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Archive for the ‘women’ Category

The “morning-after” birth control pill prevents ovulation; it does not cause abortion of an embryo. This is the news, this morning, in a New York Times editorial :  How Morning-After Pills Really Work. This fact removes one of the final blocks to access (other than cost, a problem in some cases) to a significant advance in birth control pharmacology, that block being the presumption that the pill was killing something. As the editorial points out, this belief was never more than speculation, and in fact there is NO evidence for it whatsoever.

To the contrary, as another recent article in the Times points out, “Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb…” What they do establish is that medications like “Plan B”, the most widely known “morning after pill”, delay ovulation, which essentially places a time barrier between sperm and egg. This works because, contrary to common belief, sperm and egg to do not unit at time of intercourse, but rather days later. Sperm require time to travel and position themselves, and will die in a mere few days if no egg is available to act upon.

Such a “time barrier” will still be objectionable to those conservatives who believe that all interference with what they stipulate to be the sole legitimate purpose of sex – reproduction – is immoral. I find such objections to be unreasonably arbitrary. They are made primarily by men who want to control the behavior of women.

I was a young man when the birth control pill for women became easily available. It appeared revolutionary at the time, and that appearance has been confirmed over the years. Rejection of the pill as “immoral” seemed presumptive and poorly argued at the time, and that, to me, has not changed either, with the passage of time.

The world does not need more babies, much as I love them. Nor does it need more pregnancies – which, after all, have enormous physical, financial, and social implications in each and every case. I sometimes think that the solution to human beings who think and breed like rabbits might be to provide them with a lifetime supply of rabbit feed, and a large, solitary cage. (OK, that’s absurd…but something needs to be done about the thoughtless, or witless, who just keep having large families without regard for the implications of their act.)

It’s worth recalling that the birth control movement came about because of the problem of poor women having babies they could not afford. Women were dying, from pregnancies they didn’t want which went bad, and from dangerous attempts at inducing abortions. Where affordable birth control is not available, this is still happening. I’ve never heard cultural conservatives express moral outrage about that, sadly – nor about the unfairness of being born female and being compelled by biology to become pregnant as a result of acting on ones sexuality.

There are two arguments in favor of birth control (and more in support of the birth control pill, which in some cases has clear medical benefits not at all related to birth control): one has to do with moderating human breeding, and the other with empowering women relative to whether or not they become pregnant. Both are critical considerations, but today, for me, I’m impressed mostly by the latter. Pregnancies impact women far, far more than they do men. Women should be the decision makers regarding whether or not they become pregnant.

We now need to see that “Plan B” type birth control becomes available to all who want it.

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[UPDATE: Amnesty International tells Egypt to probe mob attacks on women (Question: Why do they have to be told?)]

This is hard news:

Egyptian women protesters sexually assaulted in Tahrir Square – Mob attacks small group calling for an end to sexual harassment as women continue to demand a ‘new Egypt’ post-Mubarak

Before I was a psychotherapist, I was (and still am) an anthropologist. I understand the evolutionary heritage of our particular branch of the primate family tree. I understand that our species has a social adaptation (we survive as a social unit, unlike, say orangutans), and that critical to that adaptation is that males have organized “military” power, while females have charge of rearing our highly vulnerable young. There is a power imbalance inherent in this, and one sees this in all places, at all times, in our history. Those who rail against our “patriarchy” do well to understand how deep lie its roots in our species. It is not an ideology (though ideology may be used to justify it at times), it a biologically derived social adaptation.

That said, it has long been time for change, and it surely IS happening, though hardly overnight. For example, women are becoming the majority at many institutions of higher education, throughout the “developed” world, and in many other places as well (I heard today that this is the case already in Libya). Yet there are still many issues to resolve, and many, many places where they need resolution.

Consider, in my country – the U.S., “…40 years ago doctors in America were prosecuted for providing women with birth control, and women risked jail for using it”[1] And to this day, there are very significant forces in my country who would deny women access to birth control. One of the two major US political parties regularly fields candidates who oppose any kind of public funding for birth control, and who in fact would be fine with making it illegal. Backward leap anyone?

New version of “All Your Base Are Belong to Us” – All your uterus are belong to us!

Kind of catchy, don’t you think? Certainly reflects the mindset of those guys in the US – not mention those cultural conservatives in Egypt who regularly grope women in public. Their message is clear:  women are for their control and use.

So…take note – of the ongoing struggle in Egypt, and the courageous women at its center (read the article above to learn to what I am referring). The last paragraph of that article:

“Women activists are at the core of the revolution,” said Ahmed Hawary, who attended Friday’s protest. “They are the courage of this movement. If you break them, you break the spirit of the revolution.”

I’m no authority on gender and names in Egypt, but I believe that’s a male speaking – the women are hardly alone in their struggle. And I’ll wager that those women won’t break.

Let me close by giving the highest praise to the cordon of men who put themselves between the female core of the protest march and the mob around them, and who continued to attempt protection when their cordon was shattered and they were significantly outnumbered. It must have been a fearful melee.

Real men do not assault women. Real men appreciate and protect them, and all who need protection (and that includes other men), against those who would do them harm without justification. Let us pray that the veil of ignorance obscuring the vision of the male perpetrators of the assaults reported in the article above will be lifted sooner rather than later. It is only right, and the only outcome that can be acceptable to all of us.

Note

[1] Griswold, Privacy, and the Right of Women to Religious Liberty, downloaded 2012.06.09

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By at least a ten to one margin, the most read and commented-upon post to this blog is my August 1, 2007 End times: Coming to the end of psychotherapy. I had not expected this, when I published the piece.

Originally written to help one of my clients sort out their thinking as they came to the end of their time working with me, I had posted it because I did think others might find it useful. It appears, now, that it addresses a real and persistent problem. Well, such problems are what we deal with in psychotherapy, and sometimes in our blogs as well.

So, “what’s the problem”? There appear to be two of them: psychotherapy clients, and their therapists. That’s simply what the data appear to support. Let me address each, in light of the continuing comments to the blog entry, and in relation to one in particular (which was withdrawn by its author, so you cannot find it there).

THERAPY CLIENTS AND THEIR ISSUES

Clients appear to have trouble with leaving for several reasons, among which are:

  • They cannot decide if it’s time or not. They don’t know how to arrive at  a decision they can feel comfortable with.
  • They have to leave, and don’t want to, and it’s disturbing them.
  • They’re ready to leave therapy, but don’t want to lose contact with their therapist.
  • They want to leave therapy, but their therapist is objecting, or advising against it.

I think you’ll agree that that covers a lot of ground.

THERAPISTS AND THEIR ISSUES

From the report of people writing comments to my blog entry, it appears that therapists also have trouble with therapy termination for a variety of reasons, among which are:

  • They think their client is making a poor decision, and really isn’t ready to leave.
  • They think their client is being “resistant” to therapy, and is basically “fleeing” therapy.
  • They appear committed to a long term relationship with their client, for reasons which (to me) appear suspicious, and object to a client’s attempts to break free.

I want in this post to comment about therapists and their problems, mostly, since the clients’ side of the picture has been commented upon by me extensively in my original post, and in my responses to readers’ comments.

When therapists think their client is making a poor decision, and really isn’t ready to leave. In a hospital, if the doctor treating you isn’t ready to discharge you and you leave anyway, which is certainly your right, unless you’re being held there under court order, you’re advised that it will be noted in your chart that you’re leaving “AMA” – again medical advice.

In other words, it is customary to tell you that we think (I used to work in a mental hospital) that you’re making an ill-advised decision. Partly this is to protect ourselves legally, but it’s also a last chance to ask you to think things over. Warning you about an “AMA” discharge seems good practice for both parties, and it’s usual and customary practice.

Such circumstances certainly occur in outpatient practice as well, and the same justifications for voicing and recording objections of the treating professional to the departure of the client hold weight in this context. In other words, we are almost certainly remiss if we DO NOT give this warning.

So, clients, you do well to consider the larger picture when you find that your therapist does not support your leaving. The disagreement likely has in it an element of real concern for your welfare.

Yet some clients come to therapy with the expectation (which can escalate to a demand) that their therapists “support” them, period. This is both unreasonable AND reasonable, in the following senses:

  • Reasonable: Our first obligation to you is to support the promotion of your health. It’s the oldest admonition in the healing arts. This means that we need to be able to offer you an informed opinion about your condition, AND that we actually make you that offer. But…
  • Unreasonable: There’s no guarantee that you’ll like what you hear  when we offer you this kind of support. Making you immediately happy is not the purpose of such support. Assisting you to be healthy in the long run IS.
  • Reasonable: “Support” is a favorite word women use in talking about their close social relationships, and with good reason (men seem not to talk about this). It’s a high value for most women, and by “support” they mean what I would call the offering of emotional congruence. That kind of support is appropriate in therapy as long as it supports (in the other sense!) your health. Such support can very meaningfully help a client learn to value their own feelings and viewpoints, for example. But…
  • Unreasonable: Do not expect us to support you emotionally while you make what appears to us to be a bad decision. That’s like praising you for staying on road while driving, as you drive across a washed out bridge.

So, can we do both at the same time? Can we support your “personhood” while disagreeing with your decision to leave? Of course, and I think we must.

I think that at all points in the therapy relationship we need to support our clients’ thinking for themselves. This, fundamentally, is about self respect. But, we also need to MODEL this behavior, which is what I do when I disagree with a client’s decision to leave. How can I advise you to respect your own thinking if I do not respect my own? Therapists are in many ways like parents: they cannot be, or act like, “friends” or “buddies”. We are coaches,  sources of expert opinion and intervention, and most definitely models. Any other understanding is almost always ill-informed and ill-advised.

Basically, our being both supportive and unsupportive of a client, when we find that that is our true position,  is asking a client to be an adult. We’re saying “It’s important that you make your own decision, and do what you think best. Nothing else will really work for you, howsoever scary it may be at the moment.” And then we may also say “And I do not agree with your decision to leave therapy at this time. I think it’s ill advised.” And then, finally we say (at least I say this, because I think it’s very important): “Now you have to make a lonely decision. I’ve given you my best thought, and the most important part of it is that it’s up to you to decide, just as it’s your fate to meet up with the consequences of your decision. This is the way life really is, and I’m here to help you with this little piece of it.”

Some clients have trouble with this, in large part, I think, because we therapists don’t work hard enough making clear what our purpose is: not to make life easy, but to make it better. Often, that means “no pain, no gain”. Some clients really kick and scream about this. I consider that a normal part of their life development. We’ve all done it at one time or another, believe me! And we therapists must remain adult, hold our ground, and hold out for the overall improvement of our clients. We, too, have a lonely decision to make: just as you have to do what you think best, and no one can really take over for you, so do we. It’s part of our ethical commitment to you.

(I’m laughing to myself right now…recalling how many times I know of parents who truthfully told their kids “You’ll thank me for this some day.” What a day of true joy THAT is – ha!)

When therapists think their client is being “resistant” to therapy, and is basically “fleeing” therapy. Well, some clients ARE resistant, and they do flee. The “resistance” is typically based either on a failure to understand what therapy is actually about (“What? I have to walk TOWARD my pain? Are you NUTS?”), or on fear, or both. The “fear” is more serious, more complex, and more difficult to deal with.

Just to give one example: a client I had once basically had never, as a child, had an emotionally supportive, protective relationship with an adult she could trust. I was probably the first person who’d ever invited her to trust herself (AND me) as we looked back at the painfulness of that childhood. She’d thought that therapy would be like a magic pill, and that we’d quickly and permanently anesthetize large parts of her memory.

When I advised her that that wasn’t quite accurate, she simply couldn’t trust that I knew what I was talking about. I think that she also couldn’t trust that she could survive contact with her feelings. She ran, against my advice and in spite of my best efforts to calm and reassure her. I believe her departure was due both to her mis-perceptions about how therapy works and her fear of herself and all other adults. A tough story, for both of us.

On the other hand, some therapists call any client who want to leave before the therapists deems them ready “resistant”. I strongly object to this. First, I don’t think it’s helpful in any way. Second, I think it a poor characterization of what’s actually happening.

Resistance can be a very good thing. I will resist your picking my pocket, for example. But it also can be a completely wrong word. If I resist having a perfectly good meal with you, because if I do so I’ll miss my train, “resisting” your invitation is simply rational. So is it rational if my client evaluates her situation, listens to me and anyone else she cares to listen to, then decides that what she want to do is leave? In that case, her leaving is the only sane, rational thing to do, and I would strongly support her leaving for that reason.

I have in fact most certainly told clients who I thought were leaving therapy prematurely (I do get a few!) that I thought all in all they simply had to go, that not to go would be wrong because it would be an act of self-disrespect. And I said this after telling them that I was convinced that therapy would be good for them, and  thought they needed it.

Again I say: I know this isn’t simple. But it IS true, and telling the truth is my first interest and first obligation. The challenge of understanding this truth is a completely separate issue.

WORKING TOGETHER TO MAKE THIS EASIER

From the moment I began addressing this topic, over a year ago, I knew that often it’s a difficult one for all concerned. I have, at all points, felt most concerned about the difficulties clients have with ending therapy. They are the more vulnerable, less informed, less experienced of the two individuals involved. I think we therapists need to help them with this issue just as we do with others.

Therapists get in trouble with this issue just as do their clients, sometimes for the same reasons! Sometimes their troubles are of their own making, and sometimes they are due simply to the nature of the problem. A fundamental objective of my writing on this topic is to raise awareness by both therapy clients and therapists both of the pervasive existence of this problem and of its nature.

We need to talk more with each other about this matter, preferably from an informed point of view. We certainly also need to respect each others difficulties in dealing with therapy termination. All in all, this problem isn’t going to go away, and isn’t likely to get much easier over time. It will just be there, waiting for us.

When therapy termination time comes, we need to do with this what we do with other problems in psychotherapy, turn toward it, look it in the eye, see its parts, feel our feelings, talk to each other, and, while as fully alive and functional as we can be, simply walk through the fire. It’s what we do, and it’s what we’re good at – or trying to get good at! It’s just another part of a life which isn’t always easy but which IS manageable.

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