What Is He Thinking?

I Hope Nobody Finds Out: Imposter Syndrome, Survivor Guilt, and the Bane of Progressive Political Organizations

Michael Bader, D.M.H. — Fri, 11 Sep 2009 03:54:49 +0000

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Over the last five years, I've had the privilege of coaching quite a few leaders from several different labor unions. Often, I hear some version of the following: "If people only knew that I really don't know what I'm doing..." Such is the secret worry of almost every union leader I've ever coached. In this, union leaders are no different than others who have acquired some degree of authority, expertise, wealth, recognition, or power. Hardly a day goes by in my psychotherapy practice that I don't hear some version of this feeling voiced by my patients, whether they're professors, lawyers, or CEOs. Union leaders, however, seem to have their own special brand of what is commonly known as the "imposter syndrome." Understanding this problem is crucial to overcoming it.

This syndrome should be familiar to readers. Psychologists and Organizational Development folks talk and write about it all the time. It has even made its way into the mass media, sparked workshops galore, and spawned its own organization (impostersyndrome.com)! This state of mind is marked by the feeling that you're not supposed to have the type of authority or competence that you actually have, that you don't deserve it, that you didn't quite earn it. You feel like you're fooling others and that some day they'll get wise and expose you. It's a feeling that you've somehow snuck into a club in which you're not a legitimate member. The club might be the club of "real leaders" or "experts" or "people who know what they're doing." Since you don't belong in the club, you have to police your behavior so as not to draw the wrong type of attention to yourself, attention that might lead to your dreaded "outing." You see others whom you imagine belong in the club who don't have to be careful. You wonder how they do it. You go to sleep at night thinking, "How did I ever get here?"

For some, this sense of fraudulence is mild; for others, it's chronic and intense. For some, it wanes with experience; for others, it is never-ending. In a room of such leaders, it floats around like a collective delusion. Everyone else is comfortable with what they're doing and who they are-you are the only one who isn't. It tends to be more prominent in women leaders because their personal insecurities are compounded by the sense that they're not really welcome "at the top" because of their gender. They dismiss their real achievements and attribute their success to luck, contacts, or affirmative action.

In my coaching with union leaders, this issue of fraudulence is ubiquitous, stressful, and produces maladaptive responses. I believe it is a form of survivor guilt, the unconscious and pathogenic belief that we're not supposed to have more of the good things in life than our caretakers, or than people with whom we're intimate. Some of these "good things" include power, authority, and expertise. The problem arises because we are also ambitious and seek to grow, exercise our competence, and succeed. We do so, but then pay the price: A sense of fraudulence.

The most interesting and important dimension of this phenomenon is not its existence but the ways leaders respond to it. Fraudulence, the imposter syndrome, survivor guilt-whatever you call it-is a feeling that leads us to be less than we're capable of being. Or it leads us to fail to take legitimate pleasure and pride in our very real accomplishments. It leads some people to sabotage themselves when they get power, almost as if they are punishing themselves and thereby reducing the conflict between their ambitions and their guilt. But even if they don't overtly shoot themselves in the foot, they deal with their sense of fraudulence in other, subtler ways, but ways that invariably limit their effectiveness and impair their satisfaction.

Union leaders experience this insecurity routinely. Every leader I or fellow coaches with whom I've consulted have worked with wonders more or less whether he or she fooled someone in order to get promoted into a position of leadership. Leaders respond to these beliefs in several different ways:

1) One leader told me that he spent a lot of time making sure all his legal, budgetary, and administrative "i's were dotted and t's were crossed" in case someone from his Executive Board or the International ever investigated. Such defensive activity took up way too much of his time and held him back from being a bigger player in his state and in the International.

2) A woman recently elected to a top position in her Local described her reluctance to "hobnob" with politicians in her state because of a worry that they would think "who the hell is she?!"

3) Another woman in a senior position in her local told me, with some humor, that she became aware of her feelings of being an imposter at a recent cocktail party. There she was, carrying her large pocketbook, standing off in the corner. She noticed that a woman she greatly admired who was high up in her International union, was "working the room" without carrying a purse. "It occurred to me then that if you aren't carrying a purse, you can use both hands to meet and greet, carry a plate of food or wine, etc. I, however, was weighed down by this ridiculous bag!" The bag, exactly like her feelings of being an imposter, was holding her back.

4) A man I worked with in a large local told me that he felt a need to stay in his office, consumed with internal affairs, because he felt safer and more comfortable in that milieu than in going outside to interact with members and other union leaders. When he was "inside," he felt more protected from attack. When he was "outside," he felt vulnerable to being critiqued and somehow exposed. An undue focus on internal governance is often a consequence of feelings of fraudulence and survivor guilt.

5) Another leader, a woman known as a brilliant tactician, was embarrassed to admit that she felt uncomfortable talking about strategy and vision, burdened with the worry that such an ability was the province of men, charismatic white men in particular.

6) A black male leader I coached confessed that he felt uncomfortable in the company of other union leaders who had college or graduate educations. He reacted by alternating between retreating into silence or by speaking in an elaborately verbose manner, making his points in ways that were ultimately confusing and tedious.

7) A male leader known for being a brilliant campaign strategist was also known for being a flake: late to meetings, poor at paperwork, and inconsistent around accountability. The net effect was that he wasn't always taken seriously. Upon exploration, he admitted that he felt secretly inadequate and worried that he wasn't a "real leader" and that he diminished himself through his irresponsibility as a result.

8) A woman leader was tough and popular with members, but was considered "high-maintenance" by her staff. She was overly emotional and burdened others at work with her personal moods and problems. It turned out that she felt that if she was too "professional," others would resent and feel put down by her. Instead, she put herself down by her office antics.

These behaviors and conflicts are common. For union and other progressive political leaders, however, the difficulties in feeling powerful and "owning" their authority is exacerbated by the fact that they identify so much with the underdog. Their entire work life is devoted to helping people who are powerless and victimized. There is therefore a powerful motive to not see themselves as having power and authority themselves. They mistakenly feel guilty about putting themselves above their members or, worse, exercising power in a way that might victimize others. It leads them to feel especially uncomfortable with owning and exercising their actual power and sets in motion many covert strategies to undo or diminish themselves.

This special guilt about the exercise of power can influence leaders to hesitate to take risks in moving their organizations in new and more radical ways. They fear that various constituencies-staff, members, allies-will feel left behind or betrayed. While there might be grains of truth in this fear, at its core it reflects survivor guilt and feelings of fraudulence, i.e. "If I act boldly and expect more of others, the prior status quo in which everyone plays it small and safe will be violated and I'll be attacked."

The solution to the problem of fraudulence is to decrease the distance between someone's self image and his or her objective position. There are several ways to do this:

1) Insight: It's vital that the person understand that he or she does, in fact, feel fraudulent and why. When such beliefs and feelings are exposed to the light of day, they begin to lose their power. When the origins of such beliefs and feelings are understood, their irrationality can be recognized more deeply and more effectively counteracted.

2) Separating necessity and fantasy: Once the presence of such a syndrome is fully recognized, it's important for the person to understand how it plays out in his or her everyday work life. Here, the challenge is to separate the rational from the irrational. In other words, sometimes a leader does something, or fails to do something, for a combination of rational and irrational reasons. There may be a good reason to focus on internal union affairs at the expense of external ones. There may be rational reasons for hunkering down and protecting yourself from criticism. There may, in fact, be people out there who want to undermine you if you act big. Such considerations have to separated from the irrational fears and guilt around feeling and acting big, competent, and/or visionary. Sometimes we have to do good things for bad reasons and vice versa.

3) Support from others: You are not alone. Everyone in positions of authority have had these feelings or currently have them. If they deny it, they're lying. It is tremendously liberating to share these doubts and fears with others and thereby reduce shame about something that is human and universal.

4) Self-Compassion: Deliberately cultivating an attitude of self-compassion is a crucial part of overcoming survivor guilt and the Imposter Syndrome. Such disabling feelings are harsh, unforgiving, and unfair. If your very value as a person is at stake when you act like a leader, you are holding yourself to an impossible and emotionally debilitating ideal.

5) Combat Perfectionism and Act: The story is told that during the marches and protests that the Rev. King led in Chicago, he reportedly told his fellow leaders one evening at their hotel, "I wonder what people would think if they understood that we didn't quite know what we're doing." And the next day they went out and marched. Perfectionism is a defense against fraudulence ("if I get it perfect, I'll be above reproach") and is a spirit-killer. People have to act in the presence of uncertainty, in the midst of doubt, and in the face of potential failure. In addition, by acting as a leader, by "walking the walk," it is possible, if one is mindful of the issues involved, to gather evidence that dis-confirms these negative beliefs. The old axiom, "fake it ‘till you make it," is often one of the most powerful ways to correct a false belief.

Feelings of fraudulence plague today's progressive leaders and will not go away any time soon. The challenge is to recognize and reduce them. The consequences of not doing so are not dramatic-the status quo remains, the collective delusion that "no one else feels this way and so I better keep these feelings to myself" continues, and leadership continues to play it safe. When Marianne Williamson said that "playing small does not serve the world," she was talking about the cost of survival guilt and the imposter syndrome. Union and other progressive leaders need to learn this lesson.

What Makes Right-Wing Mobs Tick?

Michael Bader, D.M.H. — Mon, 24 Aug 2009 03:12:30 +0000

A lot of heavyweight thinkers have offered explanations of the irrationality of modern political behavior--you know, behavior like Medicare recipients at town halls screaming about the evils of government-run health care or otherwise reasonable people likening Obama's plan to Nazi eugenics. George Lakoff theorizes that conservatives interpret reality through metaphors and meta-narratives modeled after authoritarian family structures. Drew Westen argues that they interpret facts according to emotionally based investments in conclusions they already hold, bypassing cortical centers of reason altogether. These and other analyses are powerful and helpful. But they aren't satisfying to me because they aren't specific enough to account for the passionate urgency and self-destructiveness of the right-wing rejection of a program that will obviously benefit them.

In both my consulting room and my writing and teaching about organizational and political change, my focus is on understanding the causes of irrational and self-destructive thinking and behavior. It's much more difficult to be objective, however, if I have a stake in the outcome like I do with the health care debate. In this case I feel an overwhelming impulse to leap through the television and throttle the whole bunch of them-the right-wing fear mongers, the pseudo-neutral mainstream press, the idiotic spittle-spewing town hall demonstrators ranting about communism, and the cowardly Democratic party fat cats who are barely to be seen. Like so many others, I'm sometimes reduced to feeling simple awe, wonder, and despair at how screwed up the world-and people--seem to be.

But when I put my professional hat back on, the behavior out there is still a compelling puzzle crying out for further explanation. I'm not talking about the behavior of people who have a vested interest in the status quo or are shilling for them. I'm talking about ordinary folks who repeatedly vote and act against their best interest. Of course, they don't think that this is what they're doing. When people do or say irrational things, they always think they're being reasonable. I'm saying that it's against their best rational interests to fight against health reform, to vilify government when it helps and protects them every day, and do so in ways that insure that the folks who are screwing them continue to be able to do so. And I'm saying that explanations that rely on notions of brainwashing, racism, or fundamentalist moralism are, while useful, insufficiently specific and psychologically complex.

It is certainly true that liberal attitudes, like conservative ones, can also derive their force from deeply personal, unconscious, and irrational sources. But I'm not a relativist who believes that the "truth" depends on your point of view or cares much about the fact that the Fox News audience would label me the irrational one. In my view, conservative irrationality is much more blatantly self-defeating than is the liberal variety and, thus, of more interest to me in regard to the current debate.

Here's what I think is going on: People in our culture have an inherent resistance to feeling helpless, victimized, and in need of protection, care, and help. This resistance takes many forms, some of which promote hostility toward government in general and toward liberal and humanistic political agendas like health care reform in particular.

Feelings of helplessness and dependency can feel toxic. We all naturally tend to take responsibility for our lot in life. We want to feel that we choose our lives, that we have some inalienable and existential freedom to determine our present and future, that we are actors and agents. While true in some deep and important way, such a belief can and does create problems when our choices are limited or constrained by limited resources, the interests and needs of others, or the demands of institutions, when, in other words, we are actually helpless and in need of help. Helplessness is an extremely painful state, one that the human psyche will do almost anything to escape.

But if our over-investment in being free agents leads us to refuse to face feelings of helplessness, then our suffering has to be fault. If we always have choices, then we're also always accountable for their outcomes, and if these outcomes are negative then we have no one to blame but ourselves. What do we do, then, about all the areas of life that we don't control, never controlled, never will control? What about our relative helplessness and dependence as children on our families? What about the profound influence of our culture that shapes our opportunities, crafts our values, and defines our sense of what's possible and what's not? What about our on-going need for collective responses from entities much bigger than the self to such things as the excesses of the market, the protection of the environment, public safety, international conflict?

Our responses to this conflict are complicated. On a personal level, we usually insist on maintaining the illusion of freedom and autonomy, but only at the cost of becoming self-blaming and guilty. For example, in my clinical practice I hear patients frequently describe abusive conditions of childhood in terms that regularly forgive parents and blame themselves. Children who are neglected grow up feeling guilty about their need for caretaking. Kids who were hit a lot tell me that they were "hard to handle." It's said that children would rather be "sinners in heaven than saints in hell," that they would rather exonerate their caregivers and feel guilty than hold their caregivers accountable and feel innocent.

Culturally, we enshrine ideals of free choice and personal responsibility in the notion of meritocracy-the belief that people rise or fall to the level of their essential ability and value. Therefore, if we're ultimately responsible for our social position, then its limitations must reflect something essentially limited about us. Despite the obvious barriers and constraints on social mobility, people still secretly blame themselves for their lot in life.

The reason that the story is complicated, however, is that it doesn't stop here. If it were, there wouldn't be so many people out there blaming everyone and everything in sight for their stress and suffering. Self-blame and guilt-the unfortunate byproducts of our American belief in freedom and choice-are also difficult to tolerate because they're painful. On an unconscious level, the mind tries to get rid of these secret toxins in various ways, even though most of these strategies invariably fail to offer permanent relief. Sometimes we blame others: "I'd be happy if you (fill in the blank-liberals, government, etc.) would just stop getting in my way, stop trying to hold me down with (fill in the blank---regulations, taxes, laws, etc)." Such complaints seek to proclaim innocence, to blame government so as not to surrender to self-blame. They are attempts to reverse and deny troubling private feelings of responsibility. Conscious claims of innocence and victimization seek to counteract private feeling of guilt.

Blaming others may be a time-honored strategy to alleviate feelings of guilt and helplessness, but because it's defensive, it doesn't last very long. It has to be stoked over and over with new accusations, new grievances, and thus the creation of new and powerful "others" posing a threat to us. At the end of the day, however, the self-blaming resulting from the illusion of individual free choice comes back to haunt us.

Other folks get consumed with envy of people that they imagine are being taken care of, in effect complaining: "We're sacrificing and enduring deprivation and those people over there are getting away with something, getting a free pass. We're responsible for our own lot in life but they seem content to get handouts." This was the psychology behind Reagan's demonization of the mythic "welfare queen" that so stirred up the envy and resentment of white working class men in the 1980s. And it lies behind the equally vitriolic resentment of the imaginary others who will be taken care of by the Obama administration-the uninsured or the poor-while "we" pay the bill through our sacrifice and higher taxes.

Unconscious longings and conflicts such as these are especially apparent in the bizarre claims about "death panels." The sheer irrationality of the claims suggests that something psychically powerful and conflictual is at work. The fantasy behind these claims is that the handicapped, the elderly, and the demented, will be killed. What these groups have in common is that they're innocent and helpless. Those raising the specter of government ordered euthanasia are defending the innocence of others because they are so terribly conflicted about giving voice to their own. They feel terribly guilty and ashamed of their own legitimate dependency needs. Unable to accept them, they project them onto others, locating them-in a sense, the vulnerable and innocent parts of themselves--in others who are indisputably dependent to whose defense they can safely come. My view is that they can't experience fully that dimension of their own lives in which they are innocent and helpless, for example, in their families, communities, school systems, workplaces, and health care system. Their militancy on behalf of grandma is a disguised once-removed militancy on behalf of themselves.

We all have a longing to be cared for, a longing that unfortunately comes to feel inherently in conflict with autonomy and freedom. The conflicts that we all have about being deserving of such care thus get distorted and appear as anti-government paranoia. Our own internal sense of being undeserving of care becomes, then, a rejection of the need for care which becomes an external distrust of the care that is actually being offered. Government-as-caretaker becomes a threat rather than a gratification. If you see government as providing help, you are forced to accept that you need help, and that position is what ultimately is intolerable.

This dynamic process in which need becomes fear becomes anger is well known to clinicians who treat paranoid patients. The threat feels external to these patients, but the source of it is really internal, a fear of their own dependency needs being manipulated and used as a means to control them. The only way that they can feel safe and innocent is if they locate the problem outside them in some larger malevolent power and then aggressively defend themselves against that power. If they join with others in the process, all the better, since such imaginary communities provide a further sense of safety and connection. In the end, though, the paranoid system has to be continually replenished with new enemies, new threats, and, therefore, new dangers to battle. For the hard-core Right, egged on by their media and political patrons, the government provides an endless source of new enemies.

The answer to this type of dynamic in which feelings of helplessness, dependency, and innocence are so dangerous isn't through reason. In my experience, there are two options. The first is to give up on attempts to reach them, an approach that I think is perfectly appropriate for many of the hard-line paranoid anti-government types. I am generally a therapeutic optimist except in cases where there is significant paranoia. Since everything I do or say is seen through a paranoid filter, there is little chance for me to reach the person. Politically, we shouldn't try. We should outvote them, outfight them, and defeat them. The other option, appropriate with other less rigid and brittle members of this psychic class is take a longer view. In these cases, while defeating them politically we have to also disprove or disconfirm their experience in practice, to provide over time experiences in which they can feel some control but also get helped. It's almost as if you have to take care of them in spite of themselves, in ways that allow them the maximum amount of freedom and the maximum autonomy to say No. Only then will you stand a chance of them hearing your arguments.

Spending Time With Your Doctor is a Radical Demand

Michael Bader, D.M.H. — Sat, 20 Jun 2009 23:17:15 +0000

The New York Times recently ran an article about the movement within primary care medicine to develop systems that allow doctors to spend more time with their patients. New technologies enabling doctors to electronically record, store, and manage records, handle appointments, bill insurance companies, refill prescriptions and communicate directly with patients are allowing physicians to spend more time seeing fewer patients while maintaining their incomes. One physician moved from a large clinic where she was required to see 25 patients per day to a smaller, more efficiently run practice where she saw only 12. Instead of only treating presenting symptoms, she was able to better understand her patients’ entire history. Another doctor made house-calls, managing most of his practice through special software on his laptop. Both providers maintained regular contact with their patients via email.

There is overwhelming evidence that patients who get more time with and attention from their providers do better. Compliance and follow-up improves. Fewer medication errors are made. Hospitalization and re-admissions decrease. Benefits accrue not only to patients but to doctors who feel more engaged, successful, and fulfilled in their work. And, of course, society benefits in the form of lower medical costs. It’s a win-win proposition all around.

Yet the progressive side in the political debate about health care tends to neglect this aspect of quality health care in favor of issues of access and cost. Who will be covered and who will pay for it dominates the discussion. Care for those with none, cheaper care for those with some, guarantees of care of everyone—these are our goals. But what about people who already have insurance, whether from their employers or because they can afford it? What’s their stake in reform? What needs of theirs are addressed by the campaign for universal coverage? Are we writing them off as potential allies or relying on their altruism and basic liberal sensibilities for their support? In either case it’s a mistake. The pain and suffering fostered by the American health care system isn’t limited to those who can’t afford access to it. It occurs every day in the many ways people feel treated like a thing and not a person in their interactions with their providers. If we can find creative ways to put relationships on a par with cost and access at the heart of our campaign, we might energize people who today are on the sidelines of this struggle.

Behind debates about efficiency, technology, compliance, and treatment outcomes lay the transformative power of relationships. The relationship between patient and doctor, it’s quantity and quality, is powerfully implicated in medical outcomes. For many people who do have medical coverage, getting in contact with a doctor is difficult, mediated as it is by labyrinthine office procedures, phone queues, or office policies that simply prohibit it. Once an appointment is made, not always a simple matter, patients often wait for a long time. When they eventually see their doctors they are made to feel that their problems, questions, and concerns are taking up too much of their providers’ time which is apportioned in 5 – 15 minute increments. Referrals to specialists often take weeks or months. Follow up is usually left to the patient who may or may not be proactive enough to do so.

The result is what psychologists call an “anxious attachment” to the doctor and to the medical system in general. Lacking a secure sense that one is correctly understood and reliably cared for, patients give up, become cynical or nervously dependent and needy, and fail to internalize the treatment and care that is being offered. Treatment outcomes suffer, prevention strategies founder, hospitalizations and emergency room visits increase, and everyone involved – including taxpayers --pays the price.

When a doctor has time to spend with a patient, a more trusting and caretaking relationship can develop. Patients feel understood. Doctors learn about patients’ real lives and social context which enable them to tailor their treatment to the idiosyncratic needs of the three-dimensional people under their care. It is axiomatic that when someone who is sick feels understood, he or she feels better, more engaged, and more likely to take care of him or herself.

These issues are exaggerated among people who have no or limited access to care. But there isn’t a person I know who has medical insurance, who doesn’t have a story about neglect or mistreatment at the hands of the medical system, who doesn’t share the frustration of not being able to get through to the doctor or of the latter being unresponsive to his or her needs.

Recently, a family member asked me for help with her 17-year-old daughter who had been suffering from intense back pain for 2 months. This girl eventually saw her primary physician at a loca HMO who told her that only the physiatrist in charge of Physical Medicine (including Physical Therapy) could order an MRI. When she went to the PT department, she was told that she first had to have physical therapy for 4 – 6 sessions before the physiatrist would see her and, if necessary, order an MRI. My friend raised hell and got the physiatrist to order an MRI before physical therapy began, although it took 10 days to schedule. She was then told that it would be another 10 days before she could meet with the physiatrist who would read the MRI, evaluate her daughter, and recommend treatment. I intervened and took the daughter and her MRI to a neurosurgeon I knew at a nearby University hospital who saw immediately that there was severe disk disease and that surgery was imperative. He called the chief of neurosurgery at HMO who saw the patient the next day and operated on her—successfully—2 days after that. Obviously, without the help of someone like me who could pull strings (in another bureaucratic medical system), this girl would have suffered the fate of many other Kaiser patients who spend untold days and weeks in needless suffering because their medical system doesn’t relate to them as real people in real need.

I’m sure that there are many patients at this HMO who have found their care to be adequate or even good. We all tend to accept what “is” as the way it’s “supposed to be.” When the rudiments of medical care are delivered adequately and we’re helped to feel better, we don’t naturally judge the process critically. The problem, of course, is that we haven’t experienced any alternative and, when we do, the problems of the original system become immediately apparent. Everyone has stories of going to see a specialist or an internist who spent a lot of time with them and, to a person, they leave with an enthusiastic, even ecstatic view of how great the doctor was—simply because of the time, interest, and sense of personal commitment they experienced. Too many of the stories, unfortunately, are of the opposite.

We all have stories like this. “We” includes folks with insurance, even with decent insurance. Unfortunately, most progressive demands for universal coverage include little obvious direct benefit for us. Yes, we occasionally hear about demands to reduce waiting times, and slogans like “quality care” might be interpreted to include concerns about time spent with providers. But, in general, all sides of this debate focus primarily on access, availability, and affordability. They avoid the “soft side” of the issue primarily because of the implicit assumption that some care, even indifferent care, is better than none, and we have to start with the basics. Thus, many of us who do have insurance support progressive health care proposals either because we fear losing ours or because we have general liberal proclivities to help those who are disadvantaged.

In my view, this is politically misguided. First, we need to speak to the widest range of needs in people we wish to organize, not just to the more “fundamental” physical and economic ones. When a movement addresses needs for meaning, relatedness, and recognition, that movement is strengthened and its members energized. For a campaign for universal coverage to succeed, it has to have the energetic support of multiple constituencies, including those that might already have decent coverage, but who suffer in less dramatic ways in the course of interacting with their doctors and hospitals. Their suffering, the suffering of bureaucratic indifference, mis-recognition, anxious attachment, and being shuffled around like a thing in an environment that doesn’t see us as people, isn’t any less politically important to address than the suffering of people without any coverage. The suffering I’m describing might not rise to the level of tragedy but nevertheless corrodes our spirits, increases our cynicism, and contributes to terrible and costly long-term outcomes. And most important, it’s suffering that were we to address would expand our political base, reach out across class and party lines, and strengthen our chance of success.

In addition, addressing the non-economic frustrations in the current system of health care delivery invites alliances with health care providers at all levels who are burned out and alienated in relationships with patients increasingly perceived as demanding, non-compliant, and ungrateful. People don’t become doctors and nurses to provide assembly-line service or express indifference, but to provide care, and systems that compress that care into 10 minute segments are as oppressive to doctors and nurses as to patients.

We on the Left so often find ourselves fighting for the most stripped down and basic elements of social welfare programs. We do so because the present balance of political power makes us do so. We’re realistic. We should be. The human cost of not accepting some compromise in the health care debate is too high. But in this case, we’re fortunate because shooting high is eminently practical. Focusing on the relational quality of care is not only economically practical but speaks to the psychic bruising and frustration that is so built into many encounters with the medical system that those enduring them hardly think there is any alternative way of being treated. Such a focus, however, can bring this frustration to the surface, connecting with the experience of people who might, themselves, not be suffering from problems of availability or cost, but suffer nevertheless. It positions our movement for health care reform as one that speaks to what ails all of us.

Why Women Want to Cuddle and Men Don't

Michael Bader, D.M.H. — Thu, 14 May 2009 16:11:27 +0000

Women want to cuddle after sex and men don't. Stereotypes. Lots of exceptions, overlap, blah blah blah. I know. Still-it's true as stereotypes often are. Everyone recognizes it even if everyone doesn't do it. What's up with this gender difference? Women like to make eye contact and stay close after the deed is done while men want to roll over and, literally or figuratively, light a cigarette.

Here's what my clinical experience tells me: women need the reassurance that the man doesn't just want to f**k her and men need the reassurance that it's OK to do just that. Women need the intimacy of post-coital connection while men need to separate from that connection. Women like to gaze into a man's eyes; men like to go to sleep.

The causes of these differences lie in the different ways that men and women enjoy sex and intimacy. I know there's a lot of culture and socialization here. But I'm going to present an explanation that's so Freudian it'll sound like it comes from Central Casting. Fortunately, it also happens to be true. Here goes: For women, sex and intimacy tend to be intertwined in an obligatory way because women often feel unconsciously guilty about having more sexual pleasure and fun than their mothers. Sex for its own sake would feel like dancing on their mothers' graves. For men, sex and intimacy have to be separated because otherwise they feel both too close to and worried about women-originally, their mothers. If their partners are objectified, these men can feel safe from both dangers.

Thus, after sex, women need the reassurance that they, themselves, haven't abandoned themselves to it for its pleasure. Men need to pull away so as to not feel any risk of merging with the woman or having to take care of her. Voila!

Neither gender has it right-or wrong. It's ridiculous for women to claim that separating sex and intimacy is inherently degrading. It's also ridiculous for men to claim that a woman's need for intimate connection during and after sex is some type of burdensome dependency need. Intimacy can enhance pleasure or detract from it. Objectification can be a springboard to intense pleasure or an obstacle to it. Drawing battle lines about what's healthy or not when it comes to love and sex is perilous and usually serves neurotic purposes. We should all just get over it.

Mega-Churches, Psychology, and Social Change

Michael Bader, D.M.H. — Tue, 28 Apr 2009 14:38:33 +0000

The Reverend Rick Warren was in the news last January because of controversial positions he'd taken on gay marriage, positions that some felt should disqualify him from appearing at Obama's Inauguration.

I found it interesting because I'd had reason to study Warren's Saddleback Church in recent years as part of work I've doing with a large social change organization that wanted help developing more extensive and deeper relationships with its members. We concluded that Warren was on to something. And it had nothing to do with Jesus.

Besides being part of the evangelical movement, Saddleback had the following characteristics: it welcomed newcomers and explicitly refrained from requiring them to worship in any conventional way. Visitors and members could go to the Church on Sunday and feel free to attend services or not. The bar to entry was very low. Saddleback has groups of all kinds going on all the time--classes for adults, couples, and kids, recreation activities, childcare, and other helpful services. The core of the religious life of the Church takes place in small groups that meet in members' homes-giving rise to Malcolm Gladwell's description of it as a "cellular church." People can rise up within the Church hierarchy steadily if they wish. If they don't, that's fine too. And Saddleback's membership has grown rapidly to its current level of over 20,000 members.

The reasons for Warren's success are probably complicated. My view is that he connects with the widest possible number of needs that his parishioners have. Saddleback doesn't only address needs to worship, but needs to belong, to get recognition, and to satisfy longings for meaning and for a sense of agency. They relate to their members as whole people, not simply as "members." This is the lesson that other organizations can and should learn. When you connect with people on all levels, they become more engaged, loyal, and active in your organization. Sounds simple, right? It's not.

Too often, social change organizations ignore this lesson and see their members as a means to an end-the "end" being the agenda of the staff or leader. The relationship is instrumental. Labor unions, for example, tend to view their members as narrowly motivated by needs for economic security and protection on the job and not as people with needs for meaning, recognition, learning, and relatedness. The engagement is narrow. They follow the "commonsensical" notion, popularized by Abraham Maslow, that people have to have their survival (translated: economic) needs met before they can adequately meet their higher order psychological and spiritual needs. As a result, in most unions, regardless of size, only 2 - 5% of the membership is actively engaged.

This version of Maslow's hierarchy is wrong and lots of progressive social change organizations have suffered because of it. People often deem their non-economic needs as more important than their economic ones. People crave recognition and will often work for less money in exchange for it. They need to be connected to something bigger than the self and will often sacrifice a great deal in the service of this longing. And, of course, we know from decades of research that the need for attachment and mutuality often trumps even the need for physical safety and security.

Any organization that wants to grow and really energize its membership should look at the mega-churches. They "get" something that we don't.

Frustrated Golfer Syndrome: Causes and Cures

Michael Bader, D.M.H. — Fri, 17 Apr 2009 18:13:09 +0000

The frustrations of golf are well known. Mark Twain is quoted (although falsely) as having said that golf is "a good walk spoiled." The sports writer Jim Murray said, "Golf is not a game, it's bondage. It was obviously devised by a man torn with guilt, eager to atone for his sins." Their humor notwithstanding, these quotes express an essential truth, namely, that golf is an emotional roller coaster for many, if not most, of the people that play it. This is especially true for men. Many men give up the game altogether and still more, myself included, play it and suffer in the process. And yet we long-suffering golfers return to the links every weekend hoping that this time it'll be different. We remember our few great shots, savor them, and keep playing the game in hopes of recapturing that experience, as a gambler returns to the tables chasing the memory of a winning streak, or a crackhead to the pipe looking for that magical buzz. Still, misery waits in the wings, poised like a thief in the night ready to steal our confidence and render a perfectly enjoyable activity into a nightmare.

O.K., I guess I'm being a little melodramatic here. Some golfers tolerate failure better than others. And most even have-dare I say it-fun. But most amateur golfers will immediately recognize the torments I'm describing. I have been a practicing therapist for 30 years and have treated hundreds of people who punish themselves for all sorts of imaginary crimes and faults, but I rarely see the type of raw self-hatred and despair that can suddenly consume the average golfer whose crime may be no more grievous than missing a four-foot putt. I call this the Frustrated Golfer Syndrome.
If all non-human sound were to suddenly cease on a typical public course on a typical Saturday afternoon, and one's hearing were good enough, male voices shouting "F... me! "I suck....!" "Take off your panties and putt it!" would punctuate the silence. And if one's vision were equally good, one would see faces contorted in rage, shoulders sagging in dejection, clubs furiously shoved back into the bag, stomping, thin and tight smiles desperately covering imploding self-esteem, heads hung low-all part of the choreography of failure on the golf course. Thus, the Syndrome.

Golfers who hit a bad shot feel helpless. We had an intention but failed to execute it. The mental picture we had of our swing and its glorious outcome shatters at impact. We don't really know what happened. But because it's mysterious, we can't correct it and we can't be sure it won't happen again. The extreme example of this is the dreaded shank-a rogue hit off the hosel of the club that squirts away from the golfer dead right. It's embarrassing. The problem is that once you shank, you begin to imagine that another shank lies inside you, waiting to possess your body and make it do bizarre things. It's like being incontinent and not knowing when you might lose control in public.

But the feeling of helplessness isn't limited to extreme mis-hits like the shank-it's there whenever we don't realize our intentions, whenever our picture of what we want our bodies to do fails to materialize. We make up stories about it to gain an illusory sense of control: "I knew I was ‘off' at the top of the swing-I should have stepped away," or "I didn't feel right standing over that putt," or "I hurried up my swing....I have to slow down," or "I held on and didn't release the club like I should have." All of these "shoulds" and self-observations may be correct, but they're usually either irrelevant or wrong. The fact remains that we usually don't know why we hit a bad shot.

The stories we tell ourselves may sound technical, physical, or even psychological. Invariably, though, these stories are superficial and are belied by an underlying view of who we are as people. These deeper conceptions are the stories we keep hidden, and yet they're the ones that account for our frustration and suffering. They include stories like "no matter how hard I work at this game, I can't master it-there's just something wrong with me that I'll never be able to correct," or "I hate myself when I can't do something right," or "I'm a failure," or "I'm not a man," or "I'm crap and unlovable," or "I'm doomed." You don't have to be a psychologist to know that these feelings and beliefs are common among golfers. Most of us intuitively know that we regularly mistake our golf shots with our selves. If our golf shots are poor, our self-esteem drops, even if for a moment, despite our conscious mantra "It's only a game." Our conscious minds know that this is how we should feel, but our unconscious minds don't buy it. It's hard to feel that it's "only a game" when we're in a bunker, trying to hit a high soft one onto the green, and instead skull the ball 50 yards into the woods. No, at that moment, the game has become a deadly one, one in which we've just revealed our shameful incompetence to an unforgiving world. The source of the anger so often seen (or heard) on the golf course is simple-rage is a normal human response to helplessness. It's a protest, a defiance, and an energizer. Since there's no one to direct it at, we direct it at ourselves. Since there's no one to hate, we hate ourselves.

What's the ultimate source of the helplessness, anger, depression, and self-hatred that appear in our minds on the golf course? One important source is our failure to live up to overly perfectionistic ideals. You can see an early prototype of this issue by watching a very young child struggle to master something, a physical challenge (catching and throwing a ball, perhaps), a developmental milestone (say, walking), or a social rule (like sharing). The child's intensity is palpable and the need to try it-and fail-on his or her own is powerful. And failure is inevitable. We've all seen children who cannot tolerate failing, who either retreat or throw tantrums. They encounter a physical and social world that they can't immediately control, that doesn't automatically bend to their wills and intentions, and they either tolerate that frustration long enough to learn and adapt or they fall apart in some way. Learning depends on the ability to tolerate failure.

Such an ability is importantly shaped by the response of the environment to the child's encounter with failure. If parents are too nervous and worried about the child's frustration, they may take over and convey a sense that they lack confidence in the child. If parents react with exaggerated displays of frustration, impatience, and anger, the child comes to feel that failure is unacceptable and so doesn't bother to even try. If the environment is generally supportive and encouraging, however, the child learns to tolerate failure and imperfection enough to learn and master the unfamiliar.

Some of us grow up so intolerant of failure, we won't try to learn anything new. Others will appear to take on challenges but do so in such a self-effacing, ambivalent, and timid way that they can excuse their failures by a lack of effort. Some are so ashamed of failure that they believe that they have to be perfect all the time to avoid even the scent of it. They maintain impossibly high expectations and view falling short as humiliating. And still others blame everybody and everything else for their failures in an attempt not to blame themselves. In the end, all these attempts to avoid facing our imperfection fail, and we end up blaming and hating ourselves.

We see all of these variations on the golf course: The guy who blames his game on a lack of warm-up, on the weather, an inability to practice, his bad back, or the condition of the course. The guy who becomes a goof-off, exaggerating his lack of concern almost clownishly. The guy who is sure that others in his foursome are watching and critically judging him when he makes a mistake. The guy who hunkers down, surrounded by despair and rage much like Pig-Pen of Peanuts was surrounded by a cloud of dirt. And of course the guy who swears at himself, throws a club, or slams it 10 inches into the ground after a bad shot. We've all seen these guys or have been these guys. They/we struggle with our omnipotent wish to be perfect, to have perfect bodies, perfect swings, perfect mental attitudes, and perfect scores. They/we want to realize our intentions effortlessly, bending reality to our wills. The problem is, reality usually doesn't cooperate. Our reactions to the inevitable discrepancy between our real and ideal selves determine how much we can both enjoy and develop our golf game.

The problem is that we're not sick, broken, wrong, or bad. And neither are our swings. What we are is needlessly ashamed of having a conflict. We can't change and develop our game if we hate ourselves when we fail, if we can't tolerate not-knowing or falling short of our own expectations of perfections. Even though we all use them, the terms "good" and "bad" are irrelevant descriptors of a golf swing. A golf swing can be more or less effective, more or less efficient, more or less adapted to achieving our intentions. As golf guru Fred Shoemaker has argued, ultimately it's just a motion of the body, a club, a ball, an intention, and a target. None of these have moral connotations, none of them are intrinsically worthy or unworthy, none are good or bad. In a recent golf school I attended, Shoemaker asked a group of us to try to distinguish these simple neutral realities from the highly passionate meanings that we assign to our swings and their outcome. Once we were able to discern the strength of the self-critical and gloomy narratives so easily evoked by a "bad" shot, their strength weakened. We loosened the link between our shots or scores and our selves. It was only in this environment that we could look into what was getting in the way of our ability to make an efficient, powerful, and effective swing.

Because there is, indeed, a lot to learn about making a more effective swing. It involves balance, an awareness of the body's center of gravity, a feeling of connection to the club and an even deeper connection to a target, an accurate picture of the position of the club's shaft and head, a freedom from tension, and the unleashing of imagination. Each of these dimensions of an effective powerful swing can be explored and strengthened, but only if we stop judging ourselves. By explore, I mean developing an increasingly keen sense and awareness of these different dimensions of the swing. Shoemaker argues that the primary difference between a professional and an amateur golfer lies in the extraordinary awareness of the professional, an awareness of body, club and target.

The cure to Frustrated Golfer Syndrome is to first become acquainted with the self-critical mind. Begin by asking yourself the question: What is the worst thing that can happen if I hit a "bad" shot? Then, try to catch hold of the thoughts and feelings that go through your mind when you actually hit one. Don't ask yourselves these questions to "get rid" of these thoughts, but, instead, to become aware of them-their content, their intensity, their attitude. It's not easy to do this. We don't want to linger there, to think too much about the sources and meanings of our frustration. We want to fix it. Instead, it's crucial to do the opposite. Don't fix it. Just become aware of it. Notice the differences in your thinking when you hit the ball solidly and when you don't. Become familiar with your inner world, with the stories that reside there about success and failure, and about the meanings you associate with each.

By all means, get instruction, read books and magazines, and watch videos of great golfers, but do so with a different attitude. Don't view a recommendation as "the answer" or as something to add to the list of "shoulds." Instead, go to the range and try out the "tip," or "fix," but do so with compassion and curiosity, letting yourself feel the differences between swinging in the new way and in the old way. Go back and forth between the old and the new. Feel the difference; don't just hit a few good shots using the instruction and then move on. Use your practice time as a laboratory, as a safe time to investigate your experience rather than to coerce your body into the "right" patterns.

Get a friend or instructor to watch you when you try something new. Tell them not to comment on anything else, but to simply be quiet and watch you while you go back and forth between the old and the new way of swinging. This is the place to use videotape if you have it. But don't let the observer comment on anything else you're doing and instruct them carefully that you do not care at this moment about the outcome of your shot, but only in the process. This is crucial. A keen observer, especially if he or she is a friend, will always want to say a lot when invited to critique your game. But if you're working on something in particular, tell that person to keep all these other thoughts to himself.

Try to set realistic expectations for your game over time. For example, if a professional golfer hits a drive into the woods, he's momentarily frustrated and then quickly moves on to consider his next shot. It's a freak occurrence. No use investing it with any meaning whatsoever. If a 16-handicapper does the same thing, however, he is likely to get frustrated and angry and stay that way for a while. His reaction borders on outrage, as if fate has dealt him an unfair hand or as if the bad shot reflects a moral failure of his own. And yet, unlike the pro, the amateur golfer almost always hits a ball into trouble. It's the unalterable, undeniable consequence of his real level of ability. I certainly believe that someone's game can dramatically improve quite suddenly, and I've certainly experienced a golf game that's very suddenly fallen apart. But the fact remains that there is a role for some simple reality-testing in the midst developing self-awareness: namely, that someone who is a 15 handicap is going to average 17 or 18 strokes above par in any given round and thus chunking, slicing, duck-hooking, blading, yanking, pushing, and-yes-even shanking are going to be apt descriptors of some of your shots on most days you play. Think about this reality when you find yourself starting to lose it. Step back. Laugh at yourself. Share the laugh with a friend. Think about how ridiculous it is to hook your self-esteem to something as simple and ultimately meaningless as a golf swing.

Instead, consider the possibility that you could invest golf with other meanings, meanings that don't guarantee helplessness, anger, and self-condemnation. Perhaps you want to experience a feeling of athleticism, or learn again to "play" like you did as a kid. Perhaps you want to have the satisfaction of seeing yourself master a challenge and get better at a physical skill, or to enjoy the social life available in a foursome. Perhaps you want to experience the intensity and focus that comes with competition, and the satisfaction and pride that comes with victory, or enjoy the exercise, the beauty of the natural surrounding. Or perhaps you want to use golf to explore yourself, to understand more deeply how you think and feel when you succeed and when you fail. All these ambitions are healthy ones. None of them require the type of self-critical intolerance that afflicts the average golfer.

Bobby Jones once said, "Golf is a game that is played on a five-inch course - the distance between your ears." Understanding the stories we tell, the realities we distort, and the meanings we tack onto our golf games can help us play both games together, the one between our ears and the one in play on the course.

The Difference Between Coaching and Therapy is Greatly Overstated

Michael Bader, D.M.H. — Thu, 16 Apr 2009 03:55:21 +0000

I've been working with a lot of executive coaches recently, and have the utmost respect for many of them. They're smart people who help their clients immensely. But they always want to tell me that they're not doing therapy. And they usually offer up a similar story about how coaching and therapy differ. They (coaches) apparently work with the future; I (therapists) work with the past. They work to make healthy clients better; I work with pathology and illness. They work with the conscious mind; I work with the unconscious mind. Their work is time-limited, with specific desired behavioral outcomes, and is often on the phone; my work is open-ended, with understanding as its primary aim, and is in my office. The list can and does go on and on. What these coaches are describing are actually false distinctions that don't make a difference.

It seems to me that this is a mythic narrative that aims to insulate coaching--a profession in its infancy--from claims that it's therapy without a license. It seeks to protect the egos and wallets of coaches while appeasing therapists on the same grounds. I think that the problems with this narrative, however, are caused more by therapists than by coaches. In my view, we therapists too often practice with a model of psychotherapy that is so ridiculously narrow and theory-driven that it leaves us open to the types of caricatures that coaches, for their own reasons, then legitimately apply to us. In this sense, therapists and coaches have more in common than they know-a professional myopia that gets in the way of helping people.

I was trained as a psychoanalyst, and still consider my approach to be psychodynamic, but let me go on record now and say the following about my clinical work:

1) I am concerned primarily with concrete changes in a person's real life, including actualizing their potential, promoting their growth, improving their efficiency and productivity at work, overcoming inhibitions, and resolving symptoms.
2) I only delve into a person's past if it significantly helps that person understand and master those habits, feelings, and thoughts that hold them back from achieving their most important goals.
3) I often work in a time-limited manner, on the phone, and have specific behavioral outcomes in mind at all times as an empirical measure of success.
4) I work to make relatively healthy people healthier as well as to alleviate the suffering of people who are frankly sick.
5) I work with the client's conscious experience, while helping him or her understand that sometimes their self-limiting behavior is being by thoughts and feelings and beliefs about which they are unaware.
6) I focus a great deal on the client's real interactions within the various social systems in which he or she is embedded. The more I understand the social and practical realities of a client's life, the better able I am to help him or her in therapy.
7) I am rigorously self-correcting about whether I'm on the right track with someone, a commitment made easier by my belief that a therapist can usually tell almost immediately if an intervention is useful or not.
8) I have no compunction whatsoever about getting involved in various ways with a client outside my office if I judge that to be necessary to advance our work.

Now, it escapes me how such practices as these can possibly be differentiated from good coaching. Just because a client may have the belief that there's a difference between coaching and therapy doesn't mean that there is one. By arbitrarily defining what they do as "focusing on health and not illness," coaches have simply found a way to engage in a fundamentally therapeutic process by implicitly reassuring the client against the latter's irrational fear and shame of being screwed up. That's terrific. If I thought that that would enable a particular client to open up and be more candid, I'd find a way of offering a similar reassurance. But let's not confuse what we say to a client in order to help him or her feel safe with some underlying and fundamental reality. For me, the issue-the only issue, really-is how I can help this particular person feel psychically safe enough to more candidly explore his or her inner life with a view toward moving more efficiently toward his or her goals. My impression is that because of the stigma of psychotherapy, many people can only accept it under the rubric of coaching. My only problem is mistaking something's label from that thing itself.

Unfortunately, my own profession of psychotherapy has contributed to, if not created, this confusion. Our theories are not patient-specific, they privilege understanding over symptom relief and behavioral change, they proscribe rules and norms on therapist behavior that are not flexibly related to outcome, and they advocate notions of neutrality and abstinence that are impossible to achieve and often obstacles to therapeutic success. We lend ourselves to being caricatured by clients and coaches alike.

I don't believe that there are many general principles of therapeutic technique because my view of therapy is that it has to be entirely client-specific-that is there are few things that a therapist "usually does or does not do" independent of what a particular patient needs. There is no such thing as neutrality or abstinence. There is no a priori focus on "the past" or "what's wrong" or on "deep interpretations." My work with some patients is explicitly time-limited, with others it's open ended; with some it's focused entirely on work or geared to practical help, while with others it's about intimacy and geared to enhance self-esteem. Sometimes the help I offer is based in insight, other times in helping provide experiences that are corrective. It begins with the assumption that clients who seek help from coaches or therapists want to get better, that they are held back by maladaptive expectations, beliefs, and emotions that derive from both their current and past realities, and that the job of a therapist or coach is to figure out how to get on the their clients' "side" in the latter's attempts to overcome these irrational feelings and beliefs.

Understanding the unconscious meanings and childhood origins of a client's behavior isn't necessarily my focus, but frankly it is almost always extremely helpful in guiding my work. How could it possibly not be? The more deeply you understand someone, the more effectively you can help that person. Is there really any debate about this?

The biggest difference between coaching and therapy, in my view, is that the theory that guides my work as a therapist can explain how coaching does or does not work, while theories that guide coaches can't do the same about therapy. This difference, while true, seems inconsequential to me. What matters is that people get help in their efforts to grow, master their problems, and become more effective in their lives. Both approaches aim to do this. Who cares (licensing boards notwithstanding) what you call them?

"Not Tonight, Dear..." Explaining Sexual Boredom

Michael Bader, D.M.H. — Sat, 04 Apr 2009 05:03:09 +0000

It's no news flash that sexual passion declines over time in intimate relationships. "Not tonight, honey, I have a headache..." Words that live in infamy-or at least too often in the bedrooms of married couples. Billions of dollars are spent to address the problem, from ED drugs and sex toys to advice columns in women's magazines and psychotherapy. And yet the problem persists.

Most explanations of sexual boredom are wrong. It's not about our biology (yes, we're wired to desire erotic pleasure and its accompanying sense of connection, but, no, that doesn't explain anything at all about the how, what, with whom, or how often of sexual desire). It's got nothing to do with some evolutionary imperative (apparently males achieve reproductive success through inseminating multiple females-ho-hum...so how does that account for why my patient Ben prefers porn over his wife?). The fact is that it's all psychological and entirely understandable if you accept the premise that sex begins in the mind and travels downward, not vice versa.

Here's the Rosetta Stone for understanding sexual desire-or the lack thereof. You can't get aroused if you feel, consciously or unconsciously, too worried, responsible, or guilty about your partner. And you can't get turned on if you're feeling rejected or inferior either. These states of mind are incompatible with sexual excitement.

The opposite of feeling worried and responsible is feeling selfish and, indeed, there is an element of selfishness that is absolutely necessary for maximum sexual desire. The emphasis today on getting more attuned to one's sexual partner is fine, but if it leaves out selfishness it's a disaster. You have to be able to be both connected and separate, separate enough to surrender to your own pleasure without worrying too much about the other's.

Enter intimacy. Unfortunately, the thing that's great about intimacy-security, giving and receiving caretaking, feeling deeply understood and accepted-works against separateness. It opens the door to greater guilt and worry-greater because you know your partner better and care about what you know. You can't ignore his or her vulnerabilities, nor can you conceal your own. The very conditions of intimacy are a potential cold shower for the libido

Yeah, yeah, I know that this varies greatly, that some couples have much better sex for a time precisely because they learn more about each other's needs and preferences. And I know that each person also brings his or her own idiosyncratic problems into the bedroom. I wouldn't be in business if this wasn't true and if I weren't able to help such folks. But let's get real-regardless of these variations, the thematic truth of the matter is that desire wanes over time.

The important thing is really what we do with the fact of sexual boredom. Here's what I see people doing that's both unreasonable and either self-destructive or destructive to their partners: First, people feel way too depressed about the decline in sexual frequency and intensity, as if it means you're a failure, a loser, or a sad sack. It doesn't. Second, in response to boredom, too many people think that the solution is to change partners. It isn't. The solution is unfortunately more complicated. I won't go into detail about the healthier strategies that people can employ to deal with sexual boredom, because it would take too long and distract from the point I'm trying to make. But suffice it to say that in addition to understanding the underlying dynamics of the situation, sometimes you just have to lean against the wind, figure out how to insist on sexual contact even if you or your partner don't spontaneously want to rip each other's clothes off. Why? Because when couples have sex, even if intermittently, they usually feel closer and their relationship and self-esteem gets better. And because for most folks, once you get started in the bedroom, you're usually reminded of how much you enjoy it.

Sexting and Gomorrah

Michael Bader, D.M.H. — Sat, 28 Mar 2009 20:59:01 +0000

When European friends visit my wife and me, they often comment on how incredibly repressive and hypocritical American culture seems to be about sex. On the one hand, we use it to sell everything from beer to mutual funds, and on the other hand we impeach our president because of a blowjob.

Nowhere is this contradiction more apparent than in our attitudes about child pornography. While Calvin Klein ads and slasher films frankly depicting nubile sexuality proliferate with impunity, a real teenage girl, Marissa Miller from Tunkhannock Area High School in Pennsylvania, was recently threatened with child pornography charges for a photo taken of her wearing a bra at a slumber party 2 years ago, a photo apparently discovered on the cellphones of teenage boys in her school. That’s right. The photo was 2 years old. It showed her at 13 wearing a bra. And someone else texted it around without her knowledge. But now Marissa Miller is being threatened by the Wyoming County, PA district attorney with charges that could land her both jail time and the special privilege of being a registered sex offender for the rest of her life.

As a society, we’ve gone off the deep end when it comes to pornography, and child pornography in particular. Look, child pornography has always been illegal for one simple reason—adults were presumed to be hurting real children in its production. But as sex has been increasingly politicized (need I mention the debates over abstinence education and gay marriage, or the brouhaha over Elliot Spitzer’s use of escorts or Congressman Mark Foley’s flirtatious text messaging?), it seems that sexual thoughts are as dangerous as actions. Congress recently outlawed the possession of sexualized images of children that are completely computer generated. While no child was hurt in their production, the titillation they create was, therefore, effectively criminalized.

The Wyoming County DA thought that the picture of Marissa Miller was lewd and wanted to teach her a lesson. The issues, however, go way beyond this type of boneheaded prosecutorial misconduct. The recent upsurge in what is called “sexting”—the transmission of sexual images via cell phone—is rife with issues never before faced by teenagers and parents alike and has to be addressed in ways that don’t make kids paranoid, drive their sexuality even more underground, and further accentuate the technological divide between the generations. Harsh and negative prohibitions make real conversations impossible. The legitimate problem potentially associated with sexting has to do, not with sex, but with privacy and autonomy. As they increasingly individuate and claim their independence, teenagers often do not understand the potential dangers of revealing personal matters in cyberspace, whether it be via their cellphones or facebook pages. There’s a saying that “information wants to be free,” meaning that what goes out onto the Internet or SMS networks remains there forever and is not any more under anyone’s individual control. And yet control is exactly what adolescents are striving for. It is crucial that parents and schools help their children understand this. The involuntary disclosure of personal images or writings on the Internet is uncomfortable for anyone, but especially harmful to children and adolescents.

Adults in positions of responsibility need to help protect kids from this danger, not from sex.