Sep 13

“Tiny Beautiful Things”: The Couples Therapy (Spoilers)

Tiny Beautiful Things on Hulu is a fictional adaptation of advice columnist Cheryl Strayed‘s 2012 book Tiny Beautiful Things: Advice on Love and Life from Dear Sugar. (For additional background, see this previous post about the film Wild based on Strayed’s solo hike of the Pacific Coast Trail.)

As the series Tiny Beautiful Things begins, Clare (Kathryn Hahn) has not yet fulfilled her writing ambitions; also, she has not yet become “Dear Sugar.” She carries tremendous grief about her mom who died from advanced cancer, can’t connect with her teenage daughter, and is separated from her husband Danny (Quentin Plair) but pursuing couples therapy with him.

In Episode One we see that Clare “doesn’t trust their therapist, Mel, who wonders aloud whether Clare’s instability is due to latent anxieties about her decaying beauty as she approaches 50” (TV Line). While this statement seems out of left field and representative of a biased attitude toward Clare that gets repeated down the line, the style of this therapist (Tijuana Ricks) with Danny seems different, possibly even flirtatious. The latter has actually been acknowledged by both Hahn and Plair (Decider).

Beyond this, however, there’s a lot we don’t get to understand about the couples therapy dynamics.

For example, although it’s briefly mentioned early on that Danny has met with Mel separately, we don’t know in what context or how many times. Did Clare choose not to attend a session or more? Was Danny in individual therapy with Mel before it became couples therapy? Or maybe he still has separate sessions? Whatever the case, perhaps there were appropriate reasons for separate sessions, just as there may have been inappropriate ones.

A Google search reveals that many viewers are confused about what is happening between Danny and the couples therapist. Many wonder if Mel is a bad therapist, period. Question categories include:

  • Why is Danny seen (by Clare) chatting with Mel in her office after their session has ended? (A major stressor for Clare, by the way, who only witnessed this inadvertently.)
  • Does Mel pick on Clare unnecessarily? Is Danny Mel’s “favorite”?
  • Why did Mel single Danny out by sending him that column (that led to his realization that he needs to end his marriage)?
  • Is it appropriate that Mel then gave him a special after-hours individual session? He clearly requested it, but is this the right course of action?
  • Is Danny “Johnny,” the married sender of the letter to Sugar about falling in love with someone—and is that someone Mel?

It’s left for viewers to draw their own conclusions. As a viewer myself who’s also been a couples therapist, I do have a few thoughts.

  • The dynamics in the couples sessions do seem out of whack and biased towards Danny. (But you didn’t need me to tell you that.)
  • The dynamics outside of couples sessions do seem inappropriate. If couples therapy is going to proceed fairly, each party should be informed if separate talks are occurring with the therapist.
  • Mel did show a clear bias or favoritism by sending the column to Danny only. Why not share it with both of them, if at all?
  • It follows that the “emergency” session with Danny didn’t have to happen if he hadn’t received this special treatment from Mel. Moreover, I think it’s implied that Clare is not aware of this happening.
  • If Danny has fallen for Mel, she likely has contributed to this. And if something more intimate is happening between them, it’s highly inappropriate and unethical on Mel’s part as a therapist.
Sep 06

Maria Bamford: “Sure, I’ll Join Your Cult”

An acclaimed comedian chronicles her experiences with mental illness and her search for community. Warning: her hilarious riffs will make you feel seen. Adam Grant, reviewing Sure, I’ll Join Your Cult by Maria Bamford

Maria Bamford—the favorite stand-up comedian of Stephen Colbert, Tig Notaro, and other notables—and star of Netflix’s Lady Dynamite (2016-17), which dealt with the aftermath of her actual mental breakdown, has a new book: Sure, I’ll Join Your Cult: A Memoir of Mental Illness and the Quest to Belong Anywhere.

You can read an excerpt on Slate (My First Cult Was My Family. My Mother Was in Charge“). The “cults” she tries (beyond her family) in order to belong somewhere/anywhere include 12-step programs such as Debtors Anonymous and Sex and Love Addicts Anonymous as well as Dale Carnegie’s “How to Win Friends and Influence People” and the programs of Richard Simmons.

Bamford has long been open about her various mental health struggles. Among the list are anxiety, depression and suicidal thoughts, binge eating, a form of OCD called “unwanted thoughts syndrome” (for which she named a comedy CD), and Bipolar II Disorder.

Kirkus Reviews summarizes that Sure, I’ll Join Your Cult “is a memoir that examines her life in comedy, dealing with mental illness, and finding a way to belong.” Bamford, however, advises readers this is not your typical “trauma, healing, and victory” story.

More from Kirkus: “Bamford creates an effective mix of introduction (or reintroduction) to a fascinating comedian, a guide to the self-help industry, and an encouragingly lighthearted, respectful assessment of mental health, reminding readers that they are not alone.”

Publishers Weekly: “It’s all delivered with Bamford’s trademark blend of disarming intimacy and dark whimsy. The result is a consistently funny and occasionally heartbreaking glimpse into a unique comedic mind.”

On Goodreads Kendra Gayle Lee, an indie bookstore owner, writes:

If you’ve done a 12 step program, you’ll laugh. And nod along.
If you’ve struggled with anxiety, depression, OCD, you’ll feel so seen.
If you’ve ever felt like the only person in the world who didn’t get a ‘how-to’ manual for this life, you’ve found your book!

And, finally, I think Lee’s conclusion is definitely worth adding: “But what really got me was the last chapter on suicide. Maria Bamford wrote such a tender, compassionate tribute to folks who fight suicidal ideation–and sometimes die as a result of their mental illness–that it shifted something in me. She helped me understand something heretofore incomprehensible to me. I’m grateful for that.”

Aug 23

Women With ADHD: Often Looks Different Than Men’s

Women with ADHD: the condition often looks different for girls and women than it does for boys and men.

Therapist Sari Solden pointed out years ago that girls with ADHD are often overlooked. She’s the author of the groundbreaking and bestselling 1995 book Women with Attention Deficit Disorder: Embracing Disorganization at Home and in the Workplacerevised and expanded in 2005. Her newer book, A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers, followed in 2019.

Dr. Ellen Littman, co-author of Understanding Girls with ADHD, indicates that girls’ symptoms often increase after puberty, which is the opposite for many boys. And Solden notes that girls who are smart and receive good support and structure are less likely to draw notice.

Solden devised a self-test regarding women with ADHD. Click on the link.

One of the newest books about women with ADHD is Adult Women With ADHD: The Unconventional Guide To Coping With Neurodiversity With Tips for Avoiding Distractions, Managing Emotions and No Longer Feeling Like a Failure, Turning Into a Superwoman by Pansy Bradley. Enough said!

Zoe Kessler, who didn’t find out she had ADHD until she was in her 40’s, wrote ADHD According to Zoë: The Real Deal on Relationships, Finding Your Focus, and Finding Your Keys (2013). The online Jasper/Goldberg Adult ADD Questionnaire helped her self-diagnose (HuffPost):

By question four, I panicked. I had no idea why these questions were even on the test. Wasn’t everybody like this?

Apparently not.

Getting diagnosed, though, led to a “positive shift in self-perception” for her. She adds, “Knowledge about ADHD will set you free from a path of unmet goals and unanswered questions.”

Another resource is Linda Roggli‘s website and book. Midlife women with ADHD can find support at Roggli’s ADDiva.net. Her 2011 Confessions of An ADDiva: Midlife in the Non-Linear Lane has been widely praised by those who can relate.

A few brief quotes from “This Is My Brain on ADD”, found on her website

The psychiatrist who specialized in adult ADD told me to come by at 3:00 p.m. I arrived at 3:14 p.m.
He wasn’t surprised.

I did try medication—several of them, in fact. Some of them made me sleepy, which piqued my interest. If my brain slowed down on stimulants, maybe it did have some wiring problems.

Ultimately, medications didn’t work for me (in part because I couldn’t remember to take them).

The following two guides are also from the chapter in question:

ADD clues you won’t find in the DSM-IV
• Illegible handwriting
• “I have to do it my way”
• Profound sense of failure
• Feeling like a fraud; hiding yourself
• Overcontrolling of self, others, events
• Interrupting yourself
• Easily frustrated; quick trigger to anger
• Very emotional; highest highs, lowest lows
• Obsessive tidiness
• Constantly reorganizing, creating a new “system”
• Making simple tasks complex
• Inability to stick with a diet, exercise; weight issues
• Many intimate partners; impromptu sex
• Difficulty with spatial tasks–puzzles, etc.
• A constant sense of being “swamped”
• Anxiety; a baseline of unease in the world
• Sensitive to labels in clothes, bright light, loud noises

The Truth About Diagnosis
• There is no absolute test for ADHD
• It’s OK to get a “second opinion”
• A “functional diagnosis” can be made via a thorough intake interview with an ADD-savvy physician or psychologist
• Expect to feel relief and grief after diagnosis
• Not everyone has ADD – despite what you may believe
• Having ADD does not mean you are brain damaged
• Medication helps some people; expect to try several of them

See this page for additional books by various authors on this subject.

May 30

Therapy Quotes (Humor)

The following therapy quotes find the humor in what clients and therapists experience.

My therapist says our sessions are a safe space, a judgement-free zone, but I think she only told me that to see how I’d react. Avery Edison

My therapist gets so upset when she walks into her waiting room and finds me treating her other clients. Jenny Mollen

Do you ever feel like your therapist is the priest from the Exorcist who catches your demons and then jumps out a window? Trevor S

Dear creators of every new fall sitcom: I am sorry your parents were so noisy and shitty, but can’t you punish a therapist instead? Dave Holmes

I go to therapy just so someone will talk to me without looking at their phone. Patrick Walsh

Next time I try therapy I’ll bring up how I’ve never been more than once since my need to please makes me feign recovery after 1 session. Erin Whitehead

Can anyone recommend a bad therapist? (I need a good scapegoat). Josh Comers

˝Gonna talk about you in therapy today˝ -21st century romance. Jake Weisman

Therapists are the atheist’s confessional. So long as you tell your therapist about it, you can keep doing it with a guilt-free conscience. Erin Whitehead

Therapy hasn’t really made me feel any better, it just made me understand why I feel bad. Corey Pandolph

i go to therapy to deal with people who don’t go to therapy. Lauren Ashley Bishop

I like to call therapy baggage claim. Aparna Nancherla

my therapist gave me homework to do before our next session so now I can never go back to therapy maura quint

Among other therapy quotes I’ve found is this one from Laura Munsons memoir, This Is Not the Story You Think It Is…:A Season of Unlikely Happiness:

Probably the wisest words that were ever uttered to me came from a therapist. I was sitting in her office, crying my eyes out. . . and she said, “So let me get this straight. You base your personal happiness on things entirely out of your control.”

Also, from Sofiya Alexandra‘s Tumblr:

“Ten Things My Therapist Says That Make Me Angry,” Sofiya Alexandra

  1. “Exercise does wonders for depression!”
  2. “You’re of course aware that alcohol is a depressant?”
  3. “Maybe we should consider medication.”
  4. “It seems like your boyfriend had a point.”
  5. “Maybe we shouldn’t consider medication and just stick to exercise.”
  6. “It’s warm in here, isn’t it, I’m going to turn up the air.”
  7. “You’re of course aware that marijuana can be a depressant?”
  8. “You seem angry.”
  9. “This is going to require a lot of patience and hard work.”
  10. “I no longer take Blue Shield.”
May 24

Short-Term Therapy Vs. Long-Term Therapy

Is short-term therapy better than long-term therapy? Or is it vice versa?

It depends who you’re asking.

If it’s clients, on one end of the continuum are those who prefer the briefest of therapies (à la Bob Newhart‘s “stop it!”)—or even no therapy at all—while, on the other end are those who love having a therapist to see over the course of their lifetime, if not continuously at least on an as-needed basis.

But then there’s the money factor. For some without means (underinsured, uninsured, or unable to pay) it doesn’t feel like a choice: short-term therapy is a cost-saver and therefore preferable.

Enrico Gnaulati‘s Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science are Ruining Good Mental Health Care (2018) cites a number of other factors that work against longer-term therapy. They include Big Pharma‘s pushing of psychotropic medications directly to consumers via TV and other ads, the ability to get such medications from one’s physicians versus having to see a mental health practitioner, and the fact that health insurers push quicker treatments (again, the money issue).

Gnaulati believes (Psychology Today) talk therapy is “seriously under threat; at least as it applies to varieties of talk therapy that are relatively non-directive, time-intensive, in-depth, and exploratory in nature—typically under the psychodynamic and humanistic umbrellas of care.”

The newer trend, indeed, is to provide “evidence-based” treatments, which according to Gnaulati are “CBT-type, short-term psychotherapies supposedly tailored to reduce the symptoms associated with a given diagnosis.” He regards the studies that tout such treatments as somewhat misleading, however:

Evidenced-based treatments such as these are problematic because they measure progress strictly in terms of symptom reduction over the short term, not greater social and emotional well-being over the long term.
It turns out that evidenced-based really is evidenced-biased because the bulk of current empirical evidence substantiates that ‘contextual factors’ in psychotherapy are most predictive of positive outcome—empathy, genuineness, a strong working alliance, good rapport, favorable client expectations. And when you survey clients they overwhelmingly want a therapist who is ‘a good listener’ and who has a ‘warm personality,’ not someone skilled in the latest techniques.  So, CBT-type evidenced-based treatments should not be monopolizing the field right now in the way they are.

Whether shorter or longer, talk therapy, I agree, does need to be saved. “Fifteen Facts About Mental Health That Show Why We Need to Save Talk Therapy” was posted by Gnaulati’s publisher, Beacon Press. A sampling:

  • 90% of people claim they would rather meet with a therapist to talk about their problems than take medications.
  • Only about 3% of Americans ever enter psychotherapy, even though roughly half the population meet lifetime criteria for a serious emotional problem.
  • Of the approximately 49,000 psychiatrists in the United States, the vast majority exclusively prescribe medications. Fewer than 11% provide talk therapy to their patients.
  • 58% of emotionally troubled people take medications only, with no psychotherapy. About 10% of emotionally troubled people attend psychotherapy only and opt out of medication usage.
  • 50% of research articles in the field of psychiatry are ghostwritten in some shape or form, penned by outsiders and published under the names of prominent academics, all whom draw paychecks from pharmaceutical companies.

In sum, as a talk therapist myself, I don’t believe one size (of therapy) fits all. Medications may be all some people need, while others may need to talk things out, some over a longer period than others. When talk therapy is the choice, the relationship between each particular therapist and client is what often matters the most. And last but not least, money should not have to be an issue—needed therapy should be made affordable for all.