Dr. Greg: Why Hate Fat People?

Dr. Greg describes how Prop 8 affects his life and explains why a client does "bad things for good reasons."

This episode touched on three major aspects in my life: developing empathy for a client, working-out, and the timely issue of marriage. Let's start with the last one first.

The question of marriage is on everyone's mind lately as the Supreme Court is about to hear the case of Proposition 8 in California, which limited legally recognized marriages to those between a man and a woman. The majority of California voters put a halt to a nearly five-month period in 2008 where two people of the same gender could be legally married in the state. Those who were married in California during that period can remain legally married; those who did not are (for the moment) prevented from doing so. Also being contested by the Supreme Court is the Defense of Marriage Act (or DOMA), which was enacted on the federal level in 1996, and also limits the legal sanction and federal benefits of marriage to opposite-sex couples. And it is up to the Supreme Court to decide the outcome of both cases.

In a quick scene in our backyard, Kevin and I talk about our "marriage." We chose not to get legally married during the small legal window in California because we were hoping to wait until our anniversary to make that happen, but the window quickly closed. The way we are using the word "marriage" is more to affirm the relationship that is already in place, because we still could not get legal recognition. Rather than continuing to wait for a legal sanctioning of our relationship, we decided to socially sanction our relationship by having a ceremony. This is not unlike couples that have a ceremony to reaffirm their vows. The timing of our decision was borne of the concern for family members who were aging and wanting them to be there while they were still able. We are not starting something new (as in most legal marriages), but celebrating the love that has been there for 23 years. But at present, we have no legal right to "marriage" in California or the federal benefits. Hopefully, that will all soon change.

You also see me going to a gym and training with a trainer. Working-out is one of the most important aspects of my life. Though I have done it since high school, I started working out with a trainer and doing intensive boot-camp style workouts about 10 years ago. Doing so not only changed my health but every aspect of my life for the better. Besides the improved physical aspects, it is the best mood-elevator, mind-sharpener, and stress-reliever I know.

Ten years ago, I was working four different jobs. I had a full-time managerial job in a large non-profit overseeing four departments and approximately 50 employees. But on the side, I was the clinical supervisor for a large mental health research study at a local university. Meanwhile, I taught a class once a week at a local clinical psychology doctoral program and maintained a small private practice of about five patients a week. I literally worked every day from morning until late evening and rarely took time to see friends or even watch a movie and my diet was mostly junk. My relationship with Kevin was significantly strained and my health became compromised. Then the house of cards came tumbling down.The comment I overheard Kevin say about my weight was during this difficult time. That comment hurt, but it did not spur me on to action, as the episode seems to suggest. What spurred me on was the realization my life was out of balance and that career advancement was not as important as relationship and health advancement. By changing priorities and focusing on the things that mattered most in my life, everything else improved. Whenever my priorities get out of whack, I just remind myself of that difficult time and redirect myself back to what's important in life.

The episode also shows my own breakthrough as a therapist in developing empathy for his presenting problem: "I hate fat people." This was a difficult one. But as a therapist, I know that people do "bad things" for "good reasons." My job as a therapist was to find out what those "good reasons" are so I can help him develop a better way. A boy who was both older and overweight had bullied my client as a child. The other child had an unfair advantage and terrorized my client for a long time. As a result, my client developed not only an aversion to the person who bullied him, but to all people he perceived as "fat." This was my "aha" as therapist. The aversion to all people who are overweight became his brain's way of keeping him away from getting attacked. This is the "good reason."Now, my client avoids people who are overweight and if he cannot, he punishes them, rejects them, or attempts to teach them a lesson in order to make them change.  You see me explain to him that his power was taken away as a child and now he is seeking to get it back. My job now as a therapist is to both help him regain his power without resorting to harming another person and to help him realize the harmfulness of his actions while developing compassion for people who are overweight. Changing an aversion is not something that is easily done, but I am happy my client is up for the challenge.

To try to help him along in his journey, we will have him meet a group of women who were once overweight to hear about the impact his comments make and to hopefully help him develop more empathy for their struggles. That happens next week. See you then!

Power Struggles

Dr. Greg explains why he saw Tamara individually during couple therapy.

Couple therapy is very different than individual therapy in that you are treating the relationship primarily rather than just two individuals. That is why it was such a problem that in the second "couple therapy" session, Steven did not come to the second session with Tamara. At this point, I had two choices: see Tamara alone or send her away.

I did see her, but before I did, I informed her the research literature has shown that one-partner “couple therapy” may result in a negative outcome for the couple (Wilcoxon & Fenell, 1983). Understanding the possible impact, she agreed to stay and to focus on her specifically and tried to leave Steven out of it as much as possible. 

As a result we uncovered her issues with desire for respect and being liked. I explained the often inverse relationship with the two -- that someone who is highly respected is not always liked, and someone is well-liked is not always respected. Sometimes what gets you liked by others can also diminish their respect for you, and vise-versa.

What also became apparent was the use of the animals in the relationship to cut the tension between the two. Couples often do this with animals, but also use other means such as television, alcohol, or even their own children to help them avoid any tension. A little is OK, but too much can drive a wedge in the relationship. In the third session, Tamara brings her cat to the session -- an act I labeled as "passive-aggressive." 

A passive-aggressive act is typically an aggressive act done in some non-assertive manner. Here the aggressive act is that Tamara brings her cat (Kozy Mel) to the third session even though I asked her to come "without Jimmy Chew [the dog], without any animals." Then she claims she thought it only applied to Jimmy Chew. Passive-aggressive acts are typical when people feel powerless in a relationship; yet wish to express their power and/or anger in a situation. As it turns out, this passive-aggressive assertion of power with me turned out to be typical in her relationship with Steven. Because of the cultural expectations of women, her own upbringing, and the dynamic in their relationship, Tamara had learned to put her own power aside so that she can be liked and not ruffle feathers. But also because also wants respect for her intelligence and capability, she is in conflict.  So, she uses indirect or passive-aggressive means to assert her power that can end up being destructive to the relationship.

Talking about this seemed to make Steven uncomfortable. He even mocked the quote by Rosanne Barr that I paraphrased but actually reads, “The thing women have yet to learn is nobody gives you power. You just take it.” This is going to clearly upset the dynamic in the relationship, but speaking up for what she wants is something Tamara needs to be doing more. And, Steven needs to do his part by taking her seriously, listening to her, and accepting her influence. Once this happens the relationship will thrive.

A post-script: what you may not have seen was the clear love and respect that Tamara and Steven did have for each other. Though we did uncover issues that were getting in the way of the relationship moving forward, they also had far more strengths that we could use to support their bond. And, I am happy to report that Tamara and Steven are getting married!