Please Remember Me

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Today, I heard another one of those “Where have you been all my life?” songs on the radio. I tracked it down and found it’s called Dante’s Prayer, by Loreena McKennitt, who has apparently been around forever, with me being shamefully ignorant of her amazing voice, her soul and her talent. So, now that I know, I want you to, too. I know it’s annoying when you’re trying to skim along through someone’s writing (mine, in this case), and they (me, in this case) insist you stop and do something, but this gal has major soul, and I really encourage you to follow the link below and actually listen to the song first before going on. Furthermore, listening to the song will be good ‘practice’ for you, in slowing down and actually being PRESENT for a few moments. Being where you are, when you are: what a concept! (Aren’t therapists obnoxious?) Okay, so here is the link, and I’ll see you on the other side.

{{This space reserved for you, the beautiful, conscious and conscientious reader, to slow down and make room for what Ms. McKennitt went to all that trouble to do for you.}}

This song was apparently inspired by Dante’s The Divine Comedy, which McKennitt was reading while on the Trans-Siberian Railroad (yeah, I’m a regular passenger on it, too – I just don’t brag about it. Not!). While it’s above my pay grade to do an in-depth exegesis of how the song relates to The Divine Comedy, I fortunately found a personal story that somebody posted about attending a concert by McKennitt that will do just as nicely. Apparently she told this story at the concert, by way of introduction to the song. While transiting Siberia, the train stopped regularly so the passengers could get out and purchase food from local vendors along the line, the train not having a dining car or food service available. They had exactly twenty minutes to get their food and get back on the train. There was an attendant on the train who looked particularly glum throughout the day, as the train stopped, and passengers got off and did their thing, then back on. At first, McKennitt assumed that maybe her demeanor was just a reflection of Russian culture.

But one time, as McKennitt got back on the train and saw the attendant, she gave the glum lady some of the food she had bought, and was rewarded with a sudden smile of surprise and gratitude. Loreena wondered if anyone else had ever taken the time and care to consider the woman, as she traveled back and forth across the vastness of Siberia, mile after mile, year after year. McKennitt was struck by the smile, and hoped that during the woman’s dark moments, she would stop to remember McKennitt’s act of kindness, and it would return the smile to her face. And in that moment of connection, the song was born, and the plaintive refrain, Please remember me.

And, in your dark moments, whom do you ‘remember’? And do you ever wonder who remembers you? As a therapist, I get to hear the real story (not the one for public consumption) about who really mattered, who made a difference, in the lives of my patients. And some of the answers would surprise friends and family members: a remembered pat on the butt from a coach, a nod from a teacher, a fishing lesson from a neighbor man, a kind act by a stranger, can literally make the difference between life and death. And sometimes I even get unexpected ‘appreciations’ of me that are kind of stunning in their way. For instance, one day a young man I had worked with for years, and had never particularly voiced his feelings about me, suddenly said,

Gregg, I’m going to see you till you die, and after you die, I’m going to find a medium who can contact you, and then I’m going to see you through her, for as long as I can. 

No, I don’t intend to see him till I die, and no, he doesn’t literally mean that – he’s just expressing a feeling – but how many people are able to do work where they get to hear something so moving and beautiful, to have the gift of working with people at that depth, to be a team with someone who would say that to them? I mean, “How sweet it is” to work with people, walk beside them, and believe in them.

But back to Please Remember Me: I know the song stayed with me, because a couple of days after hearing it, I was taking a walk with my ear buds in my ears, trudging blithely along, and a song by Van Morrison came on: Have I Told You Lately That I Love You? Suddenly, it all came together and hit me like a ton of bricks: I should be saying ‘I love you’ to God, or whatever force made us all, who has given me, and all of us, so very much. I actually teared up, right there on the street, and felt ashamed for having taken so much for granted, without giving any thanks in return. I tilted my head up (He is ‘up’, right?) and said,

 Oh my God (like, literally – not OMG!) – I haven’t even spoken to you for months, maybe years – I’m so sorry and ashamed for having ignored and neglected you, and taken you for granted. Thank you so, so much for all you have given me – and all of us. I promise not to forget that fact, and you, for so long again. I love you.

And I wondered how many times, how many years of my life, have gone by with my not even thinking to give thanks and appreciation, to the Creator, to Creation, to Life, for everything. All the times I partook of glory, both the little and the big, but didn’t give back: a beautiful song, a sunset, the rain (my all-time favorite weather), people that do and say amazing, surprising things, the people I love and who love me. How many times did I take these things for granted, instead of stopping and letting them sink in, good and proper, then offering my thanks for all that is given?

Well, back to my walk. I thought my ‘prayer’ (or whatever you want to call it) was over, but I discovered it wasn’t. I went on, addressing Whoever’s In Charge:

And now that I actually think of it, I also wanted to say thank you for ‘letting it go’ that I never gave you back even a word of thanks, and for understanding, for being patient, and for not making a ‘big thing’ of it, even though, now that I give it a second’s notice, it IS a big thing. So thank you for that, too.

Oh, I know there are infinite ways to give thanks to you, and I guess my way has been trying to be a good person, mostly – busting my ass to be the good parent I never had, to be a good husband, a good friend, and a good therapist to my patients. But now, somehow, those don’t seem enough – like they are just the regular ways of being, stuff we all do routinely, and damn, you must have noticed all along that I was skating.

Well for what it’s worth, I’m going to try to make a habit of noticing and giving thanks to you whenever I can – no, not going to church or tithing or reading the Bible – those are all fine, but they’re not for me, and I know you know that, so you’ll understand I have to do it my way. I’m no Holy Joe, god knows, but then I’m no heathen, either – just an oddball who can feel things deeply without all the window dressing of choirs and sermons and stained glass. For me, it’s enough that when I say I’ll try, you know I ‘mean it’, because you know All.

And I’ll also work on not hating you anymore for taking away my son, which I still maintain is one of your all-time screw-ups, and no, I’m not one of those Pollyannas who says “God works in mysterious ways” and lets it go; nope, I don’t let it go that you did that – not to me, but to Brett (my son), of all people – the most joyous person I ever met. You were wrong there – real wrong.

I remember very well when I saw the movie Open Range, there was a scene where the ‘bad guys’ kill Mose, one of Robert Duvall’s cowboy traveling partners, a very lovable guy, who was ‘family’ to Duvall, and kill their trail dog, too, whom they all loved dearly. After the gravesite is prepared, and both are in the ground, it’s time for someone to speak over the grave. Duvall’s second-in-command says to him, “You wanna say some words?” (i.e., as boss of the outfit). Surprisingly, Duvall says, “You wanna speak to the Man Upstairs, go on and do it – I’ll stand right here and listen, hat in hand. But I ain’t talkin’ to that son of a bitch. And I’ll be holdin’ a grudge to Him for lettin’ this befall a sweet kid like Mose.”

Well, God, since this was the first movie I had seen since the death of my son, that scene hit me like an atomic blast, and to say I ‘understood’ would be small potatoes indeed: I more than understood – I’d LIVED it, and that is exactly the way I felt about You, God – or Allah, or Yahweh, or whatever you’re calling yourself this year. I hated you, and I wasn’t nice about it either.

So, God, if that’s way off base to you, I am sorry about that, but I can’t be honest with you and not tell you about it: I guess that’s about the closest I can come to ‘confession’, but then as a lapsed half-Jew, maybe I get a pass on that one too. 

But you do so much more than kill people: for example, you were the one who gave Brett life – so how can I hate someone who gave me my son, even though he took him away? Sure, that is ‘mysterious’, and even a little crazy-making, as we say in the psychology racket (but of course you know that, having created everything, including the psychology racket). So maybe when you screw up (like killing Brett), you’re trying to teach us acceptance, and forgiveness, and big-heartedness, by us having to learn to forgive you, to notice, and admit, that you do so many wonderful things that aren’t screw-ups: could it be that you do these things on purpose, to give us a chance to learn, and expand our hearts? I don’t know – I suppose people who study the Bible or the Koran or the Upanishads have already thought up this concept and talked it to death, but for me, it’s the first time it’s occurred to me, so there’s a minor miracle for ya, that, maybe, I finally gave back to you, after you handed me so many miracles over the years, including the years themselves. And, if you didn’t do it on purpose to teach me forgiveness and acceptance – why, I’m just going to go ahead and use it that way, anyway: so there!

Again, sorry if I’m insulting you – or confusing you. Well, as Doyle Lonnegan said in The Sting, “Ya folla?”

Ah hell, I know you do. (sorry about the ‘hell’)

Oh boy – I can see you sitting up there saying “God damn – that guy can talk”, and you’d be right. I know that, in the Bible somewhere, you said, “Be still, and know that I am God,” so I am actually going to shut up now and just say,

Thank you. Thanks for sending me Please Remember Me, and that Van Morrison song, too – sorry it took me two tries to get it. So, even though I reserve the right to hate your guts sometimes, for you-know-damn-well-what (you’re just gonna have to work with me on that one), I want to stop right now and say, I’ll remember You.

Thank You, from the bottom of my heart, and I’ll be back – often.

Amen.

 

 

 

 

 

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

Secretariat and Me

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Today, I was reading a fascinating book about horse racing: Inside Track, by Donna Barton Brothers, a former jockey and current racing commentator. I heard her interviewed on NPR in the days leading up to the Belmont Stakes. It was a big deal because California Chrome had won the Kentucky Derby and the Preakness, the first two storied major races for three-year-olds, and thus had a shot at that rare feat, The Triple Crown, the summa cum laude of horse racing, if he went on to win the Belmont Stakes.

Well, California Chrome didn’t win the Belmont, but Donna Brothers did win me over, and I went out and bought her book: I didn’t really know why, until I was halfway through the book and read the name Secretariat, and felt a thrill run through me. Secretariat – that’s where this story begins.

In 1973 I was a graduate student at the University of Tennessee in Knoxville. I was in my second year in the program, plugging along towards a Ph.D. Studying, attending class and more studying was pretty much my whole life. I knew we were supposed to be fascinated by research, and shooting for a professorship somewhere, preferably at a ‘good’ school. The phrase, “clinical work”, i.e. doing psychotherapy, was usually accompanied by a tolerant frown: oh sure, you were supposed to know your transference from your elbow, and maybe “keep your hand in” by seeing a few patients when you became a professor, but beyond that, well – making a career out of it was simply beneath a serious “scholar-researcher.”

But not for me. In my mind, I was at a trade school, learning my trade: psychotherapy. And to get a license to practice it, I had to jump the hurdles they put in front of me: a make-or-break test the first year, called Comps; a make-or-break test the second year, called Generals (I still shudder at the name), and of course, the crowning glory of all this foolishness, a Dissertation, which you ‘defended’ in your Orals. There may have been even more make-or-break stuff, but in my dotage, I have developed a blessed amnesia for all of it. Nowadays, of course, one can get a Psy.D. pretty much anywhere, which is as close as you can get to actual trade school for doing therapy. After all, Medical School is basically a trade school for doctors, isn’t it? But not then: it was Research Or Bust, and I was determined not to bust.

Well, one day someone happened to mention that, for a nominal sum, you could go see the Kentucky Derby with a group of students, Louisville being not all that far from Knoxville. Imagine that: there was a real world out there, where people actually did real things, and had actual fun! It appealed to me immediately, and I ponied up the necessary grubstake (and when I say ‘nominal’, I mean nominal – I think it was maybe fifty bucks for the whole shebang – transportation, accommodations, and the race itself). Wow, real world here I come!

We piled into an ancient, rattly bus and were off, our sleeping bags stowed in the hold and our bag lunches on our laps (I’m pretty sure we also brought our own three-course dinners for the two nights: cold cuts, chips and Sno Balls). As I remember, the “accommodations” were south of spartan: throw your bedroll down on the concrete floor of a huge warehouse somewhere on the outskirts of town, and try to catnap through the obnoxious blare of the country music that was the lingua franca of U.T. degree-seekers of the time. But no problem: we were in the real world, going to a real event!

The next day we bussed it to Churchill Downs, bleary-eyed but ready to grab the brass ring of history. Everyone went his or her own way: our tickets were for the infield, the horse racing equivalent of baseball’s bleachers, or maybe a knothole in the fence. Oh well, we certainly didn’t have to worry about being overdressed: anyone who had a pair of overalls, shorts or holey jeans to his name was a king. To say people were drinking – well, let’s just say Southern knighthood was in full flower, with multiple mint juleps in plastic cups being the order of the day for those who weren’t guzzling Gallo red or Thunderbird from tote-along jugs, or mixing beer with pink gin shot from squirt guns. Holy hell would be a nice, quiet term for the din and riot of sweaty humanity that spun and thrashed on that grass oval inside the track. Hieronymous Bosch comes to mind.

Well, I had done my homework: I knew a horse named Secretariat – supposed to be pretty good – was the favorite, and I lined up and bought a win ticket, which was something called an ‘entry’ – you bet on two horses at once. I didn’t care if it was madness all around – I had a ticket on the favorite, a plastic mint julep in my mitts, and, after a half hour of pushing, shoving and fierce body blocks, I had myself positioned at the finish line.

They’re off!

Now the insanity rose to new heights, with people climbing on each other, screaming and contorting in ways I didn’t think possible for homo sapiens. Since I had traded any shot at an over-all view of the course for my one millisecond of glory at the finish, all I could do was battle to hold my position in the hysteria and wait it out.

Crowd: Here he comes!

Me: Who?

Crowd: Look at him go!

Me: Where?

Crowd: They’re cominnnnnnngggggg,….!!!!

I pushed, I shoved, I jumped up for a second’s peek. I held my ground savagely, like a nose guard protecting his quarterback. This is MY territory: they shall not pass!

Now I could FEEL ’em cominnnngggg – I pushed forward at the exact instant a huge, reddish monster crossed the finish line. I thought I saw the ‘right’ number flash by, somehow, identifying him as my horse. Could it be…

Crowd: Secretariat! – you did it! We love you, Big Red!

Bedlam, crazed joy, roistering insanity ensued.

By god, ‘We’ had done it – Secretariat and me. Or maybe, me and Secretariat – my old pal, my running mate, my bosom buddy. (Well, possibly, in all candor, seven or nine mint juleps were kicking in by now, as I reveled in my spiritual brotherhood with Big Red, what with my having bought the ticket and all.)

Then I heard the buzz around the infield:

Look at that time!

This is crazy!

Not that I understood a blessed thing from watching the time they posted: 1:59 2/5, but word soon zinged through the crowd like an electric jolt: New Kentucky Derby record! New track record! My god, it was a mythic race, after all – I had seen history made.

After that, Big Red was my horse all the way, as he cruised through the last two legs of the Triple Crown, not only setting Preakness and Belmont race records, but track records for the distance in both of the runs – records which still stand today. If you want a real thrill, and a glimpse of Big Red’s dominance, listen to the announcer at Belmont call the race here.

I can see you saying, “So, what’s your point?”

My point is simply this: your relationship to things changes drastically, when you have a ‘rooting interest’ in them. For years, I never understood why gambling on sporting events was such a big deal: after all, to me, the games themselves were ‘enough’. And why did the Commissioners of Baseball, and Football, seemingly tolerate, maybe even encourage gambling, and betting, on the games, when ostensibly they frowned on such activity? Now I understand: for most people, the games are not enough – they get personally interested only when they have a personal stake in the ‘action’. Like me, in my ridiculous identification with Secretariat in 1973 (and ever after), they feel WE won the game when their ‘guy’ wins, or even that THEY, themselves, won the game, when their team, or horse, wins. It’s not “they did it,” but “we did it” – i.e. a guy roots fiercely only because his own ego (and adequacy, and expertise) is on the line. And, by the same token, if ‘his’ team, or horse, loses, he not only feels a sense of personal failure, but often that the team, or horse, let him down.

So what happens as soon as a new patient walks in the door, sits down and tells you his or her story? You start to develop a ‘rooting interest’ in them, that you would not have had before. In a certain sense, their triumphs become YOUR triumphs, their failures your failures. This is what “makes it a ball game”, to continue the sports analogy – much as the bettor now feels an identification with ‘his’ team’s outcomes. This is the same thing that happens with one’s children, of course, or other family members – a child born to you becomes more than a child, it becomes part of “we”, and you rise and fall with its progress, step by step. Just this – this primal “family identification”, is the real source of why people are so absorbed in sports: going to your home team’s baseball game is more than being a fan – it is being part of a family: it is suddenly okay to talk to the guy next to you; regardless of ethnicity, social class or anything else, you’re brothers for three hours.

And this, to me, is the joy of being a therapist: I care in a deeper way about people than I would if I saw a stranger on the street. Yes, Charlie Brown famously said, “I love humanity – it’s people I can’t stand!” – but the converse is true, too: you can’t possibly care about, and feel for, humanity what you can feel for those who are ‘your people’. Having a therapist-patient relationship with someone pulls the caring out of you – you’re on the same team now, and you have an ego stake in the outcome – no, not to the point of your feelings dominating the scene, but in terms of rooting for the patient, much like a parent would (or should) do. Yes, therapists are taught in school to hide their feelings (even from themselves), to remain ‘objective’ at all times, to maintain a detachment from the patient, and there is a place for this, but come on folks: the experience of being CARED about by someone is a huge part of the healing process for therapy patients.

I wish student therapists (and I have seen so many of them in therapy) were encouraged a little more to admit and acknowledge their feelings openly, rather than (artificially) suppress them, in the service of ‘doing it the right way’ and looking good (i.e. safe) to the supervisor. For only by acknowledging the feelings to yourself, can you make sure they are used in the service of the patient, rather than bubbling along below the surface, creating unconscious imperatives for the patient that neither of you even recognizes (and often repeating the exact unconscious family dynamics that brought them to therapy in the first place). A ‘rooting interest’ is GOOD – it is only misusing it, denying it, or hiding these feelings, that causes trouble. We care because we are personally involved – yes, personally – not just because “I care about people” (i.e. generically).

Sure, we all “care about people”, in the abstract, but what makes you Root for someone, Fight for them, Think about them, Worry about them, and even be willing to Suffer for them, if necessary? Personally caring – that’s what. Having some of yourself invested – that’s what. Feeling that if they win, you win – that’s what.

I came to the 1973 Kentucky Derby on a lark, to get a break from studying for a weekend. Yes, as a general sports fan, I knew the names of the most famous racehorses in history: Swaps, Whirlaway, War Admiral, Citation; the most famous jockeys: Eddie Arcaro, Johnny Longden, Willie Shoemaker, and the names of the ‘Triple Crown’ races: The Kentucky Derby, The Preakness, The Belmont Stakes, but that – a vague sentimentalized overview of racing’s “greatest hits” – is all I knew. But, because of what happened that day at Churchill Downs – happening upon probably the greatest running of the greatest horse racing event of all – I loved Secretariat to the day he died, and I cried – yes, cried – the day he died, a big red horse that I saw flash by for but a millisecond.

And that, more than all the damn courses I took on psychodynamics, differential diagnosis, or professional detachment, is what my whole career, and the enduring joy of my whole career, has been about: how to get involved, and stay involved; how to root for people, to live and die with them, to look at them in their tragedies and say, “We’re in it together”, to look at them in their moments of triumph and say, “We did it together!”

And that’s the story of Secretariat and Me.

 

 

 

 

 

 

 

 

 

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

Understanding

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The Blue-Footed Booby

 

Understanding is the booby prize…
— Fritz Perls

People in therapy, people in crisis, people in flux, people in life, want to understand: and they want to understand NOW! They want to know what is happening, why, where it will go next, and everything else they can find out. We love to snoop on the lives of others, especially the ‘inside dirt’. We don’t like it, but when we see the latest copy of People, or The National Enquirer, or Celebrity Burn-Out, or see a headline, “Diana addicted to coke, says butler”, or “Donald Trump: Broke!”, we LOOK – we don’t like it, but we look. We compare, judge, and we congratulate ourselves for not being ‘them’, the famous ones who screwed up. We want to know ‘what went wrong’, and ‘why’?

Well, we do it to ourselves, too. We are cynical and mean to ourselves, we poke and prod and look for weaknesses, in our personal lives, in our work lives; we tear ourselves down when things don’t go so well, we wonder why we goofed up, why we did wrong – Why? Why? Why? If we could just UNDERSTAND, now that would fix everything.

People come to therapy to have you tell them about themselves:

What’s wrong with me anyway?

Why am I like this?

It doesn’t make any sense, but I keep doing it – why?

Always: WHY.

What is this obsession with understanding? Do we think we’re a geometry problem, and the therapist is the tutor? Even a good geometry tutor will tell you that merely giving someone the ‘answer’ is not enough: you have to pay attention to the student’s learning style, his anxieties, his learning history, his assumptions (I’m stupid; I’m lazy), and even that is not sufficient.

Even if the tutor had a perfect understanding of the student’s ‘issues’, it still wouldn’t be enough. Imagine merely explaining to the student: “You can’t learn geometry because your sister is supposed to be the one who’s smart at math, so when you contemplate a geometry problem, you’re actually not allowed to be smart enough to solve it, or else you’d upset the balance of the whole family. Oh, you can have art, and maybe even music, but as for math, the family says it’s a no-no: when it comes to geometry, you’re all washed up, dude.”

Now, do you imagine the student would jump up in glee and say, “Wow – so THAT’S it! Oh my god, it just dawned on me: I LOVE geometry! Praise the Lord, and pass me that theorem!”

I don’t think so. I’ve seen many, many therapy patients who have been in therapy before, sometimes many times before, and their most frequent complaint is this:

In therapy, I think I pretty much figured out what went wrong – what I suppressed, how my fears and insecurities are illogical, what my mother did, what my father didn’t do, how my sister lied to me and how the neighbor boys teased me: so why do I still feel the same, and why do I still do the same stupid things?

Notice that they don’t question the sacred assumption that Understanding is the Key to Change: they just wonder why understanding (all hail!) didn’t work, in their particular case. Or they may say, “I guess therapy doesn’t work for me,” thinking “therapy” equates to “understanding the reasons for your problems.” They even wonder, “Could there be something else wrong with me – something the previous therapists missed?” Maybe they were molested by aliens in a previous life, and in deep age-regression hypnosis, it will all come out? Maybe their sixth-grade teacher once said they were too dumb to take the college prep courses, and they repressed it and that scarred them for life? They want that “Oh my god” moment, the breakthrough insight, that will, as the motivational speakers say, “Unlock the joy,” “Free the soul,” and be “The key to unlimited power and energy”.

Well, we all want that. In the film noir, Somewhere in the Night, a young couple on the run bursts into a waterfront rescue mission to hide out from the bad guys. When the surprised priest asks them why they’re there, the girl answers, “We just came in to be saved.” The priest wags his finger, “There’s a little more to it than that, young lady.”

Indeed.

However, we persist in wanting to understand, to be told. Me, too: to renew my psychology license, I have to take continuing education classes. They’re usually not too horrible, but the bane of my continuing ed existence is when I hear these most dreaded of all words:

It may not have been clear in the syllabus, but this class is mostly experiential: so break up into small groups, please.

AAARRRGGGHHH!!! NO – not that, anything but that! This is when I suddenly have to weigh how much I paid for the course against the relief of fleeing the room and living to be educated (properly!) another day. I want to say, “Look – if you don’t have anything to tell us, why don’t you just admit it, instead of making US do all your work!”

Is that true? Is it fair? No, of course not. I’m sure most of the instructors had marvelous reasons for asking us to break up into small groups, and had a lot to say, but knew we would learn it much more efficiently if we experienced it, rather than sat and listened to it. That is, I’m sure, but I don’t really know, because I usually didn’t stay.

And, likewise, ‘getting better’ is a lot more than understanding. I hate to be the bearer of bad tidings, but like in those horrible continuing education classes, it has to be experiential, not just didactic. As the therapist Frieda Fromm-Reichmann once said,

The patient needs an experience, not an explanation.

No, we don’t have to break up into small groups (thank god), but we do have to have something happen in the therapy relationship, something you can’t get anywhere else, short of a good childhood, and if you’re reading this, you’re probably more than two or three years old, so we can assume it’s probably too late for you to have had the ideal formative experience the first time around.

So, does the therapist become a second parent? No, that’s not necessary. But the therapist does have to perform some functions of the parenting process, and I might add, not only be a ‘good parent’, but a ‘corrective parent’, which is a hell of a lot harder, because you are not only providing good parenting, but compensating for the questionable parenting the patient has already had, whose effects now have to be superseded by the therapy. (The parents got 24/7 access to the patient, from birth to at least 18 years of age, to make their mark; you, on the other hand, get 45 minutes, once or maybe twice a week, to do your thing: foul!) It may seem a crass analogy, but in truth, the therapist is more like a maid than an architect: you don’t get to build the initial structure – you get to clean up the mess someone else has made. And no, I’m not disrespecting what parents do here: I’ve been one and done my share of screwing up, despite my best intentions, and I’ve also been the father of grown children in therapy (ouch!), so I’m talking about damage done (mostly) unintentionally, by parents who are giving it their best shot.

Does that mean the therapist has to care about the patient as much as a parent does? Well, that depends on what you mean by ‘care’. Once, after having had to face a slew of ugly things about my upbringing, I snapped scornfully at my therapist, “Are you telling me hired help (aka my therapist) loves me more than my parents did?” He flinched a bit, but got it together and answered, “No – but maybe more effectively.” Well-played, lad.

A colleague of mine, who went into research, and looked down upon psychologists who ‘wasted their talent’ on becoming therapists, once said to me, “I don’t see how you think just talking to people is going to change them.” I answered, “It’s talking, but in the context of a relationship.” The talking is the ‘words’, but the relationship is the ‘music’, and it takes the skillful use of both to make any kind of magic happen.

Of course you (the patient) want to know “what’s happening,” but in fact, it’s mostly not particularly important that the patient know what’s happening. Because, contrary to the patient’s expectations (and wishes, sometimes), the locus of control is mostly with the therapist, not the patient. It’s not, as most patients would prefer, “Tell me what to do, so I can go off and do it,” it’s more like, “Do me right, for god’s sake, so I can get out of here.” If the therapist knows what he or she is doing, the patient mostly has to show up and be willing. In fact, constant questioning (“Are we there yet?”) is usually detrimental to the process. It’s like planting a plant, then pulling up the roots every ten minutes to see how things are going: it kills momentum and breaks the ‘spell’ of the work.

Frequently, when the patients get frustrated, or confused, or stuck, they say, “What am I supposed to be doing?” or “What am I doing wrong here?” And my response:

“Raise your hand if you’re being paid to do a job right now, please.”

Whoops – I am the only one with his hand in the air, which is as it should be. I am the one who’s supposed to “know what he is doing,” and if anyone is “doing something wrong,” it is I, not the patient. Do I understand what is going on? Usually, yes. Does the patient need to understand what is going on? NO – in fact, if you’re strictly on the ‘understanding’ level, you’re not present enough for therapy to happen. Therapy involves skill, expertise, patience, caring and self-honesty, on the Therapist’s part: the therapist is working, the patient is just required to show up and try to be open, allowing, and willing, if possible, though granted, even that is often not possible, since the patient’s past experiences with sharing, closeness, intimacy and trust have not been such that they are particularly interested in repeating them: after all, that’s why they are in therapy in the first place.

Of course, the patient has a very important, and difficult, role, too, and that is making his ‘insides’ available to the work. I often explain to people I work with:

  It takes two of us to pull this off: I am Mr. Outside, and you are Mr. Inside*. We both need each other: you can’t know what you look like from the outside, and I can’t know what it’s like to be you on the inside. We have to work together, and neither one of us alone is sufficient.

So, therapy is about willingness – about doing, not understanding. As someone smart once said,

If you want something different, you have to do something different.

Note: no mention of “understanding” there. It’s all about willingness. Your mind is just a bystander: sometimes it can help keep you there, by overruling your feelings, which are telling you to flee, like I did in those horrid continuing ed classes. But usually the mind is not particularly an ally of therapy: it is the one that doubts, that questions, that interrogates, that says, “This doesn’t make any sense,” and the famous: “I don’t understand what’s going on here.”

Even when I Do try to ‘explain’ to people what is going on, and why, it often flies right over their head, for a couple of reasons: one, if a patient is actually ‘there’, he is not in a place of words, but of experience. Also, what makes us think that words should necessarily be able to express everything perfectly, or even adequately? How well do they express feelings, flights of fancy, hunches, the quick cuts of the mind? Consider the following sequence, where I had a small ‘insight’ about a patient. If I tried to ‘wordify’ it for the patient, it would go something like this:

Wow – when you said ‘I guess my mother was kind of smothering’, I immediately thought of what you said about your brother being overweight, then I jumped to that time I was in Point Reyes and the cafe was closed, and I was really hungry, and a woman outside offered me a bagel, and I was really grateful, then I jumped to what you said about your mother offering food as love, then I thought about how the time spent doing the cooking is a form of love, and how she probably didn’t feel she had anything else to offer you, so she pushed food at you, and then I realized that she was probably kind of empty inside, and I felt kind of sorry for her, but she is still responsible for her behavior, and then I realized that what you experienced as smothering was really a kind of desperation on her part to get you to love her even though she didn’t have a lot to offer, and that made me really sad for both of you, and that brings us up to date. Any questions?

Do you really want to hear all that? Words, words, words. This is why many, if not most, things of significance that happen in therapy are silent, expressed in gestures, looks, feelings. As the Bible expresses it, “the peace of God, which passeth all understanding”. (In fact, there is a very good article expressing a lot of what I am discussing today, but from a religious perspective, right here.) Or, if you prefer Shakespeare: “Truth hath better deeds than words to grace it.”

It is more about the willingness to trust – the process, the therapist, oneself, than about understanding. In fact, understanding is often wheeled in as a deterrent to therapy, by the forces of negativity, of going-it-alone, and self-sabotage (aka the Goon Squad). Someone can be right in the middle of doing amazing work, when they suddenly look up with a face full of tears and say, “Is anything even happening here?” I often liken it to a boxing referee, stepping in to say, “Okay, you two, break it up!” The Goon Squad hates the trust, the closeness, the openness, of a good therapy relationship, and loves to find ways to distract from the work, to hijack the patient’s mind with sudden questioning (“So – remind me: what are we doing here again?”), anything to “break it up”.

So, is understanding really the booby prize? Well, it has its uses, mostly in the area of using the mind to override the inner forces that try to derail you (“I’m a big fat failure – I should quit now”; “That term paper will keep — nothing wrong with getting high just one more time, is there?”). But for the big stuff, understanding is just along for the ride: understanding how to swim, is not swimming! And understanding your problems, or ‘how therapy works’, for that matter, is not the same as participating actively in the healing process.

So, why settle for the booby prize, when you can have the Grand Prize: a life of your own!

 

*Mr. Inside and Mr. Outside originally referred to the West Point football players Glenn Davis and Doc Blanchard, who played on the great Army teams from 1944-46. And no, this won’t be on the test!

 

 

 

 

 

 

 

 

 

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

Dive! Dive!

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I have always had a fascination with World War II submarines. Is it the beauty and deadly efficiency of the sub itself – a shark on the prowl, unseen, in enemy waters? Maybe. The adventure of setting out on a daring voyage where the possibility – the likelihood, even – of death, from depth charge, from bombs, from equipment failure, from human error, is your constant companion? Possibly. The thrill of being on watch, topside, in the middle of a star-choked night, plunging along at flank speed, with the spume of the huge black waves breaking against your face, just a speck in the glory of all creation? Could be.

But I think it has more to do with being part of a group of men of solitary purpose, there by choice, not conscription, hidden to the world, unknown to most, misunderstood by many, maybe even a bit crazy, but putting that one crucial task above all personal concerns: sink enemy shipping.

In the classic submarine movie, Destination Tokyo, one of the older, married men is explaining what he likes to do when on shore leave: “You fellas know me – I’m no highbrow. When I come home, if there’s any grand opera playing, the whole Connors family goes down there twice a week. Don’t ask me why, but to me it’s like going down in a sub. You shove off, go deep under the sea, and when you come back up, you’ve got something inside, that’s never been there before.”

That’s as good a description of therapy as any I’ve ever heard. It’s a secret mission, strictly confidential, not talked about ‘on the outside’ by the therapist, of course, but usually not even by the patient. You are there to do the hard things you can’t do on the outside – face big fears, make big decisions, ask the hard questions, look at your life unvarnished, tell the whole truth, trust someone else, trust yourself.

And it is certainly judged, questioned, misunderstood and even mocked by those not in the know. My father’s assessment of my career plans: “Why would you want to sit there and listen to a bunch of women whine about their problems all day?” My friend’s father, when I came home to visit, would always snort, “So, all your people still in a tizzy?” My mother was just quietly disappointed that I wasn’t a ‘real doctor’. One of the fathers at my son’s soccer awards dinner leered, “So, how many you got in your stable?” And I can’t count how many people have said versions of, “How can you just sit there like that and hang out with weak, needy people?”

Well, I’ve got news for them all: I get to hang out with my kind of people – the kind who are truth-tellers, seekers, the kind who have the courage to say they don’t know, to admit mistakes, to sit with terror, disappointment and tragedy, to learn how to grieve, how to have fun, how to be a real woman, how to be a real man, how to be a person, and hardest of all, how to be themselves, right out loud.

We dive down into the frightening waters of the past, and learn how to have a different relationship with it all, so that it doesn’t control the present, and future. We find out that, as a team, we can do things that we couldn’t have done alone. We find out that we DO need other people, but that to need isn’t needy – it’s just human. We find out that claiming our own perceptions, and living by them, isn’t selfish – it’s just selfing. And we try on new ways of being that seem unnatural and foreign at first, but we keep at it until they’re a part of us:

The ex-nun who felt so self-conscious when she first wore high heels for her new ‘civilian’ job that she could barely leave the house on Monday. By Wednesday, she felt like a whore. By Friday, she said that for the first time in her life, she felt kind of sexy.

The young man who had spent his whole life in his room, trying to ‘level up’ in video games, who reported that, even though he was terrified, he went to a school dance and had a good time. He raised his head and, looking at me directly for the first time ever, said, “Gee, Dr. B – I guess I leveled up, for real.”

These, and many others, have had the courage to dive down and go to war with old limitations, parental voices that doubt and mock, ideas about human behavior that strait-jacket them, people in their lives who lie and hurt, assumptions about life that cripple and distort the beauty of who they really are, and what life can be.

Yes, we dive down together – and when we come back up, there is something inside, that wasn’t there before.

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