Meanwhile, I’ll be catching up on some admin work, writing a blog post or two, and making up new apocalyptic names for the storm and its effects on a city that’s not used to digging out from under snow and ice, let alone driving through it. (Ice-chaton is a twist of “eschaton,” a term for the end of the world. And no, you don’t need to know this, or care!)

Oh, and I’m taking these lovely creatures out for regular snow romps. Be safe!

Stella and Hoku ala enjoy the winter wonderland.

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Too bad that not only doesn’t work, but often enough makes things worse. Specifically, when I go into fixit mode, I run the risk of communicating to my spouse some bad things. First, I’m probably communicating that I’m not there for him. This is counter-intuitive, so think about it for a minute. You might naturally think that because I’m trying to solve my spouse’s problems, I may be annoying, but I’m there for him. I have good intentions! I want to help! I have solutions! But the inadvertent message my spouse receives could be: “I’m so anxious about your [insert one] bad mood/difficult problem/emotional quandary that I can’t simply be present with you and allow you to work things out on your own. I can’t calm down when you’re upset. And therefore, I’m not really here for you.”

Second, I run the risk of sending my spouse the message that I don’t respect him, that I don’t think he’s a responsible adult who can “fix it” himself.

What would it be like if, instead of rushing into fixit mode, I said, “You look upset. I don’t know how you really feel. I do know I don’t feel connected to you right now. That’s okay, but I just want to let you know that I love you, and when you’re ready to talk, I’ll be here for you.” What would that be like?

It’s hard to say. But it’s possible that your spouse or partner would feel 1) relieved that at least for now, you know something’s wrong but you’re not trying to solve her problems for her, and yet you’re there for her; and 2) you respect her and know she can work most of this out herself. You still have to have The Conversation at some point, to clear the air and talk through the situation. But if you’re communicating to your beloved that as upsetting as things are, you’re okay and you’re here when s/he’s ready, it could give both of you a chance to calm down, get some perspective, and re-engage with each other in an atmosphere of gentleness and mutual respect.

You didn’t fix it…and that might be one reason why it gets fixed!

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But what I liked best was his courage. Here’s an excerpt of what his brother had to say about it. I harp on courage with my clients. The old song “Love is all you need” has been a bane of this therapist’s existence: love is not all you need. It’s courage that you need. Courage to confront your partner about the truth that needs to be told. Courage to confront yourself about your failings, blind spots, weaknesses. Courage to pursue the best possible relationship: one that is filled with honesty, vigorous argument, ecstatic union, and thousands of days of ordinary kinship and friendship. Love also requires courage in no small part because the price of love is grief, and that price is often staggeringly high.

Chances are good that if there’s something wrong in your relationship—it’s falling flat, or it’s driving you crazy, or it seems to be slipping away from you, right before your eyes—you will probably find your way to a new, rewarding relationship when you begin to think, talk, and act courageously.

I highly doubt that Hitch would have been very interested in my line of work. But he has contributed something to it, nonetheless. I remember him for this, and raise a glass of Jim Beam to his memory. (Just one! I would never have been able to keep up with him.)

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Here’s why. If you have medical insurance, it’s possible that your insurer has listed me on their website as a provider, whether I’m “preferred” with them or not, and it’s also possible that they have told you they cover couples counseling. But this is technically incorrect. And to do it, I’d have to breach my own ethical code. Here’s the explanation:

The insurance industry is built to serve individuals, not couples, which means if we bill your insurance, I have to diagnose one of you with a mental disorder and bill the session as an individual session (with the individual’s spouse/partner present), implying that the session is intended to treat that one individual’s mental disorder. This is why insurance companies don’t really cover couples counseling: they cover individual counseling with the (presumably non-disordered) spouse/partner in the therapy room. And in my book, that’s not couples counseling.

If I were to bill the session properly and ethically, I would diagnose neither of you with a full-blown disorder, but would code it V61.10, which is “partner relational problem.” And there are two reasons why that won’t work. First, I’m still billing your insurance for one of you, not both of you, and that’s inconsistent with my view of you as my client. You are both my client—my singular client. Your dyad is my client unit. And I believe that these little details do matter. They have an effect on how we see ourselves and each other, try as we might to avoid it. And the second problem is that no insurance company I know of pays claims with V61.10 as the diagnosis. It’s a V-code, and my guess is that the V stands for Very Unlikely We’re Going To Take Your Problem Seriously.

“But,” you say, “I do have a mental disorder! I’m depressed, and my relationship problem contributes to my depression. So I’m fine with you diagnosing me and billing it as an individual with his partner in the room.” I understand that, I really do. I even share your belief that working on couple issues can alleviate depression and other disorders like anxiety, PTSD, and many more. Maybe it seems like an absurd distinction, but to serve you ethically I still have to hold the line on my belief that what we do in couples counseling treats both of you as a unit, and to do that effectively, I can’t have the paperwork telling me, you, and your partner that your depression is the central problem. It truly might not be. Let’s say your partner also has a disorder in the category that includes depression—bipolar, say, or alcohol dependence. Why should I put your name on the chart and not his? Maybe his alcoholism is a bigger issue than your depression…but your depression is also a really big deal. It becomes an ethically shady game of drawing false distinctions. I know many therapists (my past self included) who have blurred this line and said, “Oh, it’s not a big deal, I know the truth,” but I’ve been doing this work long enough to know that blurring a line like that is dangerous.

Two more points and I’m done, I promise! I want to add that my holding the line on this can be a source of comfort for anyone who is afraid to begin couples counseling because they (understandably) fear that the therapist is going to side with their partner. I am doing everything I can in and out of my sessions with you to prevent that from happening. In the sessions themselves, when I am naturally drawn to your partner over you, I go on alert and wonder how I’m being “drawn in,” and what you’re all about, and how I can be as well connected with you as I am with your partner. And outside of sessions, I pay attention to things like this insurance issue to be sure the structure of our therapy—even the tedious paperwork—is not getting in our way.

And finally, I have learned through long experience that out-of-pocket therapy is generally more effective and powerful, both for couples and individuals—and perhaps more so for couples. You’re investing time and hard-earned money on your relationship. That motivates you, and it makes it a true investment on your part. It can be expensive (though perhaps not as much as you fear…many couples require surprisingly few sessions). But you really do get what you pay for.

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Dear Mr. President,
Great to talk with you today. Thanks for the invitation to what promises to be a great state dinner. See you there.
Take care,
–Stephen

If I’m doing a long back-and-forth email string, at some point I’ll ditch the “take care” and just respond more casually:

Barack,
No, I’m right-handed, so it doesn’t matter where they seat me. But next to you or Michelle would of course be great. Tell Malia I love the shoes!
–S

But these days I’ve been ditching “take care” entirely, replacing it with (drum roll) “Only good things.” I got it from our favorite dog trainer, a skilled professional who uses completely non-violent methods in her training programs. I’ve assumed all these years that she uses that signature line because it fits best with her general philosophy of life. It certainly fits with her work training dogs: no punishment, no nastiness, only treats for good behaviors and an understanding that dogs learn best when the training is positive and thoroughly non-violent.

But I had another reason for switching my signature line. I recently attended a workshop on conflict resolution, and the workshop leader mentioned that telling people to “take care” is actually problematic. Taking care of oneself seems like a perfectly good thing, right? Except sometimes the healthier choice is to take a calculated risk, or make yourself intentionally vulnerable. I know from years of working with people on relationships that self-protection is never enough to ensure a healthy union. If I’m 100% safe, I’m probably only 0-50% intimate with my spouse or partner. Relationships are about both risk and safety.

So I suppose I could sign emails, “Take care—and take risks!” But that’s clunky, and corny. And as a therapist I don’t need any help being clunky and corny. So I decided our dog trainer has it right: I wish you only good things. I don’t wish you badness, malice, or suffering. You may suffer if you take the healthy risks I wish you would take, but that’s different: that is the suffering of growth, so in a backwards way it too is a good thing.

Some of you may think all of this is silly. It’s an email signature line, what’s the big deal? Well…it’s not necessarily a huge deal. But it is one of those everyday things that can gradually have a significant influence over you, day by day. Now that I sign emails “only good things,” I’m reminding myself daily that a well-lived life isn’t only about safety, and there are good things to be had when we do something brave, or move outside of our comfort zone…when we stop just “taking care.”

Only good things,

Stephen

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Years ago I knew someone who was prone to anxiety attacks. I had read while studying Dialectical Behavioral Therapy that holding your face in a bowl of ice-cold water for 30 seconds can be a quick and effective way to, well, literally chill out. I think DBT also taught me the ice-cube technique I used on my friend. I told him to just sit tight, I’ll be right back. I went to the fridge and filled a cereal bowl with ice cubes, came back, and said, “Here. Hold these in your hand.” He obeyed (he was too anxious to resist or push back with questions). Within one minute, his anxiety attack was over. He was looking at his freezing-cold hand, and the pain of that coldness had yanked him out of his anxiety. His brain had something else to focus on.

Is this the total solution to your anxiety problems? No. You’ll probably also have to talk about it, to work through it cognitively. But it’s a great example of how water (this time, in its frozen form) can manipulate our bodies in such a way that anxiety suddenly drops down to normal levels. This is because we experience emotions in our physical bodies. Emotions are physiological phenomena. The ice-cube technique works with anxiety, but also anger: if you’re enraged about something, go grab some ice cubes. You’ll start to calm down almost immediately, and you can then work effectively deal with what (or who) made you mad.

Hot water works too. I’m a big fan of hot baths as a way to relax, but also regroup, re-organize, and re-orient both my head and my heart so that I can look at a problem in a new way. Even simply washing your hands and face with hot water and soap can be an effective self-soothing skill that frees you to engage your problem with strength and renewed concentration.

We’re mostly made of water, and we live on a planet with 70% of its crust submerged under water. Water is everywhere. It only stands to reason that water can be a powerful tool that helps us relax, refocus, and approach our complex issues with a refreshed body and mind.

Bonus: ice cubes are way cheaper than meds…and no side effects!

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I’m not whining. (Okay, I’m whining a little.) I say all this (more importantly) because I’ve noticed something while spending so much more time with our puppy dogs, Stella and Hoku ala. Whenever they can—that is, whenever I can provide a place for them to do it—they just, you know, lie around.

Of course they do, you’re saying. They’re dogs. Big deal. But it is a big deal. It’s one of those obvious things in front of our noses that we too often ignore: the fact that all the other mammals on this planet, after finding food, satisfying today’s procreative needs, and securing shelter, just…lie around. They don’t have to do anything. Only the benighted humans have created a world in which they have to do things, do more things, do so many things that their sense of self-worth is caught up in all the things they do, or can’t do.

Why don’t we all do something unusual today: after we’ve taken care of the basics, why don’t we all just lie around? I’m going to give it a try.

Hoku ala enjoying the simple experience of being an earthling with nothing to do.

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Think about all the things you do regularly whether you want to or not: pay the electric bill, service the car, go to work, drive your mom to the doctor, and on into infinity. These are things you do because, well, because you do them. They have to get done. But if you’re like a lot of people, your relationship is not required. Everything about it is voluntary, and, therefore, open to being blown off. And then you wind up in my office! Here’s a primer on date nights, a Date Night 101:

1. Pick one night, the same night every week. (Yeah, I can already hear you saying, “We can’t! His rotation changes by the week and I’m a bartender so I never know when I’m going to be scheduled, and it’s always at night!” Even if one regular night is impossible, there’s got to be some block of time each week—3am to 7am on Sundays??—that will work for you both.)

2. During that special time, nobody gets in your way. If you have kids, you pay for a sitter and get out of the house. Maybe it’s okay for you to share date night with friends, but wait a bit before doing that. Get into the rhythm as a couple first.

3. Repeat 52 times. Then evaluate. How’s it going? What’s different about your relationship, about you, about how you feel about each other? Anything need to change, or be adjusted? Some of my clients come to counseling and then go on their date night. I recommend this. It makes the whole thing even more intentional.

Whatever you plan, set it in stone. It’s the Law. That way, your relationship is not completely vulnerable to the tyranny of your schedules, whims, emotions, and issues. At least this one block of time each week is immune from all of that.

Note to singles: this works for those of us currently not in relationships. No matter what your relationship status is, if you set aside one block of time each week just for yourself, what do you imagine might change in your life? Have you ever really done this? (I know it’s hard for me!) I’d hazard a guess that your blood pressure would be lower, you’d feel healthier, and you’d feel a lot less frazzled and crazy. And you could kick it off with a nice individual therapy session!

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