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General

Depersonalization Disorder: A Hypothesis

In one of our first sessions, Carl told me that his feelings of depersonalization began several years ago when he was reading a self-help or psychology book (he can no longer remember the name of it) and one of the author's ideas gave him a sudden unpleasant insight into himself. He can't recall exactly what he realized; but at that moment, he felt himself lift out of his body, into his head and out through the top of it where he has remained ever since. He's now more or less constantly preoccupied with attempting to regulate how he appears to other people by mind-reading and "empathy." Other than a pervasive feeling of anxiety, he has little idea about how he feels.

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Mother-Baby Music

I've always had a problem with the term attachment to describe what happens between mother and baby. Today, in session with Janice, I remembered the word attunement and felt it was a much better, more accurate descriptor.

Janice began the session by talking about her husband's almost complete inability to read her body sexually and to identify what gives her pleasure. The way he had been touching her the night before felt completely unrelated to her own responses; it distressed her so much that she began to cry in the middle of sex. When they talked about it afterwards, he told her he felt there was a very narrow pathway of acceptable behavior and that if he deviated from it, he'd upset her. Janice acknowledged that there was some truth to what he had said. She next talked about how he doesn't pay much attention to his intonation when he plays saxophone, that he often sounds shrill and off-pitch but doesn't seem to notice. Her mother had been like that, too -- interested in music but unable to carry a tune.

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A Call for Participants

Now that I've nearly finished my book on defense mechanisms, I'm wondering what to do next. I'll continue with my book on shame and the defenses against it, but I'd also like to work on something more interactive, involving visitors to this and my After Psychotherapy site.

The project I have in mind would last about a year and eventually evolve into a book. At the beginning of each month, I'd post an exercise in a separate section of my personal website. During that month, participants would independently undertake the exercise, then share their responses with one another as comments to the posted exercise -- a kind of virtual group therapy.

I would also respond to and engage in the conversation. Participation should involve no more than 5-6 hours per month.

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ADHD Symptoms: A Psychodynamic Perspective

After the spirited discussion about my two posts on ADHD symptoms, I felt eager for more experience working with someone who considered himself "ADD"; my intake on Friday with a new Skype therapy client did just that and, even in the first session, provided many details that pointed toward a psychological explanation for his ADHD symptoms.

Adam told me he had been diagnosed as an adult for having a history of difficulties in the areas of concentration, classroom behavior, and for performing below his ability level. He has taken medications for two years.

Over the course of the session, Adam described his struggles in several different areas. His main concern -- the reason for beginning treatment -- is his recent infidelity, uncovered by his wife, which is jeopardizing his marriage. He also talked about problems at the law firm where he is a first-year associate.

In preparing for a recent trial, he "went AWOL" in order to be with his wife on a day when she was awaiting some important test results. He told no one at the firm he'd be away, he just simply disappeared. The partner on the case kept calling and texting him throughout the day but Adam ignored him. He felt the other associate on the case could handle the trial prep that day and they didn't need him.

When he returned to the office, the partner was furious. As a summer associate at a different firm two years ago, Adam had run into similar difficulties with the higher-ups and didn't follow through on assignments; at the end of the summer, he did not receive an offer to return once he finished law school.

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