific trend, and as I have pointed out several times in this blog, it is not just biological psychiatrists and managed care insurance companies that push for it. The culture at large demands it more and more. And yet we wonder why so many people feel that their lives are empty, and fill their time with narcissistic pursuits or crass materialism.

In the lead article of the magazine, psychologist Ronald Siegel makes the following valuable points. We in the profession all need to keep making them, both to our fellow mental health professionals and to the public at large. Unfortunately, too many people in our fields are, when one gets right down to it, wimps. When managed care insurance companies say, “Jump,” they ask, “How high?"

• Even though the therapy literature, modeled after double-blind drug research, has tried to eliminate the person of the therapist as a variable, studies consistently show that the most important variable in therapy success is the patient’s relationship with the therapist. It has proven far more important than any therapy technique.

•  Patients do need to feel deeply understood by their therapist, and for the therapist to really be there with them, in order for them to be helped to find a way to overcome suffering and lead a fulfilling life.

• Sometimes when patients' despair seems to be increasing rather than decreasing, it is actually a sign that they are finally beginning to grapple with their most troubling issues. It can therefore be a sign of progress rather than that therapy is going in the wrong direction. A wise therapist will know, in a given instance, which of these two possibilities is occuring.

• It should be OK for the therapist to not immediately know what to do with a patient during a session. Sometimes it takes a lot of time to figure things out. People are complicated. Managed care insurance does not want clinicians to ever acknowledge this fact to their patients, especially when that would involve longer treatment. 

I would add: a very troubling manifestation of this problem is that, a long time ago when I first trained, we would write down our conclusion after taking an initial history and doing an examination as a diagnostic impression, rather than as “the” diagnosis - just in case later information changed the apparent clinical picture. This was true in all of medicine, not just psychiatry. Now, the insurance companies demand a diagnosis right off the bat, or they will not pay the insurance claim. The initial diagnosis then stays in the patient’s insurance records even if it is later changed to something entirely different by the clinician, and gets listed as a “pre-existing condition.” Therefore, patients buying a new policy are refused future coverage for a condition that they never even had!

• When therapists are stuck with a particular treatment ideology, they often ignore information that does not fit with their preconceived model, and elaborate on any information that supports their ideas. Of course we all do that to some extent, but therapists do need to be aware of this tendency. When I was in training, some of my supervisors used to refer to the “Procrustean bed” when discussing any “one size fits all" model. Having never actually read the myth, I missed the nuances of what the phrase meant. Procrustes lived on busy road and invited travelers to spend the night on his grand iron bed. If the traveler was too tall for the bed, he would cut off their feet. If they were too short, he would stretch them to fit!

• The symptom-focused approach leads therapists to focus solely on the “problem du jour,” and miss the larger problem of dealing with the many ways a given patient clings to behaviors that seems to bring on his or her own difficulties.

• People who learn how to be introspective are much likelier to do well in therapy than those who do not.  Siegel adds, “Our clients are themselves discouraged from introspection by the pharmaceutical industry, which offers images of unbalanced neurotransmitters to explain their difficulties (the ads neglect to list ‘may lead to an unexamined life’ among possible side effects).”

 Now that’s wisdom.

8 Fabulous Fathers Day Gifts for the Man Who Spawned You

This Sunday is Father’s Day! Looking for a great gift for Dad, Father, Pater, Pa, Daddy-Wiggums, or That Man Who Spawned 'n' Spurned Me? I’ve rounded up some top choices that will make Dad cry and beat you quicklike, before retiring to the "teeth optional" dive bar on the corner for the remainder of the evening.

At "I am a stuffed animal" you can order a stuffed version of your daddy! It's better than the taxidermized version, because it has no feet, only stumps. Daddy can snuggle it while he watches football, which he invariably does. Then daddy can molest it, which he invariably does. (Note how they captured the model's thuggish cruelty hidden beneath the friendly smile? And the fat eyebrows that sit on his brow like malignant caterpillars? That is artistry, baby!)

Many people who come and go? Shouldn't father sort of come and...stay? What's with the father who "goes"? Isn't he known as a shithead and a deadbeat dad? You'd do better to break this stupid faux wooden plaque over his goddamn head!

The World's Largest Gummy Bear! When daddy eats it his insides will gum up and he will start to have a crazyass acid trip and he will eat his socks and wind up curled in the corner like a small bean, weeping. Why are they all STARING AT ME? They glisten.

This T-shirt is actually pretty awesome. But if you give it to your dad, you will have to include the infant in the gift package or else he won't get the joke, think the shirt is too small, and beat the living fuck out of you.

Jerky of the Month Club, jerky jerkface daddy who never showed up for my ballet recitals! I hope your blood pressure shoots up to salty heights of meaty badness.

This Is What the World's Best Dad Looks Like. He has BOOBS. Awesome.

Damn, this daddy must be hot because he is spawning children faster than we can make amorphous pawprints from them! Are Jordan and Caleb the total black sheep of the family, or what? Did we run out of K names?! What about Kaleb and Kordon?

The little hearts on the base of this figurine do nothing to eliminate the fact that you have given your father an image of himself as a wild and predatory animal, sitting on the shitter. Is that how you see your father? When he is done manhandling his beer, laptop, football, cell phone, crown, paper, and woolly balls, he will take a switch to you.

You might also like: All The Beautiful Ways To Say I Love You

That Bushy Faced Devil Who Shares My Bed

Since my husband now lives in the attic, emerging only to take meals and refresh his glass of low-sodium V-8, he has grown a ferocious beard. The beard is larger than his whole head and exists, presumably, to scare off any intruders when he drops on them, catlike, from the spot he occupies in the eaves.

This is not my husband. My husband is hotter. But a beard does not look good even on this reasonably attractive fellow.

 

The beard is of the ilk that would cause Jeeves, Bertie Wooster's man, to discreetly place a razor at the side of the breakfast plate each morning with a poignant, meaningful "Sir" until the matter were dealt with appropriately. It has quite taken over my husband's dear face, such that I can see his glimmering, beady blue eyes winking through the coarse matting.

Some elements of the beard are asymmetrical and tufty.

I am in some ways responsible for the beard, for I am fond of a "rugged, manly look." I did not know that it would so quickly o'ertake his face! I did not know that it would grow, and grow, as if an angry marmot were ravishing his chin!

I have begun to fear that the beard has addled his normally sharp brains. For example, I often ask his advice on some of my writing projects. He usually responds with appropriate and kindly criticism. But not since The Beard hove on the scene and began, with its coiled tendrils, to tighten its grip on certain areas of the brain responsible for common sense and intelligence. Last night I asked him what he thought of something brilliant I had written, and his response was lukewarm.

"Really?" says I. "I thought it was rather clever!"

"You are wrong," says he.

"Am I?" says I. "You don't think it's prize-worthy prose?"

I heard a voice speaking out of the tufted mass of tangled hair, and it said something like: "No one will ever buy it. No one will ever read it. No one gives a shit about such topics!"

"I will no longer dedicate my book to you, then!" says I heatedly.

"Poo!" he snarked. "Don't, then!"

"I won't!" I cried. "And another thing, I am going to write rude things about you, and post them online!"

"Do your worst clangings and bangings and tippity-tappings!" he said, sounding and looking an awful lot like "Gurgi" from the Chronicles of Prydain.

His beard sharpened into steely points, and we were at an impasse. I have set traps for him, and they are baited with Bushmills whiskey and Guinness.

“Expert” Doctors Who Shill for Big Pharma Get Greedier

In several posts on my Family Dysfunction and Mental Health Blog (8/7/12, 6/19/12, 3/6/12, 2/21/12,  1/31/12, 10/19/11, 8/31/11), I describe in detail the propaganda and truth-twisting techniques used by the “expert” doctors who shill for Big Pharma (referred to by Pharma as key opinion leaders). They use these techniques in order to sell high-priced, brand-name drugs when cheaper drugs would be just as effective, and, in many cases, psychotherapy would be even more effective. 

In a sense, many of the shills (though certainly not all - some really don’t realize how much they themselves have been influenced) are willing to sell out the well-being of psychiatric patients for money. So the fact that their greed is now being used against Big Pharma in Australia, and most likely everywhere else as well, should not come as much of a surprise.  When it’s done to Pharma instead of for them, the drug companies then squeal like little piggies.

Irony, thy name is Pharma.

Thanks to Ken Harvey, a colleague in Healthy Skepticism, for a heads up on the following story:

Megan Reynolds (http://www.6minutes.com.au/news/latest-news/transparency-will-expose-demanding-doctors) a journalist for the Australian website 6minutes, (a daily pdf newsletter sent to Australian GPs and other healthcare professionals)reported the following on October 2, 2012:

“Demanding doctors with ‘unreasonable’ expectations are driving up the costs of medical educational events, a Pharma industry insider says.

In a submission to the ACCC (Australian Competition and Consumer Commission) the next update to the Medicines Australia's Code of Conduct, an anonymous 'player in the pharmaceutical industry  ‘supports full disclosure of sponsorship payments as he says under the current system of self-regulation, ‘Key Opinion Leader’ doctors are coercing Pharma companies into contravening the Code.

The 'insider' says some doctors demand $1-2k or more for a brief talk based on company-provided slides, in addition to business class airfares of up to $15,000.

Key Opinion Leaders also enjoy holidays as extensions of their conferences, and sometimes never turn up to meetings they are sponsored to attend, as they are 'probably off motoring around Europe somewhere!' he claims.

But companies are reluctant to complain about such demands for fear of alienating doctors of influence, who they claim often pit companies against each other in bidding wars for their services.

‘The Code needs to be stronger to help companies deal with these situations and know that any company that does not do the same thing will be exposed. Until that happens everyone is afraid to be the odd ones out,’ he writes.

He urges the AMA to set industry honorarium fee rates to stop bidding wars, and limiting doctors to just one sponsored event per company. He adds that most doctors as well as the public would be shocked by the amount of ‘paid comment’ to be revealed by transparency.”

Drug companies demanding transparency.  Now there’s a switch!