Dear Dr. Rob,

After you wrote this post for men I thought for sure we'd see a follow-up for the female readers, something to help us in our relationships with our boyfriends. And yet, nothing! Do I have to go to Dr. Phil for good advice?

Lynn

Let the word go forth and make no mistake: if anyone here takes Dr. Phil's advice over mine, she will be banned from this website forever, never to return. Banished for life.

A few years ago a large portion of my clientele was women, aged 21-35 or so. Most of them had what seemed to be potentially great relationships with their boyfriends. However, all the women had a common feature: a need for excessive attention from their boyfriends and a constant reassurance of the relationship's stability.

None of these women were narcissists or suffering from Histrionic Personality Disorder (more commonly known as "Drama Queens"). They all hated the idea of being labeled "That Girl," the one who might have a few too many drinks and blow a gasket when their boyfriends didn't call or wanted to spend a night with the guys. And yet that is exactly what they were turning into. Successful women with great jobs, loving friends and goals that ranged from writing books to raising large, healthy families. So why were they needing to be the sole focus of their significant others' world? Why the constant and debilitating anxiety from any signal suggesting a lack of complete and total devotion? Simply put, they were all afraid of loss, and this fear was a huge problem.

The women would come to me seeking ways to lower their anxiety levels, feel less jealous about ex-girlfriends, develop ways to not freak out that their partner didn't say 'I love you' often enough. I will tell you exactly what I told each of them.

There are no magic words, no breathing or muscle relaxation techniques, no amount of drugs (recreational or medicinal) that can take away all of the angst and distress if you insist on making a small number of erroneous and perhaps not entirely conscious assumptions:

1) There is such a thing as a 'guarantee' in relationships or life in general. Read my post on why marriages fail for more on this. Life actually brings just the opposite: a constant series of risks, especially at the romantic level. Just think of the number of dates/hook-ups/boyfriends you and your friends have had over the course of your life. How many of those have ultimately ended? Almost all of them.

2) Men can essentially be put in a bubble, removed from their history and current interactions with the outside world, that they can have a healthy life generated solely by your relationship with them.

3) That you 'can't live without him.'

In other words, unless you embrace the fact that your man has a past and present that doesn't include you, that there's no way to ensure things will be Happily-Ever-After and, perhaps most importantly, that you are not made of glass and would survive if the relationship dissolved, then you've ironically already destroyed the good thing you have. If you can't be comfortable in your own skin - knowing that if you were betrayed or dumped or both, that you'd get up, dust yourself off and move on - then give up on that relationship now. As cliché as it may be, you simply can't ask someone else to tell you that things will be okay if you are unable to do it yourself. There's no way the relationship will work. There's no chance.

The good news is that once you've eliminated the aforementioned assumptions from your mind set, all the 'symptoms' will go away. No more worry, no jealousy, and finally some fucking inner peace. Why? Because you'll know that while it's painful to lose someone important to you, loss is a part of life and that you can be okay with that fact. You can and will move forward, as hard as it may be.

One further piece of good news: men who are interested in meaningful relationships will find this mind set attractive. You'll strangely get so much more out of your relationship if you're fully prepared to lose it.

Easy to say, right? Of course it is, and that's why therapy is actually quite simple. It's not a collection of mind-blowing words of wisdom that you've never heard before. Not at all. But unfortunately it is a process, not an event. You have to take information that you might actually already know and absorb it. It has to transform from an intellectual understanding to a more visceral one. And when that happens, people feel better.

Give these words some thought. Not just 'yeah yeah, I get it' thought. Sit with the three assumptions above and embrace how untrue and maladaptive they are. That will help. Trust me, I'm a doctor. Not a real one, but close enough for the purposes of this discussion.

During my post-doctoral training I was fortunate enough to be educated at a prestigious hospital in upstate New York. My office overlooked an executive golf course and lots of small, rolling hills and greenery. Albeit slightly pretentious, the whole campus smacked of top-shelf, brand name mental health riches.

On the grounds of the hospital were lots of groundhogs who seemed to patrol the campus, almost like sentinels. My fellow students and I called them Land Monsters [1]. We often tried to pet them - despite the potential diseases they carried - but they would never allow us to get too close before scurrying off to safer pastures. But when you saw them from your office chewing on leaves or grass, you felt at peace. Top notch training, a killer office, wild beasts running amok. This is what it's all about.

One day I received a call from a client who was an avid animal lover. Her cat had just been diagnosed with a terminal illness and had only a short time to live. She lived at least an hour away and since I only had a small number of open therapy slots that day it seemed prudent to have a telephone session right then and there.

As we talked about loss, grief and human attachment to pets, I glanced out the window. On the grass was one of the Land Monsters who was whittling about on a twig. In the distance, a bus approached, one that usually carried patients who were receiving partial hospitalization treatment [2]. As my patient was crying, practically wailing into the phone about how she would miss her cat, the Land Monster started to work his way toward the road that twirled its way through the hospital grounds. It crossed my mind at that point that tragedy might ensue but since the driver was too far away to hear me my focus needed to stay on the conversation.

As the client continued and my eyes fixed upon the scene developing outside, the Land Monster moved into the street just as the bus cross his path. Pow! While the driver had attempted to turn at the last second, the Land Monster was struck by however many tons of steel and could barely move away as the bus continued on. It shuddered on the pavement for a few moments, then suddenly lay still. Dead.

I couldn't believe what I had seen and stared out the window, mouth agape. Meanwhile, the client was moaning into the phone about her impending loss. As blood trickled away from the dead Land Monster into the grass - an image that is as fresh in my head today as it was seven years ago- I completely lost focus.

"I'm sorry, I...I can't concentrate right now."

My client and I had worked together for many months and she knew I wouldn't pull some psychological hamstring injury on her for no good reason. "What's wrong," she sniffled into the phone.

Knowing her passion for animals (what she called "critters") I paused. "I don't think I should tell you. Trust me, it's for the best."

"Well, alright," she said. "Can we talk later?"

"Yes yes, I promise. I will call you later this evening and we can talk more."

I'm a huge believer that shrinks need to check their problems at the door when they start working (with the exception of when I reinjure my back because there's just no hiding that pain). That's part of the contact with the client. She is paying me for my time and attention to focus on her problems, not mine. But how do you keep your focus on the client when you are both traumatized at the same time? In this case, you can't. Or at least I couldn't. Normally I would suppress whatever I was feeling for the eight hours or so that I am at the office and deal with things later. But in this case I got off the phone, sat in my chair and rocked back and forth, freaking out that I just watched a small animal get crushed by a bus. I actually considered sucking my thumb or falling to the floor so I could enter the fetal position, but there's only so much drama that's acceptable for one afternoon.

To this day, when I see a groundhog, I feel a sense of grief for his brethren, guilt at bailing out on my client, and anger toward the bus driver for not paying closer fucking attention. I never did tell my client what happened. I just simply apologized for needing to hang up so abruptly. Given her passion for animals and her current state of mind, I think she would have responded even more emotionally than I did.

[1] We actually stole this name from an obscure Simpsons episode in which Homer refers to a groundhog in his presence during his stint in the Garden of Eden.

[2] This is a very intense form of treatment where patients spend the majority of the day at the hospital, engaging in group and individual therapy, then return to their homes in the evening.

A few years ago I performed a weight loss surgery evaluation on a young man, 25 years of age [1]. For reasons that I cannot go into, he was clearly unprepared for the extensive lifestyle changes that were required of him to make the surgery successful. When he was informed that my recommendation would be that he would need to need to get both nutritional and psychological counseling he blew a gasket. He hemmed and hawed, threatened to call the licensing board, promised to have his check for the service canceled, and called me a "dripping gay wad." That seemed like such an infantile and unusual insult for a mid-20's man to throw out so I looked it up. I found nothing.

The next day I got a call from the man's mother. She was equally upset because the surgical team had, in fact, decided to delay surgery. I immediately explained to her the following:

- Because her son was an adult, I was unwilling to go into extensive detail about her son's case. He could explain that information to her himself should he choose to.

- Her son was not disqualified from having the procedure; rather, that he was required to have further counseling to make him a more viable surgical candidate.

- I was not a "dripping gay wad," whatever that meant.

Rather than listening to my points, however, she simply called me a charlatan and accused me of purposely denying her son the chance to have multiple medical problems corrected for my own personal gain [2].

This is where I lost it. What possible motive, by any stretch of the imagination, would I have to temporarily deny a morbidly obese man a surgical procedure that would clearly improve both his health and quality of life? Why, on Earth, would I do such a thing? Because I'm against the procedure in general? If I were anti-surgery I wouldn't be part of a surgical weight loss team. Because I wanted to mandate further sessions with me for financial gain? Hardly. Not only do denied patients rarely come back to see me specifically due to being pissed off, but there are plenty of other Psychologists in this city who are better, cheaper and move conveniently located. Because I get off on making people angry? The man's name wasn't Dr. Steve so wrong again.

So why then? Because I noted things that qualified him as high risk. He was set-up to fail due to psychological factors. If he went forward with the surgery right then and there, as he had planned, the likelihood of success was small. However, if he addressed a few minor points, including spending more time with the dietician, his likely prognosis would be significantly better. At 25 years of age his need for surgery was not imminent and I was told a few more months would not put him at any further medical risk.

I was so irate at her accusation that I got up on the highest horse I could find and told her that she should be thanking me for protecting her son from significant medical risk.

"A good mother would be grateful that I'm not putting him in harm's way," I yelled into the phone.

"Did you just insinuate that I'm a poor parent?" she asked, and I could practically hear her angry breath reaching through the phone to choke me to death.

"I...I'm sorry," I said, suddenly very ashamed.

"Whatever my son called you, he's right. You are a Dripping Way God."

The woman's take prior to the shouting match is an example of mindset that gets us into trouble so much. In the face of problems people far too often say not, what can I do?, but rather who can I blame? Rather than accept what is and work within the framework given, they decided to attribute the problem to me. Some may consider this a form of resolving cognitive dissonance, where a person needs to deal with the distress of holding two contradictory ideas at the same time. I want/need to have the surgery, yet it is not going to happen, at least right now. To get rid of this feeling, I'll blame the Psychologist. But it's really just a rationalization, because taking responsibility is, in all honesty, a pain in the ass. It's often easier to just lay the problem at someone else's feet than to say I'm at fault, perhaps even flawed or defective.

But here's the rub: there is no one to blame. No one is at fault or weak. It is what it is, and if the man did what was asked of him he would have had the surgery. Instead, though, he decided to find another hospital where they would perform the procedure without a psychological consult. That was his prerogative and people seek 2nd opinions all the time. But bypassing the psychologist via another hospital isn't accumulating new opinions, it's ignoring direct advice and assuming you know more. Maybe he got lucky and I was mistaken. We all know that psychology isn't an exact science. Perhaps the surgery was a success, that I'll never know. But had he and his mother simply followed the recommendations given he would have avoided a significant number of potential pitfalls. And he could have done everything asked of him without having to deal with the dripping gay wad again.

[1] Click on that link to read about the specific arguments both for and against weight loss surgery for morbid obesity.

[2] It is well documented that weight loss surgery can treat a number of medical issues simultaneously, such as high blood pressure, high cholesterol, diabetes, sleep apnea, etc.

Before writing group started this week one of the members was discussing her 11-year old son. Specifically she was talking about the changes she's noticed at his age in the areas of verbal and cognitive abilities.

"He's a very smart kid," she said, "much more verbal. But his friend, whom I just recently met, is ridiculously sharp. He's 11 as well but is just incredibly astute and witty. He's like an adult."

I raised my hand. Given that there were only four of us, that was kind of a stupid gesture.

"Yes, Rob?" the woman said.

"Is it possible that your son's friend, given that he's so smart, is perhaps not a child, but rather a very intelligent midget, possibly a pygmy?"

Another woman from the group looked at me with a confused laugh. "I thought that, given you're a shrink, you might say something psychologically insightful. Boy was I mistaken. Do you always think such strange things?"

Sadly, I do.

If you'd like to read more asinine muses such as that one feel free to follow me on Twitter by clicking here. You'll probably regret it and end up deleting me from your account at some point, but you'll never know until you take the plunge.

For those who are interested, Twitter will be the best way to hear quick updates on how the book is coming along.

Hotwheelz and I decided to chew the rag a bit on how we go about writing about difficult topics such as mental illness and physical disabilities. Somehow we just ended up talking about ourselves, however. What I learned though is that this young man is a trooper and has a lot of great things to say. Below is an excerpt, check out the first part of a conversation here:

Dr. Rob: At a young age I developed a knack for poking fun at myself without sacrificing dignity. I was lucky enough to know that I'm inherently flawed in many, many ways, so I thought by acknowledging my imperfections and having fun with them I could take away their potency. Ironically I think it helps my self-esteem. I always grapple with people who are elitists and narcissists because I'm constantly thinking, "everyone, except you of course, knows that you're just as fucked up as the rest of us. Why can't you see that?"

I was standing outside one of the hospitals where I do consulting work, sipping a coffee. After a very long week that included working with two suicidal clients I was secretly hoping my beverage would magically transform into a whiskey. But no luck.

A small boy, three years old at most, started ambling toward me in that zigzag way toddlers walk. I don't think he was coming at me per se, as I'm told I give off a vibe to children that screams STAY AWAY! This is probably true because I'm very much afraid of small children. I can't exactly figure out why this is, although part of me thinks that if I come in contact with one and hold it, I'll end up dropping and breaking it.

The toddler wasn't in any real danger as we were on a secluded street without a lot of traffic. But as the child moved farther from his mother, she began to angrily shout. "You stop! If you don't come back here bad people will get you and hurt you and take you away forever!" The child started crying, turned around, and ran back.

I really wanted to punch the woman in the face. I loathe poor parenting, and this was uneducated child rearing at its worst. Yes, toddlers should not be roaming free along the streets of New York City. Yes, children are kidnapped every day. And yes, sometimes children are very recalcitrant, causing parents to lose their tempers. So what is the problem?

The problem is that scare tactics like hers send an indelible message: fear the world. I touched on this here but it bears repeating. While no one can deny that living in the modern world carries risks, people are unable to live happy lives if they are fearful of every possible negative event. This is why hypochrondriacs (those who constantly believe they are deathly ill) are usually in fine physical condition, yet are miserable almost all of the time, because there's that chance, that ever so slight chance, that they have a life-ending ailment.

After 9/11 I spent a lot of time with parents talking about how to discuss safety with their children. There wasn't a simple answer because none of us had any ideas about the likelihood of another attack, when or where it would occur or in what form. The best statement about the intersection between safety and mental health, however, came from a father who should have been Parent of the Year:

"All of us have a relatively short time on this earth. It could be 100 years or just a few days. So we have to make the most of it. This doesn't mean taking unnecessary risks or treating yourself like you're invincible. It means enjoying your life while recognizing the potential dangers of it. If you can do that you'll more often than not be happy. Don't live with a fear of the world, just a respect for it."

So how does this wisdom translate to the mother with the toddler? She obviously can't tell him that he might drop dead tomorrow. That will terrorize him. She should be saying something like this:

"When we go outside on the big city streets I want you to stay close to me. The city is a great place but there are some things that can hurt us, like speeding cars, so we need to be paying attention. And although most people are very nice, there are some people who are not. Until you are older I want to make sure that you don't get hurt by any of them so please stay next to me while we're out. That way we'll have the most fun possible."

I'm sure there's some mushier, more motherly way of saying that while still getting the point across, but knowing how moms speak to three year-olds is beyond the scope of my expertise.

Instead, this poor kid is being taught that there is a predator every fifty yards who'll chop off his hands and feet if he moves away from his mother. These are the children who turn into anxious adults. They don't ever hear the proper message so they grow up with a twisted one. These people unfortunately end up playing the game of life not to win, but rather simply not to lose.

The next time you see parents using scare tactics on their kids feel free to throw your scalding coffee in their faces. Or, failing that, politely direct them to this post.

A few years ago, a married couple I was working with in therapy got into a heated debate about the use of pornography in their relationship. Contrary to what you might think, it was the woman who enjoyed watching porn on the internet while her husband found it unacceptable. Apparently they would argue about porn's merits, or lack thereof, for hours on end throughout the week.

"What's the big deal? It's just sex. Fun sex! We should watch it together, spruce things up."

"Absolutely not! It's completely unhealthy and I don't want that in our lives."

Over and over, day after day. Ultimately the woman won out, as she simply watched porn when her husband wasn't home. It's not like he could stop her, so he simply tried his best to ignore that the issue existed. This, however, left him feeling bitter and resentful.

We all know that porn is more readily available today than it ever has been. And unless you've been living in a cave since the birth of the internet, you also know that millions of people, both single and in relationships, "use" porn on a regular basis. Good or bad?

The answer lies in the motivation. Like almost every other element of sexuality, pornography can be beneficial to people or serve as a detriment. It can be celebratory and exciting or objectifying and numbing. This is what I attempted to explain to my therapy couple. The problem was that each was so sure of his/her position that neither wanted to hear that the answer was far more nuanced than a simple good or bad.

Using a model of traditional, "regular" porn (e.g., not amateur, not child and completely consentual), what are some of the specific pros and cons of pornography in people's lives and interpersonal relationships [1]?

Benefits

1) Pornography can be used by couples to enhance their sex lives.

As previously discussed on Why Marriages Fail, most species are not designed for monogamy and humans are no different. If we are hardwired to have sex with many different people, one could argue that pornography is an acceptable way to do that without deviating from the relationship (see counterpoint to this below). I've had more than a few couples make statements along the lines of, "we are both attracted to other people but we don't want to be swingers, have an open relationship or betray our partner. Porn helps us to live out these impulses in a safe, mutually agreed upon environment." This is a variant on the defense mechanism known as Sublimation, which involves taking unacceptable impulses and channeling them into more appropriate actions. This, of course, assumes that both partners consent to the notion that watching porn is acceptable. But when they do, many state that it enhances their own sexuality, with some reporting that it gives them new things to try in their sex lives.

2) To some degree, pornography brings fantasies to life.

Sex is just as much about your brain as it is your body (see more on that below). Until the first pornographic films came along, many people's visual fantasies were confined to photos, the written word or perhaps the burlesque house. While little can replace pure imagination, porn can be used to bring sexual elements into people's lives that they might not have the opportunity to experience (unless, perhaps, they are willing to pay for it). Very few people can be rock stars, but porn brings people that much closer to having whatever they desire in the bedroom (or whatever room it is that you tend to do those things).

3) Porn can be considered as simply an aspect of human sexuality.

Philalawyer and I shot the breeze on how sex is awesome. Is watching other people have intercourse an extension of our own sexuality? If it's something to be celebrated and enjoyed, who is to say that consenting adults shouldn't be allowed to experience others engaging in the act, even if they are, in fact, acting? Stereotypically men are sexually aroused by visual material while women benefit more from verbal/spoken stimuli but the reality is that both sexes are fully capable of heightened arousal through watching others have sex [2].

However, as I pointed out to Philalawyer, sex can have enormous psychological ramifications. So if pornography is truly a form of human sexuality it doesn't come without potential pitfalls and consequences.

Detriments

1) Pornography rarely, if ever, demonstrates real intimacy.

This point is most important for late teens and 20-somethings. As I said, complete sexuality involves both your body and mind. Many people, especially those who are new to sex, bypass their brains and emotions for the sexual release. However, this is only a fraction of what sex is about. The most satisfying sex comes from a complete physical and mental experience. Porn does not provide that. In the simplest terms, porn shows people fucking, nothing more. And if you watch closely, a huge percentage of pornography has no kissing in it whatsoever. No one is required to crave emotional intimacy, yet most people do at some point in their lives. Porn will never make achieving that goal easier.

2) Porn can create unrealistic expectations for "real life" partners.

Assuming we aren't talking about amateur porn and/or voyeuristic material, make no mistake: the people you are watching are actors. They are wearing make-up to cover up their flaws, there is flattering lighting for the scene, many have had plastic surgery, they are tanned and often very good-looking. This problem is along the lines of what you see in glamour magazines with colossal amounts of photoshopping, and we know what most celebrities look like without make-up (thank you paparazzi for the one thing you are good for).

The actors in porn, whether they get any enjoyment out of their work or not, are doing just that, acting [3]. The moaning and screaming gives the impression that sex will always be a mountain crumbling, novel and mind-bending experience simply because it's happening. If these are the messages you are carrying into your relationships your partner will inevitably fall short of your expectations. In fact, this failure will probably lead to emotional distance in a relationship because you will often be left thinking "why isn't our sex like the one I saw on the internet?"

3) Depending on your relationship status, porn could be viewed as a form of cheating or sexual abandonment.

This is the counterpoint to benefit #2. Most significant relationships have the understanding that there will be an attempt to be monogamous. That generally involves a physical, mental and emotional commitment to a partner. While few would disagree with the idea that it's natural to feel some sort of attraction to other men/women, many would argue that using pornography is, in fact, being with someone who is not your partner. Your mind and body aren't with the person you committed to, are they? Some people have reported to me that one member of a relationship isn't even interested in having real-life sex, but would rather be with these "other people" he/she sees on the screen.

So, is pornography for you and your partner? Only the two of you can answer truly answer that. Challenge yourself:

1) Am I appreciating porn for its true colors while at the same time recognizing its artificiality and inability to translate with significance to real life?

2) Am I using it in a way that my partner would accept and/or want to be a part of?

3) Am I developing unrealistic expectations for a current or future partner?

These are the questions you should be asking yourself when pop in that DVD or click on your favorite porn site. If you're answering these questions as yes, yes and no, respectively, then get off this site and go enjoy yourself. But if not, then it's time to start rethinking what it is you are getting from porn and how it's negatively impacting your life.

[1] I say SOME as I base these reasons on both my clinical training and practice. This list is by no means exhaustive and could probably be added to ad infinitum by anyone with an imagination.

[2] "Voyeurism" is actually a DSM-IV diagnosis, but requires that the person being watched is unaware of being observed.

[3] We must also remember that many of these actors need plenty of Viagra and many actresses use recreational substances just to be able to do the job, which detracts from the "enjoyment" you are seeing on screen.

I received this email from John:

To: RDobrenski@aol.com
From: XXXXX@gmail.com
Subject: Fuck!

A guy came into the office today for an initial appointment due to work problems. As we talked about his current situation, he mentioned that a positive in his life is his new girlfriend. Apparently he's been with this woman for about three months. As he started to describe her (e.g., job, personality, looks) I realized she sounded an awful lot like XXXXXX!!!!!!!! And, sure enough, when I asked him what her name was, he said, "XXXXXX!!!!!!!!" My patient is dating my ex-girlfriend! I didn't say anything to the guy and he's already made a 2nd appointment. What do you think? I'd ask you not to put this on your dumb website but I'm sure that's a waste of time.

Here is my reply:

To: XXXXX@gmail.com
From: RDobrenski@aol.com
Subject: Re: Fuck!

Hello Dear Friend,

Don't worry, I promise I won't put this on my dumb website. When did you and XXXXXX!!!!!!!! break-up, anyway? I'm really sorry to hear about this. She's a great lady. And hot, too! I'll bet that client of yours is probably on an amazing date with her right now, perhaps even in his apartment. He's a lucky man.

Lunch tomorrow?

Best Wishes Always,
Rob

John made a crucial error in keeping his mouth shut about his prior relationship with the client's new love. Starting off therapeutic work with a fairly large lie of omission is definitely not the way to go. John simply got caught in the intersection of our work and life's realities and turned into a deer in the headlights. I'm not sure if this was due to sheer surprise, jealousy at the fact that his ex-girlfriend has a new (and probably better-looking) lover, or something else altogether. But when you keep information like that to yourself you're simply asking for trouble.

As I had strongly advocated a shrink isn't obligated to alter much of his life simply because a client may see him in a different role. However, this rule is for out-of-the office behavior. When working it's the therapist's responsibility to protect a client from a possible conflict of interest. Although the client didn't come in specifically to talk about his relationship, the reality is that love interests almost invariably works their way into the conversation. If John keeps the information to himself there's no way he can remain objective. If he confesses later on, the client has every right to feel betrayed to the point that the therapeutic relationship might be beyond repair. Either way John will have royally screwed up as a professional.

I called up John later that day and told him to man up and simply call the guy to give him the truth. He simply had to refer him to another therapist because of the dynamics involved. John agreed but dreaded making the confession, although I'm guessing the client will appreciate the honesty and accept a referral elsewhere. Some clients will insist on still being seen, believing that the therapist can still do the job despite the issue at hand. Why this is the case is not entirely clear, although many readers tell me that it's simply very difficult to find a good shrink. Perhaps once someone believes a strong connection is present they are hesitant to give that up. But although I'm not a huge believer in protecting people from themselves, this is one of those times where that philosophy applies. So even if this guy sees John as the next Freud, he's got to find someone else with whom to work.

Knowing John he'll probably tell the client to avoid me as a therapist at all costs, but there's not much I can do about that. He's just jealous of my success. When you've blessed yourself with a wedding photographer's drinking water and have had a child accuse you of being a terrorist people will envy you. It's just a fact of life.

There are generally three scenarios when I will directly address loud patients in the waiting room of my office suite:

1) They are bothering the client who is currently in my office
2) They are bothering me
3) I am in a very bad mood

Reason # 3 has only happened one time in my entire career, and I apologized soon afterwards. Numbers 1 and 2, though, aren't unheard of by any stretch. Therapists often use white noise makers or music in the waiting area to help drown out voices coming to and from the office. However some people, especially New Yorkers, easily overpower these feeble instruments, making it difficult for both client and therapist to focus on the problems being addressed. As soon as my concentration gets impaired because of outside noise, I immediately begin to perceive my client as being cheated. He paid for a session and deserves my full time and attention. That's when I tend to take out my can of Shut-Your-Mouth, open my office door and politely but firmly ask anyone in the waiting room to do shut up.

As I had mentioned I recently moved into a new office suite. The noise reduction there isn't bad at all, but on one recent day there were two adolescent girls in the waiting room with their father. I had never seen them before and I'm guessing the kids were somewhere between 11-17 [1]. The two youths were yelling at each other at a banshee-like volume, something about the Jonas Brothers or something, with the father speaking equally loudly for them to be quiet.

"Is that noise bothering you?" I asked my client.

She looked a little flustered. "Not really," she said.

Sometimes clients don't want to appear rude or demanding, and it was so noisy that, in retrospect, my question was pretty stupid. It had to have been bothering her. It sure as hell was pissing me off.

At that moment I heard a door open. It was from one of the other offices. Someone spoke. Loudly. "Excuse me! Shut up! Damnit you shut up now! This is a professional office and your behavior is reproachful! It sickens me. All three of you should be ashamed of yourselves! Rubbish!" Slam.

It was one of the therapists who shares the suite. "Rubbish" isn't a term that immediately jumped to mind when thinking about the loud trio in the waiting area, but it apparently got the job done. You could hear a pin drop for the remaining 38 minutes of our session.

"Wow," the client said. "Well said."

"Yeah, that was kind of impressive."

"Do you think that shrink has an anger management problem or something?"

With all of the yelling it crossed my mind that all four of them out there had anger management problems. As discussed anger has a purpose. It's an alarm, a potential sign to assert yourself and protect your rights. If we didn't experience anger we might simply get stepped on by anyone who wanted to take advantage of us. Clearly the therapist next door wasn't about to let that happen. However, anger becomes problematic when it impairs your quality of life and/or leads you to engage in extreme behaviors that are damaging to yourself or others. Assuming this therapist didn't need to do deep breathing for fifteen minutes and didn't start honing a steak knife after the confrontation, calling this an 'anger management problem' is a little strong.

"I'm going to say no, especially if this was an isolated incident. The people were pretty annoying, disrupting the office and they deserved to be called out. The reaction was a little strong, but it's not like that therapist came out and beat them."

"Well, hopefully that therapist doesn't carry any weaponry."

I intend to learn more about this...assertive person who works in my suite. But thanks is certainly required for establishing order in the office. Because if it were up to me, anger problem or not, I would have smashed them all in the head with my DSM-IV.

[1] I'm unusually bad with guessing ages. I once asked a new client for her Medicare card and it turned out she was only 41.

When Dr. John and I were in graduate school we took part in a study that was attempting to measure the accuracy of first impressions [1]. The study involved a group of undergraduate students who rated each other on dozens of personality variables (e.g., likeability, gregariousness, introversion, etc.) at an initial group meeting. Then the students would spend weeks and weeks together, kind of like some academic reality show, only to rate their peers again on the same variables at the end of the study.

At the time John and I were in our fourth year of graduate training so we were considered experts in personality. Our job was to watch hours of video tape showing the students interacting together, both in group settings and one-on-one dialogues. Based on what we watched we too rated the students on the same personality variables. Comparing the students' initial takes on each other with both their later ratings as well as the "experts'" opinions would ideally shed some light on how accurate first impressions are.

John and I got together a few times per week in this small room (the "lab") on the top floor of our university's main building. We were actually in a tower and I would incessantly suggest that John let his long hair flow out the window like Rapunzel did. He never found it all that funny.

When we watched the tapes I put on a white lab coat that I had found in the closet. "You a real scientist now, Dobrenski?" John asked.

"I like to take my work seriously."

"Me too. Hand me that six pack of Corona."

We watched hours and hours of these ten or so students hanging out together. Even as they got to know one another, however, they all seemed pretty reserved and reticent. John hates that. He's a social addict, a partier and, as we know, he wants to have sex with your mother. But he's extremely happy and that's not something that happens to a lot of us.

"These people are so fucking boring," he said, cutting up a lime to go into his beer. He actually brought a cutting board to the lab.

"Maybe it gets more intimate when they do the one-on-ones."

"I hope so. Some of the chicks aren't all that bad."

The one-on-ones were not, in fact, more intimate. Most of the guys tried to act like perfect gentlemen when talking to the ladies, and the women presented as demur and straight-laced.

"Maybe being filmed makes it hard for them to let their hair down." I said. "Speaking of, why don't you..."

"Will you please shut the fuck up about my hair and this Goddamn tower?"

Each person in the study had pre-scripted questions to ask during the one-on-ones. During one session a woman referred to her card and then asked the man sitting across from her, "What would be the most absolutely perfect day for you?"

The guy thought about it for what seemed like forever. "Well, I think I'd like to get up at a pretty early hour and go for a long run. Then I'd come home and take a hot shower, followed by a great breakfast out with my friends. Then we'd go kayaking for the afternoon. I'd come home and call my girlfriend and we'd go out for a nice dinner and maybe a movie."

"That's nice," the woman said.

"Sounds like kind of a standard Sunday to me," I said.

"What. The. Fuck?" John said.

"This is such bullshit," he continued. "This guy has no clue how to live. A college kid, in his stupid Abercrombie and Fitch hat and popped-collar polo shirt, wants to have his perfect day involve rowing a boat and eating dinner."

"He's probably just holding out to not look stupid."

"No way, this guy just doesn't get it. She asked about his 'absolutely perfect' day. Not a good day, not a great day, not one of the best days ever. Perfect. This guy doesn't know shit. How many lives does he thinks he gets to live?"

What would your perfect day be?" I asked.

John paused for a moment. "My perfect day would begin with a big, fat blowjob from that nursing student who won't give me the time of day."

"I see. A regular blowjob won't cut it? It has to be big and fat?"

"Right. Then a masseuse would show up and work on me for about an hour, followed by some time in the sauna. If it were a Sunday in the fall I'd be on the 50-yard line for the most important football game of the year by early afternoon, drinking beer and talking with Steven Speilberg."

"He likes football?" I asked.

"I don't know. Who cares? It's my perfect day and he's my favorite director. So I'd catch an errantly thrown ball, which Steve would sign, and after the game he, Deion (Sanders) and I would hit the best restaurant in whatever city we were in. Then I'd get a call from Pamela..."

"Anderson?"

"Right. She'd call to ask me to go to over to Heff's place for a small party with the bunnies. I'd have sex with all of them..."

"How many women would that involve?"

"Umm...nine."

"All at once, like a 10-some, or separate experiences?"

"Both."

"Fascinating."

"Then Hugh would hit me up with a few C-notes for being so cool and I'd take a limo back to Pam's place. She'd ask me to marry her that night and, although I'd decline because of my newfound status as a sex machine, I'd put her in my Rolodex for future encounters. She'd be perfectly happy with that."

"I'm glad you're so thoughtful toward her needs as well."

"Damn straight," he said, and threw back the last of his beer.

I knew from the day I met John that he was hard-core on many levels. But at 27 years old, having had been nothing but a student my whole life, I hadn't lived all that much. At least not the way John did or how his fantasies suggested he wanted to live. Right then I wanted to be like him. Not because he was drinking beer during a research student or pissing on a student for having such a lame fantasy or because of the Playboy bunnies, but because of his brazen love of life.

Ten years later John continues to refuse to have hang-ups or live life on the brake pedal. He takes it all by the horns. And yet - perhaps miraculously given the exorbitant amount of alcohol he drinks - he simultaneously acknowledges his responsibilities [2]. He loves his job as a shrink and does it quite well. In some ways he is a real-life version of the main character in Happy-Go-Lucky, save for the fact that John probably has Syphilis and she did not.

I never ended up being as hard-core as John, if only because of my fear of STD's. But he did teach me that it's difficult to experience real happiness without a complete absorption of life. In fact, without him, ShrinkTalk.Net probably would never have existed. I would have been too scared to put myself out there, to deal with colleagues and clients who frown upon my take on psychology. But John drove home a point that I knew only in a peripheral, intellectual way: you only get one life, make the most of it. So if you're a fan of this site, join me now in a toast:

To John: may you have all the 10-somes your hard-core life will allow. Salut.

[1] I believe the study was abandoned midway through the academic year so I don't have any results to report on it. This is unfortunate because it's an interesting concept.

[2] Although it should be noted that many of our colleagues disapprove of his rogue mental health practices. And his love of MILF's.

For reasons beyond my control, I needed to abruptly move out of my office to a new suite down the street. It's actually in a better location, closer to major subway stops. I've been there a few weeks now and it's become clear that the leasing/managing office prefers to handle tenants' issues in their own time and via their own methods.

The original plan was to have my name on the door of the office suite within 2-3 business days. A week went by and nothing. I knocked on management's office door at that time and the superintendent of the office simply yelled through the door. "WHAT DO YOU WANT?"

"It's Rob Dobrenski, I need you to..."

"WHO?"

"Rob Dobrenski, in Suite 705. I need you to put my name on both the suite door and the professional directory in the downstairs lobby so my clients can find me."

"WE ALREADY DID THAT."

I looked to my right and down the hall where my office is located. Unless someone had snuck over there during this brief, loud conversation to put my name on the door with those acrylic letters, then tip-toed back past me, the job was not done.

"No, you didn't do that. I need you to address this right away."

Shit, I could hear the man say loudly, which led me to believe that stentorian was his normal way of speaking, because I think he said it under his breath.

He opened the door, looked me up and down, and said, "Fine. We can do that later today. What's your name again?"

"Rob Dobrenski. I emailed it to you, per your request, when I moved in. You said that would assure you spelled it correctly.

"Are you the dentist?"

"No, I'm the Psychologist. Ph.D."

"Fine, later today."

"Thank you."

The next morning when I arrived I saw the following on the door:

Ron Dobrenski, pH.d.

Back down the hall I went and knocked on the door.

"WHAT DO YOU WANT?"

"This is Rob Dobrenski. You spelled my name and credentials wrong on the door."

Fuck, he said this time, and opened the door. "Fine. What is your name again?"

"Rob. Dobrenski. Capital P, lower case h with a period, capital D with a period."

"You don't like 'Ron,'" he said with a smile. "Like Ron Jeremy?"

"There's nothing wrong with 'Ron,' it just happens to not be my name. Please change it immediately."

A few hours later a client came in with a smile suggesting he couldn't wait to have a laugh. "Hey there...Ro."

"What?"

"You see your door?" he said, shoving a thumb over his shoulder.

Sure enough, the man was right:

Ro Dobrenski, Ph.D.

There was no time to address the issue then and there, but I seethed through the entire session, wondering if the asshole superintendent was just screwing with me. After my client left humming the tune of "Row Row Row Your Boat" to further damage my professional credibility, I immediately went down the hall again

"WHAT DO YOU WANT?"

"You put my name on the door incorrectly. Please open up!"

Asshole, he said this time. "What is the problem this time?"

"My name is not 'Ro Dobrenski.'"

"It's not?"

"No. And as a matter of fact I'm willing to wager that 'Ro' isn't anyone's name, at least not anyone you or I know."

"Oh riggggghhhhtttt," he said, suddenly remembering something. "We ran out of 'B's'. We should have some in a few weeks."

I considered drawing a temporary 'b' in with a Sharpie, then realized how stupid that would look. Defeated my eyes narrowed to slits. "You'll rue this day, Super." And I walked off.

I decided to simply deal with the phantom letter until another client mentioned her son joining the college crew team. "You know," she said, "rooooooowing" with a wink.

So, in an act of defiance I took the 'O' off the door, leaving an almost respectable 'R   Dobrenski, Ph.D.' in its place. I suppose I could have just addressed the matter in this way from the get-go, but my new office mates have their full names on the door, so it crossed my mind that I might look like some sort of Shrink Rebel to my new peers. That is something I don't want, at least not yet. Of course they could just read this site and assume they will be the topic of innumerable blog posts in the future. And they'd be right, so let's all hope it doesn't come to that just yet.

I joined a writing group to help me stay focused as I attempt to write a book. It's a small club: five people who are all writing books of one sort of another, and we get together once per week. We don't actually discuss the content of our writing, but rather we focus on the process of writing: How do you get started on a particular chapter? What variables, whether psychological or practical, get in the way of your writing? What objectives for writing should you set for this week to help you complete your larger goal? Everyone is very supportive and bring out great ideas for staying on task. In addition, the group leader, C, will ask us to complete interesting homework assignments to help keep motivation high.

This week, C asked us to imagine our books on the bookshelf. She asked us to consider what we would like the brief reviews - the ones on the back of the jacket - to say about our book. The reviews could be from whomever we choose and should say exactly what we are hoping to achieve. This is a great exercise in behavior modification and is often used in therapy. For example, if you have a client who is working on smoking cessation, you get them to imagine what life will be like after they've achieved their goal. Picture it. What will it feel like when you're able to run that 5K without coughing up black death? See yourself crossing the finish line with bright and shiny white teeth instead of yellow and plaid-tinted incisors and breath that could kill Freddy Krueger. Imagine your hair being simply sweaty instead of encrusted in smoke and cancer.

Stuff like that.

Like many things I had trouble taking this exercise seriously. This is what I pictured on the back of my book:

Dr. Rob writes with an insight heretofore seen in only Chaucer, Shakespeare, Dickinson and Moliere. Brimming with love, humor, terse wit and highly charged sexuality, Dobrenski will soon be receiving a new, previously unknown award from the United Nations: The World's Most Incredible Human Person Ever Award. - New York Times Book Review.

When Dobrenski speaks or, in this case, writes, you damn well better listen, because what he says will change not only your life, but three other people of your choosing. - Entertainment Weekly.

In his very first book, Dr. Rob Dobrenski took a bat made out of Zoloft, a Valium-filled baseball and the steroid-clogged soul of Freud to hit a mental health home run! - Journal of the American Medical Association.

I have a new wingman, and his name is Dr. Rob. - Tucker Max.

All that would be well and good, but I guess that's not what's really important. It's only been a little over a month, but the writing consumes me. Even when I'm not at the computer generating words, I think about it. Will it be any good? Does it convey what I want to say? Will I be a laughing stock after people read it?

Clearly I'm making more out of this book than is necessary (although one could argue that since I'm old, alone and childless, it's pretty much all I've got going on at this point in life). The reality is that the book may suck and never see a Borders or a Barnes and Noble and I have to be okay with that. If it does though, the back of it just has to say one thing:

Say what you will about the writing, the stories, the humor (or lack thereof), but the guy loves mental health. He definitely has demonstrated that whether you're a shrink, a patient or someone in between, it's okay to be neurotic. We all are. That's part of being a person. - Any critic, any publication.

That will be enough for me.

Dr. Rob,

Over the past few years I had noticed my mood taking a subtle nose dive and I decided to see a therapist. After asking me millions of questions about myself, my parents, my wife and kids and everything else she could think of, she told me that I had Dysthymic Disorder. I had never heard the term before and it kind of scared me. I knew that I might have some mild depression but didn't think I qualified for anything in the DSM. When the therapist explained to me that Dysthymic Disorder is basically a low-grade depression that lasts a long time I was slightly relieved but still felt a little uncomfortable because I now had this 'label' attached to me. My question to you is do you agree with psychological diagnoses and why?

J.C.

A lot of people have very serious concerns about DSM labels, especially since psychology/psychiatry are soft sciences. We can't put a dipstick into someone's head and measure how anxious or sad he is, so how do we definitively label someone with an illness we can't even really see? And I've bashed the DSM-IV before so I can't turn around now and be its best friend. It's a flawed tool used by shrinks, no doubt about that. However, part of the problem with the criticisms is the undue significance people place on mental health diagnoses.

In the simplest terms, a 'diagnosis' is a social construct. It's a collection of 'symptoms' that shrinks pull together to create a system for communication. Life becomes remarkably easier when you can say 'this person suffers from schizophrenia' and have another professional know to some degree what you are talking about. In many ways, diagnoses are simply shorthand. Today diagnoses are also required for insurance companies but that wasn't the original plan when they were developed.

The problem is that rarely, if ever, does one person's schizophrenia diagnosis look like another's. The same is true for Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder and any other listing in the DSM-IV. Diagnoses are models but the actual problem hardly ever manifests itself exactly the way the book describes. This makes mental health simultaneously frustrating and fascinating, because it's essentially impossible to accurately quantify and compartmentalize human experience.

In my work I often (although not always) share the diagnostic label I've assigned with the client. The cardinal question I ask myself is "will the person benefit from this information?" More often than not the answer is affirmative because knowledge is power. If a client and I are speaking the same language and he knows what this label and its limitations mean he is more empowered with what the condition is and what can be done about it. We're on the same page now and a treatment team.

There's another, more subtle benefit to diagnoses that I wasn't aware of until a client educated me. When I was in graduate school a young woman came into our clinic who had been mugged about nine months earlier. She couldn't bring herself to go near the street where the offense had occurred, was having flashbacks of the incident, regular nightmares about the attack and an overall heightened sense of vigilance about the world around her. She told me that she knew that after the assault she would be distressed for awhile, but she had no idea that her life would be impacted so drastically and for so long. After about three months she was surprised she wasn't feeling better and was outright shocked that she couldn't even talk about the incident six months later.

When I explained to her that she was suffering from what sounded like Post-Traumatic Stress Disorder (PTSD) she immediately wanted to know everything I could tell her about the disorder. I was 24 and a first-year graduate student at the time and as ignorant as a bag of rocks so I actually had to refer to my textbooks with her sitting there in the therapy room. However, in addition to providing her with a laugh due to my red, professionally naïve face, she learned something else. "If there's a name for this," she said, "that's means that other people have it. I'm not alone." This is a psychological concept known as Universality and - provided that the clinician doesn't invalidate someone's personal experience by lumping her in with everyone else who has come through the door - can be a powerful therapeutic tool.

"Thank you," she said. "This helps a lot."

"Therapy can be very helpful for PTSD. I hope you'll consider it."

"I will. Would you be my therapist?"

"No, as a first year student I only do the diagnostic interviews. But I'll get you a very good therapist."

"That's probably for the best," she said. "You seem kind of clueless without your textbooks."

As a seasoned professional I know now that what she really meant by that was you are far too attractive a man to be my therapist. I wouldn't even be able to focus with that cute red face of yours looking at me all day! Please say you're not married! But let's just take what she said at face value for the purposes of this discussion.

Rereading this I'm not even sure I answered J.C.'s question directly but I think you get where I'm coming from. No diagnostic system is perfect and it will never be to everyone's satisfaction. But if used in the proper way, in the spirit in which it was intended, mental health diagnoses can actually be a useful, therapeutic tool.

I had a friend in college who insisted that not a single person on Earth disliked her. This is not to say that she believed everyone liked her, or even preferred her; rather, that no one actively disfavored her. "That's just not my personality," she said. "I don't rub people the wrong way. Maybe that's true for you too."

I was particularly puzzled by this assertion because I could easily have named a dozen people who hated my guts and another three who had bashed this very friend the night before. "God she rubs me the wrong way," they all agreed. "She's such a bitch. I'd like to put her face on fire and then stub it out with a pitchfork."

If my friend ever knew these people felt this way about her she would have been not only terrified for her face, but would have been psychologically devastated. She truly believed (or at least really wanted to) that she was free from the disdain of others.

Now make no mistake: this wasn't narcissism on her part. She wasn't grandiose or self-entitled, had plenty of empathy, and never exploited another person to meet her own needs. The reality is most narcissists know that plenty of people can't fucking stand them but they just don't care because they're "special," or "gifted" or lots of other amazing qualities they actually are not.

No, this was more of a childlike naiveté that helped her obtain worth because she wasn't able to simply value herself by the sheer fact she was a person and therefore of worth. She had to obtain validation from others. She needed to believe she was unconditionally accepted to at least some degree by others. This grand-scale coping mechanism isn't only unnecessary, it's self-defeating: because someone doesn't like you, it doesn't have to matter.

How do I know - other than by the hate mail I receive - that some people don't like me? It's simple: I'm human. That means at times I'm obnoxious, irritable and certainly disagreeable (just read about my interactions with colleagues, it's right there in black and white). These negative aspects of people are simply part of the spectrum that composes the human psyche. These states make a person real.

My friend disagreed that she was ever those things. Shy at times? Sure. Outgoing at others? Of course. Independent at various points in her life, more conforming at other moments? No doubt. But mean-spirited, acrimonious? Never. She believed she had people tricked by having more benign quirks. Even if this was true, however, there are some people who simply don't like one or more of those qualities as well. And because humans are prone to drawing large-scale conclusions based on a small sample of behaviors, inevitably there will be those who simply dislike you for being a full person.

The great Albert Ellis said that one of the best ways to create misery is to work from the mindset that all people must like you at all times. You'll fail at it, plain and simple. Not only that, but this approach to life will cause you to constantly be modifying your own thoughts, behaviors and identity to suit the perceived desires of those around you. This saccharine façade will ultimately be detected and people will know you aren't being your true self. This just won't cut it.

Unfortunately for my college friend, she never learned this lesson. Rather, when she was told about someone's dislike for her she fired back with "well, that person must have her own issues then." That's Polite Person Code for "if that slut doesn't like me then she's a total skank slag!" The reality is it's easier to get angry and point the finger then sit with aspects of ourselves that might be uncomfortable. The problem with this is that it's not only short-sighted, it's factually inaccurate. And unless my friend found herself a good therapist she is probably still living out this perpetual dream, viewing others as toting neurotic baggage instead of acknowledging that she's sometimes a pain in the ass.

Do I relish the fact that some people don't like me? Of course not, I'm not a masochist. Unconditional love at any and all times sounds kind of sweet. But I have to accept this fact, and that subtle difference can change everything. I can always prefer that things be different on this score, but knowing that it's not going to happen makes my day that much more manageable because I can simply be me, free from the emotionally draining pressure of seeking validation from others.

Some people learn this simply via experience, witnessing repeatedly that the world doesn't end in an apocalyptic frenzy when someone dislikes them. Other people require a model, a therapist, a life coach or peer, someone to drive home the point that what we desire and what is necessary is not one in the same. And if you're me, you need both, to help you sit with the fact that no matter what you do or say, someone won't approve of you. And when you can simply sit there and embrace that, you recognize that nothing truly horrible happens, that what might feel like a glass ego isn't all that fragile.

What, if anything, should you take from this? That it's desirable to work on modifying specific behaviors for a greater good. However, this must come not from a desire to be loved by others but simply for yourself and the promotion of a greater society. In other words, you can change plenty of things about yourself, but accept that you are permanently fallible and that some will simply not accept you because of that. This will make your life much easier. And if you're really, really lucky, you might even get your face lit on fire.

If you're an adult whose name isn't Dr. Pete you probably have at least one former significant other in your life. Hopefully you're curious enough about your past to learn something from it as you move forward into more ideal relationships. If so you need to check out Jen Straw's weekly piece "Meet the Exes." This week she interviewed me in hopes of getting some trenchant, ground-breaking psychological insights into learning from prior romances. While I doubt she got what she was looking for I did try to contribute in some meaningful way. Below is an excerpt.

Head on over to MissAttitude.Us for the complete interview.

Q. It's been suggested to me that I'm not going to meet someone better suited for me if I keep focusing on the past negative situations. Do you think there's any truth to that?

A. There's truth to that only if your hyper-focus doesn't allow you to see new and better situations for what they are. There's no shame in remembering the negatives of life; it shows you've been paying attention and makes you less naive going forward. But when people have been burned they tend to associate any similarity, no matter how small or trivial, with the original offense. This is where it becomes problematic. The goal is finding a balance between using what you've learned and being open to what is fresh and new. I'm currently writing a book that probably won't teach you how to do that, but you should buy it anyway.