I’m in a very loving and healthy relationship with a divorced father of a 5-year-old. I feel we are deeply in love and we plan to marry, however, when he has his son I feel like nothing more than an outsider. Although he is very fond of me, I can’t help but be overcome with jealousy at the attention my boyfriend gives him and I distance myself in order to hide my feelings. I end up feeling isolated and alone which ends with tears if he asks me what’s wrong. I’ve tried to separate my feelings from reality, because his son deserves his attention and time. I see him light up when his kid’s around, but it’s hard for me to understand their relationship since my own father is a deadbeat and I’ve been dealing with abandonment issues my entire life. I don’t want him to feel guilty because he’s such a great dad and misses his kid and I don’t want his son to feel that I’m indifferent to him and ignore him, but I can’t help but feel like the jealous older sister. My goal is to remove myself from these emotions and learn to appreciate our unique family blend.

Don’t feel guilty for your thoughts or feelings, particularly when your actions don’t reflect those feelings. You can feel wrong as long as you do right.

And you must be doing a good job with managing your bad feelings, because, regardless of how jealous or bummed you feel when you behold your fiancé’s warm father-son relationship, you’ve done a great job of keeping them to yourself. You’ve succeeded in protecting your most important relationships from the negativity.

One definition of professionalism is behaving in a benevolent, job-oriented way without letting negative feelings show or interfere. You’re obviously a pro, particularly since you’re doing it while managing a shitload of pain.

You’re entitled to ask yourself whether you can put up with the painful feelings, and keep yourself under pretty good control, once you’re married. A better way to put that question is, are the advantages of the relationship worth it, assuming that your control is good enough. My guess is that it is, and it is.

There’s also the possibility that, after enough time goes by, your painful feelings will ease up, particularly if you and your fiance’s son have a chance to hang out and develop your own relationship, creating your own unique bond so you have nothing to be jealous of.

What you don’t want to happen is to let your disgust at your negative feelings destroy your confidence or make you feel guilty. If you feel you’ve got to purge yourself of those ugly feelings, or confess them, you’ll make them worse.

Forget the exorcism then; you’ve got a demon, but disowning her entirely will only increase her power to terrorize you. You came by her honestly, you’ve done a good job of stopping her from running your life, and accepting her will let you re-affirm your solid self-control.

If your fiancé asks why you sometimes seem unhappy, tell him a positive version of the truth; that, because of your background, you sometimes feel painfully needy, plus he’s much nicer than anyone you knew growing up. You’re also confident that the feeling will pass because you love them both so much.

As you settle into your new life and new family, the feelings will settle as well.

STATEMENT:
“Sometimes I feel like a motherless child, which is to say hollow and mean, but I keep this problem to myself and, as a result, I’ve got a great fiancé. I expect to feel needier in some ways as we get closer, but it’s worth it, and I think we’ll be OK.”

I’ve got an evil father-in-law who is always ready to say something nasty about me, and my wife never really supports me. Right after I set up a rule or schedule for our family, my father-in-law will go out of his way to defy it, and then ask my wife to bring our daughter over for a visit. Instead of standing with me and telling her father that he has to respect our rules and that I’m a part of the package, she goes over there by herself and acts as if nothing happened. I wonder if I’ll ever be able to trust my wife again and, if that’s the case, I don’t see how we can stay married. My goal is to do my best to get her to see what her father is doing.

It’s infuriating, when you’re trying to manage a family, to have someone sabotage your arrangements and make you look like a dictator instead of a parent and husband. Still, it happens, and it’s hard to stop, even when your partner is in total agreement with your every move.

On the other hand, many of your not-so-distant, not-so-wealthy ancestors may have had to live together in close quarters and couldn’t escape. As a result, they probably checked out their in-laws very carefully before deciding to marry, because they knew, once things got started, they were stuck.

If you can bear the humiliation for a minute, stop and consider what’s best for you. Put aside your fury at your wishy-washy wife and meddling father-in-law and ask yourself whether she’s a good partner in other ways—as mother, manager of time and money, and loyal companion (in every non-paternal relationship).

No, this is not an attempt to change your feelings for her; it’s to get you to think about whether getting rid of the feeling of betrayal will be worth the loss of her partnership and the impact of divorce on your daughter, which will push her into your father-in-law’s arms. Your feelings are about betrayal, but if you let them run loose, you may expose yourself to a much greater betrayal with more dire consequences.

If, feelings aside, you believe you’ll have a better life and stronger influence on your daughter by avoiding divorce, then ask yourself whether you can learn to live with anger and bitter mistrust while keeping your feelings to yourself. It’s possible (see case above), but admittedly difficult. If you decide to go that route, seek coaching and a good support group.

If you can’t imagine living with those feelings within a marriage, then you can’t, but don’t expect divorce to provide you with rapid relief. On the other hand, if you stay married, you’ll probably have many opportunities to run the family circus, just not all the time and not with your wife’s full cooperation/compliance.

Your goal, if you choose the trial of living with your Judas wife, won’t be to regain a feeling of marital comfort and trust, but to learn how to live without those feelings, knowing that, on some rational level, the value of your wife’s strengths as a partner outweighs the pain that your father-in-law has stirred up. If you want to remain a full-time parent and husband, you don’t have a choice.

STATEMENT:
“I’ll never feel that I can fully control my household or trust my wife until my father-in-law is dead. Nevertheless, she and I are a good team and my ability to keep our daughter from over-bonding with her grandpa is better if I’m around full-time rather than during visitation only, so I’ll try to stay married and set quiet limits on an intrusion I can’t always control.

I wish my boyfriend wasn’t so critical about the money I spend on clothes. Couples therapy helped me understand that growing up poor left him with deep insecurity about money (he still doesn’t make much compared to me, though he’s a hard worker). What therapy hasn’t done, however, is stop him from giving me a hard time about every sweater I buy, even though I’ve got good savings, no debt, and a total willingness to carry more than my share of expenses. If we get married, I’m sure his criticism will get worse and I don’t think I can stand it. My goal is to get him to back off, so we can have a life together.

The potentially bad side of couples’ therapy, as readers of this blog know, is that it can encourage a person’s tendency to take unlimited responsibility for getting through to their spouse. Like food, booze, or anything you enjoy, communication should be enjoyed in moderation.

After all, you’re supposed get a break from that responsibility once you’re sure you’ve done the right thing, but couples’ therapy can make you into a share-aholic who can never rest until togetherness has been restored.

Discussions that could be settled in hours are instead plumbed for weeks, accomplishing nothing positive (unless you’re the therapist, who’s putting every hour of your bullshit towards his/her mortgage).

In other words, if you give proper attention and respect to your partner’s objections, continue to believe you’ve done the right thing, and offer a respectful response, you shouldn’t have to talk about the issue any more, even if he remains unhappy and angry about it. It’s unfortunate that his childhood was poor. You can still buy shoes.

If you feel obliged to keep on explaining and defending yourself because of his feelings, you’re making yourself responsible for something over which you have no control. Of course, you wish he could feel better about your spending decisions, but if you make yourself responsible for changing his mind or doing whatever else is necessary to ease his unhappiness, you’ve downgraded the importance of your own moral compass, and that’s dangerous. It’s not good for either one of you, and it could ruin your relationship.

You’ve already decided that your fashion budget isn’t a sin. You’ve given the higher priorities their due, including saving for the future, doing your share with your partner, and, I assume, giving to charity. If you’ve passed your own ethics test, you shouldn’t have to feel guilty about enjoying your money; as you’ve suspected, facing regular budgetary non-acceptance from a spouse isn’t good for a marriage.

So forget about his feelings about your money and your feelings about his feelings. Let him know you believe your budget is morally justified, and you don’t want to hear about it. You aren’t expecting his feelings to change; you don’t want to be punished by them or hear about them anymore.

For both of your sakes, you hope he can shut up, regardless of how he feels. You’ve given up on the hope that he can feel great about your money; but, if he can keep his feelings to himself, you may have a good working partnership. You’ll know what the future holds by observing how he acts, and then you can reward yourself for doing the right thing with some new boots.

STATEMENT:
“My guilty pleasures feel a lot guiltier when I see them reflected in my boyfriend’s low-budget eyes, but our relationship won’t work if I have to apologize for good, responsible spending habits. I don’t want our partnership controlled by his feelings (particularly since I don’t think he has control over them himself). I’ll stand by what I believe, and let him know that his feelings are his responsibility to manage.”

People see me as successful because I’m a well-regarded doctor who makes a good income for doing interesting work, but I’ve really lost interest in it myself and feel like I’m going through the motions. To my mind, I’ve become like Richard Corey in the poem, who kills himself because of the gap between how he feels and the way people respect his appearance. I’m not doing a bad job, but I feel like a failure because, in spite of all the hard work and good income, I just don’t care, and every day I go to work and have to pretend that I do. My goal is to figure out where I went wrong.

Your letter is a good example of how dangerous depression can be when negative thinking burrows into your system of beliefs. Indeed, your words are the very weapons your depression is using against you. They’ve already beaten you into thinking you’re a failure, so stop them before they do any more harm.

If you judged yourself objectively, you would see a man doing good work and helping people. You wouldn’t hold him responsible for feeling happy; after all, life routinely destroys the happiness of good people who are well insured. Depression is just one of the many, many totally uncontrollable ways that life can do that. You would never be so cruel as to suggest that a suffering, unlucky friend was therefore leading a meaningless life.

Take inventory if you like, but as long as you’re making a living, taking care of yourself, providing good service, and helping people, you’ve got lots to be proud of. Nothing has changed except your feelings, and they can be ignored.

Once you pay more attention to your values than your feelings, you’re ready to protect yourself from insidious allegations of failure. The only thing that has failed is the happiness carburetor in your brain.

While we can’t (and wouldn’t) assure you that medication or any other kind of therapy will restore your happiness—it might, but it might not, because treatment is uncertain and no one controls happiness—my message is that your happiness is unimportant, at least in comparison to your pride. You have a right to respect yourself. Defend your self-respect, and your unhappiness is just another source of pain. It’s bad, but it isn’t you.

Once you see your unhappiness as nothing other than a form of pain, rather than personal failure, you’ll deal with it more effectively. You won’t give up on the good activities and people you formerly liked because they now leave you cold. You’ll let others know that you continue to care about them even if you don’t feel particularly caring at the moment, and that you appreciate their interest and concern. You’ll spend less time alone reading poetry, and eventually, you won’t notice the pain as much.

STATEMENT:
“It drives me crazy the way everyone sees me as the picture of success when I feel like a total loser, but I know I’m not a loser and feeling this way is just part of the pain of depression. I won’t buy the idea that I feel this way because I’ve made mistakes or bad decisions. I’ll respect myself for doing a good job and putting on a professional smile when I really feel like shit.”

My 15-year-old son needs treatment for his irritability. He gets unbelievably angry over small things, to the point that he ups and goes to his room. He agrees that things are basically OK and he’s sorry afterwards, but it happens at least once a week. We have a happy home and he has friends in school and gets good grades. I think it’s his mood that’s the problem and it causes him and our family a lot of pain. My goal is to figure out how to get him some help with psychotherapy and/or medication.

Just because someone’s in pain doesn’t mean he needs help. Pain is just part of the complete life package, along with joy, hunger, death, etc.

Of course, you’ve got less to lose and more to gain from treatment if his irritability has caused bruised knuckles, broken sheetrock, and a growing familiarity with your local police. Pain is a normal part of life, but serving life in prison isn’t.

What you’re saying, however, is that, aside from his verbal explosions, he remains in physical control, does self-motivated time-outs, retains good relationships, and has no trouble focusing on work and getting it done. No pill could improve upon that.

So, if he’s handling his pain well, getting things done, and engaging in life, then making him get treatment for his irritability may make a bigger deal of his problem without necessarily providing relief. It’s a sad fact, but neither talk therapy nor psychiatric medication reliably improves irritability—just sometimes and more often than placebo.

It’s always possible that his irritability foreshadows a mood disorder that will eventually get worse and might be prevented or disarmed by beginning medication early. The trouble is, we have no way of telling whether he’s at high risk, and the medication has risks of its own, as well as being costly. The risks from antidepressants aren’t great, as far as we know, but there’s always the risk of what we don’t know because our tools for examining the long-term effects of medication on the brain are limited. If you try an antidepressant, ask yourself whether it’s helpful enough to be worth that risk.

As for most mood stabilizers, like Lithium, Depakote, and Abilify, the risk is much higher than for antidepressants (although you wouldn’t think so if you didn’t listen carefully to the end of Abilify commercials). Sometimes, pain treatment is worse than pain, and shouldn’t be considered without a careful assessment of the risk and rewards. From what you’ve said, the risks of most mood stabilizers dwarf the rewards by a mile.

Psychotherapy can be harmful if his shrink doesn’t accept the fact that treatment has limits. Find someone who can accept the possibility that your son’s irritable outbursts are unavoidable and coach him on managing them if they can’t be cured—though, clearly, your son is already a good manager himself.

In the end, the decision is yours, and various treatments might be helpful. If you accept the possibility, however, that treatment for painful conditions is not always better than no treatment, then you will weigh risk against benefit, regardless of how you feel, and make a good decision. After all, it’s risky to overestimate the power of medication and treatment, but it’s riskier to underestimate your son.

STATEMENT:
“It breaks my heart to watch my son have a meltdown and I’m terrified of what can happen to a teenage boy with an anger problem. I know he’s a good kid, however, and he’s showed an amazing ability to keep it together socially and academically. If a treatment seems to help him and be worth the risk, I’ll support it. If it doesn’t, I’ll support the many good ways he’s dealing with his temper and help him develop even stronger anger-management skills.”

My son is a nice kid, but his ADD makes him completely irresponsible. He seems motivated about getting his college degree, but, even when he takes his medication, he always comes late to lectures, leaves assignments to the last minute, and doesn’t get problem sets finished. He was asked to take a semester off because his grades slipped and he seemed out of control. Now that he’s back at home, he pays no attention to his bank balance and has bounced a lot of checks. When I confront him, he’s sincerely apologetic, but then he does the same thing the next day. I just wish I could get him to stop lying and care about what he’s doing.

If you can’t help someone with love and medication (see above), it’s normal to assume that he doesn’t really want to get better and your goal is to find the key to motivate him. The trouble is, some people who are motivated (and medicated) are nevertheless unable to perform.

They feel ashamed, apologize, avoid, feel more ashamed, and so on. They seem sleazy and unmotivated. The problem is that, if you treat them as if they’re sleazy and unmotivated, you make them worse.

The sad fact here is that medication can usually sharpen attention and make learning easier, but it can’t correct the executive function problems that make it hard for many people with ADD (and others) to get things done and deal with unpleasant priorities. Yes, you need character and willpower, but you also need some help from your brain, and some brains are too “in the moment” to be pushed into planned, prioritized activities, even when the will is willing and the attention razor sharp.

In that case, your goal isn’t to get your son to stop lying—he’s not purposefully dishonest, just permanently flakey—but to disarm his shame while helping him face the full extent of his disability. Forget about his lying, insincerity and apologies. Make it clear you’re not interested in the merry-go-round of avoidance and remorse and instead want to examine the power of whatever makes him fuck up in spite of the fact that he doesn’t really want to. That said, your goal is to help him find ways to manage himself.

Don’t let him present himself as a bad guy who could do better if he’d just try harder, because the evidence says otherwise. In reality, he’s a good guy with a permanent impairment, and it will take him a lot of work to get a handle on it.

Ask him if he’d like a wake-up call in the morning, or whether he should compose a daily log of his lateness to see when it’s better or worse and whether it’s responding to interventions, including medication changes. The more you talk about his lack of control as a fact, the more you challenge the shame that reinforces avoidance. Too bad he’s fucked, but there’s lots to be done. Most of us have weaknesses we have to work hard to manage, but most involve food and don’t involve bank fees.

Once you limit his responsibility and yours for what he doesn’t control, you’re free to bear down on the one part that he does have some power over. You don’t expect him to change his disability or understand why he has it—it is what it is—but you’re confident he can work on managing it, and that, with hard work and discipline, he can gain the control he needs and lose the shame that’s holding him back.

STATEMENT:
“It’s hard to watch my son’s overly sincere apology for behavior that cost us half a year’s tuition, knowing that, if he hadn’t lied about what was happening, we could have helped him, and that he’ll do the same thing again. Nevertheless, he wants good things for himself and has a legitimate problem that is worse than a poor attention span. I will talk to him about the good things he can do with a bad problem, and urge him to seek coaching rather than moral reform or absolution.”

I think my girlfriend is basically committed to me (after 4 years of our having a steady relationship, despite living in different cities). After much backing-and-filling and hemming-and-hawing, she introduced me to her 3 kids and her ex. The problem, I think, is that her ex-husband is an evil drama-monster who bludgeoned her with tantrums, legal threats, and ultimatums until she would do anything to appease him. It makes her a total wuss with the kids and interferes with her availability for our relationship. That makes me push her sometimes, which makes her jump like she’s been scalded and trapped between two powerful, demanding masters. I don’t think she’s into dominant men any more (at least, I don’t see myself as one), but my goal is to help her resist her evil ex without making her feel she’s doing it to appease me.

No matter how nice your girlfriend is, if she’s over-reactive to an evil ex, you can find yourself getting irritated, worried, and sometimes outraged. You’re sorry she has trouble setting limits with the guy, but you sure don’t want him to control your life.

If she doesn’t learn how to manage him and the feelings he stirs up in her, however, that’s what will happen, and your relationship will be riddled with the drama you’re both trying to avoid (and also become very crowded).

That doesn’t mean, of course, that she loves him more than you; he just has the power to make her more frightened or guilty than you do, because he isn’t as “nice”, and she doesn’t know what to do with those feelings other than appease him.

Of course, that may tempt you to fight back by showing her that you’re just as good at making her feel bad, which would turn you into a chair-slinger in someone else’s soap opera (as well as something of a jerk), and it’s clear you’re not letting that happen. That doesn’t mean you’re doomed to a relationship with him if you want a relationship with her.

Your best weapon is the same one we use as shrinks (and the one you seem to be using now); coach her to see a better, though not comfortable, alternative, urging her to use a lawyer to figure out when she can say “no” and what to say to her ex and kids if they attack her for being mean or unreasonable. Support her in doing what she believes is right and what will work out better, rather than in doing what will make you happy or her less stressed. Odds are, if an action is right and reasonable, it’s guaranteed to make her ex pounce.

Continue to offer her your positive perspective; she’s a good woman who has done her job as a mother and can do a better job by learning to say no. In doing so, her best therapist is her lawyer (used not for venting feelings, but for information about standards and consequences).

If she can’t make progress with that approach, then the package is what it is, and you’ll need to take it or leave it. What seems to be happening, however, is that she’s getting tougher, in part because you know how to keep a lid on your negative feelings while giving good advice. Her ex puts a burden on your life, but he doesn’t control it, and he doesn’t have to ruin the life you and your girlfriend share.

STATEMENT:
“My girlfriend’s wussiness about her ex drives me crazy, but I know she’s a good, responsible person who’s come a long way in learning how to take a stand. It’s been frustrating, and often feels like work, but I’ve done a good job managing my anger, she’s doing better at managing her fear, and we both continue to feel the relationship is worth it.”

My ex-husband has the divorce court judge in his pocket and it’s driving me crazy. Regardless of our divorce agreement, he takes me back to court every year for additional money for our daughter’s residential treatment (she has as addiction problems), and the judge buys his story in spite of its being full of lies and bullshit. He says I have money I don’t have—I can no longer afford a lawyer. He wants me to pay for a fancy, private facility that won’t take our insurance when there’s a good one in our insurance company’s network. As a recovering alcoholic myself, I want my daughter to get treatment as much as my husband does, but what I really want is for that judge to know how wrong he is to think I’m a skinflint and allow my ex to torture me year after year.

Unless you grew up with parents who were always fair and unbiased, you know there’s a real danger in expecting justice. The more justified you are in feeling screwed by the judge/parent, the bigger the danger.

Yes, you’d hope that expressions of injured innocence would get him/her to reconsider and, in a fair world, that’s what would happen. In this world, however, expressing negative feelings about a judge’s judgment usually makes the judge feel attacked and insecure, particularly if you’re angry and right. Not only does justice does not ensue, your hole gets deeper, as does your injury, anger, and tendency to make more trouble for yourself.

If your ex-husband is an Asshole (readers of this blog understand that I use this term diagnostically, and not pejoratively), he truly believes he’s a righteous defender of the weak, so it’s not hard to see why a judge who doesn’t know him would be taken in. If you then attack him, you’ll look like the angry girl your ex says you are.

So put the same lid on venting outrage as you do on alcohol; stay sober, and stay quiet. Remember, keeping negative feelings inside is not nearly as bad as letting them out in front of the wrong audience.

Now that you’re ready to eat your shit sandwich—cry if you must, but please don’t bring it up again—you’re ready to say something positive about your own plan for your daughter. Namely, that you want her to get help as much as your ex does, but you expect her to need help for a long time and you’re trying to save money now, because she’ll need it later. That’s why you’re trying to save on legal bills and don’t want to pay for the best intervention program when the difference between best and good is not worth it.

Don’t get distracted by the judge’s willingness to believe you’re a bad, stingy parent and don’t defend yourself by attacking his judgment or the unfairness of being dragged back into court. Stay on message: talk about your concern for your daughter and your belief in the advantages of your plan.

Given time and no attacks from you, the judge will probably catch on to your Asshole husband’s bullshit, particularly if you stick to your agenda and don’t push his buttons. You might not get perfect justice, but you’ll get a good feeling of pride for having expressed yourself as a caring mother, without getting screwed by him and your old negative feelings.

STATEMENT:
“It’s horrible to feel I can be dragged back into court at any time, to be judged by someone who believes I’m an asshole no matter what I say or do, but that’s life. I know I’m ready to do right by my daughter and that I’ve got a good plan. Beyond that, I don’t control.”

My ex-wife became the victim from hell after our divorce, which she and the kids blamed on my messing around with another woman. The truth is, I’d been eager to get divorced for the past 10 years, particularly because my ex was so good at messing up and then acting like a victim. I didn’t have that or any affair until I had almost put the divorce in motion and the youngest was about ready for college, and my not-mistress has subsequently become my wife. I felt guilty, however, and the kids see me as guilty, so they punish me with silence, or worse, extend an invitation to have a talk so they can hit me with a blast of endless recrimination before returning to silence again. Needless to say, explaining doesn’t help—their anger is endless—so when they call me up, I wonder what to say. My goal is to help them with their pain and restore a normal relationship.

Most good people feel guilty about leaving a marriage, whether or not they’ve done anything wrong. Guilt the emotion, as opposed to guilt the legal state, is never necessarily caused by bad behavior.

You feel guilty because those you love are hurt and disappointed, and happen to blame you. Given the fact that one of the most important reasons that people marry—perhaps the most important—is to have someone to blame, guilt is an unavoidable part of both marriage and divorce that should never, ever be considered proof of criminality.

As natural as your guilt is, it’s dangerous to let it guide you when you’re managing seriously angry kids (or adults, especially when they’re acting like kids). It’s like showing fear to a tiger, or blood to a vampire, or low-hanging comedic fruit to Ricky Gervais. They’ll just keep coming.

Your first job is not to respond to the kids before you’ve decided for yourself whether you’re guilty, and what for. Begin by listing your standards, which should probably include trying hard to make marriage work, giving priority to the needs of the kids, and behaving well in a difficult situation.

They should probably not include being happy or keeping your family happy, because life is often unavoidably unhappy, and looking for marriage to make you happy, though nice when it does happen, is ridiculous.

The question is how dysfunctional your wife’s behavior was and how badly it affected your partnership, as well as your mood and behavior. My guess, from what you say, is that you tried hard, put great importance on raising the kids, but found yourself hating your marriage. If you believe that’s reasonable grounds for divorce (if you were judging a friend), then it’s time to stop apologizing. If not, then figure out what you did wrong (excluding everything that you didn’t control), apologize, and then don’t apologize anymore.

Once you’ve prepared your statement (see sample below), you’re ready to draw the line on receiving punishment you don’t deserve. You and the kids deserve a better relationship, and from your point of view, their anger is the main obstacle. You hope they can stop it, and the first step is allowing yourself to stop feeling perpetually guilty for doing what you believe was necessary.

STATEMENT:
“I feel like I failed my first marriage since I’m the one who was unhappy and broke it up, and my kids blame me. After thinking it through, I see my responsibility as limited. If this response doesn’t satisfy the kids, I’m sorry, but I’ve heard their views and accepted their feelings and it’s no good for negative conversations to continue indefinitely. I love them and believe we can have a positive relationship, if and when they’re ready.”

The main thing wrong with my marriage is that we lost the incredible love and closeness we had for the first few years, and a major reason is that my husband keeps his distance. No, I don’t think he’s having affairs, and we still get along very well as partners and parents, but he says he just hasn’t felt comfortable with me since I went through a depressed, nasty period, so he avoids kissing and sex. I’ve told him I can’t go on like this, but I’m not going to beg for sex if he’s not going to give it to me. I don’t mention it most of the time, but it hurts. My goal is to figure out how to get the old love back or decide whether the current situation is good enough for me to want to stay married.

The trouble with mixing sex and love in a marriage is that sexual withholding feels like a loss of love, and a loss of love causes deep pain, which causes sexual withholding, and around it goes, flushed down the marital toilet.

If you think sex might bridge the gulf between you, then don’t request it as evidence of his love, or as satisfaction of your needs. To do so is to make the issue more wrought, personal and emotionally explosive. Of course you have those feelings, but expressing them won’t clear them up—it will make them worse.

Instead, propose sex as an activity that might reduce the distance between you by having a positive effect on your emotions. Now that your nasty period is over, you’re confident it will be a good experience, and, if repeated, it might build trust, as well as reducing an issue between you. As long as you don’t emotionalize sex in terms of love and intimacy, you reduce the risk of failure. Market it as nerve tonic, not as proof of his dedication or your personal worth.

If he doesn’t respond, then you know you haven’t scared him away; he’s simply stuck. You haven’t let your hurt feelings make you passive; you’ve done what you can, and your actions haven’t added to your pain by expressing it.

I assume you’ve apologized for the past (see above) to the extent that you could have controlled your nasty behavior, so it’s time to stop apologizing. Propose a better way forward and see if your husband can join you. Having sex, if he can do it, is a way of putting negative feelings to one side. The love issue will have to wait.

STATEMENT:
“The lack of a sex life leaves me feeling guilty, sad, and punished, as well as horny and needy, but I know I’ve been a good partner for a long time and don’t deserve punishment. I believe it would help my husband, and our relationship, if he could put a lid on his anxieties and just do it. It’s his job to try. What he does with it will tell me whether he can.”

While most mental health clinicians would feel guilty admitting this, I’ve been in the biz for long enough that I don’t give a shit and I need to vent. Most of the crisis calls I get from my psychotherapy practice are senseless and irritating; they’re from patients who feel bad because they forgot to take their medications, or drank too much or when they shouldn’t, or allowed their demons to wreak vengeance on their enemies, the nearer the better, self best of all. A few call me because they’re feeling suicidal (but won’t go to the hospital) and just want me to make them feel better, which is hard when it’s late and I’m tired, and often impossible just because I don’t have that kind of power. I try to be civil, but their calls leave me feeling helpless and wondering whether I’m doing any good. Discussing their responsibility for their behavior is useless, because it usually makes them mad or apologetic. My goal is to figure out what to do with crisis calls that are really a useless pain in the ass.

Many crisis calls you receive as a shrink do a good job of showing off a patient’s worst behavior. It’s like having partial custody of a colicky child.

It’s not that their distress isn’t real and severe—it is, almost always—it’s that it causes self-defeating behavior, like drinking or mouthing off or retreating from the world, which creates a jam that is extra hard to get out of.

Bad feelings cause bad behavior, bad listening skills and bad regrets about going into the therapy business instead of owning a Toyota dealership.

You’re right to wonder whether your response to crisis calls is helpful. Whether you realize it or not—and you seem to realize it—your words sound moralistic and angry, though for good reason. The more you care about your patients’ welfare, the more upset you get about what they’re doing to themselves and how it undoes all those good talks (and/or medications) that seemed to help. As you say, their negative feelings become contagious as you wrestle with your own fatigue, doubts, and fears about more calls to come.

Unfortunately, a moralistic tone usually makes people who’ve messed up feel more messed up. You judge them as having made bad choices, whereas they experience a rush of emotions and habits that sweep all choice away. Your intentions are good, but labeling your bad-behaving patients as irresponsible bad-choosers will usually make them feel like losers talking to their dads.

The good side is that you’ve given them a focus for their anger and disappointment that isn’t themselves. The bad side is that you may get an honorable mention in a suicide note.

If you truly believe in your observations, however, assure yourself that you’re not responsible for making the crisis caller less destructive. The threat to you isn’t the intrusion on your time, it’s feeling responsible for the mess they’re in, which you’re not. Their mess is out of your control, and theirs. Your only responsibility is to give them good advice and do what you can if they’re not safe.

Tell them what you think they eventually need to be able to tell themselves; it will pass, there are good things to do meanwhile, and they’ll sort out the cleanup when they’re better rested. If they’re not safe, they should take themselves to an emergency room.

Assure them you’ll work with them on increasing their self-control over anything they think they’re doing wrong, but it can’t happen now. Good night and good luck to them, and I hope it felt good for you to vent.

STATEMENT:
“It’s hard to stay calm when I see my patients fucking up their lives and then wanting me to make them feel better during my spare time, but my feelings are just a reflection of their feelings, and don’t have to get in my way. When I can’t help them, it’s too bad, but it doesn’t help to blame them, and we can make good use of the experience later, when we talk during work hours.”

As a therapist, I assume that my strongest weapons are kindness and empathy, but sometimes the process is exhausting and my family does not appreciate the amount of time I spend fielding patient phone calls off-hours. When I get desperate calls at dinnertime or late at night, they interfere with my family life, but I don’t believe in hanging up until my patients feel better. Many have been traumatized and go through terrible periods of emptiness and they need to know that someone cares. My family jokes, somewhat bitterly, that my patients have more access to me than they do. I feel unappreciated, tired, and torn in many directions. At least my patients feel that I care. My goal is to help my family see that I also care about them.

If empathy and kindness were as powerful as some therapists and Christians believe, the world would be a lot better than it is. As your family correctly observes, however, the calls keep coming, there are no cures, and What About Bob is coming down the road.

Ask yourself whether your patients are actually getting better, or just feel better because they’ve found someone nice to take their calls. If they are feeling better, figure out if it’s because they’re better at managing their own crises, or because you’ve confirmed their right to have a nice response whenever they need it. If it’s the latter, heaven help them when you’re not there (and help your family when you are).

It’s good that you’re kind and empathic; that’s why your family and patients like to spend time with you. What’s wrong, however, is that, in over-valuing the therapeutic impact of those qualities, you’re putting too much responsibility on yourself for your patients’ problems (see above). Realistic experience should tell you that kindness doesn’t cure. Neither (see above) does moralistic confrontation.

That is sad, and limits your powers considerably, but it also means you should keep calls short and treat them as evidence of your patients’ need for better self-management. If a patient is willing to try improving his/her self-management, that’s a great focus for treatment and the calls are grist for the mill.

If, on the other hand, a patient can’t see any possibilities for better self-regulation and wants nothing other than better treatment from others, your therapy won’t do any good other than providing him/her with a short-term fix and your family with an empty seat at the table. In that case, Forget Bob and return to the family fold.

STATEMENT:
“It feels right to soothe those who are in despair, and to help them carry their load, but I know that I can’t really carry anyone else’s load and that responding to repeated off-hours calls doesn’t help patients appreciate and make best use of their own resources. Without sacrificing my kindness, I will offer them ideas about how to manage their moments of disorganization and despair, and I will do that most effectively during treatment hours and not at other times.”

I have always had a problem with keeping friendships because of moving too much, anxiety, and some other reasons. Almost every friend that has come into my life seems to be very needy and I tend to become anti-social when this happens. My current best friend has showed many signs of being very clingy and a bit controlling; she buys me things when she knows I am busy just so she can hang out with me, she calls me frequently even though she knows I dislike talking on the phone, she is demanding and apologetic at the same time. I am confused on what to do because she is always there for me and I can’t always be there for her. Lately, I have been having so much negative feelings about her that I don’t want to work on the relationship and this is exactly my problem—I lose people because I let my feelings get in the way. Maybe I am not finding the right people to hang out with? I mean we have so much in common, but that might be the problem because we both have severe anxiety and what we hate about life seems to be all we talk about, so it’s just negative energy most of the time. I will admit I am selfish and should be more thankful that I have someone that understands me and is there for me, but I guess I am too unhappy in my life and unhappy with myself to be appreciative of the goodness in others. It’s something I would like to work on, but I don’t even know where to begin.

Whatever draws people into relationships– neediness, sex, an encyclopedic knowledge of “Law & Order”—it isn’t necessarily good for you. When you’re operating on instinct, you stop thinking.

It sounds like you’ve got a good idea of what’s good for you, and it’s a friendship that discourages whining and encourages breathing room and independence. Nevertheless, you give in to the pull of your instinctive need for needy, whiny friends.

Once you give in, you’re stuck. You like the close attention and some of the intimacy, but you also don’t like the high demands and expectations, so you want to pull away. That leaves you guilty, lonely, and more in need of a needy friend. The shitty friendship cycle remains unbroken.

Instead, get a grip and start to choose friends who are more independent and less fun to complain with. Don’t expect the getting-acquainted process to feel as natural and easy as it usually does, because if it feels too comfortable, you’re probably making the same mistake.

At the same time, discourage your current needy friends from expecting long windy complaint-fests. Keep the conversation positive, don’t share negative feelings, and stick to a schedule. You may be pleasantly surprised to find that needy friends get less sticky when you give them firm boundaries.

Don’t let guilt make you passive or discouraged. It may be impossible to change your relationship preferences, but you can have better relationships if you’re clear about what you want, force yourself to make better choices, and get the kind of friend you really need, not a needy friend.

STATEMENT:
“I feel like I’m a selfish friend who never gives as much as I get and resents the needs of others, but I believe I can do better if I find friends who are less needy. It’s time for me to find such friends, discourage needy behavior in others, and avoid indulging in it myself.”

My closest friend and I usually tell each other everything, and she always seeks my advice before doing something rash and probably dumb (she’s really ADD), and give it to her straight (within reason, and/or as tactfully as possible). The problem is that, when she wants to go forward with a decision she knows is risky (at best, really dumb at worst), I become the bad guy who won’t admit that I really don’t want her to be happy, even though, in reality, I just want what’s best for her. When she got together with her now-husband, I told her the situation was tricky (long-distance, financially rough, etc.), and when she stuck with it and complained to me about the whole thing, it was hard to be totally supportive. After a while, she took my worries about the nature of the relationship as me lying, actually hating her husband, plotting against her happiness, etc. So she didn’t tell me she was eloping hundreds of miles away until the last minute, and when I couldn’t make the arrangements with 10 minutes notice, she thought it was another lie, not a logistical nightmare. When I found out that I was the only person not told she was pregnant, that was the last straw; she said she wanted to talk about it, but her lying to me was so hurtful, unfair, and hypocritical that I didn’t see the point in trying to change her mind anymore, and it’s been months since we’ve talked. My goal is to do the right thing, and while I don’t want to hurt my friend and I miss her, my gut tells me it’s best to just let her live her life and protect myself from being hurt again, since she treats me like an enemy, anyway.

Whenever you find yourself giving a close friend constant coaching about her life, watch out. Intimate advice-giving makes a relationship feel very close and, at times, it may do some good; but you’re playing with fire or, more accurately, all the feelings your friend has towards her parents and everyone else who has given her advice and criticism over the years.

Given that she’s often impulsive (or so you’re implying), she’s probably received more than her share of disapproving advice and is touchy and defensive as hell. She doesn’t think you’re a liar—she thinks you’re her mom.

True, we shrinks give coaching and advice all day every day, but it works best when we keep it brief and business-like and don’t need friendship from the person we’re advising. When we start to care too much, we sound like parents and stir up the same damn hornets’ nest of negative feelings in those we advise.

Imagine, for a moment, removing the “tell each other everything” part of your relationship with your friend and then ask yourself whether the friendship might still be worthwhile. Yes, it would be less satisfying for both of you, but, if she really likes complaining about her life, she should get a dog (that’s my answer for almost everything). If you really like giving advice, become a shrink. Or a manicurist.

When the stinging goes down a bit, firm up your boundaries and see if your relationship becomes more positive. Say whatever honestly positive things you can possibly say about her husband, marriage, and pregnancy. Discount your months of withdrawal in a way that blames no one and signals no danger of confrontations—just wish her well.

Perhaps your performance will salvage the love and good times you’ve shared over the years. If not, you’ll hurt, but you’ll know you did the right thing, and that’s the truth.

STATEMENT:
“I feel unbelievably hurt by my friend’s shutting me out after we’ve been closer than sisters for many years, but I think she did it because we were too close, and not because she wished to hurt me, and there may be a way to build a better relationship. I’ll try to ignore the hurt, build on what was good, and see if a better kind of intimacy can develop.”

Like a lot of artists, I don’t think I’m good at anything else. I’ve been “the arty one” since I can remember, I went to art school on a scholarship, and I’ve gotten illustration work pretty steadily since then. Ever since my last job, however, I’ve started to wonder if I’ve lost it somehow. I got a steady gig in a graphic design department, and at first, I totally got along with my co-workers and we seemed to share a sensibility. Then, for some reason—maybe it’s my age (I was the youngest one), the new department head, an off-the-mark project I completed, I don’t know—the group consensus turned on me and I was treated like an untalented hack for the first time in my life. I’ve never dealt with this before, and I still don’t get it, because the higher-ups were still pleased with my work even if my peers decided it sucked, and I was always nice to everyone. The only thing that did happen was that I started to doubt my ideas more, because every time I’d come up with something I’d immediately think of all the reasons my co-workers would hate it. After a few months of this, I couldn’t take it anymore, so when a college friend told me there was an opening at his work, I jumped on it. The problem is that I still can’t get that negativity and doubt out of my head—maybe I am a hack, after all—and I’m terrified of starting this new job and either not coming up with anything good or not coming up with anything period until eventually I can’t get a job at all. I’m not good at anything else, but what if I’m not good at design anymore, either? My goal is to get my mojo back (or at least get these assholes out of my brain).

One of the curses of being talented, in arts or sports, is that talent becomes the heart of your self-esteem. Talent and ego have a flawed-yet-symbiotic relationship.

It’s particularly true if, like many talented people, you’re actually not so hot at doing other things. It’s as if your talent takes up extra brain-space, crowding out room for the basics and leaving you both gifted and klutzy, brilliant and ADD, hyper-capable and totally incompetent.

Other people might tell you that you’re good at other things, but those other people are wrong; they don’t have or understand an artistic mind. They had to decide on a career, whereas you probably felt like you didn’t have a choice. They also probably have health insurance.

What you’re “good at” is what you and others respect until you come to believe that nothing but hard work stands between you, success, and being a somebody. That’s when ego starts to assume you’ve got control over your artistic career when, in truth, no one controls art.

Even with all the hard work in the world, art is outside of your control. Sooner or later, you’ll perform poorly, perform well but meet an unresponsive audience, and/or get ill, injured, or misunderstood. And that’s when, if you rate yourself by performance, you’ll start to fear failure, and then fear the fear of failure, which is the fear of losing your mojo.

The feelings are awful and there’s no avoiding them. You can sense the rejection and feel your creative juices drying up, like you’ve lost your gift and can’t get it back. Meanwhile, you feel like there’s nothing good you’re good at. Without talent, ego feels like a total failure.

So here’s the hard part for people who want to do well at what they’re good at (and everyone else): develop a deeper set of values. You’ve already got the hard-work ethic for managing the controllable part of your gift—no need for improvement there. Now, learn to respect yourself for dealing with shit, which is just a technical term for that part of life that you don’t control.

Counter those fucked-up feelings with your beliefs; that you’ve done your best, and if you can’t do what you’re good at, you’ll do your best with other things. You’ll try to make a living and be a good friend. You’ll do what matters with what you’ve got.

Remember, what you admire most in others is not their ability to do great things, but to eat shit and still be a good person (unless, of course, you’re one of those shallow people who admire nothing but good performance, and then you don’t really have any friends and you’re probably an entertainment executive). Suck up the pain and remember who you are.

That’s the antidote to losing your mojo: redefining what you value. When you decide that mojo doesn’t matter, it comes back. When you care more about trying and less about results, results improve.

No one can stop the agony of unfulfilled talents, but the real challenge is to bear that pain, remember what you’re here for, and do what you can with what you’ve got until your ego’s healthy enough for talent to return.

That’s not easy to do—it’s a lot harder than being lucky and performing well—but it’s an art in itself, and a much higher achievement.

STATEMENT:
“I’m stuck with excruciating feelings of failure and self-doubt, but I have no doubts about my hard work or my ability to do whatever is necessary when I think it’s worth doing. I have no doubts about my ability to be a good friend. I will not let my feelings touch my self-respect.”

I can’t deny that I’ve had success as a musician—I’m well known in the area—but fashions have changed over the last few years and now gigs are far from plentiful. Financially, though I have a day job, I’m just getting by. I do my best to schmooze and talk up producers, but I’m basically a shy person who’s happiest to be alone, practicing. I know the economy is bad and every performing artist is having a hard time, but I can name at least 3 other musicians of my generation who are doing much better than I am because they’re more energetic and sociable and maybe more talented. I feel like a failure who’s wasted his life and watched his professional reputation ebb away and now I’m facing a sad end in a lonely rooming house. My goal is to turn this situation around.

As noted above, it doesn’t matter whether you’ve proven yourself as an artist; sooner or later, the pursuit of an artistic career exposes you to an unusual amount of shit you don’t control and, when that happens, it feels personal.

Fortunately, you’re too old and well-established to worry about the negative impact of your feelings on your music, and thus on your career, and thus on your music, etc. It’s good not to worry about the losing-your-mojo whirlpool.

It’s not much better, however, to fear that no one cares about your mojo, you’re facing a sad and lonely decline, and you’re sure it’s your own fault, as proven by the fact that your peers are doing better.

That kind of proof, however, is one of the nastier tricks the human mind plays on itself in the name of so-called reason. You know you’ve managed a good career for many years, in spite of a shy temperament, and you’ve never neglected the business side of music-making. You also know that other people’s gifts, both musical and non-, are different than yours. So real logic tells you that the only thing that deserves criticism is your luck.

If you believe in making music, you also know it’s a meaningful thing to do with your life, whether or not it pays. Remind yourself that no artist in his or her right mind expects to get rich and that living with poverty is part of your job description (though one you hope to escape).

Be proud of your choices and the good music that resulted. Keep with your successful formula, playing when you can and paying your bills when you’re able. Don’t doubt that you chose a tough life…and did well with it.

STATEMENT:
“When I’m poor, old, and gig-less, it’s hard not to feel miserable; but music is important, I worked hard at it, and I will not regret past or future sacrifices. Life is hard, but good music is forever.”

I am in the fourth year of a partnership with a great guy—smart, athletic, caring, fair, trustworthy, all of it—but I am bored out of my mind. Although he loves outdoor activities like biking and skiing by day, his only hobby in the evenings is watching TV. I am a musician, artist, craftsperson, not an outdoor whiz, and I feel like I am completely uninspired in this situation. I have talked with him about at least not watching TV every night, and we try for a while, but it always ends up back where we started, with him watching TV, and me in another room reading or doing something somewhat productive, or just giving in and watching with him (I hate TV, wish we didn’t have one). I want to do things together but he is not interested in any of the things that I am interested in. Maybe this is just the most a person can hope for in life and I’m spoiled for wanting more than loyalty and love from someone, but I feel guilty all the time for hiding these thoughts from him. Maybe he would be better off without me, too, you know? Maybe I should let him go so he can find a girl who is really IN LOVE with him.

How much you love someone depends, in part, on the effect of partnership on the necessities of your life, as well as your interests. In your case, however, you don’t seem to see partnership as necessary for the necessities, so the difference between what you two want may be be more than television.

If you’ve been struggling to make ends meet and/or raise kids and someone enters your life who’s decent and willing to share the load, you’re probably going to wind up loving him, even if you don’t love everything you do together.

On the other hand, if you’re a fairly self-sufficient person who doesn’t need a partner in order to have a decent standard of living and raise kids, then there’s no reason to live with anyone who doesn’t ring your bells or leave the couch.

You didn’t mention kids or finances, so I assume you’re kid-less, and, despite being an artist and musician, miraculously not broke. If that’s true, then what do you need this guy for? If you haven’t grown to depend on him after four years of living together, and you’re not eager to have a family, then it’s hard to see him as a better off with you since you don’t really sound better off with him.

Be careful not to get paralyzed by guilt. You can’t control your feelings about him, and what you’re going to do next isn’t about failing or lacking, it’s about evaluating how well the two of you match up and deciding whether that match suits your goals. So add up what life would be without him (the effect on your time, bank account, plans, etc.). You sound as if you’ve done this, but sometimes, feeling guilty can prevent you from doing routine accounting.

If, as you suggest, you can do better without him, don’t feel defensive about letting him go. You both made a good effort to make it work, and you have many good things to say about his character and can be sure he’ll do well with someone else. You’ve just seen many big differences in your interests and activities and have gained a healthy respect for their importance in making a relationship work. Neither of you were stupid to try this relationship, but, despite being a good idea, it was a near miss you can both learn from. You’re doing the right thing for both of you by moving on.

If the pain of breaking up is more his than yours, that’s not as important as the other stuff you evaluated. As a matter of fact, you suspect he may well have an easier time finding his next match than you will.

If this experience has taught you about your needs and you respect what you’ve learned, you’ll become better at screening out your dates and ensuring that you don’t compromise your independence again unless you encounter a more compatible candidate.

If you aren’t happy with someone who’s “perfect” for you, then they probably aren’t. And if you don’t need a someone, period, give them the chance to find someone new (or spend more quality time with the TV).

STATEMENT:
“I wish I could like my boyfriend better and I don’t want to hurt him, but I think I’m better off without him and vice versa. I won’t let fears about negative feelings stop me from doing what’s necessary and remembering that break-ups are part of the learning process.”

Now that I’m 35 and looking around for a wife, I can’t help feeling that I destroyed my future by not marrying my college sweetheart. She’s a terrific person and we had a great relationship, but I wasn’t ready to settle down back then. So I dumped her, she found someone else, and now she’s happily married with kids and I’m a successfully executive who can’t find anyone to compare with her. The women I meet always have something wrong with them and I think my mistake has doomed me to die single and alone.

The biggest danger you face is not dying single, but dying defeated. Well, the biggest danger you face after death itself.

Some good people are single because they aren’t lucky about finding a mate—their lives are too complicated or, for various good reasons, they don’t meet someone who’s both available and on their wavelength—but that doesn’t mean they’re sad, lonely failures. They’re simply dealing with a mixed bag of luck, like everyone else.

As Christ might have said, if he hadn’t been so busy telling parables, what’s important is not whether you find riches or happiness, it’s how you deal with it when you can’t find riches and happiness. And, despite dying penniless, single and alone, he seems to have done alright for himself.

In addition, your negative attitude may be damaging your mate-search technique. While your college relationship taught you that you have a good capacity for friendship and partnership, it’s the timing that was wrong; your personal equipment—the size of your heart, and size is everything—has proven itself. So instead of feeling sad and defeated when you think of your old flame, be proud of your relationship and determined not to give up your independence unless you find someone just as good.

Assess the efficiency of your mate-search. Like any kind of search, it needs to be done efficiently or you’ll wear yourself out and then, see above, feel tired and defeated. That’s often a sign that you’re spending too much time on unsuitable candidates and losing your focus. Ask yourself whether guilt, horniness, or sentimentality are causing you to prolong pseudo-friendships that drain energy, reduce availability, and leave you yearning for solitude. If so, get a coach and learn how to do a good, tight search and a rapid, polite exit.

You can’t make yourself lucky, but you can be sure that there’s nothing wrong with your ability to be a good partner. If you’ve also given yourself the benefit of a good mate-search, you also know you’ve done your best. You may be sad about being single, but it’s not personal and it’s not failure. It’s just life, which, as always, is preferable to the alternative, no matter what your relationship status is when you enter it.

STATEMENT:
“I can’t avoid feeling that I fell off the deck of the love-boat after having been given a choice cabin for two, but I’ve made reasonable choices, I’m a good candidate, and I know what I’m looking for, so I will pursue my search with patience, I will not doubt myself, and I will never give up. “

I was diagnosed with major depressive disorder and anorexia nervosa purging type a few years ago. Both of these issues had pretty much consumed my life during the years leading up to that diagnosis and have continued to be impairing ever since. I started cutting myself two years ago (it has become more frequent this past year), and I’ve had several panic attacks in the past several months. Fortunately, my overwhelming desire to commit suicide has subsided, although I still think of suicide and my death in general fairly often. In addition to my own issues, I have watched my mom slip into a state of psychosis during the past two years, triggered by the death of her father. She has become so depressed, delusional, and violent that my parents separated and sometimes I don’t even feel safe staying in the house with her—a few weeks ago my dad and I had to stop her from going through with a suicide attempt. The police were called, and I had to hold her arms down while she was clearly in a psychotic rage. At one point, she tried to stab my hand to make me let go. She was taken to a mental health facility where she stayed for a week, and now she’s furious at us for making her go there and hasn’t been much better since then. I feel like I never get anywhere with therapists because they just prescribe medicines that make me feel numb to any emotions or focus on my eating disorder so much that I never get to work through these other issues. I feel like my life is unraveling and it’s gotten so bad that, honestly, I don’t feel like I even want to fix it. My goal in telling you this is to figure out a way to help my mom and how to get through school while I’m dealing with this.

It may seem strange to hear this, for someone who suffers as much as you do from depression, anorexia, and the burdens of taking care of a very sick mother, but I think you’re doing an amazing job.

Yes, you’re chin-deep in shit, but you haven’t drowned, and that’s a remarkable accomplishment.

Your depression hasn’t made you hate people or blame them, and your anorexia hasn’t caused you to pretend you’re not sick, so you must have a solid hold on reality. There you are, with all your pain, finding the love to help your mother and the energy to go on with your studies. You’ve got good values and a big soul.

So you feel hopeless because treatment hasn’t done you much good, or, I should say, hasn’t done your symptoms much good. It sucks, but that’s the way it usually is when symptoms are as severe as yours. That doesn’t mean they won’t get better by themselves, or that a better treatment won’t come along. It does mean that, at least for the time being, you’re stuck with heavy-duty pain.

That’s not important, however, or at least not nearly as important as what you’re doing with that pain, which is, as I said, amazing, and there’s treatment that can help you distinguish between you and your symptoms. Any good cognitive treatment will help, whether it comes from a cognitive therapist, a good coach, or a friend with a positive attitude. One treatment that is aimed specifically at helping people with this much pain keep a positive attitude is Dialectic Behavioral Therapy, or DBT.

The inventor of this treatment, Marsha Linehan [link: https://www.nytimes.com/2011/06/23/health/23lives.html], suffered similar symptoms and, like you, managed to stay focused on the value of helping people and improving her own skills. She wound up inventing a kind of treatment that helps others do what she did for herself, and, like you, she found that helping others was a great way to keep her own demons in check.

It’s normal for you to feel that your life is unraveling, but trust me, it isn’t; your pain is a mess, but you’re doing a good job of bearing it and doing good things with it.

You are not your pain; you’re dealing with a lot of shit, but you are anything but. You’re the person who’s managing it while leading a good and meaningful life, and that’s not someone you should give up on.

STATEMENT:
“I may feel like a hopeless, deteriorating mess, but I love my mother and care about my education and I’m doing good things about both. I may not be able to stop my symptoms or save my mother, but life sucks and that’s not a personal failure. I haven’t let my symptoms stop me, however, and that’s why I’m doing well, even if my pain and my mother are doing badly.”

I have a great life and there’s nothing I care about more than my family, so I became really worried when, out of nowhere, I started to have horrible thoughts about murdering my children. I’m too ashamed to tell my husband. I’m not an angry person, and I love my kids and get along well with them, and I’ve never needed a shrink, but the thoughts keep me up at night. If there’s the slightest chance I could hurt my kids, I’ve got to do something about it, but I don’t know what to do. Please help.

Before you get crazy about having crazy, murderous thoughts, check out the risk factors for crazy murders. It’s not hard to do. What you’ll find out is that crazy murderers don’t just have intrusive murderous thoughts; they’re crazy as well.

By that, I mean they’re very detached, or they have strange ideas about their kids that they actually believe in, or they’re hearing voices, or going through extreme mood swings.

Ask yourself whether you fit the picture of people who really run amok. While I don’t know you, of course, my guess is that you don’t fit the picture at all, which means you run the same finite-but-small risk as your average Joe.

Trouble is, everyone who has intrusive, horrible thoughts without other symptoms of craziness is nevertheless terrified of losing control, so reassuring yourself is hard to do. What you want, of course, is total reassurance that the horrible thoughts will go away and that you’ll never, ever lose control; as you say, if there’s the slightest chance that you might hurt your family, you feel obliged to take definitive action. Unfortunately, you can’t. No one controls such thoughts, and trying to control them will just add to your helplessness.

Your goal then isn’t total reassurance or freedom from fear, but reasonable self-control and an ability to go ahead with your life in spite of fear. Assess the real risk you pose to your family and take steps to protect them if you think it’s necessary. Having done that (and realizing that your family is better off with you just the way you are, crazy thoughts and all), learn to bear your fear and go about your business, which isn’t easy to do.

If you want to tell your family about your symptoms, that’s the story you’d tell. You’ve got these crazy thoughts, but you’ve checked on the internet, and probably seen a shrink, and discovered you’re at no particular risk of doing harm, you’re just at risk of suffering from creepy thoughts. Reassure them that you have no intention of letting the crazy thoughts interfere with your normal activities and that, if you thought you were dangerous, you’d do whatever’s necessary to protect them.

As with the woman above, you are not your symptoms; a good mom can have crazy thoughts, and a great mom can carry on despite them.

STATEMENT:
“I feel like I’ve got crazy thoughts and might lose my mind but the truth is that I’ve checked out my symptoms and the part of my mind I’m losing is pretty small and insubstantial (although the process is scary and painful). Whether or not I can make my symptoms go away, I’m competent to manage them, keep everyone safe, and go on with my life, and that’s all I need to do.”