Soothing: Lives of a Child Psychologist

By W. Hans Miller

Soothing: Lives of a Child Psychologist tells two stories, both of which are about the search for ways to soothe ourselves and others. It is part memoir, part autobiography, and part essay on the critical role soothing plays in everyday living. It is the sometimes comical quest of one person who struggled to integrate lifelong personal conflicts and a career as a successful child psychologist, finally finding peace in a wider view that brought coherent meaning to his life.
Along the way, the writer learned that he was not trained to successfully treat the wide and fascinating individual differences in human psychopathology, which required constant creativity and innovation. Each new therapy partnership inspired personal growth and ingenuity that often made a difference in the lives of his patients.

• Language: English
• Publisher: Xlibris US
• Release date: Feb 6, 2017
• ISBN: 9781524546328

W. Hans Miller

Wm. Hans Miller is a clinical psychologist in private practice in West Los Angeles, California. For over four decades he has treated children and families with a wide variety of emotional and behavioral difficulties. Throughout his career he has maintained an active interest in neuroscience, behavioral medicine and especially the biology of normal and abnormal emotional development in children. Dr. Miller pioneered the development of the first Medical Center Parent Training Clinic in the 1970s, which is still active. For many years he lectured and conducted workshops on parent training and severe personality disorders in parents in the USA and Europe. After a long career in the Department of Psychiatry at UCLA where he received numerous teaching awards, he is now an Associate Clinical Professor of Psychiatry at the UCLA Semel Institute for Science and Human Behavior. His writings include numerous essays and the books Systematic Parent Training: Procedures Cases and Issues, and Personal Stress Management for Medical Patients.

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Copyright © 2017 by W. Hans Miller, Ph.D.

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Library of Congress Control Number:     2016916228

ISBN:              Hardcover                    978-1-5245-4630-4

                         Softcover                      978-1-5245-4631-1

                         eBook                            978-1-5245-4632-8

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Rev. date: 04/10/2018

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CONTENTS

Preface

Introduction: Joanie

What Is Soothing?

PART ONE:  Beginnings

Luck

Ancient Beginnings: Blue and Red

Recent Beginnings: Bulahhead

Talking: A Mini Memoir

Ray

The Missionary

The Performer

The Reformer

Sid

Dr. Bill Boardman

Westward Bound: UCLA

I Can Do This!

Who Am I Kidding?

Dan

My First Wider View

More Beginnings

Learning to be Afraid

The Train with the Giant Red Light: Four Years Old

The Dynamite Cap: Five Years Old

Learning to Hope

The Thermometer: Six Years Old

The Orange Crates: Eight Years Old

Grandma’s Lap

Searching for the True Self

Mommy, Daddy, and Me Once Again

My Helen Keller Moment: Discovering Abstraction

Discovering the Moving Goalpost Syndrome

Escape to Baseball

Living the Dream

The Golden Years

The Perfect Game

The Long Road to Freedom

PART TWO:  Practicing

Learning about Psychotherapy

This Fruud Guy and The Psychopathology of Everyday Life

Dr. Florene Young and Toys Out the Window

Dr. Rick Ward and the Fish-Tank Kid

What Makes Psychotherapy Work, or Not

Model Scenes Can Tell the Story

Lindsay and Me

Getting Well with Empathy: Dr. Kohut and Adolf Hitler

Getting Well With Creativity, Insight and Initiative: Remembering Joanie

Rigidity: Michael and Better the Devil You Know

Paranoia: Kimberly and Her Nervous Therapist

What Doesn’t Happen in the Therapist’s Office

Wagons in the Front Yard

When Sarah Started Talking Again

Westward Bound

Dr. Young, Once Again: Darlene’s Story

The Parent Training Clinic: An Alternative to Psychoanalytic Child Therapy

Getting Started: From Outpatient Psychiatry to Navajoland

The Parent Training Clinic’s Greatest Challenge and Discovery

You Can Go Home Again

Private Practice

DR. MILLER! Honeymooning in Maui

David: A Professional Tragedy

Lynda, Who Taught Me How to Do Therapy

Andrew: The Joke Killer with a Rifle on the Roof

Nobody Doesn’t Have Scoldophobia: Sasha’s Story

Gone! How Charlie Stopped Counting and Started Living

Getting Rinaldo and Ted to Sleep

Rinaldo: Sleeping with Hypnosis

Ted: Sleeping with Nothing and Four Sleepy Questions

Ava: The Manic Defense and the Capacity to Be Alone

Monica: Protecting the True Self at All Costs

PART THREE:  The Mockingbird

Searching for Integration and the True Self

The Potato Digger

The Bagpipe Professor

The White Oleander

The Mockingbird

Acknowledgments

For Nancy Miller

PREFACE

I decided that that although nobody’s life makes any sense, if you are going to make a book out of it, you might as well make it into a story… Don’t look for strict chronology or tidy connections in the rest of the trip. The journey itself will tell you—as it gradually told me—what the book is about.

Russell Baker

T HERE WAS SOMETHING special about putting my life and work down on paper. No matter how much I have shared with therapists, closest friends, and a soulmate, there was always more that was unshared. I needed a record of the big moments in life to keep from forgetting or repressing them, all the way until I was seventy-four and had gathered enough confidence to go public, which is why this memoir was sixty years in the making.

Writing an extended memoir gives a different kind of freedom than talking; publicly or privately, talking is too guarded by the vigilant social brain. With a memoir all you have to do is find your one-of-a-kind river, jump in, and surrender to the current no matter where it needs to go. I found that in my river I could laugh about what I write without caring if anyone gets the joke; it is me only on my terms. Family members will disagree with my memories, readers will like me or not, but no one else can understand what is going on the way I understand.

Early on I discovered that one of my few talents is a very good memory of the past, from what someone said or did many years ago to the odd ability to recall most of the meals I or my companions had at restaurants. But all memories are imperfect; every time brain circuits containing a memory are activated, they open up like the gates of Troy to the influence of new Trojan horses sneaking in with whatever is meaningful at the moment. The Pulitzer Prize–winning writer Annie Dillard mourned an even greater loss for memoir writers: After you’ve written, you can no longer remember anything but the writing. Yet I’ve learned to trust most of my memories and hope that the stories written here are more fact than wish.

In William Zinsser’s wonderful teaching memoir Writing about One’s Life, he cautions against the urge to tell the comprehensive story, preferring to catch a distinctive moment that can reveal the importance of some life event or life stage. Then, if there is more to say, a different memoir can be written. Lives of a Child Psychologist breaks his rule, telling a lifetime of stories about suffering and soothing on the way to self-acceptance and a kind of contentment. I suppose that makes this book an autobiographical memoir. This approach is based on my belief that with enough good stories from enough parts of our lives, common themes emerge that can define anyone.

Because I have been on a lifelong quest to find my ‘what-ness and who-ness,’ I was extremely lucky to become a therapist for children and their families, since their stories have had such a great influence. I was never taught how this two-way, giving and getting arrangement can make therapy succeed or fail. I was professionally raised in the days of the dominant medical model which meant the doctor diagnoses and the patient gets treated. The importance of a therapeutic partnership was not part of the training.

I learned something else about the stories I tell that stimulated more stories with each telling. I have a strong feeling that by the end of this book my stories will begin to converge on a common theme based on the blurred histories and life experiences of my parents, all of my mentors and relationships, my patients, my choices, and no small amount of luck. I can now see that my life has been a series of returning loops, and that is the only way I can think about it.

But before I began writing, I wanted to make sure someone else hadn’t used soothing as a home base for their memoir. In my search I found everything I needed to know about 50 Ways to Soothe Yourself without Food, Lovers Massage: Soothing Touch for Two, Chocolate to a Lovers Heart: Soul-Soothing Stories That Celebrate the Power of Love, the self-help book Recovery: Self-Soothing Techniques and many similar titles. At least in my small survey, it appeared that I had a memoir about soothing all to myself.

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Early on, while describing my book plan to a therapist colleague, he wondered why I was concerned about integrating my professional and personal lives. Don’t most people go to work and then come home to a different life? They don’t worry about integration; they just go with the flow. They leave their work at the workplace and it’s better that way. I have observed others who are able to do this, but for me, this was a new concept. The problem was that I was competent and mostly conflict-free in my office but had little peace of mind away from work, and I did not know why. Yet I was in the peace of mind business. What was happening to my self-esteem and confidence when I was not helping others?

About the same time, a writer friend saw my idea for the title of this book, shook her head and said, It’s too big a subject. It covers everything. Even evil acts can make some people happy. Everybody needs it. Try to narrow it down by describing how as a child therapist you found ways to soothe patients like yours. I understood the challenge but got excited about describing a subject that might bring together my personal and professional lives. It would also be about how I didn’t make much progress anywhere until I started inventing healthier ways to soothe myself.

My version of ‘narrowing down’ is to find what the psychoanalyst Joseph Lichtenberg called model scenes, which contain in simple stories the larger picture of life lessons. Model scenes are single episodes, such as an unforgettable interaction with a parent that have great influence throughout life.

Writing about model scenes is the method used throughout this book to describe the major influences that made me and all of my patients who we are, for better or worse. Some scenes are about the general topic of soothing, but most try to capture the essence of the people I am writing about. For these individuals and families, model scenes can help explain how we sometimes get stuck with damaging negative self-beliefs, but with help, can learn something about self-acceptance. With hard work and good fortune, we can even find ways to create more optimistic stories about the future.

In Part 1, Beginnings, I describe in some detail the events of my early years that organized my beliefs and intentions. More recent influences tell about my emotional extremes and how I handled and failed to handle the challenges of growing up. Part 1 contains the stories of my seemingly endless attempts to self-soothe and find a sense of unity.

Part 2, Practicing, is about the ways my own problems helped me to invent better ways to soothe others. It tells about the professional strand that for years seemed so alien to the personal strands in Part 1. For example, I spend some time describing my UCLA Parent Training Clinic where I found what I was after: measurable proof that I could not only discover out what good parenting was all about, but see problems coming before anyone knew they existed. I now think that this scientific veil was all about the need to sanitize the disturbing model scenes of my childhood. But I was on autopilot, going after the facts about families in need with my own unexamined motives.

All good therapy eventually soothes, and when the partnership was working, my patients left with the tools and positive beliefs they needed to soothe themselves as they moved forward in their lives. I will constantly emphasize the importance of features of the therapist that are essential for the treatment to work, such as empathy and caring, creativity, and understanding the model scenes in child development.

In addition, I watched as two features of successful patients emerged: the personality traits of openness to change and the presence of internal motivation to improve. I will also describe patients who seemed to feel soothed just by showing up for their appointment. Yet without being an active participant in their growth, lasting improvements in self-regard, relationships, and mature productivity were unlikely. Also, in Part 2, I have included nine of my most interesting and challenging private practice cases.

Finally, Part 3, The Mockingbird is an attempt to braid together the two strands of my competent and conflicted selves. This attempt at integration also showed me how writing about a better understanding of my true self was surprisingly richer than the help I received from my own therapies and hours of mental introspections. I am still looking for this ever-widening view of victories, defeats, and existence itself that together with a loving relationship are the ultimate soothers.

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No section of this autobiographical memoir stands alone, although the mini-memoir Talking comes close. Just as my memories unfold, each of the stories loop around each other, hopefully on the way to some kind of coherence. Each of them shares patients and interventions, based on whatever idea I was pursuing at the moment. Yet they are all on a common road, hopefully headed toward a larger story in which the parts become braided so tightly they cannot be separated.

INTRODUCTION: JOANIE

Each person deserves a day in which no problems are confronted, no solutions searched for.

—Maya Angelou

S OOTHING IS WHAT we can’t stop needing or giving whenever possible. For all psychotherapists, the goal is not only to relieve discomfort but also to add something to the patient’s life: new healthy ways to self-soothe. Yet sometimes, even when we do the best we can and know that we have been helpful, it’s not enough.

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I had a good idea what was wrong with four-and-a-half-year-old Joanie the first time I saw her clinging to her mother on my waiting room couch. This kind of knowing came partly by having been there; it was about shame and hopelessness. It also came from recognizing the pattern and getting to know many Joanie’s with their uncontained suffering. I’m not referring to her chopped off, balding hair, which most people would recognize in photos of the butchered haircuts of Jews in the concentration camps. Joanie clearly had a disorder called trichotillomania, or compulsive hair pulling. What I saw that day was a defeated child in the despair that sometimes fill even young lives like hers.

Joanie’s mother Adriana was referred by a pediatrician friend. She called and said that like herself, Joanie had always been anxious, but not with the crippling panic attacks that kept her from school when she was young. Joanie had already been in psychoanalytically-oriented play therapy for anxiety but without much success. Adriana wondered if there was any effective treatment other than medication, which is usually not recommended for preschoolers.

After this brief phone interview about Joanie’s problems, we set up a time to meet. Joanie’s divorced father Larry, who had joint custody, did not come to the meeting.

In the office with her mother, Joanie would not look up from the floor, nor did she allow herself to become unglued from her mother’s bosom. I rolled my chair over to a safe distance and said, Joanie, I don’t know you very well but I do know how sad and scared you are right now. What if I told you that with you and your mother working together, we can try to make things better? I finally got to see her eyes and she asked, How are you going to do that?

I explained that her mother had already told me what was going on and asked if we could start by my having a look at her bald spot. It had the medical name of noncicatricial alopecia areata on the right side of her head, meaning her hairless scalp was smooth with no scars. This disorder is found in about 3 percent of the population and can be caused by faulty genetic and brain chemistry, as well as chronic life stress. Serious hair pulling even occurs during relaxation when the mind is pleasantly wandering.

All girls play with their hair; with Joanie I would have to answer the question What does she need that she can only get by pulling her hair out? It is useless to look to the patient for the answer at almost any age about any symptom; they don’t know. For Joanie, it could have been self-punishment, a plea for help, a safe haven from an avalanche of harm, or even a neurological symptom of obsessive-compulsive disorder or Tourette’s syndrome.

I felt better about her motivation for accepting help when Joanie bent down her head so I could have a look. She was clearly using her dominant right thumb and forefinger to pull her hair without injurious scratching or much discomfort. Later she said it happened mostly when she was studying or daydreaming. Because the habit was automatic, occurring when she wasn’t aware she was doing it, the therapy would require training her to become much more aware of the urge to move her hand toward her head, and then to interrupt any movement in that direction. The bald spot was about the size of a half-dollar. The rest of her hair appeared to have been twisted off at various lengths.

I told Joanie that I was going to help her the same way I always do when I see little girls who are having trouble letting their blonde hair grow out. I asked her to watch me while I strongly pressed my right thumb and forefinger tightly while pinching a finger on my other hand. I then asked her to show me what her pinching looks like, which after a few moments she did with some intensity and then repeated the exercise several times. Then I flattened out my right hand with fully extended fingers, pressed hard on the right side of my head with my palm, and rubbed a small area of my hair round and round while saying, Now my itchy scalp feels better. Together we all repeatedly practiced a hard pinch of thumb and forefinger followed by widely opening her hand.

I asked Joanie to carefully watch her mother while she copied everything I did, speaking to her mother exactly as I spoke to Joanie. I told her to copy her mother and me over and over so that she could get the feeling she needed to stop pulling her hair and instead, firmly rubbing her head with her hand. I wanted her to practice this every day with her mother with just one rule. She would show me her hardest pinch with her thumb and finger for the very last time; no more pinching was allowed, only rubbing her bald spot in a circle as hard as she wanted with open palm and stretched-out fingers.

The three of us together practiced in each session spreading her fingers apart widely and using our palms to rub different parts of our scalp. Privately, her mother and I role-played ways to let Joanie know how smart and strong she was to practice this new habit, how this was going to work, and what it would mean for her. I wanted the therapy for hair pulling, the real changes, to occur at home and not in my office. If the treatment was successful, Joanie would learn a new, natural habit that was the opposite of the symptom.

I also wanted to test the seriousness of the problem by first treating only the symptom. What’s more, pediatricians have a way of sending their acutely disturbed child patients for symptom relief, not deep psychotherapy. Week by week Joanie’s hair slowly started growing again. In six weeks her bald spot was nearly invisible; in four months she had the nearly full head of the blonde hair that she was certain had been lost forever. Her mood had also improved and she no longer felt helpless about her future.

An important issue remained, which is always a child therapist’s greatest concern after rapid success with what can be a serious disorder: is there more to this?

As it happened, the successful treatment of Joanie’s hair pulling was the first in a series of treatments for other fears and phobias: next was the onset of encopresis, or inappropriate bowel elimination often due to fear of the toilet, then terrible nightmares which were only calmed by sleeping with her mother and her boyfriend. Next, she could sleep alone but not without a light on. But with a light in her bedroom she imagined monsters and insects were crawling toward her. Each of these symptoms were treated by a procedure known as systematic desensitization, in which Joanie became less sensitive to the source of anxiety by gradually and safely approaching the fearful situation.

Using a 0-3 fear rating scale, Joanie was only allowed to move forward after reporting comfort and low scores at each step. For example, if she reported that she was at a 3 while imagining a strange-looking shape in her bedroom, we would draw all kinds of monster figures that she could look at while taking slow deep breaths and then imagining them with her eyes closed until her number was 1 or 0. Joanie liked this highly structured measurement approach because she was always in control of the pace, and she quickly mastered the steps.

Then came a disabling fear that she would never learn to properly write out her schoolwork; each time she tried at her school she felt everyone was watching her make mistakes. We both had fun with this and Joanie was the only patient I ever taught from scratch to write letters and numbers and spell, homework and all. It took two months to teach her graphic skills, and this was one of the few treatments that actually took place in my office.

Each of her panic-causing problems were treated successfully, reminiscent of Freud’s famous symptom substitution theory. He taught that underneath all symptoms there was some sort of sexual trauma produced—an inner pressure that could only be cured by bringing it to consciousness through dreams and free associations, and that directly treating a superficial symptom would only release another symptom.

Joanie’s insecurity was so widespread that it kept finding new ways to show itself, and for a while I wasn’t sure where it would end. It soon became clear that Joanie had a form of generalized anxiety disorder just waiting to attach itself to anything that bound up her anxiety. Yet because there were no indications of specific trauma anywhere in her history, I thought of her diagnosis in terms of genetic risks for anxiety disorders and the impact of intense parental fighting which had started the previous year.

In our second year, Joanie’s beloved blind dog Chucky passed away, which was immediately followed by the onset of a hysterical fear of all dogs which looked at her, and then all dogs everywhere. I called for a meeting with her mother, her boyfriend, and ex-husband. Again I explained how her genetic risks on both sides of her family and, together with the battles between her mother and father, made it impossible for Joanie to believe that she could be truly safe.

No one liked what I told them next: I would not treat Joanie for her dog phobia for at least six months for two reasons. First, this fear was not completely irrational; years earlier I had successfully treated a number of children who learned to trust dogs, one of which was bitten in the face by the normally friendly dog next door. But most importantly, I wanted Joanie to have a more normal childhood, growing up in peace for a while with all of her anxieties bound up in one neat belief: I’m okay as long as I’m not around dogs.

Meanwhile, she continued to see me, and we talked about other things. I said that she could bring up the idea of watching kittens and puppies in a nearby animal store anytime she wanted. Then in one unforgettable session, Joanie came in looking tense, standing shoulder to shoulder as usual at my desk with the blank pages she used to draw her weekly picture. Looking down, she said, I hope you’re not going to be mad at me. I said that would never happen, and then she told about her best school friend April, who had complained that day about being afraid of bees.

Joanie described how she explained to April with great precision the step-by-step method she had used for herself. She first had April imagine and then gradually get closer and closer to a bee in a closed jar while taking deep breaths and moving as she wished on the 0-3 fear