During a tangent in a consultation group, a professional colleague expressed remorse and frustration that the movie “Birdman” had not committed to delusion or reality during, or at the end, of the film! Without giving too much away, for it is a movie that works best the less you know going in (hence the subtitle:The Unexpected Virtue of Ignorance?) I will opine that this ambiguity is one of its greatest accomplishments! The need to decide whether you are viewing truth or delusion is one of the delicious thrills of “Birdman”as you descend deeper into Riggan Thomson’s (Keaton’s) psyche.


Before I discuss the film, I will digress to say that while the issues we grapple with in therapy might not always be as existentially or artistically threatening as what we witness in “Birdman”, the ability to tolerate ambiguity is both a hallmark of clinical skill, and necessary when viewing this movie. Parallel to tolerating ambiguity is tolerating madness. A former instructor in my earlier training once offered her firm opinion that, “There is nothing romantic about mental illness”. I disagreed at that time, but couldn’t articulate exactly why.

The movie “Birdman” helps me to say why and how. The journey portrayed, of Thomson’s inner experience of potential madness is captured in a visually powerful way as the Birdman persona encroaches into his psyche over the course of the movie. His personal struggle is romantic, and dramatic, as he fights to maintain his sanity as well as excelling artistically within the grips of debilitating internal voices telling him what a wimp he is, or his daughter Sam railing at him for how relevant he isn’t (incredible acting by Emma Stone!) My former teacher’s declaration misses the point: mental illness is “romantic” from within or least makes a good movie!



While my consultation colleague was disappointed with no firm answers at the end of the movie, I again disagree. Meaning is offered in the final shot of the film. As people seeking more literal meaning, or definite answers, we may not like the end of the film. And like the family members of the mentally ill, it is understandable that we don’t find the confusion and lack of clarity of their symptoms “romantic”. Our real world clarity is challenged from the beginning of “Birdman”. By the time we reach the end of the film, we have been on a wondrous, romatic, dramatic, confusing and tension-filled journey. Again, the stuff of great film-making, and an Oscar-winning effort.

(If my discussion seems limited it’s because I’m seeking not to give much away about the film! There are many subplots, great acting by Edward Norton, among others, and amazing cinematography to enjoy in this movie).


Anger Management 101

I wrote this entry back in October, 2014.

Since an “Anger Management Training” in September, I am now a Certified Anger Management Counselor. While I already knew that anger was a healthy emotion, responsible for helping to set boundaries, and motivate action, I was less familiar with aggression and rage being the unhealthy expressions of anger. I can count on one hand the number of times I ever saw either of my parents model rage, to me or to each other. Passive-aggression, however, was an artful skill in my family of origin.

hulk rageRage is when you are overwhelmed by the primal emotion of anger, your primitive brain kicks in with hormones that excite and arouse your body for battle or flight. Rage bypasses the thinking part of your brain and you can no longer anticipate consequences. You’re a Nike commercial: you just do it. This was great when being pursued by, or hunting beasts 20,000 years ago but it is much less functional now, in our modern life of cars, traffic, office and home environments, shopping, families and standing in lines.

Aggression is only one method of communicating anger. My family of origin tended towards passive aggression or passively withholding anger. Anger turned inwards leads to depression and resentment. Building resentment can make one snap if one does not have an opportunity to assertively express one’s angry feelings, and one’s needs and wants. Sometimes simply expressing oneself can release internal pressure. This is partly what therapy is for, a place and time in your life when you can release some of the internal psychic pressure building up inside.

Anger Management is a place and opportunity to learn skills to create awareness of when one is angry, and figure out alternate ways besides aggression, rage or passive-aggression to respond to anger. Another important detail I learned is that Anger Management is not therapy. It is psycho-education involving a workbook, homework and weekly meetings. I have not yet developed an Anger Management Group in Pasadena, but if you are interested, please let me know and I will start a waiting list. See my Contact page.


The Efficacy of Psychodynamic Psychotherapy

This excellent, yet technical article, with good statistics, attests to studies demonstrating the value of psychodynamic therapy. In brief, Jonathan Shedler, Psychologist, outlines 7 specific qualities of psychodynamic therapy.

These are (paraphrasing):

1. Focus on expression of emotion
2. Exploration of attempts to avoid distressing thoughts/feelings
3. Identification of recurring themes and patterns
4. Discussion of past experience
5. Focus on interpersonal relations
6. Focus on therapy relationship
7. Exploration of fantasy life

This article is good for both practitioners and informed clients alike but includes plenty of jargon and psychological terms, so be warned! A pdf is available here.


The Journey of One Thousand Steps

Starts with the first blog post! I know blogging is not new, but I am new to blogging. An immediate challenge for a psychodynamically trained therapist like myself is that self-disclosure is not encouraged. And by “self-disclosure” I mean the various thoughts I might share on a blog! The stated reason for this, is that you, my readers, need to be able to project various feelings and explanations onto me, that is imagine what I am thinking or feeling as you sit opposite me in my therapy office telling me about your life.

The manner in which you make those feelings obvious, or the manner in which I pick up on your feelings, or details about your explanations, and then ask, or make verbal observations, or guess at them, are all major components of psychotherapy. The idea is that you are not supposed to know too much about me. That way you create some story about me and react to your version of me in your head (and heart). We explore and attempt to make conscious that process, while also talking about your relationships and daily life. The general idea is that how you do this with me in the room is mirrored by how you do it in your life, with others.

Of course, in 2014 with social media rampant across the virtual land, and companies like Google, Facebook and Twitter encouraging us to connect, connect, connect, not saying a lot about ourselves feels odd and different. But therapy is “odd and different” when compared to connecting on social media. I am “showing” myself on this blog and website, not to be your friend exactly, but to (potentially) be your therapist. We can be friendly in that process, but being friends would make psychotherapy more difficult rather than less difficult.

So despite those difficulties and challenges, I am also taking a first step on my one thousand step journey of blogging as a psychotherapist. Welcome.


Psychotherapy San Francisco