Confessions of a Therapist for the Very Rich

If wealth gives you the freedom to travel, the money to satisfy expensive tastes and the resources to take care of your family, what could you possibly have to worry about? Plenty, says Naples psychiatrist Richard Capiola, who hears the troubles of the affluent through his work with NCH Healthcare System's Intensive Outpatient Services program. He sat down with us to talk about why those who might seem to have everything can still be in psychological pain-and what can be done to relieve it.

For one thing, he says, many of the qualities that make the driven, charismatic individual a great success in the business and social world are the same qualities that can cause that person psychological distress when transitioning to a simpler life. For those who were once big fishes in small ponds, CEOs and business owners well known in the community and responsible for the well-being of hundreds of employees, the relatively anonymous life of Southwest Florida can bring up some fundamental questions, beginning with "Who am I?"

"The people who see me really do struggle with this sense of how they restructure their identity," he says. In their own minds, their whole being was "the meaningful power position that they held. Now their life is getting a bagel in the morning and taking a nice walk on the beach."

In fact, many classic type-A behaviors can be seen as a form of self-medication for this crowd, says Capiola. Workaholics are able to grow booming businesses while avoiding emotional issues with their wives and children. The CEO who holds everyone to a strict schedule at the office finds himself recreating it in retirement: breakfast at seven, the marina at nine, the club at noon.

It isn't the same as having to be at the office because you're the only one who can be relied upon to make the hard decisions, but it might be a good psychological substitute. And a necessary one, for this clientele. "No one is worried if they don't show up at the marina at nine o'clock, but I think it gives them a sense of focus and purpose," Capiola says, noting that most of the people he sees function better if they stick to some sort of regimen. Financially, Capiola says, they can afford a life that emphasizes spontaneity and relaxation over obligation and duty. "But I think it's a hard place to go psychologically."

Although those who have made this transition with relative ease are more likely to be found swapping stories with new buddies than sitting on the therapist's couch, they are navigating these issues as well. Many, he notes, decide they are going to let go of their pretenses and hang with the local crowd, only to find that a good portion of it is made up of former bigwigs just like themselves.

"You go to a place like the Country House or The Cove [in Naples], and all of the sudden you're sharing your eggs with somebody who's done amazing things," Capiola says. He says many of them come to appreciate the uniquely Naples experience of being able to live a relaxed lifestyle while still sharing ideas and experiences with a like-minded peer group. "They don't have to put on a coat and tie. They don't have to put on airs. But they still have a life of talking about important things that they've accomplished," he says.

Even as a former bigwig is reveling in his new "regular Joe" status, sometimes his wife becomes depressed over this transition, particularly if her identity was wrapped up in his. In Michigan or Ohio, she was married to an industrial titan; now she lives in Southwest Florida with some guy in Dockers who drives his golf cart around all day.

In fact, the Southwest Florida retirement lifestyle-with most couples far away from friends and family, their lives devoted mostly to leisure pursuits-can be the perfect Petri dish for marital problems that have lain dormant for years. If the husband can't let go of being the boss, the couple find themselves at war over a household that the wife has managed alone for decades. It's a familiar story to Capiola: The husband never knew his wife was doing so many things "the wrong way"; she had no clue he was such a control freak. (Although his employees could have told her.)

Many wives also had no idea how much of their husbands' daily lives included drinking. "Within the business setting, the use of alcohol as a social lubricant is often very accepted," Capiola says. "You get used to the idea that everyone has a drink at the end of the day." Alcohol use can also escalate with opportunity, particularly for a former executive who used to wait until arriving home at six or seven to have his first drink. In Southwest Florida, those dinner-hour cocktails are still routine, but now they may be joined by a scotch-and-water at three o'clock and a couple more while toasting the sunset.

Capiola says people go through complicated mental hoops to convince themselves that even though they are having four or five drinks a night, they don't have a drinking problem. They aren't going to work while intoxicated, and, particularly in communities where the club is within walking or golf-cart driving distance, they defend themselves by saying they aren't driving while intoxicated. He's treated clients who had no idea that they were alcoholics until they were hospitalized for an unrelated health condition and began having withdrawal symptoms.

For couples who can't or won't work through their issues, separation and divorce bring about a whole new set of challenges. Friends tend to choose sides, as when any marriage ends, but for those whose lifestyle is about being part of a certain social scene, a divorce might mean that an ex-wife is dropped from the black-tie and benefit circuit while her husband's new spouse takes her place. Still, spying their photos in glossy magazines isn't what people usually miss about their old lives: "Losing connections is what's most painful," Capiola says.

The death or lingering illness of a spouse or long-term partner can also bring up thorny dilemmas related to identity, family dynamics, and-often-money. Capiola remembers one couple who had been together for decades but weren't married. As one partner became more medically ill, the other began asking, "What will happen to me if this person passes away? How could I manage the life we built together?" In turn, the ill partner waved away his partner's request for any sort of formal relationship contract, seeing it as an affront to his honor as a businessman whose word had always been his bond. In situations like this, Capiola helps the client learn how to identify and ask for what they need to feel safe in the relationship.

The more money at stake, the more difficult the subject can be. In situations where a surviving spouse is not the first wife, she may have no idea of her husband's intentions for his estate. Decades of marriage might not matter to his children-or even to her spouse-as far as inheritance is concerned. A man who has amassed a large estate may see distributing assets evenly among his adult children and his wife as the most equitable solution. To the wife, it feels as though she's being treated like a child, and it may color her perception of what she saw as an "emotional, connected and loving" marriage. Still, Capiola appreciates the difficult decision that is being faced. "How do you turn a relationship into a number?" Capiola asks. "I'm not sure there's a nice way to make that smooth for everybody."

Sometimes it is the children who are surprised by the division of assets; if one child has been financially independent and another hasn't, the one who has relied on the parents for hand-outs may find that the tab has been taken off the top of his or her inheritance. This reflects an issue that many of the affluent grapple with on a regular basis: Under what circumstances should they give their adult children money? Whether rich or poor, if you have a child in trouble, "you try to bail them out in the ways you have available," Capiola says. "If you have a great deal of money, you may be able to put a lot of money into the issue."

Guilt comes into play if the wealthy person feels that his moneymaking years were time he might have spent with his children, teaching them the skills he used to navigate in the world. Pride is a factor, too, for the man who has made a fortune by keeping a cool head and never letting his rivals take advantage of him. Capiola says they ask themselves-and him-"Do I take a hard line when it comes to my money?"

Although the right answer varies in every circumstance, one constant piece of advice that Capiola gives is that neither a family nor a marriage can be looked at in the same way one would look at a business concern. "Applying business models to emotional relationships doesn't work," Capiola says. "In fact, it's a good way to damage a relationship."