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How Therapy Enhances Psychopharmacology

Frank Anderson On The Process That Gets A Client’s Body On Board

NP0038: Who’s Afraid of Couples Therapy?

Welcome to our “Who’s Afraid of Couples Therapy?” This exciting series, back by popular demand, is based on our November/December 2011 issue on this topic and will explore the challenges of couples work. What are the most effective strategies in working with couples? How can therapists structure therapy—particularly in the early sessions—so that couples leave with a sense of hope, rather than frustration? Can working with individuals who have serious issues in their relationships actually be detrimental to them? Find out the answers to these questions and much more. In this first session with expert couples therapists Ellyn Bader and Peter Pearson, the creators of the Developmental Model of Couples Therapy, you’ll find out why clinicians often avoid working with couples and how you can better prepare yourself for couples therapy work. How can therapists most effectively work with emotion in the consulting room—particularly when it comes to couples therapy? Learn with internationally known couples therapist Hedy Schleifer how to help create a nourishing connection between partners, define a role as therapist-as-guide, and much more. Schleifer, who’s pioneered the training of Imago Relationship therapists internationally, will go into how to use this theory in practice and how to best work with emotions. What happens when partners in couples therapy have two different agendas in mind? Hear from expert William Doherty on this little spoken about topic. Learn how Discernment Counseling, an approach that helps couples clarify their feelings about the next step in their relationship, can help both clients and therapists. Is it possible to rebuild trust and intimacy in a couple’s relationship after a partner has had an affair? How can therapists help? Hear from Esther Perel, author of the international bestseller Mating in Captivity: Unlocking Erotic Intelligence, on how to help couples after an infidelity and the role that cultural perspectives have in this emotional situation. Explore this classic dynamic of couples therapy—an angry woman and a withdrawn man—that’s often confusing for therapists, with couples therapist Jette Simon. Learn more about what’s behind the feelings of anger and the behavior of withdrawing, and how clinicians can more effectively work with shame and fear of disconnection. Hear an unconventional perspective on couples therapy from David Schnarch, who believes that the best way to help couples is to challenge partners to change their individual behaviors and attitudes. Schnarch’s direct, upfront approach to helping clients will illustrate a different viewpoint on effective couples therapy. Join Marty Klein, a marriage and family therapist and certified sex therapist, us for a candid discussion about the assumptions that both clients and therapists often share that can get in the way of improving couples’ sexual relationships. Discover with Kathryn Rheem how to respond effectively when clients express strong feelings in session. Based on Emotionally Focused Therapy, you’ll explore attunement and how to use your own emotions to help clients move beyond attachment injuries. After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

Whole Psychiatry: Alternatives to Conventional Psychopharmacology with Robert Hedaya

Meds: Myths and Realities: NP0035 – Session 4

Is psychopharmacology is a 'go-to' in your practice? Join Robert Hedaya as he discusses how to treat the bodily systems that underlay many mental health issues while avoiding medication. After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.

Treating the Mixed-Agenda Couple

Bill Doherty On An Approach For Unaligned Relationships

Tough Customers: Is It Them or Us?

Tough CustomersBy Rich Simon As therapists, many of us practice in two different worlds. In the first, we see polite, well-behaved, articulate clients with solid values. They engage fully in therapy, talk cogently about their problems, listen attentively to our responses, make reasonably good-faith efforts to follow our suggestions, and sooner or later get better. No wonder we genuinely like these people!
Royal Flush

The Perils of Charisma

By Frank Pittman

When the first space folk arrive from Uranus and ask earthlings to take them to their leader, will they be presented to Kofi Annan or Paris Hilton? Real leaders are genuine to the extent that they can arouse in a population a grander, nobler vision of themselves as a people. But while trendsetters and stylists merely influence people to change their clothes and alter how they perceive themselves in their mirrors, political leaders inspire people to strive toward something beyond their own self-preservation or advancement. But either kind of leader is in danger of falling in love with his or her own charisma and forgetting a simple lesson of history: they'll all come crashing down in due time. (Calling Ozymandias.)

This fall, at a time when competent, sensible leadership seems in especially short supply around the globe, three films appeared almost simultaneously to explore the nature of both leadership and celebrity, especially their pitfalls.

At 14, Marie Antoinette, the youngest child of Empress Maria Theresa of Austria, was married off to physically and psychologically prepubescent Louis XVI of France. Sexually constricted by severe phimosis (when the foreskin of the penis cannot be fully retracted), Louis had little awareness of sex or of anything else much beyond his obsessive hobby of locks and keys. He compensated by giving his untouched bride an unlimited clothes budget. With it, she became the world's Queen of Fashion and Extravagance, perhaps the most celebrated clotheshorse in history.

After seven childless years of marriage, Marie's worldly older brother arrived from Austria, sized up the situation, and proceeded to educate his brother-in-law about the proper conduct of connubial relations. Once a stroke of the scalpel corrected the problem of phimosis, Louis and Marie began to produce a family.

By that point, Marie Antoinette had already become not only the Queen of France and an icon of fashionable style, but widely adored and emulated at her own court and others throughout Europe. The upper classes gathered in her elegant opera house and, when she rose to applaud, gleefully followed suit. But in time, the same courtiers who'd flattered her conspired against her, and ordinary people could no longer bear her extravagance. Marie, history's ultimate spoiled child, became not just a liability, but a threat to the aristocracy and the nation.

A truncated version of this story--with none of the real pathos or political drama of Marie's life--has now reappeared. It offers minimal dialogue and a two-hour fashion show of the queen and her ladies-in-waiting, with their clothes, shoes, and carriages--much like an 18th-century version of a People Magazine story. All of this is grandly filmed at Versailles, resulting in a boring costume drama with a flashily modern look. It was written and directed by Sofia Coppola, who so brilliantly detailed human loneliness in The Virgin Suicides and Lost in Translation.

Coppola opens the film with her ultimate commentary: the Gang of Four sings "The problem of leisure is what to do for pleasure." The music is anachronistic, but the story--the excesses of the irresponsibly rich and high born--is timeless and up to the moment.

Kirsten Dunst, who starred in Virgin Suicides, is vaguely sympathetic as a childishly mischievous Marie. She had to renounce everything Austrian when she entered French territory, down to her dog and her underwear, and got little in return except closets full of designer clothes. In the movie, she longs for human intimacy, which is denied her by her husband. The almost lunatic formality and ceremony of court etiquette puts barriers between her and everyone else. She's left with rooms full of untrained dogs and beds full of handsome strangers.

As the revolution engulfs the young couple, Marie shows unexpected strength, even real courage and nobility, as she tenderly comforts her inept husband. The peasants capture the royal family and guillotine the royal couple, in part because, like Imelda Marcos, Marie was thought to have overspent the country's budget on shoes.

Marie Antoinette was often a silly, immature, rather lonely woman, whose worst sin was throwing the king's money away on gambling and frou-frou, but it helped get her killed. By contrast, Ugandan dictator Idi Amin murdered several hundred thousand people and died safely in bed, albeit in exile. The Last King of Scotland is a vivid movie about Amin, one of history's most narcissistic, psychopathic, failed leaders. The movie was written by Peter Morgan (who also wrote The Queen) from a novel by Giles Foden. Shot mainly in African villages where life is being lived outdoors, it's an ineptly directed film in which there always seems to be too much going on.

The film tells of fictional Scottish doctor, Nicholas Garrigan, played by boyish James McAvoy, who bandages the bruised hand of Idi Amin, "His Excellency President for Life, Field Marshal, Doctor Idi Amin, Lord of All the Beasts of the Earth and Fishes of the Sea, and Conqueror of the British Empire in Africa." Garrigan is promptly made the dictator's chief minister and gets to see Amin's craziness and the flamboyant torture of his suspected enemies, who are then thrown to the crocodiles. But Garrigan, identifying with the aggressor, fails to understand that all this craziness is real, with real lives at stake. Recklessly, he impregnates one of Amin's wives.

Amin only ruled Uganda from 1971 until 1979, but in that brief time, managed to kill 300,000 of his people. He was a gigantic man of great bravado and charisma, who rose rapidly in the British Colonial Army and took over the country to a hero's welcome and worldwide enthusiasm. Charming and seductive, with a sharp sense of his own buffoonery, Amin passed himself off as a cannibal--which, in a sense, he turned out to be. A devotee of boxing and comic books, he worshipped the Scots and fancied himself "The Last King of Scotland." He wrote Elizabeth II, "Dear Liz, if you want to know a real man, come to Kampala." (She declined.) His style of leadership consisted of inspiring displays of his exaggerated masculinity. He ignored any chance to achieve real greatness for himself or his country, seeking instead to awe the world with grandiose displays of brutish machismo.

The intermittently cock-eyed Amin is played by Forest (Crying Game, Color of Money) Whitaker, who's big enough, scary enough, and charming enough to play this bloodcurdling monster. It's a chilling performance in a sobering film

As Amin began to decay from syphilis and fear of assassination, he became increasingly paranoid. He joined the PLO and kicked all Asians out of Uganda. He then invaded his neighbors, who joined forces in defeating him and forcing him into exile in Saudi Arabia, where he lived in powerlessness and madness until his death in 2003.

The film implicitly asks why Westerners meddle in the heart of darkness breeching boundaries, ignoring history, screwing things up. Amin had the support of both British and American governments; the fictional Garrigan represents many adventuring Westerners who go to Third World countries mainly for their own entertainment. There's no need to ask why dictators dictate and kill. They do it to prove they can.

The Queen is a remarkably adroit and sprightly exposure of the inner workings of the very private British monarch at her moment of greatest crisis--when her son discards his wife in favor of his boyhood mistress and the discarded daughter-in-law refuses to disappear on cue. Diana, a marital victim made to order for Oprah, becomes Queen for a Day in perpetuity.

Diana embarrasses her royal ex-in-laws further by acting like a rock star and by getting herself killed, thanks to a daredevil crush of pursuing photographers, in a car wreck with her Egyptian boyfriend. The Queen hopes Diana's family will have her quietly buried somewhere out of the way without the royal family's involvement, since she was no longer a bearer of the HRH title when she died. She decrees that no official flags are to fly at half mast for Diana.

The people will have it otherwise, however, as they gather en masse to pile vast quantities of flowers around Buckingham Palace and grieve and simmer at the royals, waiting for their queen, under her increasingly shaky crown, to recognize that Diana was far more loved than Her Majesty is. In a TV-mediated world, celebrity and emulation are dependent upon charisma, not title, accomplishments, or character. First stubbornly resistant, then puzzled, and finally humbled by the popular mood, Elizabeth at last does the right thing by the woman whom savvy Prime Minister Tony Blair calls "The People's Princess."

The movie shows Diana only in newsreels. Although she's no longer a Royal, she becomes something more--a beloved cultural celebrity who kisses lepers, winks at her mobs of fans, and hangs out with the likes of Steven Spielberg, Luciano Pavarotti, and Elton John, an impressive lineup of celebrities whom her ex-father-in-law, Philip, dismisses as "movie stars, hairdressers, and homosexuals."

The film shows the surviving members of the royal family sitting around in stately, elegant, flower-filled rooms of impeccable upper-class taste, and talking with one another (and with Tony Blair on the telephone) as the crisis surrounding the basic legitimacy of the monarchy escalates. Bewildered and mother-fixated, Charles feels picked on as he must face the grief of his sons, who adored and (unlike himself, the movie suggests) were adored by their own mother.

Hard-assed, boneheaded Prince Philip always takes a macho line, which his sensible royal wife always dismisses. The Queen Mum downs her gin, awaits her own funeral, and recalls the good old days when backbone and a stiff-upper-lip got the adored royal family through the war years.

The focus of the film is the rapprochement between the queen, who's accustomed to looking to antecedents for answers, and Blair, the Labor Party prime minister, who feels the winds of change and reads the faces of the people looking to him to lead. While his outspoken wife back at 10 Downing Street has no patience with the tradition-bound royals, Blair catches on to their strength and the cohesive power of tradition. He delicately leads the queen and she, a trained leader, lets him. Without changing her sentiments, she gracefully bows to the power of celebrity-love and the wishes of her people. She does what she must do: inspects the flowers, reads the cards, and lowers the flag, with her four princes in tow.

Helen (The Madness of King George, Gosford Park) Mirren is, indisputably, Elizabeth II, in all her plainness and all her dignity and all her imposing self-control. It's not only a brilliant impersonation, but far more: Mirren takes us inside the queen, a former ambulance driver and mechanic, and a much more full and resourceful human being than her stiff carriage and monotone vocal delivery reveals on television. Mirren brings her alive in scarf, tweeds, and boots, bustling around her country estates, driving her Range Rover, walking her dogs, and once deeply moved to encounter a 14-point elk of imposing majesty, doomed, like Diana, to be stalked to death.

Blair (played by toothy lookalike Michael Sheen) comes to understand that the monarchy is about traditions and role models that pull the people together. The film's climax arrives when Elizabeth can finally feel Diana's grandeur and heart, and honor it before the nation without sacrificing her own dignity. At that moment, the queen is able to join her own constancy and stability with the compassion and style of Diana.

The Queen was directed by Stephen Frears, who specializes in films like The Grifters, Dangerous Liaisons,and High Fidelity that focus compassion on the most unsavory or unsympathetic of characters. Here, he helps us warm up to Her Stodginess the Queen.

The Queen is a provocative, witty, at times hilarious, and totally satisfying film. Mirren and Sheen are utterly convincing. Blair, a man of the moment and above all a man of the people, sees his job as showing the Royal Family their people, and thus "saving them from themselves." Her Steadiness, the queen, seems to get it: before a leader can lead, he or she must first learn to respond to the feelings and wishes of the people--something Idi Amin and Marie Antoinette catastrophically failed to do. Her Majesty Queen Elizabeth II, a woman with virtually no legal power, is the only one of the three to prove herself a genuine leader.

Frank Pittman, M.D., is a contributing editor to the Psychotherapy Networker and is in private practice.