[Advice] Rejection & Readjustment

I’ve started answering questions…with questions. If you have a problem that might benefit from other angles of consideration, send it to donovanable [at] gmail [dot] com. 

There is a woman I went on two dates with, and then we had an “are we dating conversation” she said that she enjoyed spending time with me and wasn’t romantically interested in me so she wanted to be my friend. I really enjoy our time together, but afterwards I’m a wreck, like every time is a rejection. I’m in a new area and she’s my only friend within a 30 minute drive, I think she’s awesome and don’t want to spend less time with her. I don’t think her feelings will change. What To Do?

I think you have correctly identified the important thing here—that you are the person who can change things about your reaction, and that she is unlikely to change her feelings.

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How do you spend time together?
I ask because I’m wondering if you’re mostly spending time one-on-one. This is great for building friendships, but it might also cue abandonment or rejection right when you leave. If you went to bigger events (where bigger might mean eight people playing board games together or somesuch) the end of the event may feel more like leaving an event than being abandoned or rejected. Bonus: potential for more friends.

If your friend knows more about the social scene where the two of you live, she might be able to find group events or meet you at them.

What things is your brain telling you right as you leave from hanging out? 
Whether or not you think these things are true in the cold hard daylight of not-being-distressed, what does your brain tell you? If its thoughts you don’t otherwise assess as being truthful (or you’re not sure if it’s truthful), can you practice assessing the statement during the time when you’re not distressed?

If your brain says something like “I’m not lovable” or “She hates me,” perhaps you could take some time to determine the evidence for and against this claim. Practicing in a less emotionally charged time can help transplant

Of course, it’s possible what your brain does is less about specific thoughts and more about a screechy unpleasant rejection feeling.

How do you make friends? How effectively are you pursuing this?
I expanded on this in this question. In short, it’s great that you found one awesome person who seems to, based on your description, also enjoy your time together. It might also be great to have a variety, that way you’re not trading off between having no social life and feeling awful after you do something social.

 


Photo from Flickr by Rawle Jackman

 

[Advice] Jobs & Jerk Dopplegängers

I’ve started answering questions…with questions. If you have a problem that might benefit from other angles of consideration, send it to donovanable [at] gmail [dot] com. 

At work there is a new person I need to work with and he looks just like my abusive ex-boyfriend. It’s really upsetting. What can I do?

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Reflection’s resemblance to Frankenstein is totally coincidental. 

 

Weirdly, I’ve been in the opposite position as this question; where I was the doppleganger of someone else’s Bad Person.

What is the ideal outcome for you?
I ask because I could see a couple of things you want from your experience here. One answer might be “I want to be more comfortable in my work setting so I can stop stressing out when this person and I pass in the hall.” This might mean that you would focus on figuring out ways to be comfortable with being near to him.

Alternately, you might want to just avoid, avoid, avoid at this juncture. The ease of doing things depends on a some factors like how long you’ve been at this job, how small the company is, and in what department your unfortunately-semblanced coworker is.

Who is on your support system?
Who is going to be on your side, who you can vent to or hang out with when you don’t want to see the jerk!doppleganger or are on edge from unavoidable interactions with jerk!doppleganger.

What’s your one-liner if this ever comes up in the workplace?
I think the chances of this are pretty low, but a backup plan can help. Maybe you get really good at the lighthearted “Haha, actually it’s super weird but [coworker with unfortunate resemblance] looks like someone from my past!”

If you haven’t spent a lot of time at your current workplace, you might have the option to go with something like “haha, you know me, I’m busy, busy, busy!” for when you’re ducking back into your cubicle and away from everyone.

What things work best for you when you’re feeling overwhelmed but can’t leave?
I use fidget objects to calm down or distract myself, like this fidget ring. At other times, I’ve found controlled breathing exercises give me something to do. Breathe2Relax [Android, iOS] teaches one kind, square breathing is another.


Photo credit: Reflection by jourixia

 

[Advice] Eating & Endpoints

I’ve started answering questions…with questions. If you have a problem that might benefit from other angles of consideration, send it to donovanable [at] gmail [dot] com. 

I have an eating disorder. My therapist thinks it’s anorexia, but I don’t think I’m thin enough for that to be right (I’m just barely underweight) and I haven’t lost much weight either. I don’t want to recover ’til I’m thin.

Advice?

A first note, before the rest, is that anorexia both in the U.S. and abroad is classified by behavior and perception, leading to low weight, not necessarily a specific weight limit or weight change. Many people argue that the ‘low weight’ component of the DSM is still a poor criterion. (I am one of them). That being said, it is still possible that you may qualify for an anorexia diagnosis under the strict criteria.

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Glass art by Sue Hawker

I have to admit, Letter Writer, I was not sure I could offer questions in response to this question. I could offer recognition—there is still a part of my brain that makes this argument to me, and another part of my brain that would like me to put it into action. Ultimately I think there always will be.

But if I could take myself out of this headspace, pause that part of my brain and interrogate it, these might be the things I would ask.

What does being thin mean in terms of other benefits? What values does it feel like it confers?
If you can, I would write this down, in a list you don’t have to keep or show to anyone else. If you’re like me—and you don’t have to be!—your answers might have little to do with appearance and more to do with things like ‘being acceptable to others’ and ‘moral purity’.

You don’t have to analyze these further or make decisions about them, just figure out what’s on that list for you.

What changes would it mean to how others see you to be ‘thin’?
Quotes because I mean what ever you mean by the word “thin”. What does your brain tell you about this?

How will you know when you’re thin? Specifically, is it a feeling internally or a specific measure?
I ask because I notice you said you’re a little underweight, by which I’m assuming you mean you’re under the weight recommended for your height. I think many, if not most people might be confused by hearing that you desire to be thin and also that you are underweight.

Do you have a specific, number-based stopping point in mind? If you do, do you think it’s one others would agree with? I’m not saying that other people are always great source of health information or bodily decision making, but I’m wondering what your anticipation of this answer is.

What does being not-anorexic mean for you?
It seemed like you were considering changing behavior (if I’m understanding you correctly) when you reached the ‘thin’ point. What would that be like? What would you do differently? What things is your brain telling you about what this decision would cause for you in terms of benefits and tradeoffs?

What would happen if you didn’t have access to reflective surfaces/measurements?
I ask because for me, I mostly got external information about my size (which then cued positive or negative reactions). As a sophomore in college, my dorm had renovations which accidentally removed all mirrors, except for four—one in each community bathroom. And nothing changed about my weight; I continued to have some disordered behavior and weight fluctuations, but not more or less than the previous year.

What did change was how distressed and impaired I felt by my body. I was less likely to skip class or social events due to seeing my body in the mirror on the way out the door. I could still go see myself if I wanted to, just by hiking down the hallway. But that little barrier? It did a lot to save my sanity.

I should say, I didn’t feel very positively about this. There is a quiet voice in me, one that was louder back then, that believes that I should feel shame and unhappiness about my body, that this is the correct penance.

But I wonder what you think would happen if you tried having less access to mirrors.

I don’t know, LW. I don’t know if this was helpful, or if a version of this would have helped me five years ago. I wish you happiness and health now and in the future.

 

Monday Miscellany: Prison, Phones, Social Position

1. The violent, the mentally ill, and the intersection of the two.

2. Prison psychotherapy, wire mothers.

3. When nobody else wanted to, Ruth Coker cared for and ultimately buried men with HIV/AIDS.

4. This couple has a house, and that house keeps showing up as the location of stolen cell phones. Over and over and over. If they ever do steal anything with a built-in tracking app, they’re probably going to get away with it.

5.  A meta-analysis of Kahneman’s research on blood glucose and System 1 finds that it fails to replicate. [Research behind paywall here.]

6. Breaking down the socio- and economic- components of socioeconomic class:

To use myself as an illustration: I make very little money, so I am heir to the misfortunes that disproportionately impact the impecunious – the almost-certain forthcoming hike in T fares looms large in my anxieties right now – but I am a professional with an advanced degree and possession of the shibboleths of the professional class. I didn’t stop being in the social class I had been in when I dropped to a much lower economic class. The privileges I lost were only those attendant to economic might; I retained the privileges of social position.

So, for instance, if I don’t like the medical care I get from the doctors my state-subsidized health plan (thanks, Mitt!) gives me access to, I can’t just whip out my checkbook and buy myself care from a better reputed specialist. Being poor might yet shorten my lifespan, as it curtails my access to care. But on the other hand, if I present with a serious booboo to just about any doctor, I will have narcotic pain relief offered me with no questions asked, because someone of my social class is not suspected of being one of those naughty “med-seeking” addicts. The decision of whether or not to trust me with a prescription for percoset is not made on the basis of the MassHealth card in my pocket marking me one of the precariat, but my hair style, my sense of fashion, my (lack of) make-up, my accent, my vocabulary, my body language, my (apparent) girth, my profession (which, note, doctors often ask as part of intake), and all the other things which locate me in a social class to observers that know the code. Contrariwise, a patient of mine – who is a white woman of almost my age – who is covered with tattoos, speaks with an Eastie accent, is over 200lbs, and wears spandex and bling and heavy make-up, gets screamed at by an ER nurse for med-seeking when she hadn’t asked for medication at all, and just wanted an x-ray for an old bone-break she was frighted she had reinjured in a fall.

 

[Advice] Dating & Disorders

I’ve started answering questions…with questions. If you have a problem that might benefit from other angles of consideration, send it to donovanable [at] gmail [dot] com. 

So I very recently left a longterm relationship with a girl with a history of eating disorder and some other badbrains issues. I am cautiously confident this was the right decision but I still wonder if things could have been different.

With specific respect to histories of EDs but also other badbrains, what questions are useful to ask yourself to maintain good boundaries, balance give and take of emotional energy, and otherwise have a healthy relationship?

Congratulations and condolences (simultaneously!) on your first paragraph.

I think a lot of the stuff here is about values, things you like but don’t have to have consistently, and things you’re willing to not have. Of course, the complicated thing about values is not the having them, but the figuring out which ones you have, and in what order.

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…though having reasons is often comforting. 

 

When you think about the things you enjoy doing, what types of experiences are important to you? What activities that others like that you find annoying/unpleasant/stressful?

 

When you look back on the kinds of experiences that have made you feel connected to others, were there any uniting characteristics?
Love languages might be one way to think about that, though things like “doing [activity type] together” or “spontaneity” or “vulnerability” work too.

How much can you accept someone being actively mentally ill around you? In what ways? What things will be too distressing, which will be distressing but bearable?
I ask this because it’s hard. These can be your hard limits, the things you won’t be comfortable with, and that is okay. Some examples of things you could consider when thinking about this:

-Seeing your partner self-harm (or restrict, or binge).
-Noticing that your partner is responding to internal stimuli (aka, psych-speak for experiencing hallucinations or delusions)
-Seeing obsessive or compulsive behaviors. Not once or twice, but over and over and over and over.
-Having the same conversation over and over about something that seems unimportant or silly.
-A partner who feels suicidal when you two disagree.
-A partner who declines to share their experience of mental illness with you.
-Any of the above occurring in public, unpredictably, or in ways that are considered socially inconvenient.

I note that even the most mentally healthy might do these, and of course, we don’t date our partners with a promise of Never Ever Experiencing Mental Illness, Ever.

In what ways do you like to be cared for?
Conversations about dating and mental illness are often centered around the Healthy Partner(TM) caring for the Sick Partner(TM). Lovely, but it can lead to one partner always in the mode of thinking about how they can help, and not advocating for themselves when they’re struggling. This pattern also makes it hard when someone is trapped being the Sick One—they might not know where to begin. Knowing what you like is a first step to communicating it.

What feelings or thoughts or behaviors make you notice that you’re overwhelmed or burned out? 
You asked about balancing the give and take of relationships. What things are warning signs that you might have over-extended yourself?

Good luck, LW. I wish you relationships of mutual learning and support and happiness.


 

Stuff I read when thinking about this:
On Supporting Borderlines
In a Relationship and It’s Complicated: Eating Disorders in Intimate Relationships
The Art of Comforting
Image credit: Emm Roy at Positive Doodles

[Advice] Forty & Friends

I’ve started answering questions…with questions. If you have a problem that might benefit from other angles of consideration, send it to donovanable [at] gmail [dot] com. 

Any advice on men pushing 40 to make new friends? I’m in a new city, living with my girlfriend, but she travels a lot for work and I work from home. I’ve gone for some of the low-hanging fruit. I took over a meet-up group when the leader stepped down, and the people who come to the meetups are nice but we’ve never exchanged numbers or become friends in any way. I tried volunteering, and that led to nothing. Anything obvious I’m missing?

Okay, LW, I will be honest with you; it is unusual for me to talk to forty-year old men, and I am not sure I have the best advice for you. But you did ask here, and there is only twenty-three year old me in the vicinity. So, here we go.

First of all, I don’t expect you’re missing things that are obvious; meetup.com was going to be the first thing out of my mouth. (I was just busy trying to formulate it into a question, Jeopardy-style.)

What things make you like people? What kinds of people are you interacting with in your current day-to-day? Do these two align? 
Worth taking hands to keyboard or pen to paper and making a list. People you should want to be friends with are notoriously less fun than people you want to be friends with.

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A portrait of the author, post socializing.

How much energy do you have to spend on this? Are you introverted? Social?
Do you have the energy to invite someone to do a New Friendmaking Thing every week? Every two weeks? Every month?
Friendmaking is an activity, and it can be exhausting. If you’re anything like me, you might go through cycles of

a) scheduling or committing to ALL THE THINGS.
b) followed by deciding I’ve solved the question of friendship/am satisfied with my social life
c) followed by being tired from the aforementioned ALL THE THINGS and doing my best hermit impression. This results in…
d) failing to respond to any of the next invites or spend time with any of the new people I meet.

Picking a steady rate at which to plan or do social activities and then sticking to that, rather than switching between over-scheduled and a crushing sense of scarcity has counteracted this.

What have you told people about your interest in making friends with them?
You mentioned that your meetup (points for taking over a meetup group, by the way) wasn’t creating the connections you wanted.
Especially when new to an area, it’s usually normal (though not intuitive) to tell people something like “I’m new to the area, and you seem cool. [Coffee/drinks] sometime?”
Note: if they say yes, you are usually in the position of making specific plans, not them.

In your optimal friendship situation, what do you do with people?
In the vein of fake-it-until-something-works-maybe, do you have a list of things you wish you were doing with others?
On my list:
-Sitting in the same room on the internet, occasionally sending each other interesting articles and debating their merits. Sometimes sending each other cats.
-Trampoline gyms!
-Going on food adventures, like Kitchen Kibitz.
-Food festivals.
-Cool exhibits. see: Mapparium

Can you invite not-friends-but-currently-acquaintances on some of these things?
Maybe “sit silently in the same room on the internet” is hard to describe to an acquaintance—and a little awkward to initiate or bail on—but Do Fun Thing With Person Who Might Be Fun, Who Knows? is a grand tradition in new friendship making.
Benefits: For activities that are not conversation based, you can do fun things whether or not you end up enjoying conversation with them. Aaand, you have things to talk about!

 


Stuff I read when thinking about your question:
The Main Tasks For Creating A Social Life
Operation: How Do I People?
Photo credit: Arkomas on Flickr

A Short Guide to People Who Can Help With Your Mental Health

[Written by an American. Generalities probably apply to Canada and UK, specifics certainly do not]

Psychiatrist
>Can prescribe medicine related to mental health concerns
In the U.S., virtually all psychiatrists do not do psychotherapy on a long term basis. They’re expensive, usually have long waiting lists—I’m told it’s something like an expected three month wait to see a psychiatrist in my city—and specialize in medication.

If you are making an appointment to see a psychiatrist, this is frequently considered evidence that you are looking for medication. This can cause weird misunderstandings when people think of a psychiatrist and a psychologist as identical and psychiatrists anticipate that people who come to see them are coming to see them for their specialty. Patients can (and do!) occasionally get the impression that they’re hopeless and must go on medication or that the entire mental health establishment is focused on pushing drugs.

Psychiatric Nurse Practitioner/Mental Health Nurse Practitioner
>Can prescribe medication related to mental health concerns.
I’ve only run across these in hospitals, but this article suggests they also operate in private practice. In my experience they do slightly more therapy than the psychiatrists I know and work with, though their primary focus does seem to be medication management.*

Clinical Psychologist
>Cannot prescribe medicine.
Has a Ph.D or a Psy.D. Worked a variety of successive internships to collect enough hours (1,500 to 6,000, varied by state) to become a licensed psychologist. Almost always have specialized training in administration of specific kinds of therapies, like Cognitive Behavioral Therapy or Motivational Interviewing.

My impression is that psychologists are low variance in terms of skill at administering one-to-one therapy and diagnostic work. They’ve all received lots of hours of practice before being licensed, and while there are many ways to be a clinical psychologist who does therapy, there aren’t as many ways as say, a social worker. Psychologists are also more likely to be able to sort out a diagnostic label, if that’s relevant or important for you. Others on this list could, but might not use diagnostic labels as frequently or be as comfortable getting a really specific, precise diagnosis.

Social Worker
>Cannot prescribe medicine.
Most social workers who are providing one-on-one therapy have a Master’s degree**. Social work is weird because the list of things a social worker could be doing as their job is…….very long.
Some:

  • being available to talk when someone is in hospice
  • working in school with kids who are struggling (behaviorally, emotionally, academically)
  • doing therapy in a standard couch + office + “and how does that make you feel” setting
  • investigating reports of abuse or neglect
  • coordinating other therapists and psychiatrists for clients
  • talking to people who recently were diagnosed with a terminal or chronic illness
  • helping people get into detox programs by making a lot of phone calls
  • doing assessments of children entering juvenile detention
  • helping new immigrants or refugees adapt and find services
  • going to people’s homes to assist with counseling
  • helping people deal with other bureaucracies
  • accompanying clients to appointments (such as Social Security offices)
  • leading groups (support, therapy, social skills, etc)

The main differences I notice between social workers and psychologists are:

Variance: social workers are high-variance; I happened to spend both of my training internships doing individual therapy and training in Cognitive Behavioral Therapy. It would have been equally possible for me to graduate having never done one-on-one therapy and without specialized training in a single modality.

Advocacy & Case Management: Part of the reason for the high-variance nature of training is that some social workers never particularly want to do one-on-one therapy. They might prefer ‘case-management’. Ever needed to figure out how to get into a treatment center and also have follow-up services when you left? A case manager might coordinate all the people at the treatment center plus follow-up appointments, plus check in on your progress. It’s always been an expected part of my non-case manager role that I do some of this. Sometimes therapy is put on hold to figure out how a client is getting treatment for their health concerns, or sorting out billing. This seems to be a cultural difference between social work and the rest of the list.

Mental Health Counselor
>Cannot prescribe medicine (seeing a theme, yeah?)
Like a social worker, has a master’s level degree, plus two more years of work in the field to get an independent (not-requiring supervision) license. I usually see the license called an LMHC or CMHC. Can do similar roles as any of the non-prescribers listed above. Less of an advocacy focus than social work.

Marriage and Family Therapist
>Cannot prescribe medicine.
Though all previous listed professionals could do couples’ counseling, this category specializes in it, and other family work. Master’s level degree plus two years of training to get a license for independent (non-supervised) work.

*Know more? Feel free to add in the comments.

**It’s possible to be a social worker with a Bachelor’s degree, but this generally involves more case management and very little direct therapy.  Except in my state, where you do not have to have a degree at all.