To get something out of this life, you’ve got to put something into it from the heart…
On Dangerous Ground, 1951

Trying is the hardest thing people can do. Just plain, unadorned, flat-out trying. We will go to fantastic lengths to avoid it: ‘hedge our bets’; act like we don’t care, to cushion ourselves against possible failure; try in ways that don’t count; even fail on purpose, so that we didn’t ‘really’ fail.

So why is it that someone will virtually throw their life away in mediocrity, live with terrible regrets, wake up in the middle of the night knowing they cheated themselves, and go through life half-there, to forestall the unbearableness of ‘failure’?

Well, first of all, our self-image is a very vulnerable and fickle thing. Doing therapy is a perfect microcosm to watch the way in which this crazy thing called self-esteem yo-yos back and forth. I see it constantly, for example, in patients who are therapists. I often hear that, in the course of a single day, they feel they did a great job with someone, so it’s “I’m a living god”; an hour later, they do a poor job and it’s “I don’t even have the right to call myself a therapist”. So, which is true – the good, the bad, both, neither? Each one feels real at the time, then later it may feel like, “How could I have deluded myself like that?”

In therapy, people can develop the capacity to maintain a (relatively) stable view of themselves, one that allows for failure without despair, and success without grandiosity – that, in short, allows them to try their best, without terror. But how does this happen?

As young children, we have wild fluctuations in how we see ourselves, and how we see others. “I hate you Mommy,” lives right next door to, “I love you, Mommy”; and “I’m a bad boy” is right there alongside “I’m totally amazing”.

I remember my son, at about two and a half, in a single session of trying to play catch with me. When he dropped the ball, it would be, “I hate baseball!” When he caught it, it was “I’m going to play for the A’s!”. This ‘extremism’ in how we view ourselves and others, is called splitting in the psychological literature. Of course, there are debates, hostile camps and cultic fervors attached to all the different ways of seeing, defining and understanding splitting, but for our purposes, they all involve the concept that a child sees self and ‘other’ in extreme terms of good and bad, and that somehow, the long voyage of emotional development must take the child from the raging seas of extremism to the calmer waters of a more moderated and complex view of self and other.

This teaching,by a famous rabbi, expresses this more complex capability we are all shooting for:

Everyone should have two pockets, each containing a slip of paper. On one should be written: I am but dust and ashes, and on the other: The world was created for me. From time to time we must reach into one pocket, or the other. The secret of living comes from knowing when to reach into each one.

Well, actually, rabbi, the secret isn’t in the knowing, it’s having both sides emotionally available to you, and having the capability of ‘reaching’ when it’s clear you need one or the other. And please note, neither ‘dust and ashes’ nor ‘the world was created for me’ is a self put-down – they are just different ways of holding one’s self-view.

And speaking of holding, that’s where therapy comes in. Thanks for asking.

How does one attain the capability of having these two ‘slips of paper’ in one’s pocket? Well, the way the system is designed to work is something like this: while the child is gyrating wildly between hate and love for the ‘other’ (such as Mom), the parenting figure is stable, not being devastated by the hate, not being unduly gratified by (i.e. desperately needing) the idealization by the child. And similarly, when the child fluctuates in his feelings towards himself, the parent still ‘holds’ in mind the good when the child hates himself, and the ‘normally flawed’ when the child is grandiose. The child gradually internalizes this balanced holding, which creates the capability of seeing himself as both special, and ‘regular’, depending on what is appropriate or called for at the time.

Similarly, the child starts out idealizing the parents (i.e. seeing them as perfect) and gradually, gently, as time goes by, he or she begins to see the ‘human’ flaws and weaknesses in the parent, and ideally, is able to interact openly with the parent honestly about these weaknesses, with the parent able to acknowledge these flaws without defensiveness or anger. And, likewise, the parent is gradually, gently, able to talk to the child about his (the child’s) problems, his weaknesses, but within a context of respect and appreciation and balance. Thus, through this mutual process of seeing the parent as flawed, but still pretty good, ‘special’ and ‘regular’, and seeing himself as flawed, but still pretty good, and both ‘special’, and ‘regular’, the child is able to develop a realistic, and complex, view of self and other.

And all this sets the emotional foundation, the confidence, the ‘reserve self-esteem in the tank’ that allows him to ‘try’ things, without being terrified that failure means he’s a total loser. And someone who can TRY, and be bad at first, but stay with it, and gradually get better and better until the thing is mastered, is indeed blessed. After all, we are, by definition, ‘bad’ at anything new, so if we cannot tolerate ‘not being good’ at something, how can we possibly learn new things? And if we can tolerate not being good at something, we can learn anything.

So, how does this parent-child process go off the rails, and how does therapy help? I have been talking about this complex, interactive process between parent and child, but the thing that strikes me so often in working with patients is not that their parents were bad to them, or abusive, as much as there just being little or no interaction at all, especially about emotional or relationship things.

A typical sequence might go something like this:

Someone tells me something horrible or traumatic that happened in their ‘personal life’, as a child (say, being teased and taunted for years on the school bus) and I ask, “So, what did your mom say about that?”

“Oh, I never told her about that.”


“Hmm, I don’t know – I guess we just never talked about things. Why – is that unusual?”

No, sadly it’s not that unusual. But it is very telling as far as the child’s emotional future; how can the complex dance of becoming human happen when there is no interaction, no sharing, no relying on others emotionally, no truth-telling back and forth, no real sense of belonging, emotionally, to one’s own family? A human being has to be brought in to the human race, socialized, not just ‘there’, to be served breakfast, and ‘there’, to watch TV or play video games all day on his own. Human beings have to be shown, by caring interaction, by interested attention, that they matter, not just instructed, verbally, on the ‘rules of the house’.

And in the absence of the kind of caring, individualized interaction, that gradually allows for the integration of the split self and the split other, vestiges of these extreme views persist into adult life, leaving the person not with an integrated range of self-feeling, but with a split self: a sense that they are flawed (bad me), plus a grandiose self-concept (perfect me), both of which must be shielded from ‘real life’, lest the bad self be confirmed, and the grandiose self shattered. And shielding these part-selves from real life is a severely limiting business, preventing true intimacy with another, and precluding ‘trying’ new things, because you might look bad, you might fail.

For so many people in therapy, the therapy relationship is the first time they have had anyone committed to go through things with them, not just in physical proximity to them. Human beings are social creatures, and in the absence of feeling that you have your group with you, you learn not to use others for support and self-correction. You learn self-protection, not self-expression; how to not care, not how to care.

It is HARD to care – it is HARD to try: it takes help, it takes support, it takes guts. It takes an ability to tolerate short-term pain (“I failed, temporarily”) for long-term gain (“I did it!”). But the payoff for trying, for caring, is a rich and meaningful life, lived with other people, not just around them.

A life lived with love, with trying, with caring, with help, is worthwhile, while one lived from not trying is filled with regrets, with loss, at two in the morning.

It’s true, in trying you might lose, but you’re still in the game, and you’ll have other chances; but if you don’t try, you have already lost, for not trying is the biggest loss of all.

 Never regret anything you have done with a sincere affection; nothing is lost that is born of the heart.

— Basil Rathbone






Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Love, and How It Gets That Way








Where is love?
Does it fall from skies above?
Is it underneath the willow tree,
That I’ve been dreaming of?
Where is she,
Whom I close my eyes to see?
Will I ever hear the sweet hello,
That’s only meant for me?
Who can say where she may hide?
Must I travel far and wide?
Till I am beside someone who
I can mean something to…
Wheeeeere is love?

Where is Love? from Oliver, by Lionel Bart

These heart-rending words (and if your heart isn’t rended, or even rent, watch the musical, and if it still isn’t rended, you get forty lashes and ten days of gruel), from the mouth of Charles Dickens’ immortal lost waif, Oliver Twist, express with tremendous poignancy the question we are all asking, one way or another:

Where the hell’s the love I came here for?

That’s right – we know it’s all around us, somewhere, we know everyone talks about it, they sell cards about it, sing songs about it, write poems about it, give us money instead of it, confuse it with sex, even have a holiday devoted to it, but, as Ollie himself might say, “Where the deuce is the bloomin’ stuff, anyway?”

Must we, like Ollie, ‘travel far and wide’ to find it? In Out of the Past, one of my favorite film noirs, this is this bit of dialogue:

Jeff Bailey: You know, maybe I was wrong, and luck is like love. You’ve got to go all the way to find it.
Ann Miller: You do to keep it.

All of this implies that love is like finding buried treasure: you have to seek it assiduously, putting aside other, more minor, considerations, to attain it. And, if you’re very, very lucky, you just might find it, somewhere. Jeff Bailey thought he’d found it – he even gave up his whole life, his home, his career, his reputation, his principles, and ultimately, his own personal safety, to go ‘all the way’. And what was the ‘treasure’ he risked all to attain? The kind of girl who kills without remorse, ditches him, and, at the end, when they’re stuck with each other, says,

You’re no good. You’re no good and neither am I. That’s why we deserve each other.

Cover your ears, Oliver.

Well, in all this frenzied reaching for the brass ring, this rushing about the world looking from face to face for a sign that the other is our true love and soul mate, it seems to me we are missing something important. And it is simply that the successful transmission of a signal depends on two things: the transmitter, and the receiver. The transmitter is (hopefully) the true love that the ‘proper stranger’ is beaming your way.

And what, then, is the receiver? Our ability to BE loved in the first place. It seems to me our society takes this last bit for granted, but it is by no means a small part of this whole equation, and has a great deal to do with how and why love goes wrong so often.

While it’s certainly true that, as Woody Guthrie says,

It’s a-hard and it’s hard, ain’t it hard,
To love one that never did love you,

the following is also hard, though mostly unsung: To love ‘one’ and not have it received. I had to do therapy for years and years before I realized this – that, while terrible damage is done children because their parents either do not love them, or do not know how to love them effectively, there is also terrible damage done by parents not being able to receive, and value, their children’s love for them.

People want, and need, to have an effect on others. It proves they exist. When children’s love for parents is taken for granted, or worse, forced into a meaningless Jell-O mold, like “Say you love your mother, dear,” the treasure they have to offer the world is devalued, demeaned and trivialized. And when someone feels that their cherishing, their respect, their delight, their ‘getting’ of someone else, is meaningless, then they feel they are inconsequential, no matter how much the parent repeats, “I love you,” to them (often in the same formulaic chant).

As the therapy process evolves, we see changes in many areas of functioning. It is assumed that one of the hoped-for goals is an increase in the capacity for genuine caring and love. However, someone constantly in the thrall of emotional storms is by necessity self-absorbed, and does not have the psychological wherewithal to stand back from themselves and truly love another. As the internal storms abate, there is the possibility to see, hear and appreciate another person’s qualities. This is partly why, in the ‘old days’ of psychotherapy, patients were forbidden to begin outside relationships during the course of their therapy: they had to be free to be ‘selfish’ enough to have their primary focus be on building structure inside, and on the therapy relationship.

But there are two other areas of relationship that can improve dramatically over the course of treatment, too:

1) the capacity to receive (and believe !) the therapist’s concern and caring (and, by extension later, to receive, and believe, concern from others in the outside world).
2) the growing belief that their concern and caring for the ‘other’ (the therapist, in this case) matters, and is valued and important to the other.

Perhaps older readers will remember the lyrics to the song Nature Boy, by Nat King Cole, which express this all pretty efficiently:

The greatest thing you’ll ever learn,
Is just to love, and be loved in return.

And, not to belabor the point, but bear with me for just one more, from one of my favorites, John O’Donohue:

We do not need to go out and find love: rather, we need to be still and let love discover us.

What do these things mean? That the familiar trope of seeking love by searching the world over for it, is itself kind of a grape Jell-O mold that vastly underrates the difficulty of the thing, and the accomplishment of attaining it. For this thing called love is not just praying to god you find somebody cute who thinks you’re cool: it involves a host of skills and capacities that one develops by practice, by work on oneself, by thoughtfulness, and sometimes, by therapy.

A basic, but not complete, list would include:

The ability to love another person for who she or he really is, apart from yourself, and to support the person in becoming him or herself.

The capacity to believe that the other person receives your love, and values it.

The ability to receive their love, not in a cynical way, not in a formulaic way, but to really see the ‘signs’ that indicate that they love you, and how they are loving you, and the effort that goes into it.

To enjoy their love for you, rather than taking it as conditional, a burden, a performance demand, or a stricture of some kind. Realizing that to receive the gift of love graciously is to give a precious gift back to the giver.

The ability to realize that their loving you, caring for you, wanting to help you make it in life, and even your depending on them, is not a burden on them, but the fulfillment of their own emotional capacities. After all, if you have the ability to dead-lift 750 pounds, but never lift a weight, that’s no fun, is it?

Do you start to see what I mean? The ability to love and be loved is not like rolling off a log – it is a lifelong practice, that can only be developed by being made a high priority, and it can evolve beautifully over a long period of time. It is one of the only human gifts that can continue to grow over the life cycle, and is not affected by the ‘ravages of time’ and aging.

A cute young couple out for a stroll together on a Sunday afternoon, holding hands as they plan their lives together, is a fine sight.

But that same couple in their 80’s, holding hands, laughing together, being comfortable in the silences, knowing what they have been through together, and still getting a kick out of each other: now THAT’S a big deal.

Oops, almost forgot: Ollie, you can uncover your ears now. After all, you don’t want to miss my next blog.

Ollie: What’s a blog, sir? Some sort of sausage?

Me: No, Ollie – it’s when I write down all my thoughts about life.

Ollie: If it’s all the same to you, sir, I’d prefer the sausage.


Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Part Baby

Man Holding Up Baby

Years ago, when my younger son was maybe seven or eight, we were watching some classic old Chip and Dale cartoons together (yes, on a scratchy old VHS tape!) that we had seen many times before. We were laughing a lot, glancing at each other during the ‘good’ parts. After the cartoons were over, we were quiet a while. Then, he looked over at me, very thoughtfully, and said, “Are you part baby?”

As a parent, I felt honored – like I had just been handed my Daddy diploma. But beyond that – I wondered about the question itself. Are we part baby?

We grow up fast, racing pell-mell to become adults, desperate to put ‘childish things behind us’ and prove ourselves, frantic to show the world that we’re not babies anymore. But does acting like adults, make us adults? Does something get lost in the rush? And what is an adult, anyway?

To most people who are beginning therapy, being an adult means being serious, not being needy, being independent, financially and emotionally, being able to ‘make it in the world’, being able to stand up for themselves, being a success, being strong. And to a certain extent, all these things are laudable goals in our society.

And for the same reasons, getting into therapy is a last resort for most people. Why? Because it ‘means’ (to them) they are not independent, that they are needy, that they can’t make it on their own, that they’re not a success, and that they’re weak – that they are not all those hallmarks of adulthood that I just ticked off above. And so, they come into therapy like a guy entering a pornography store or a girl going in for an abortion: squirming, ducking, cringing, uncomfortable, not wanting to be seen, embarrassed. Their whole attitude is, “Get me out of here, doc!”. So, when I basically say, “Sorry, but we have to get you in to here,” well, you can imagine the reaction.

Most people go at their lives (and their therapy, at first) like they’re skippering one of those Everglades airboats – skimming the surface of the water at top speed, bound for somewhere (‘adulthood’?) fast – moving, moving, anywhere but here. Then, they wonder why their lives don’t feel meaningful, their relationships fulfilling, their jobs worth going to.

Today, when I went outside to let Angus (my dog) into the backyard, I watched as he joyously raced into the yard, sniffing carefully around all his familiar haunts (checking his email?), leaving his calling card at important way stations, barking his hello, or his challenge, to the neighbor dog, surveying his kingdom. He was at eye-level to the world, he was of the world, close to the earth (‘terrier’ meaning just that), even in the earth, when he dug down to explore, or to make a comfortable lying-in place, as he always does.

I took a minute to look around me, and noticed, for the first time, a hollow in a tree near the back gate. In the span of a moment, a whole host of things went through my mind. I remembered how Boo Radley, the ghostly neighbor in To Kill a Mockingbird, left things in a tree hollow for Scout and Jem. Kids are at eye-level to the world, too. They notice things in the natural world: a butterfly, a smooth stone they can throw, or collect, a shrub they can hide in, a good place for digging. I also thought about how, in my early thirties, when I used to ride my bike a lot, I was surprised that I noticed things that I missed completely when I drove by in my car – noticed them and cared about them: the slow rise of a hill, the kind of trees in each neighborhood, the dogs in the yards, the potholes in the road that became familiar, pretty places to stop along the way that I looked forward to.

I even thought about a patient of mine who obsessed about what present to give her two year-old niece for Christmas. For weeks she went back and forth: A doll, if so, which one? A tricycle, if so what kind, what color? A dress, shoes, a matching outfit? In the end, she decided on an expensive toy, and wrapped it up carefully in ‘just the right’ box and paper. On Christmas morning, she could hardly wait to see how her niece liked the new toy. And what happened? The child tore open the package, threw the toy aside, and played all day with the wrapping paper and two kitchen spoons she found on the floor.

So, what is it we lose in the race to adulthood? It seems to me there are two ways to ‘move’, experientially, as a human being: deep, and laterally. As a child, we are like Angus, going deep all the time: we live in the moment, we notice the little things, we are in the world, and of it. We still have ‘intimations of immortality’, as the romantic poet said, “trailing clouds of glory” from the time before birth, when we were one with mother, one with the universe. We get hungry, we eat; thirsty, we drink; tired, we sleep; curious, we explore; need mother, we cuddle; need to be alone, we play on our own, with great concentration, wiping off Mom’s kiss haughtily when she intrudes, cluelessly, on our one-person universe. We feel our feelings, and let them show, not worried about how it looks, or whether it’s cool or not to laugh, to cry, to want, to need, to want to go go go, or crash and sleep for hours. In other words, we go deep, partaking of what the day has to offer, fully, unselfconsciously, openly, wholeheartedly.

And then what happens? A million little things, in a million different ways. We are told we are bad, wrong, crazy, selfish, stupid, too this, too that, not enough this, not enough that. As we get older, we are told we have ‘things to do’: watch your little brother, do your chores, do your homework, don’t bother Mommy, clean up your room, practice the piano, don’t do what the other kids do, why can’t you be like the other kids, be good, be right, be nice, be kind, be strong, be pretty, be enough. But most of all: Grow Up! Be a Big Boy, a Big Girl. Then later (and these come fast and furious): be cool, be hip, be desirable, do well, get good grades, stop fooling around, get serious, get a job, get a better job, make money, find the right person, get married, get a house, get children, make more money, get a better house, get more serious, take care of business. Get with the program!

And the result? We don’t have the time, or encouragement, to ‘go deep’ into life anymore. We lose touch with the moment, with our feelings, our needs, and we ‘get with the program’. Now, we have to move laterally. We need change, variation, newness, differentness, a jolt of some kind. We need the ‘new’, in order to feel anything. We need more, in order to have anything. We rev the engine, and honk the horn, and curse the other drivers. We’re impatient, driven, tapping our toes and bobbing our heads as we move, move, move to the next thing, the next better level, trying to keep up, not be left behind, stay with the herd. Now, we can only achieve a ‘jolt’, a faint echo of ‘going deep’, by drinking a couple glasses of wine, a couple shots of Jim Beam, using marijuana, meth, cocaine, MDMA, hash, speed, by misusing sex, by obsessive exercising, buying the latest this, having the newest that. We have to move, move, move, because we can’t stop and appreciate where we are anymore. We’re jaded, stunted, blunted, sated, blah, and “whatever”.

In short, we’re gone. Elvis has left the building, just as Elvis had so clearly left himself, by the end.

And how do we find our way back? We begin by doing the very opposite of what we have done to ourselves, what we’re used to. We start by Stopping. Learning to Pay Attention again. Breathing. Noticing. Being, not Doing, hopefully in an encouraging environment. There are many such opportunities in our culture, though none of them are being hammered into us by major corporations, or splashed up on billboards, or listed in People Magazine’s 100 Sexiest list.

Psychotherapy is only one of these, but it happens to be the one I have devoted my life to, and the one I used myself, so I can only speak knowledgeably about that one way. For many patients, psychotherapy in effect becomes the answer to the question: How do you cure adulthood?

Re-learning (or learning for the first time, in many cases) how to go deep, and how to re-connect with the child, takes a safe place, a safe person, and a willing participant. Though it is ‘natural’, it is hard – all change is hard. People often ask me, “Is this going to work? I can’t afford to pay for something that’s not going to work.”

“Well,” I ask them, “how much time, effort and money have you put into what you have NOW? And, did you get your money’s worth?”

It is fitting that ‘getting better’ is called recovery, because for most people, it means literally recovering lost powers, lost parts of the self, and lost capabilities, and integrating them back into the personality, putting them to good use again. For many people, therapy becomes the first time they “really laughed” in forever, really felt strongly about anything, really fought for anything, really cared, really cried. I heard a poem yesterday, that actually was the inspiration for this whole posting:

You must walk on the valley and mountain,
For days, for months, for years,
Then at last you might come to the fountain,
At last, to the fountain of tears.

The author is recognizing, appropriately, that for most people, most ‘adults’ (especially men, in our society), it takes work to get back to the capacity to cry. You have to be able to feel to cry, to respond, to something sad, or moving. That is actually the true meaning of the badly ill-used word responsibility : The ability to respond.

For many people, it takes a tragedy, a shock, loss, or crisis to jolt them back on the road to themselves. The break-up of a relationship, an auto accident, being fired, being rejected, getting in trouble with drugs or alcohol, a health crisis, the loss of a parent, spouse, friend. These and many other things can force us to question our values, and our value, to feel we are lost in life, to feel we don’t have a life, or one worth living. These things are sad and tragic, but if we use them to get back to ourselves, they are pain with a purpose.

What people can achieve in therapy is what I think of as reaching back, extending a hand back to clasp that of the child, to ‘complete the circuit’ of human capability that is lost by ditching the child in one’s frenzy to grow up. True maturity is not being only childlike, or only adult, or only independent, or only dependent: it is having the full range of human capacities in your quiver, with the ability to respond fully to all situations, with a minimum of artifice or self-consciousness, trusting in your body’s responses without embarrassment or shame, having the ability to dive deeply into the richness of the moment, in your own way.

And that is what my son meant when he asked me that question. I was there, with him, in the moment. Did it mean I was a child? No – because I have worked hard to embody all the things that make up a human being, and I hope I have succeeded, at least somewhat, in recovering my wholeness, just as I help my patients to do.

So, in that precious moment, I felt that I really could answer my son, and with some pride, “Yes, I am part baby.”

What would your answer be?

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Along the Oregon Trail

Covered Wagons

This don’t feel like home anymore;
Nothing’s familiar when I walk through my door.
So I thank the heavens or who’s ever in charge,
This don’t feel like home anymore.

I don’t feel the pain I once did;
One day just finished like a milk carton kid.
All your rooftops set free in a hurricane the wind,
I don’t feel the pain I once did.

Home was just a broken heart;
A driveway to park a car.
A memory of a dream long since in discard
So you won’t be surprised ’bout the joy in my heart.
This don’t feel like home anymore.

Milk Carton Kid – the Milk Carton Kids

Interesting lyrics – surprising. You expect “This don’t feel like home anymore” to be a plaintive evocation of the old days, when things were familiar, better, maybe – but no, it’s saying, ‘Thank god those days are gone, I feel joy that they’re over and done’. It’s sad, tragic, that many people feel this way – that they need to feel this way – about times that should have been glorious, significant and formative of all that’s good in them.

The long, perilous journey from what was to what is, is one that is not for the faint of heart, contrary to what many think about therapy catering to the weak and needy. I’ll always remember what a former patient once wrote to me about her therapy:

I thought this whole thing was just going to be a spin around the block – instead, it’s more like westward expansion on the Oregon Trail, where you’re the wagon master and I’m the timid schoolmarm from back East who’s experiencing real danger, and real life, for the first time!

To have your ‘home’ taken from you, irrevocably, and to have to ‘go West’, to a wild frontier, whether you like it or not, is a hard thing. And yet that’s what can happen in therapy. We live our whole lives in an ‘adjusted’ state of being, but we don’t realize it. We think – we know, in fact – that the way we are is us – I mean, it has to be, right? It’s all we’ve ever known. But, as I said in an earlier post, though we come to therapy to change, what we don’t know is that we have already changed; what we are really asking of therapy is to change us back, to how we started out, to what we were born to be, before we adjusted ourselves to the family drama around us, which is now, thanks to our ‘adjustments’, inside us.

And yet, the reason we hit the Oregon Trail, and suffer its rigors, is not to forget those we left behind, nor to dishonor them; in fact, in maintaining our frozen, compulsive adjustments to them, we actually diminish them, and reduce them to just the bad things they did to us, or around us. The neurotic adjustments we make, in our behavior, feelings and assumptions, are rigid structures, like marble statues we erect, to what they did wrong, when in fact they are more than what they did wrong. But, what they did wrong has to be a primary subject of inquiry, so that we can ‘cross the Plains’ to the true self. Once the true self is alive and well, we can return (usually, and hopefully) to not only what they did right, but more importantly, who they actually are.

You know, I’m starting to realize – my parents were just people. Now, I see them as maybe kind of like this old couple who used to live next door when I was a kid. They had their ups and downs, but when I take away what they did to me, well they’re just an old couple who wasn’t all that bad.

I have heard versions of this many times, in many ways, from people who have reached the security of becoming who they really are. Now that those unwanted adjustments have been ‘un-friended’, the rigidity softened, and the traumas processed, they can afford to view their parents (and other early figures) in a more mature light, as ‘just people’, flawed, weak, scared, immature, trying their best in a difficult world. Most parents were in their twenties, maybe thirties at most,when their children were born. Once you reach thirty, forty, fifty yourself, with a hard-won sense of yourself, you may begin to realize, “My god – my parents were just kids themselves.”

Of course, I’m talking now about genuine, meaningful forgiveness and compassion, the kind that comes only when you have done enough work on yourself that “what they did” is not shaping and distorting your life every day in the present. It’s not denial, just a clear recognition of their human limitations. Of course, if the damage done was by malice and intention, or too evil to forgive, then there is no forgiveness forthcoming, only a volitional letting go of the past, after you’re ‘done with it’, so that it does not poison the present any longer.

And, by the way, I don’t mean the “premature forgiveness” of those who first come to therapy saying, “Look – my parents did their best. Anything that’s wrong with me is my own fault, my own choices – I completely forgive them anything they may have done.” Nope, that doesn’t get it. First, you have to be able to stand in your own shoes and claim your damages, state your own point of view, take your place in those transactions, and yes, be one-sided. You have to be able to say, “This is what you did to me, period,” and feel it. Is it necessary to actually go through all this with your parents, or others who were responsible for causing damage and emotional limitation? No, not necessarily, and for many reasons.

Some – in fact many, parents are not capable of taking in this point of view, even in their older, presumably more mature, years. Patients often come up against golden oldies such as these chestnuts:

My god – are you going to bring all that up again?

You were always over-sensitive, and I see you haven’t changed a bit.

How can you do this to me, after all I’ve done for you?

Are you done yet? (folded arms and tapping toes can substantially improve the impact of this one)

Now you be still, and let me tell you the way it really was!

Complain complain complain – okay, then, I guess I never did anything right, did I?

Recognize anybody you know? I could go on and on, and there are astoundingly subtle variations on all of the above moves, that can be achieved by parents, with just a little extra effort, but the point is, unless the parent is willing to try and listen to the ‘issues’, or can gradually shift in that direction, sometimes with help, there is no particular gain to ‘duking it out’ directly with them. Of course, many patients feel it is important, even necessary, to exercise their right to tell the truth finally, to confront the parents face to face, to say the words out loud, whether or not the message is received. And the therapist must take these needs seriously, because sometimes ‘taking a stand’ out loud is very healing, even if the parents are outraged or rejecting of the patient’s reality.

But, on the whole, if at all possible, it is usually preferable to make the most of the therapy setting itself, as a safe place for the patient to develop his/her own viewpoint, and stake a claim to it. Sometimes it is via expressing (and ‘owning’) the feelings about the family of origin, sometimes it is more in relation to the therapist and the therapy relationship, that these things are played out.

Does this mean that whatever the patient says happened, ‘way back then’, really did happen? No, not necessarily, nor is that crucially important most times. But it does mean that they are entitled to their experience of what happened, their viewpoint on it, their reactions to it. For it is through this process of experience-claiming, that a person-in-waiting becomes a person-in-fact. It is not necessary that they tell The truth, only Their truth, and after all, that is all that any of us has at our disposal anyway.

And so, after the Indian attacks, after the water shortages, after the camp robbers, the starvation, the broken wheels, the washed-out rivers, the searing days and frozen nights, the wagon train comes to the end of the line, and the beginning of a person-in-fact’s real life. Things calm down, the passions without, turn to compassion within, rage turns to determination, victimhood turns to empoweredness; where there was confusion, there is now a glint in the eye, where there was compulsion, and desperation, there is now richness and appreciation, even gratitude.

And, for the wagon master, there is the rare honor of having been allowed to accompany this little band of courageous people across the wide prairies, toward their heart’s desire. No, it doesn’t always go like this, but it comes close often enough, to make life mighty fine, along the Oregon Trail.

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Not Knowing


In America, we’re supposed to know. We’re supposed to be decisive, not wishy-washy, sure, not wimpy, active, not passive. Americans figure out what they want, and then go get it. You hear it all the time, witness the iconic Nike slogan:

Just do it.

Of course, that’s understandable, in advertising. How many shoes (or cars, or widgets) would a company sell with the slogan, “It’s all so confusing?” How about a political candidate who campaigned on, “I do try to get it right – but then that’s not always possible?” We’re supposed to be sure. And we want to be told a product is the best, period, a candidate the greatest, period.

In the movie U-571, the head enlisted man lectures his captain, who has just been indecisive in front of the men,

“This is the Navy, where a commanding officer is a mighty and terrible thing – all knowing, all powerful…Those three words, ‘I don’t know’ , will kill a crew, dead as a depth charge…The skipper always knows what to do, whether he does or not.”

Makes sense, maybe – in war. But do we have to live our lives as if we’re at war? Do we have to adopt the forced bombast of the manufacturer of a hawked product, strutting around doing ‘great’ all the time, pretending we know exactly what we’re doing, definitive in our choices, and ‘weak’ if we are confused, or mistaken, or not aggressive?

Years ago, George Carlin based a whole comedy routine on this, when he compared football to baseball:

In football the object is for the quarterback, also known as the field general, to be on target with his aerial assault, riddling the defense by hitting his receivers with deadly accuracy in spite of the blitz, even if he has to use the shotgun. With short bullet passes and long bombs, he marches his troops into enemy territory, balancing this aerial assault with a sustained ground attack that punches holes in the forward wall of the enemy’s defensive line.

In baseball, the object is to go home! And to be safe! – I hope I’m safe at home!

A funny, funny routine – we laugh out loud, particularly as men, because we can immediately recognize the militaristic, macho, ‘code’ under which we all labor, whether we admit it or not, and whether we ascribe to it or not. It is ingrained in our society, and in all of us. The pot is constantly being stirred into a great stew: Our forefathers came here for freedom, to get away from the ingrown, hierarchical and effete British ways; we don’t depend on others but get things done on our own; we fight at the drop of a hat because we know what we stand for, and we’ll defend it to the last man. We know what’s right and what’s wrong, and we know what to do about it.

When there’s a problem, we identify it, assess it, and take immediate action: we know, and then we act.

Sound familiar? I constantly run across new therapy patients who ask the following questions about therapy, as if I am a personal trainer, or a physician treating the mumps:

Exactly what are we going to do? Give me details.

How long will this take? I don’t want to get involved with anything that takes a long time.

What can I read to make it go faster? What exercises can I do at home, what assignments: I need to get this thing over with.

But “this thing” is THEM! And the “it” in “make it go faster” is their own personal development! This way of thinking makes one into a defective product that needs to be fixed, and fixed quick. This way of thinking is fostered, and encouraged, by methods of therapy, self-help books, and websites that are ‘sure’ about what they do, and sure that it will work for you. In fact, therapists are encouraged to ‘market’ in this manner:

Find a specific niche, and fill it.

Brand yourself.

Do “solution-based”, short-term therapy (not dithering, time-consuming therapy).

Use proven, scientifically-validated therapeutic techniques.

And of course, always use Best Practices (the most terrifying, unassailable words in the medical lexicon).

Simply Google ‘Depression’ and you come up with: The most proven techniques for fighting depression. Wow, not only proven, but most proven: impressive!

But consider this: every breakthrough, every new idea, every realization, must come AFTER confusion and not knowing. There HAS to be unsureness and not knowing before there can be a higher-order of integration. You don’t go from absolute sureness to a new realization, because you don’t HAVE to, since you (purportedly) already know, right? There is no reason to explore any further if you know it all, if you’ve already reached a final and complete understanding of the situation, or of your opinions, or of yourself. So unsureness and confusion are Mandatory for growth in any realm. They say that Einstein was the one who discovered relativity because he was the one who could tolerate ‘not knowing’ for the longest, without coming to premature, and incomplete, conclusions, based on what “we know”.

Of course the search for better, faster methods of treating human beings is laudable, and can bring relief to some people, some of the time. When I started my practice years ago, the standard attitude of a new patient was, “Okay, Doc – so what do we do?” People didn’t have access to the Internet, to Googling “Therapy”, to reading up on techniques, and proven techniques, and most-proven techniques: they knew they felt bad and needed help. They had managed to find you somehow, some way, and you helped them. Sometimes I think those days weren’t so bad after all: at least they had gotten to you because someone had said, “Hey – this guy is good,” not “This guy does DBT,” (or CBT, or EFT, or EMDR, or the other alphabet-soup therapies). Not because these techniques don’t have a great deal to offer, but because, in fact, “research shows” that to a great extent, WHO does the technique is as important as the technique itself.

Much of what I’ve said above comes down to this: Therapy patients (like other human beings) like to feel in control. They like to know what’s going to happen, and when, and how. They want to know, not guess, to be sure, not doubtful.

Well, here’s a news flash: Therapists want to feel in control, too. People are complicated, unpredictable and changeable. Look, imagine having someone come to you for help: they are troubled, scared, and (maybe) a little desperate. They have already tried to do it themselves; they have tried to use will power, they may have read numerous self-help books about their problem; they have talked to friends about it. They want help, NOW. They don’t want to spend a lot of money, and they don’t want to spend a lot of time: the problem has most likely already taken a big chunk out of their lives and their potential happiness.

They tell you their story, then they look straight at you and say, “So – can you help me?”

You nod (looking confident, you hope).

But they’re only warming up:

“How? And exactly what will you do to me? And exactly how long will it take? And, oh yeah, how much will it cost me?”

How would you feel? To some extent, they’re putting their life in your hands, and they want (and deserve) answers. After all, they’ve already gotten a gunnysack-full of advice from friends, Better Homes and Gardens, Omni, Workout Illustrated, self-help books, and the Internet. So now, finally, at long last, they’ve come to you: The Real Deal. It’s Put up or Shut Up Time.

So, how would you feel? Well, if you’re like most people, you’d want a Technique – a Method, and a Sure-Fire one, a proven one, a most proven one, if you could get it, maybe even a (trumpets, please) Best Practice.

So, therapists, too, want to be sure. It’s hard to face someone and “not know.” After all, the old reliable medical model, from which we are all descended, will tell you that the patient has a specific disorder, and in case you’re not sure about that, just check the Diagnostic and Statistical Manual, Version V (it’s important to use Roman Numerals, like the Super Bowl – that way you KNOW it’s a big deal): the patient’s ‘condition’ is in there somewhere, for sure.

So now, as the therapist, you’re finally on safe ground: you not only know what you’re going to DO to them (your proven technique, remember?), but you even know what they’ve GOT (don’t worry, it’s got a long, impressive number, and that’s reassuring – go look it up, I’ll wait).

We’re all suckers for sureness, for knowing: it’s less scary, it gives us a form of security (hey, even false security is better than nothing, right?), and as therapists, it feels, well, more professional. Most non-physician therapists have had the uncomfortable experience of talking to a patient’s psychiatrist or family physician, the one who is supposed to dole out the medication. If they’re even willing to talk to you, a non-physician, at all, they want to hear ‘the goods’ and they want it in quick sound bites.

You want to say, with crisp efficiency, “I feel we’re talking Bipolar One here, with a possible secondary Adjustment Reaction,” not, “This guy doesn’t seem to know himself at all – I mean, he undermines everything he tries to do, and, well, he just seems to sit there waiting for, you know – something.” The latter would likely be followed by a sharp, disdainful silence, roughly translated, “Just what am I supposed to do with that, buddy? And by the way, where do you people get your training, if any?”

So, you want to have a technique, or approach, or method, going for you, and you want to know what they’ve got. And they want you to have a proven technique, or method, and they want you to know what they’ve got. So it’s clear why proven methods, and diagnostic slots, are so prevalent. Almost every young, or new, therapist I’ve ever had as a patient or a supervisee wanted to KNOW what to do, to fit in with a ‘school’ of treatment, and to know how to slot their patients into diagnostic categories. They want to know who they are, and they want to know what to do.

This reminds me of a man whom I had worked with for years. He had been an engineer, and a good one, but he found it emotionally unfulfilling. Partly because of his therapy, he became interested in becoming a therapist, and over a period of years, completed studies at a top psychology graduate program. He specialized in a behavioral technique that utilized a form of hypnosis for treating phobias and panic attacks. He prided himself on being more ‘scientific’ than I, much more specific and exact in his approach, and enjoyed pointing out to me that I was a throwback, groveling around in the dark ages of psychotherapy.

One day he was describing to me the treatment of a particularly difficult ‘case’ of panic attacks, with a male patient whom, I observed to myself, he seemed to enjoy and even identify with. At one point, he said, “Last time, we were in the middle of a session, and he kind of looks at me like we’re, you know, friends. And the funny thing is, I could feel it, too. I mean, I continued the procedure appropriately and everything, but I got a weird feeling that this other thing had a lot to do with what was happening, you know, like a wild card.” With that, my patient looked at me in apparent confusion.

I smiled and said, “Uh oh – looks like you were busy doing a technique, and a relationship broke out.”

All responsible therapy has to have structure, and even some ‘technique’; therapy is not just ‘let’s hang out and see what happens.’ But all responsible therapy also has to leave room for surprise, and creativity, and relationship, and for ‘not knowing.’ For human beings are not the mumps, or an ingrown toenail, for which exact, repeatable treatments are known.

I understand the forces that want to push therapy in that direction: it would be great, I suppose, if, after taking a course in a particular treatment modality, all therapists would be able to help their patients, regardless of their own personal shortcomings or the particulars of the patient’s problems. It would be wonderful, I guess, if, through some exact measure of treatment efficacy, therapists would be able to show that their treatment modality actually was better, that their prowess as therapists was demonstrably superior, perhaps even ‘most proven.’

But people are complex and complicated, and fortunately or unfortunately, when treating psychological problems, one size does NOT fit all. There are factors in play that mitigate against repeatability of approach from patient to patient, or easy ‘slotting’ of problems by the numbers, or even Roman Numerals. For example, there is the immediate sense of personal compatibility, or not, between the two parties, patient and therapist.

What if, when the patient walks into the room for the first session and starts talking, it feels like cats and dogs? What if the person reminds you of your Aunt Minnie, the one who always gave you an icy stare and treated you like a subhuman? Or your ex-spouse, the one who cheated on you, spent all the money, then kidnapped your child? Of course, as therapists we are trained to be ‘objective,’ to put aside our personal prejudices, and we all do our best to do so, but in the cases above, or related situations, doesn’t the patient perhaps deserve someone who does not have to overcome these things to be with him or her?

So, if you’re being honest with yourself, you are unsure about whether you are the right person for the job, or maybe about whether you can work with this particular problem. But, we are supposed to be sure, to know. How can we ‘not know’ and still be a good therapist? But the truth is, you don’t know, and how can you expect the patient to have the courage to face the unknown when you can’t, or won’t?

How do you ‘not know’ and still go forward? Well, there are at least three possible approaches:

  1. Ignore the feelings, trust your ‘technique’ and blast forward, hoping it all works out, and that the feelings are irrelevant ‘wild cards’.
  2. Refer the person to someone else, someone who, perhaps, would be more compatible or less triggered by them.
  3. Hold the issues (i.e. the possible incompatibility, or the feeling of being out of your depth) lightly, but importantly, and continue ahead, watching (inside and out) for what happens next. This way, you’re like a tennis player awaiting the serve: nimble, balanced, and ready to move in whatever direction is needed.

Approach number 3 is exactly what I did with a very difficult person I used to work with. He was an overwhelming, ‘force of nature’ type, very insecure, very loud, very sure of himself, a “Type A, Alpha Male,” in his own words. Even though he was very bright and very gifted (he dropped “Harvard” bombs on me at least three times in the first hour), he had been fired from several jobs in recent years, each time for his personality, not his work per se.

The first time he came in, it was clear he hated being there, in the position of a supplicant (his word), that is, not in control and having to depend on me. He quickly tried to take control, criticizing my office and my education (“So – no Ivy League for you, eh? What did you major in: remediation?”).

Once he had gotten those preliminary shots out of the way, he began his ‘interrogation’:

“So, what do you have to say for yourself?”

At this point, I was angry, a little overwhelmed, and I truly wanted to say, “I don’t know – I guess I haven’t had enough remediation,” but I couldn’t join him in his game of ‘who’s the top dog?’ if I wanted him to get better. I could feel the intensity of the forces that were driving him, the insecurity, the fear of being in a subordinate position (“one down”), and what he must have gone through to bring himself to seek help. But most of all, I could see he was trapped in an inner world of Always having to ‘know’, like a dinosaur stuck in the tar pits. If he lured me into competing with him, then even if I ‘won’, we both lost.

I knew my next statement could make or break the whole enterprise. I took a deep breath. “I don’t know what I have to say for myself, but I would like to help you. I’m not sure if I can, but I’d like the chance to try.”

He snorted in disgust, but then looked down and cleared this throat. His foot stopped wiggling, impatiently, for a moment, and, still looking down, he said, “Well, at least you aren’t pretending to be God in his heaven, like the others.”

“Oh, you’ve seen others?”

“Yeah – ‘experts’.” He named a couple of well-known local practitioners. His foot started wiggling again. “At least they’re supposed to be.”

I could feel the air in the room being let out, a little at a time. It felt like a relief to me, though his face was falling. He had given me an opening, a bone, though he probably didn’t realize it then, and I wanted to capitalize on it without alienating him.

“Wow, you must be pretty bad, if even the experts can’t help you.” Oops – had I gone too far?

His foot stopped again, and he gave a reluctant chuckle and smile, behind which I could see, for the first time, a vulnerable young boy. “Wise ass,” he said, standing up to take off his fancy blazer with the coat-of-arms buttons on it (his first layer of armor) and settle in for a while.

“Fair enough,” I replied.

We had begun our journey.

The “I don’t know” (a.k.a. inadequacy) had been flying around the room like a hot potato before I first spoke, waiting for someone to grab it. Once I caught it, with that, “…if I can” opening, we were in business. Now, we both “didn’t know”, but we had non-verbally agreed to not know together, wherever it took us.

Eventually, much of the pain that was locked up behind his superior attitude came to light, and he was able to be less defended, in front of both himself and me. His behavior in the world became more flexible and fitting to the actual situation, and, importantly, he began to have more space for other people’s needs and feelings, so that his intelligence and perceptiveness could become a tool instead of a weapon.

He could say, “I don’t know,” and he could appreciate it without disdain when others didn’t know; and when you can do both of these things, you can get to places beyond the known – places where only creativity, imagination and heart can take you.

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Foolin’ ‘Em


“Everything happens for the best”.

I don’t know about you, but that statement always makes me mad as hell. For one, it feels like a huge cop-out of personal responsibility for one’s actions; for two, it’s a Pollyanna cop-out from really trying to face the harsh realities of life; and for three, it’s a rationale for not actually caring about the bad things that happen to people. Are you getting the idea that I kind of don’t like it?

Now, if someone wants to say, “There is a Master Plan™ that Superior Forces™ on high have created for us, that we have no way of understanding, and I believe that everything that happens is part of the Master Plan™” — well, I guess I can’t argue with that, though again it feels like a cop-out for serious analysis or even acceptance of The Basic Realities of Life (sorry, I checked and that isn’t ‘proprietary’ enough to trademark, but I did sneak initial caps in there). I mean, you can’t really knock Superior Forces™, right? I mean, they Are what they Are, as God once said, if I’m not mistaken. But what good does such a fatalistic belief do you in life? I mean, even if things happen for a reason, where does that leave you? Strapped into some celestial roller coaster, with cotton candy all over your face, that’s where.

But hang on a minute: what if we turned that around just a little, and said, “I’m going to live my life so that everything that happens really DOES happen for a reason”? What if you took “That’s the best thing that ever happened to me” and made it be TRUE, in retrospect, by the way you lived your life after the ‘thing’ happened? Now, maybe, you’d have something worth shooting for! Instead of bemoaning your bad luck, or waiting for the next stomach-churning lurch of the roller coaster, what if you made up your mind that you were going to actually make ‘the best’ of what happens, that you were going to learn from what happens, to FORCE (whee – no TM needed now!) it to be the ‘best thing that ever happened’ to you?

What am I talking about? Let’s take an example – a terrible tragedy that could happen to any one of us. Let’s say you’re kind of a superior type, I don’t want to come right out and say you’re arrogant and conceited, but no offense, you’re arrogant and conceited. You suffer a horrible car accident, mangling your limbs and necessitating an extended rehab stay in the hospital. This actually happened to a patient of mine in the 1980’s – a man about fifty who was a retired high-ranking career military officer, a stickler for perfection (he used to point angrily to his watch whenever I was one minute late to the waiting room), who lived alone (he drove his wife and children away with his relentless criticalness and judging, and had no close friends for the same reason). But, to hear him tell it, he didn’t need anybody anyway – he was a ‘stand-alone throwback’ (his phrase) to the pioneer stock he came from, a one-man band who was above everyone else and therefore wouldn’t soil himself with contact with those lower on the human ladder than him (he would have made me say ‘he’ there, but he’s not watching anymore).

Oh yeah – why was he in therapy? Because his wife and kids had insisted for years that he needed it, so he came to me to prove he had an ‘open mind’ and to prove that he didn’t need it! And since he was already there in my office, proving that he didn’t need me, he used the time ‘productively’ to complain about others, to lecture me on my job, and to denigrate my profession (being that it was, of course, for the ‘weak’). Anything to help out, right?

Well, when he went into the Veterans’ hospital, he was, to put it mildly, a holy terror for the nursing and rehab staff. He lectured them on how to do their jobs, he resisted everything they tried to do for him, he refused pain medication (‘too tough to cave’), and he lay there, alone and in silent misery about the possibility that he would be physically something less than he was before. I was his only visitor, and he spent the first few visits shutting me out, ‘proving’ that he didn’t need anyone, least of all a ‘whore’ like me, who was being paid to care about him (in his estimation).

One day I was sitting there with him in silence, and I got an idea. I said, “So, why don’t you fool ‘em?”

That got his interest. He sat up in bed. “What the hell’s that supposed to mean?”

“Well, you’ve had a tough break. But what if you made a fool of Fate by making it into something good, something that actually benefited you?”

I could see he was wrestling with it, trying to figure out what I was up to. “What’s this, some kind of therapy trick? Page 222 of the manual? Something you learned in school?”

I got up to leave, and moved toward the door. “Hey, that’s okay – if you don’t want to know…”

“Ah hell – you’ve got it out of your mouth now; you might as well spit the rest of it out. I’m paying you, anyway.”

What a lovely invitation! I sat back down. “No, it’s not from a manual. It’s just a passing idea I had, that if you used all this (I gestured around the room) to your own advantage, you could turn it from a tragedy into a triumph of your will; you know – from weak to strong.”

That definitely ‘played’. He grunted. “Humph – go on.”

“Look – your wife, your kids, what do they say you need to improve on?”

Now he was mad again. He snorted, “Being human, they would call it. All that phony crap, like being nice to people, letting them in, giving a damn about losers.”

“So, what if you cooperated with the rehab program here, a little bit? Let them help you, do what they say, try being ‘nice to losers’ for a while? What would you have to lose? For one thing, you might prove that your family was wrong, that you can do it if you want to; for another, you’d be using the accident for your own benefit, just in case any of the stuff they said is true; and for another, you might actually get better. I mean, what do you have to lose?” I got up again to leave.

He snorted, “I always knew you were nuts.”

I turned as I went out the door. “Hell, that’s just an extra bonus: if you do all this and it really does turn out to be bullshit, then you’ve proved me nuts, too! A grand slam!”

He shook his head in disgust.

Well, I won’t say, “And from that moment on he was good as gold,” because life doesn’t work that way. But he did make a sincere effort to cooperate with the staff, he did bond, in his own way, with the other Vets in rehab, he did get better and recovered most of his physical functioning.

On the last day of his stay in rehab, when I came to visit him, I sat down by his bed. He looked like he wanted to say something, but nothing came out. We talked awhile about ordinary things, and then it was time for me to go. Finally, he stuck out his hand and said, “We fooled ‘em, didn’t we?”

And the best part of all is that, after his recovery, he stayed involved for years in volunteering with other Vets, giving him meaning where there had been none, contact where there had been none, and the chance to experience ‘being in the same boat’ with the rest of humanity, where before he had been superior and alone.

He stopped coming in as time went by, because he didn’t need me anymore, but we stayed in touch. And when we did, he would tell me about the advice he gave to his ‘new recruits’ at the VA Hospital:

“Sure, I felt like you – I was miserable, pissed off and bitter. But I used it to wake up to life, and if you work with me, you might do the same.”

So, does “Everything happen for the best”? No, not by a long shot. But if you can take what does happen, and live like it happened for your own personal benefit, sometimes you can fool ‘em.

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Little Things Mean a Lot








Give me a hand when I’ve lost the way,
Give me your shoulder to cry on.
Whether the day is bright or gray,
Give me your heart to rely on.
Send me the warmth of a secret smile,
To show me you haven’t forgot,
That always and ever, now and forever,
Little things mean a lot.

Little Things Mean a Lot – Kitty Kallen

So true, Kitty, and thanks for sharing. Most people aren’t asking for the world – they just want some acknowledgment that they exist, that they are heard, that they (dare we speak it aloud?) matter. In ‘civilian life’ (which, to me, means outside of therapy), these little things are the answer to man’s perennial question: “What do women want?”. What women want is (surprise!) pretty much what men want: that you (the partner) thought about me; that you are willing to step aside and make room, in your psychic life, for me; that you are willing to slow down and actually listen, without judgment, to me; that you are willing to do an occasional trade-off of priorities; that, while sometimes, it is about you, it can also, sometimes, be about me. We all want these things, and we need them.

There – was that so tough, everyone? Well, actually, according to the latest returns: YES. Hmmm, something’s wrong here. It sounds so easy, so reasonable, in theory. Give a little, take a little. One hand washes the other. I scratch your back, you scratch mine.

Sounds wonderful – on paper. But, apparently, most of us aren’t paper-trained. What sounds fine, in theory, doesn’t feel that way, in real life. It feels more like, “My god, what the hell do you want from me – my heart, my lungs, my soul?” or “You don’t want a person – you want a trained dog that knows only one command: Roll over and play dead!” That’s not even so far-fetched. I used to see a couple where the man always snarled at his pet-doting wife, “When I die, I’m coming back as your dog!”

What’s happening here? It doesn’t seem like it should be that hard to satisfy another person, to make them feel valued. Why does it feel to us, like “we” are asking virtually nothing from them, whereas “they” are demanding the moon and stars (and our right kidney!) from us? A lot of it has to do with the universal (unconscious) assumption that “they” are just a slightly different version of “us”. Yes, we’re all human beings. Yes, we all need food, water, affection, contact, some freedom and some security. But HOW we want these things differs tremendously.

Let’s take a look at it from a therapist’s perspective first. The therapist is in an ideal position to tailor what he/she does, to fit the patient, right? Therefore, it should be a snap to figure out what someone needs, and then customize your presentation to give it to them. So – easy as ABC, right?


But why not? Aren’t people pretty much the same, after all? Well, let me relate a few things from inside the therapy world. I’ll give you a very specific example from my practice. I was working with several patients who had narcissistic parents. You know the kind of parents I mean – people who are very self-absorbed, focused on looking good, maybe using the child as a means to show off to others (and rejecting the child is he/she is NOT able to be shown off), has a very limited ability to feel unselfish or unconditional love for the child. So, this type of parenting can produce particular kinds of problems in kids, which they take with them into adulthood. These problems can include inability to feel pride in oneself (parental voice: I’m the star – not you!), difficulties with intimacy (Thou shalt have no other before me), focusing on the needs of the other person to the detriment of your own (You only exist to fulfill my needs), and a kind of self-sabotage where, when you get close to a positive accomplishment or an emotional milestone, you begin to feel despair, inadequacy and “I should die” (This town’s not big enough for the two of us, hombre!).

Well, there is a wonderful book I found, that not only describes these issues, but relates the author’s own struggles with them, including her fear that writing the book itself (a positive accomplishment that ‘spotlights’ her) was going to get her punished in some scary, unspecified way. I don’t mind giving it a plug here: Trapped in the Mirror, by Elan Golomb, Ph.D. What could be better for a patient who has been subjugated like this, than to read a direct testament about it all, from someone (a therapist, no less) who has ‘been there’?

So, over a period of maybe three months, I excitedly told all four of these patients about the book, hoping, and expecting, that they would all come in and say, “Wow – now I see what you’ve been trying to tell me all this time, and now I see my behavior so much more clearly, what caused it, and what i can do about it. Thank you!”

And, what happened in “real life”? One person did in fact say that it had made a difference, to finally be able to identify the forces at work in her inner life, to finally understand the seeming contradiction of feeling BAD when you’re doing WELL. Great.

And the others? Not so much. One of them stated flatly, “I don’t know why you gave me this. I stayed with it through the first five pages, just out of respect for you, and then slammed it shut. What a waste of time – I’m surprised at you!” Oops – we had to spend the rest of that session ‘recovering’ from my bright idea. The other two said they had tried hard to see themselves in the book, but couldn’t follow what the author was trying to put across, felt kind of insulted that I thought they were ‘like that’, and really couldn’t relate to most of it. They didn’t want to hurt my feelings, but the book was boring and stupid.

                                               Patients: 3

                                              Therapist: 1

So, what went wrong? Only this: people are DIFFERENT. Yes, I had correctly grouped them all as children of narcissism – that wasn’t wrong, and they could all see how it had created major problems in their lives. I continued to work with them all, in their OWN ways, and all eventually improved significantly. But, even as a therapist, in a perfect position to fine-tune my strategy to each particular patient, I had batted a lowly .250 – not very impressive. Why did my brilliant plan bomb? Because there were factors BEYOND my little niche (‘children of narcissism’) that affected each person’s receptivity to the book. For the first patient, my introducing her to that book was one of those ‘little things’ that I did right for her – and ever after, she thanked me for knowing her so well, for knowing just what she needed, at a very vulnerable time in her life. Nice going there, Bernie.

And the others? Well, a long time later, one of them did tell me that she now, in retrospect, understood what the book was saying, and that she had been too defensive and stubborn at the time, to let it in. The other two, through the course of their (successful) therapies, continued to refer to “that time you gave me that stupid, boring book.” Oof.

So, even as a ‘professional’, I had goofed. My god, how can people in ‘civilian life’ be expected to decode the complexities of what their partners want, when even in a setting where “all I had to do” was focus on them, I had struck out? Fortunately, there are some clues out there. There are many, many systems people have come up with for describing these differences and making sense of them. Personally, I prefer the ones that don’t blame the person, that don’t rank-order people’s problems (“I’m better than you – ya ya ya!”), and don’t pathologize them (as you probably know by now, I am not particularly fond of the DSM V – or DSMs I through IV, for that matter, despite their fancy numerals). I respect the systems most, that just say, “Here are some of the ways people can be – if you recognize yourself, great.”

As I say, there are many such systems, but one that has been particularly helpful to me is the Enneagram. Again, what I like about it (and others, such as the Myers-Briggs type indicator), is that they are non-pathologizing. They are not about, “Here’s what your problem is,” but “Here’s what type of person you are, in the realm of the normal personality types that people can be” (and again, by personality types, I do NOT mean ‘personality disorders’ – if that’s your bag, the DSM V will be happy to help you out). The Enneagram divides people up into nine types, and each type has a ‘wing’ as well – kind of like the type is your major, and the wing is your minor. No type is better than another.

Not that the Enneagram, like any system, can’t be misused. Anyone who has spent time around “Ennea people” has heard things like, “Oh well – what do you expect from an 8?”, or “His being a 6 is alright, but that strong 7 wing is killing me!”. I learned, early in my career, that knowledge, and particularly specialized knowledge or insight about people, must be used only for compassion and understanding, never for ‘lording over’, putting down, slotting, snobbery, or elitism. For me, the proper use of something like the Enneagram, is in helping me bridge the gap between myself and someone else, to see how, and why, I am not communicating optimally with them, and in offering suggestions about how I might do better.

Anytime two (or more) people have to deal with each other, especially when it’s vitally important that they do their best, a system like the Enneagram can be helpful, because it at least gives you a way to see what the other person’s actual motivations might be, as opposed to what you’re projecting onto them, or how YOU would feel in that situation. It is not about good/bad, or healthy/unhealthy, or evolved/unevolved (for you spiritual snobs out there); it’s about learning how the other person takes in information, how they make meaning of experience, and what they value, in self and other.

Imagine, just as a simple exercise, that you’re dealing with the type of person who “just wants to do it the correct way”; now shift the slide to someone who is okay “just as long as we do it together”; now, “we have to do it my way”; now, “whatever you say”; now, “as long as it’s beautiful and elegant” – can you see what an enormous difference it makes? And what an advantage it might be, to know the other person’s basic motivations in transactions, in values, in life? Can you see why some kind of typing system might be of use for couples, for parents and children, for employee work groups?

Think about this: a couple has a baby. They believe, and expect (reasonably) that they will both be good parents, both love the child equally, both be equally close to the child, both ‘get along’ equally with the child. So what happens – in real life? Wow – all kinds of things: great things, unexpected things, frustrating things, hurtful things, joyful things, maddening things, easy things, hard things, crazy things. Why? Because, quite aside from all the “we’re doing our best” that the parents pour into the child, aside from the emotional problems, and strengths, that skew the interactive experience the child has with the parents, there is a whole other layer in play: the child’s type, as played against the parent’s type. Let’s put it this way: if you sat down on a bus bench next to Charlie, a random stranger, how likely would it be that you would love and treasure him to the end of your days? Uh, not very, I’m thinking. And why? Easy, you’d answer:

How the heck do I know if i would get along with this person, or be able to deal with them, or understand them, or them me, or even have any desire to hang out with them? They might not even be my type.

Well, there you have it. And, why would it be any different with your child? Because it’s yours? Because “blood will tell”? Because “the apple doesn’t fall far from the tree”? Because ”like father/mother, like son/daughter? All I can say it, good luck with that. Because your child is a person on a bus bench – sure, there’s some genetic similarity, that shows up in appearance (maybe), in the workings of the brain (maybe), in tendencies and habits (maybe). But the only real difference between your child and that dude on the bus bench is that you have to ‘make it work’ with your child, whereas you can walk away from ol’ Bus Bench Charlie.

So, you can see there’s a good chance that your joyful, well-intentioned, gushy assumptions about Junior, or Juniorette, will be way out of line. Not because of lack of effort, or lack of love. But because you really have no idea whether Junior will be the type of person you get along with easily, and want to hang out with, or whether he/she will be the type you never could understand, that always rubbed you the wrong way, and that you always steer clear of. Except, you can’t steer clear of this one – because, see, Junior’s yours, to have and to hold, till death do you part.

Don’t be shy – I’ll wait while you get up the nerve to say it. No? Well then, I’ll say it for you:

But, doesn’t love take care of all of that?

Well, as much as we might wish it so, actually, no — love is not enough. What love does is ensure that you’ll be in there swinging, and hopefully, give it your best shot. But love isn’t enough, as millions of divorcing couples find out every year. There is nothing more poignant than working with a young, sincere, couple whose relationship is falling apart because of a genuine, deep, incompatibility. At some point, they may look up at you and say, “But, we really love each other.” Yes, you do, but is it enough? The sad truth is – no. Is it a reason to give it everything you’ve got? Yes – but there are things love can’t overcome.

Of course, in the case of a parent-child type mismatch, there is no divorce, and it is not a matter of the relationship being ‘bad for both parties’, as in a marriage, because the relationship primarily exists so that the child gets what she or he needs, not the parent. So, regardless of any ‘type-antipathy’ the parent may feel toward the child, regardless of the fact that the parent may not ‘relate’ to the child, or agree with his values, the parent must work at it, and work at it, to maximize what can be made of a ‘bad’ situation.

However, this doesn’t mean that the antipathy must be swept under the rug. I am strongly in favor of being realistic with parents, and even children, as appropriate. By this I mean helping both parties bring the ‘incompatibility’ out into the open, in a safe and respectful way: to say, “You’re hard for me to deal with – I don’t understand you,” rather than, “What the hell’s wrong with you, anyway?” What is the difference? In the first instance, the parent is openly acknowledging what the child already knows, emotionally, that the two personalities are like ‘oil and water’ at times, and that the problems are due to a DIFFERENCE, not a DEFICIENCY. In the second, the parent is saying there’s something WRONG with the child, because, “As my child, you should be more like me,” which is absurd and damaging. The child does not ‘owe’ the parent being like the parent, or being ‘the type of person’ the parent knows how to deal with: the child does not have control over his type – he just IS what he is.

The parent, on the other hand, DOES owe the child a best effort at bridging the gap between what the parent is, and what the child is. And openly admitting these incompatibilities is a respectful starting place for the road back to connection, one that doesn’t make the child feel like a loser, a failure, and a disappointment, for not being easy for the parent, and doesn’t say, “What you are is wrong,” but rather, “What you are is hard for me – but let’s work on it together.” This is the work of love.

So, the “little things” are not little after all, because they require being a big enough person to do the work of love: standing back from the ‘fray’ and learning the other person, really understanding that people are different, keeping your own ego in check, and seeing that when you give, freely and with respect, you are not only loving the other person, but yourself as well.









Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Being Good


Recently I posted about some of what I would call our guilty “demi-beliefs”: fortune cookies, Fate, wishing on a star. There are many, many more, from lucky horseshoes to knocking on wood. I often watch my dog, preparing to bed down for the night. He turns around, and around, and around, before finally sighing and settling in. I fancy that if I asked him, “So, Angus – why do you always do that?”, he would unhesitatingly respond, “That’s just the way it’s done – it’s the way it’s always been done – now be quiet and let me get some sleep.”

We go through our lives performing “protection” rituals just like Angus, but we don’t realize it. In fact, most of the psychological problems people bring to therapists’ offices are in fact sophisticated, and unconscious, forms of superstitious rituals. If you put an animal, say a mouse, in a box and shock it every time it goes to the left side of the box, soon it will avoid the left side.

So next, say you take away the shock consequence. The mouse will continue to avoid the left side of the box, and by avoiding it, will never find out that there is no shock anymore: what has begun as a learned response to actual conditions, has now in effect become a (relatively involuntary) superstition, with little likelihood of self-correcting to the new conditions.

This is pretty much the paradigm of neurotic behavior. We learn to be “good” boy and girls, where what is good is dependent on a unique, idiosyncratic family system, that, for the first impressionable years of life, stands in for the whole of society. A couple of basic examples from childhood:

When I show curiosity, or enthusiasm, or strong emotions, about things, Mom gets mad, because she is busy and tired, and then I’m “too much”. I need to rein in my enthusiasm, my questions and my feelings, so I can be ‘normal’, and not too much – then, I’ll have a chance of Mom loving me. And even if she doesn’t love me, at least she won’t be mad, and I won’t be too much.

I shouldn’t be too dependent, because it’s weak, and boys can’t be weak, if they expect to grow up into real men. So, keep your feelings to yourself, like Dad does, except when he’s mad. He mostly just drinks and watches TV, and works on the car: that’s being a real man. Needing help in dealing with things is for suckers and wimps – if you just act strong and fit in with the other guys, you’re all set.

Stated like this, these belief systems sound simplistic, exaggerated, and sadly limited. But, if you change a few things around, are they much different from what we all learned? The point is that, once these belief and behavior systems are in place, they become unconscious, automatically repeated and generalized, to every environment we live in. And what’s worse, once they’re in place, they offer little opportunity to disprove the basic emotional beliefs upon which they are based, even if the beliefs are incorrect. So, even when the “shock” (“Mom gets mad when I’m too enthusiastic”; “Dad think boys are weak when they have feelings”) is removed, the belief system remains, because it is never tested. We act as if the whole world operates like our original family operated, and lo and behold, now we operate that way, too, because we’ve been brainwashed, though we don’t know it. We now assume it’s “normal” to believe the way we do, to act the way we do, to have the emotional assumptions we do. And if, by chance, we don’t act “normal”, we think we’re failures.

So, stated in terms of our hypothetical mouse experiment , the job of the therapist is to coax the person into the left side of the box, and keep him/her there long enough, to experience that there is no shock anymore, and thereby reclaim “full range of motion”, emotionally and interpersonally. The person learns that the choice is not between being ‘good’ or being ‘bad’, but between being locked in a box of their own making, or being alive and free to exercise the full range of human capability, as flexibly applied to the situation of the moment.

Of course, in actuality, therapy is a very complex process, requiring sensitivity, skill and humanity on the part of the therapist, and a great deal of courage and trust by the patient. But the payoff for all the hard work is enormous: for the patient, going from a figurative mouse in a box to a fully-formed human being. And for the therapist there is the great privilege of helping someone go from the stricture of the good/bad paradigm, to flying free for the first time — a moving and meaningful experience.

The poem, Wild Geese, by Mary Oliver, expresses this so beautifully, that I will let her say it:

You do not have to be good.
You do not have to walk on your knees
For a hundred miles through the desert, repenting.
You only have to let the soft animal of your body
Love what it loves…
Meanwhile the wild geese, high in the clean blue air,
Are heading home again.
Whoever you are, no matter how lonely,
The world offers itself to your imagination,
Calls to you like the wild geese, harsh and exciting –
Over and over announcing your place
In the family of things.

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

The Pearl Within the Shell


If you bring forth what is within you, what you bring forth will save you. If you do not bring forth what is within you, what you do not bring forth will destroy you.
– Gospel of Thomas

Good job there, Thomas. But I must say I do have a couple of immediate reactions:

  1. That “If you do not bring forth…” part sounds kind of scary, like a threat.
  2. Easier said than done. After all, it sounds like giving birth to yourself, by yourself; hard to even get a visual on that one: some kind of a rabbit-out-of-a-hat deal, but the hat is you? Makes me wince even thinking about it.

At least therapy offers the possibility that another person can help you carry out this anatomically improbable legerdemain. However, there has always been a debate, stated or unstated, raging in the therapy world. Is ‘change’ more about helping people alter their ways of behaving, thinking and feeling? Or is it more about helping them return to, or evince, something deeper – some unspecified, perhaps dormant, original ‘self’? It is unfortunate that the turf wars (read: pissing contests) in the psychological world have tended to frame these in either/or terms, obscuring the fact that there is a place, and a necessity, for both ways of engendering change, and that the seeming contradiction, and need to ‘choose up sides’ is not only specious but just plain discourteous to reality.

Which brings us to the main event: what is within us? And how do we get to it, rejigger it for the better, and maintain the changes? And what happens to what we were before? People new to therapy often wonder about that. The artist wonders ‘will you destroy my creative edge?’ The person with anger issues wonders, ‘will you weaken me?’ The meek person asks, ‘will you make me a selfish ass?’ The borderline or bipolar person might wonder, ‘will you make me boring and normal?’…good questions, all. After all, the therapy patient has no way of knowing where all this will take him or her, and has a thousand questions, kind of like someone contemplating plastic surgery: Will this make any difference at all? If it does, will I like it, or will I be some kind of monster?

After all, no matter how much people don’t like themselves and their current life, it is what they know, what they have become used to, what those around them have become used to. There is huge natural resistance to change in any system, and a human being’s sense of identity is no exception. It is only when the misery of the status quo is stronger than the fear of change, that people are even willing to consider committing to the time and cost of something as ‘outlandish’ as therapy.

I heard a writer talking on public radio the other day, say that maybe as we progress through the ages of life, we are like those Russian nesting dolls, with each new identity fitting on top of the last one; they are all still there, but we primarily identify with the current ‘version’.

And, predictably, most people only want to work on that current version, in the present tense. When I begin someone’s therapy by taking a careful history of their life, they often say, “Oh no – we aren’t going to be talking about the past, are we? The past is past – it’s already happened, and nothing we say now is going to change it, so what’s the point of going back and wasting time with self-pity, regrets, old anger and memories that are long gone?” Looked at in that way, they are absolutely correct. Nothing we can say or do now is going to change what happened in the past. However, things we say and feel now can change their relationship to those ‘facts’, and one’s relationship to past facts and events is what they functionally ‘mean’ in the present.

I use the word functionally, because when we develop rigid (even if unconscious) fixations in our relationship to past events (i.e. what they ‘mean’), this produces calcifications of function in thought, feeling and behavior. And, as you go through life, living from these frozen beliefs and expectations, you begin to identify with it all, you become it: after all, as a child you have no other frame of reference than the catalog of behaviors learned in your (idiosyncratic) family, and as you get older, you unconsciously select situations that will replicate those experiences (remember: we LOVE familiarity, and look closely at that word ‘familiar’, what do the first six letters spell?).

So, by the time an adult, even a young adult, seeks out therapy, he/she is pretty well identified with the way he/she has been for a looong time, and, being a human being, is very resistant to change, not because of any particular orneriness of nature, but just because that’s the way systems are. In effect, the person is saying to me: For god’s sake, change me – but don’t, you know, change me! What most people really want is for you to change the WORLD, not them.

They are saying, though they don’t realize it:

“Look, I always have trouble at work, and, oh yeah, in relationships: can you make all that go away?”

Or, better yet:

“I feel so depressed all the time, I can’t stand it. I don’t want to be in therapy for very long, I can’t afford very much, I don’t want to mess around with the past, and I don’t really want to change anything BIG – I just want to feel better. I think that about covers it. You may begin.”

Sounds pretty unrealistic, when you put it that way, but in a sense, they are in fact groping towards the truth. What they are really saying, in their own way, is, “I don’t want to change who I AM – I just want who I am, to work.” Sounds better now, doesn’t it? And they are right to hold tight to who they ARE, and they are right to say they don’t want to change, because the truth is, they have ALREADY ‘changed’: they have gone from the person they were born to be, with possibilities, talents, intuition, and powers intact, to the ‘adjusted’ version they became, and that process of adjusting has happened several times, leading to the Russian nesting doll they are now.

Everyone has at least hints of who they actually are: they can sense it by what makes them laugh, or cry, what they do with free time, whom they admire, what thrills them, moves them, what their dreams are, and what visions they once had of themselves. True, many people have gotten to the point where they are totally out of touch with these things, but most retain at least glimmerings of who they were meant to be.

The song Blackbird always comes to mind for me, but with this variation: most people are saying, “Take these broken wings (of mine), patch them up, and help me to fly.” Again, all therapists differ, sometimes violently, from one another in how they approach this problem. Some attack it directly, attempting to teach skills and attitudes in any number of ways. For me, I have always resonated with statements like this one, from the psychotherapist David Richo:

There is a natural and inviolable tendency in things to bloom into whatever they truly are in the core of their being. All we have to do is align ourselves with what wants to happen naturally and put in the effort that is our part in helping it happen.

Exactly: I see myself as a gardener of human beings. My job is to create conditions for growth, not to pre-decide what the growth will look like. When someone asks me what will happen in their therapy, I honestly cannot answer. It would be disrespectful to do so, as I cannot know at that point ‘who’ they really are, any more than I can know what kind of plant will grow when I water a seed I am not familiar with.

I am a gardener, not a god.

What are the conditions for the growth of a human self? Interested attention, a willingness to bring newness to every encounter, what Zen folks might call Beginner’s Mind. A willingness to be surprised by them, to sit with unsureness, to go wherever it is required to go, whether that means they need to yell at me for a year, or idolize me, or not notice me at all. This does not mean ‘anything goes’, rather ‘anything necessary goes’. It may be necessary to set limits, to take away limits, to let go, to dig in, to confront, to take the long view, to be ‘unpopular’, to tolerate unreasoning rejection, to accept flawed love. But most of all, to believe, for if I don’t believe in them, how can they? If I don’t fight for them, why should they? If I’m not interested in them, why should they be?

And if all this sounds dramatic, like being a midwife, it is dramatic, like being a midwife. Remember what we started with: “Bringing forth what is within you”? It is the most heroic journey a human being can make: the journey back home, to the greatest prize of all, oneself.

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Normal Man

Photo of 1953 Ford 2 Door Sedan

When I was a boy of maybe three or four (when you still have the time for such things, and maybe a little wisdom left from the womb), I had a regular weekday morning routine. I would climb up onto the back of the living room couch in my pajamas, lean over, and look out the front window, eagerly watching for this one particular guy to drive by our house in his maroon ’53 Ford coupe. He always had a tan windbreaker, an old, beat-up felt hat with the front brim pushed up, and a cigarette dangling from the corner of his mouth. He was medium height, not old but not young, kind of ordinary looking, but good-ordinary, and as he drove by our house at precisely eight o’clock every morning, I would nod in satisfaction and smile to myself:

There goes Normal Man.

God only knows what Normal Man was really like: maybe he’d been up all night drinking, and was just heading home to sleep it off; maybe he was living in his car. But for me, he was good old Normal Man — living, comforting proof that maybe growing up wasn’t impossible, wasn’t scary, wasn’t complicated: you could just get a job, some job, any job, and drive to work every morning, listening to your favorite program on the car radio, with a cigarette stuck in your mouth and a satisfied expression on your puss, and it was okay. You didn’t have to figure out where you fit into the world, you didn’t have to invent something fancy to do for a living, you didn’t have to drive a Cadillac, or even a Buick. You could just be a regular Joe, and that was good enough. And good enough was, well, good enough.

To human beings, Normal is important – very important.

But what is this elusive ‘normal’? Does it mean ‘the same as everyone else’? And where do they keep the Standard of Weights and Measures for ‘normal’? Is it in the Diagnostic and Statistical Manual of Mental Disorders? The National Archives? The Library of Congress? Grant’s Tomb?

More than once, I have had therapy patients tell me variations on this story:

“Before my big job interview (or date, or performance, or test), my friends all said, ‘Just be yourself’. But what IS myself?”

In therapy, over time, people can learn how to answer this question. And often as not, the question ‘What is normal?’ gradually evolves into, ‘What is normal – for me?.

One of my own personal breakthroughs on this issue came when I attended a talk by a meditation teacher many years ago. For some reason, I must have clicked with him, because to this day I still remember several things he said that day. But the one that really jumped out at me was something he kind of tossed off as an afterthought. It was a deceptively simple statement:

We are all incomparable.

At first, I thought, “Awww, isn’t that cute? Kind of like Mister Rogers saying, I like you just the way you are.” But as I thought about it more, and more deeply, over the years, I came to understand what a profound statement it really was. He was saying that we can NOT be compared to one another, because each person is one of a kind, so it would be comparing apples to oranges. So all the internalized parental voices, all the comparing and judging, the peanut gallery that goes on in my mind, and in the minds of my patients (what we call the Goon Squad in my practice), was not only wrong but irrelevant. The only person I can ‘compare’ to is myself.

And that led to another level of realization that hit me after doing therapy all these years. It came from listening to patients talk about ‘advice’ from people in their lives – sometimes well-meaning, sometimes critical, but the message was always the following:

If I were you…

”If I were you I wouldn’t drink so much”; “If I were you I would have quit that job a long time ago”; “If I were you I would study harder; “If I were you I wouldn’t rush into a relationship”, and on and on.

And of course most of us realize that the standard comeback for this would be to say, “Yeah, but you’re NOT me.” But what I’m talking about goes deeper than that. What I realized is this, again deceptively simple, but profound in its implications:

If you were me, you’d be me.
If I were you, I’d be you.

In other words, the sum total of a person’s experience, heredity and life circumstances, produces a unique self that, to that point, couldn’t have turned out any other way. Another person cannot look at them and compare, merely substituting themselves and their own chain of experiences as the subject of the sentence. Saying, “If I were you…” implies hypothetically grafting one’s own set of values and capabilities onto another person’s whole life, which is ludicrous. It would be like saying, “If that factory were a silo, it’d be a silo.” Yeah, and what’s your point? A factory is a factory, and a silo is a silo — period.

Does this mean that people cannot change? Of course not – it’s saying that what has already happened has produced this exact being, here and now, and that if you don’t accept that as fact, it’s you who are out of touch with reality. We know people whom we wish were different; even as a therapist you catch yourself saying, “Wow – he could be so much more; what’s wrong with him anyway?” What’s ‘wrong’ with him is that YOU obviously are making a judgment based on incomplete information, because if you truly saw and understood all the forces that went into shaping that person, you would not be surprised or judgmental at all – you would just nod and say, “Yes, of course”.

Again, this does not mean at all that people cannot change, only that what they are now is the inevitable result of what has already happened. You are free to introduce new experiences that can have a profound effect on the person’s life and capabilities – in fact as a therapist it is your JOB to do so. But you do not do this from a sense of judgment, impatience, disdain, or disappointment with them, because if you do, it shows a serious lack of understanding: they are what they are, period. You want to help them? Good – get going and do something. If it doesn’t work, either you, again, had a serious misapprehension of reality, or you’re not very good at your job, because it is not THEIR “failure” to get better that is the problem! You can certainly be disappointed that they didn’t get better, but not in them personally.

I once had a patient who had borderline personality disorder. He needed medication to help him handle the emotional swings that go with this disorder, and to help him utilize therapy better. He went to a local psychiatrist with a ‘big reputation’ and the following exchange happened:

Big Rep: Okay, so what’s the problem?
Patient: Well, it’s not that easy to describe.

BR: Look, do you see where it says on this form, “Problem?” Well, I have to fill in something there, so let’s start again: What’s the problem?
Pt: (beginning to get nervous) Well, how can I describe it?

BR: Try using words.
Pt: (Breathing heavily now – stands up in place, because he is feeling trapped and criticized)

BR: Sit down immediately! Remember, this is my office!
Pt: That’s not fair. I…

BR: I said sit down – now!
Pt: I don’t have to take this – I’m trying to cooperate.

BR: You’re trying to take over this interview. (Looks at chart patient has brought with him). And I see from your hospital history that this is typical for you.
Pt: (Stands up again, in panic)

BR: Sit down, immediately! You will NOT threaten me!
Pt: (raising voice) Threaten you? You’re threatening me!

BR: (Stands up, yelling) Get out of my office right now – you’re nothing but a, a damn borderline!

What’s wrong with this picture? The psychiatrist is not accepting the obvious fact that, yes, as he just yelled, the person is a borderline. It’s not something to accuse him of: it’s why he’s here! The psychiatrist is blaming the patient for the condition that brought him there: Why are you the way you are! Change!

He was being normal, for him. And that brings us to the irony of change. When you accept someone for who they are, fully, completely and without reservations, they change. It doesn’t mean you have to like the way they are, or ‘go along with it’, or be manipulated by it, or overlook their frustrating and alienating behavior, or join them in denial – it means you come from a place of assuming that “If I were you, I’d be you”, rather than “What’s wrong with you, anyway?”

And it doesn’t mean they don’t need, or want, to change. After all, people don’t decide to be the way they are, the way you decide your major at college. They are not handed a menu saying,

Which would you prefer to be? (Check One):

A borderline personality disorder.

Bipolar with touches of raging paranoia.

Happy and well-adjusted, living a very meaningful life.

And yet we often treat people as if this were true. We blame them for their problems in the spirit of If I were you…

People are who their genetics and their environment have made them. To date, we only have relatively primitive ways of knowing how all this works, but that doesn’t mean we have the right to drop down to primitive blaming and name-calling: it just means that sometimes we don’t know, and humans hate to not know, especially when they’re supposed to be experts.

Early on in my graduate school career, I worked at a Veterans’ Administration Hospital for a summer, a training internship, working with veterans with psychological problems. My first ‘case’ was a seventy year-old black man who had psychotic episodes, but most of the time he could communicate well. I sat down, prepared to be an ‘expert’ (I was all of 25 or so). As he began to talk to me about what it was like to be old, what it was like to be black, and what it was like to be a veteran, I tried to think of something I could say to convey to him that I understood him completely. I finally said something ‘impressive’ that I remembered from a book on aging that I had read. He fixed me with a weary, indulgent look and said, “Look, boy, why don’t you shut up and listen – you might learn something.”

And that, from the first few minutes with my very first patient, has been the mantra of my whole career: Shut up and listen. He’ll never know what a wonderful gift he gave me, but I do. He was right, I did learn something. I learned that the most important ‘expertise’ I could offer someone was to respect their uniqueness, and not assume I knew anything about what it was like to be them, what it was like to be their kind of ‘normal’.

And so, working with people all these years, and respecting them, finally took me back to that little kid leaning over the couch, watching for Normal Man.

I realized, at last, that the Normal Man I had been waiting for all along, was me.

How about you?

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.