Pop Psychology












Pop Psychology: The study of fatherhood.

That’s a joke, but then as far as I can tell, fatherhood is kind of a joke, in our society.

Each child is biologically required to have a mother. Fatherhood is a well-regarded theory, but motherhood is a fact.

—- P.J. O’Rourke

You hear people talking about ‘mothering,’ but seriously, does anyone ever really say, ‘fathering’? Fathers are the distant stepchildren of parenting, the ‘other guys,’ the second bananas. Whereas a new Mom is ‘in her glory,’ Pop is more like, ‘along for the ride.’ While motherhood is seen as a sacred commitment, a holy blessing and a joy forever, fathering is more like, “Hey, buddy – yeah you, the one who’s trying to lam out that back door: get back in here and do your duty!”

While many (maybe most?) young women dream at some point, or at least fantasize, about becoming a mother, I don’t think many young men would describe having a child as a life goal, or a major fulfillment (though it may become that, later). Women frequently come into therapy to deal with their unfulfilled desperation to have a child, or their guilt, loss and even shame about not having had one, but men most often seek help to talk about their ambivalence about having a child, or their fears that they won’t be able to ‘get into’ the whole parenting thing, if they do have one. While women tend to see babies as adorable and endearing, men frequently see them as, well . . . boring.

So then, what exactly is fathering, anyway, other than evidence of (uh oh!) unprotected sex?

I take parenting very seriously. When my wife’s out with her friends, I always try and check on the kid before my second gin and tonic.

— A former patient

Well, the good news for prospective fathers is that the bar has not been set very high. If you can bring in a few bucks pretty steadily, avoid hitting anyone, show up for parent-teacher nights, recitals and graduations, take a few ‘shifts’ at night, drive little people around town every so often, and remember birthdays, you’re probably in good shape. And if you’re actually willing to put in the time to form any sort of real relationship with your kids, well you’re a champ. Don’t panic: I don’t mean drop everything and give up your whole life to ‘bond’ with anyone – just be nice, try to show interest in things, teach people to shave, tell people they’re beautiful.

See – that isn’t so hard, is it?

Oh, and if, like me, you do actually find yourself getting involved ‘for real’ and thinking your kids are wonderful, don’t fight it:  you’re in for the ride of a lifetime! No, it’s not the same as winning your fantasy football league, or getting that big promotion, or making partner, or sinking that two-footer to take twenty-five bucks off that insufferable, gloating neighbor of yours: it’s better.

Look, when most men have a kid, they want to go around passing out cigars, proud that they continued the ‘line’ of Smiths, or Johnsons, or Abromowitzes. It’s like, “Look at me – the stud,” akin to strutting out of a board meeting and announcing to all and sundry, “Dude – I killed in there!”

And then, for the next eighteen years, comes the actual raising of the ‘line,’ and dude, that’s not quite so sexy and studly. You don’t swagger into the office and say, “Whoa, I rock! Three diaper changes last night, and I didn’t smear shit all over myself even once!” And you don’t get high-fives all-around for spending the day driving a station wagon full of writhing little people to a soccer game, a t-ball practice and Gymboree, without losing anyone.

But you do get something else – something that sinks in deeper, and lasts longer, than a momentary flush of manly pride. It’s the realization that, much to your surprise, you actually have the chance to influence an actual person’s actual life. No, not just mindlessly spreading your seed and ‘continuing your line,’ but maybe helping create a better ‘line’ for your kids, and doing a good job, not at work, but at home – the job of giving a little person a decent start in life, and taking pride in them, not yourself.

Now I don’t mean to imply that you’ll become a saint, or that you’ll take boundless joy in missing that Giants game on TV, in order to cart Junior around the world all weekend. No, you’ll still want to do your own stuff, and maybe sometimes resent the hell out of your rug rats for stealing what’s left of your youth, but for every withdrawal of time and energy, there’s a deposit made, that’s even bigger: the knowledge, and satisfaction, that you’re participating in something that’s bigger than yourself, something that’s even (gasp!) more important than the Giants game, that somebody needs you, and that, dammit, you’re coming through for them. And all this is something that’s really hard to explain to a guy who hasn’t had children, or is terrified by the thought of what having children will ‘do’ to his life.

Because you can’t put into words what it’s like to sit there in the stands when your son comes up to bat in a Little League game, and, with tears in your eyes, say to yourself, “That’s my boy!” Or to sit there and watch your daughter, who was scared out of her wits the night before, stand up there and belt out her lines in the school play, and think, “You go, girl!’ Is it too crazy to say it’s almost a religious experience, a spiritual one? I don’t know – maybe. But it’s not far off. Because isn’t religion all about seeing that we’re bigger than just individual blobs of protoplasm, that there are things beyond us, that we’re a part of something much bigger than being John Doe? Well, having kids takes you to those places, those spiritual spaces, beyond yourself.

Yes, I know that most men (including myself) don’t ‘get it’ until they have their own kids: before that, you hear guys talking about their children, and you nod at all the right times, but honestly, it’s like, “Yeah, whatever.” You watch your girlfriend get all excited about her best friend’s baby shower, and honestly, all you’re thinking is, “Please, god, don’t let her come home in a lather about having a baby.” It’s not that you don’t understand, in some abstract mental universe in the back of your mind, what all the hullabaloo is about – it’s just that it doesn’t really hit home.

And then your wife or girlfriend gets pregnant (planned, or not) and you decide to have the baby. And you think, “Yeah, cool – I can handle this,” but it’s still just an abstraction. And you deal with her food cravings, and it’s cute that she wants lobster bisque in the middle of the night, and gets sick to her stomach when there’s a Frito in the room – but it’s all an abstraction. And you feel her stomach when the baby’s kicking, but honest to god, you’re really just kind of humoring her, because it’s not ‘real’ to you, other than the late-night dread about your lost life, which of course you can’t share with that lady with the big belly lying next to you, that brave girl who’s willing to go through all this to bring a new life into the world – a life that is connected to her, not you.

And then the big day arrives. She says, “This is it,” and you race her to the hospital, more worried, in the back of your mind, about something ‘happening’ to her, than the baby itself. And you stand there, dutifully, in your mask and gown, or you sit there in the waiting room, and you act like you’re participating, thinking, this is it – the end of the pickles and the lobster, the end of the  backaches and the swollen feet, the end of the emotional jags and the guilt-trips about not letting her have a baby – but it’s still not about the kid, not really. And if you’re thinking anything, you’re thinking, “Oh god – just let her live! I don’t want to lose her!” and you’re so darn proud of her, for going through all of this for you, for us.

And then it happens: the baby pops out, or is cut out, or is pulled out, but somehow, it gets out of there – that zone that, a long time ago, used to be yours – and you’re so relieved, and proud, that she made it through – that your girl made it through all the way. And it’s still about her, that brave lady who has done this amazing thing, for you, for us.

And then your attention finally shifts to ‘it’ – a baby girl. And that’s when it hits you: Oh My God, it’s a baby! It’s our baby! It’s my baby! I’m a father, and I have a baby! An honest-to-god, real-life baby of our own!

And in that instant, your life is changed, forever.

How? Well, it’s hard to explain, if you haven’t ‘been there,’ but I’ll try. In that instant, you find, or rather you experience, bodily, that you are connected – to all of humanity since time immemorial, to the history of life, to everyone before you. And you are now part of the great ‘fraternity’ of life, too – the club of people who have had children. You are now an initiate into the great mystery of life: like a retired attorney is ‘of counsel,’ you are now ‘of humanity,’ a member in full standing of the chain of human events. You find your eyes filling with tears, and all you can think is, “Oh my god, oh my god, oh my god.”

In the movie Resurrection, Ellen Burstyn plays a woman who, as a result of a near-fatal accident, develops spiritual powers. At one point, she goes ‘back to the farm’ where her father – a hard, flinty man – is dying. He doesn’t give an inch, emotionally, until just as he is dying, when he begins to experience his ‘passing,’ and he suddenly breaks down and sobs, “The light . . . oh, my.” Well, a baby is like that. I have friends who say their first acid trip was like that, back in the Sixties – that it changed everything, from then on. I wouldn’t know – my only ‘trip’ ended with a desperation to come back to normal life, and a bad neck-ache for the next week.

But your concept of being a father, at the moment you see that baby girl, changes forever. It’s not what you thought, anymore: not just a series of obligations, or that you have to share your wife, or getting no sleep for the next two years, or giving up your basketball games on Saturday. Sure, it might ‘mean’ those things, technically, but it’s suddenly so much more: it’s that the baby is part of YOU, part of US, that you WANT to do things for her, that you identify with her. It’s that what happens to her, happens to YOU. It’s that how you act, now affects HER.

I didn’t have to go to Vietnam –  my bad back spared me that particular honor. So I’ll never know how I would have acted ‘under fire.’ But I wondered about it. And I think most boys think about that at some point in their lives, seeing war movies, playing video games, listening to older guys talk about their time in the ‘service.’

But I do know this: when I caught sight of my son Brett, at age three, just as he ran headlong into the surf at Sea Ranch, on a stretch of beach that was marked, “Dangerous riptides,” I ran for all I was worth and jumped in. Now mind you, I don’t know how to swim, don’t like the water, don’t even like hot tubs. But all that didn’t matter: I ran like a man possessed, jumped in the water and paddled and kicked for dear life. I could see him up ahead of me, tumbling around and around in the undertow, tossed up and then sucked down, again and again. I prayed, “Please, God, if you’re there: please help me – not for me, but for him!” It didn’t matter that I didn’t know how to swim, that I was half-drowning, myself. I was like a crazy man. All I could think was, “My boy is in trouble! I’ve got to save him – got to!” Finally, I reached him, and slung him on my back, trying to keep his head above the surging waters. I staggered, gasping for air, pushing for all I was worth against the weight of the surge that was trying to pull us backwards toward the open sea.

Finally, I was able to drop down on all fours, and with him on my back, crawl laboriously forward towards the shore, rocks and sand grinding into my knees with every move.

At last, we made it, me and my boy, my Brett who was part of me – the best part. We lay there panting for a few minutes, then he, being Brett, got up and dashed off to his next adventure, with a little glance backward that said, “My Daddy!” And in that moment, I knew I would have done just fine in Vietnam, and much more than that, that in saving my boy, I had become more of a man. I was part of the earth in a different way, part of the human race in a deeper way.

I don’t know if there’s such a thing as a God who listens to the prayers of desperate fathers, but in that moment, as I watched my boy race away, I felt that if there is a God, it’s somehow all tied up with love and devotion – because being a father forces you to get your mind off of yourself and look beyond you, beyond all of us, and be a part of something big, something that has no end.

I stood up and brushed myself off. I saw the boys up on the bluff, kicking a sparkly soccer ball back and forth, and set off to join them – so thankful, in a new and deeper way, for the grace of being a father.

And then, suddenly, like one of those big breakers, it hit me: all along, they were raising me!

I couldn’t get the smile off my face all afternoon.

Fatherhood: it’s no joke.









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

How Psychotherapy Ruined America









See? I am capable of writing, catchy, ‘marketing’ titles, as all the “How To Grow Your Blog” people keep telling me to do! Next time, I may write about Ancient Secrets Of Reverse-Aging, followed by Losing Weight Without Diet Or Exercise, and maybe How To Date Without Leaving Your Mother’s Basement – am I on the right track here?

Well, all marketing aside, the truth is, the title of today’s blog is unfortunately not just a come-on. I’ve wanted to write about this for a long time, but hesitated because, let’s face it, therapy has been under attack for a long time now, both from within and from without the profession, and I didn’t want to be the one to put yet another spear in its side. So permit me to just pen a quick anticipatory defense of therapy, then we’ll move on to our target for tonight:

Therapy is the reason I’m even alive and writing this. Without years of at least halfway-decent therapy, I’d either be living under a bridge somewhere, or long gone from this mortal coil. And practicing psychotherapy has also enabled me to have a functional role in society, doing what I’m most suited for, and I think I can say without undue horn-blowing that I have been responsible for saving, or improving, many, many lives over the years I have been in practice. I write about therapy, I love being a therapist, and I’d like to say a public and deeply-felt thank you to Sigmund, Carl and all the rest of the gang who made the whole thing possible. Okay, all together now:

Every session’s sacred, every session’s great – if a session’s wasted, Freud gets quite irate. 

Alright, now that that’s out of the way, I do have a few items on the negative side of the ledger. Psychotherapy is ultimately about the Self: claiming the Self, reclaiming the Self, rehabilitating the Self, finding the Self, enabling the Self. And that’s fine – the ‘standard’ therapy patient is someone who, for whatever reason, has not had the opportunity to establish a strong, secure, delineated sense of Self, the lack of which results in low self-esteem, confusion, insecurities, vagueness about life purpose, unacknowledged feelings, difficulty with boundaries and limit-setting, and a host of other problems. And psychotherapy is tailor-made for those people: that type of person, in the hands of a competent, dedicated therapist, stands a very good chance of finding their way to a life with more meaning, satisfaction and purpose.

And in doing therapy with this kind of person, there are certain basic principles that inform and guide the work, either explicitly or tacitly. These have never been stated openly, at least in lay terms, but I think this would be a fair listing of some of them:

Getting in touch with your OWN feelings is a good thing, and letting your feelings be your guide in life is an even better thing.

If something doesn’t work for you, you should probably not do it.

Your tendency to subsume your own experiences and needs to those of others has caused you problems: we are working to bring your experience to the fore and to help you feel that your perceptions and needs are at least the equal of everyone else’s.

If and when you stop ‘taking care’ of other people and start getting your own needs met, you will not only feel more fulfilled, but ultimately be more available, in a more real way, to attend to the needs of others without sacrificing yourself emotionally.

Okay, I could go on and on, but I think you get the basic idea: for people who have been minimized, marginalized and squashed (by others, and ultimately, by themselves), it is necessary (as an emotional ‘corrective’) to bring their own experience to the forefront, and to honor it above all.

In a crude form, you could express the task thusly:

First YOU – then everyone else.

As I said above, this goal is only an emotional corrective to having stifled their own experience before this, much the same way that Affirmative Action is a (hopefully temporary) societal corrective that exists in order to try and counterbalance forces that were out of balance before. A pendulum that is ‘out of whack’ needs to swing back ‘too far’ the other way before it can gradually swing back to the mid-point. For example, we all recognize and accept that a teenager has to ‘over-correct’ in the direction of rebellion, in order to throw off the strictures of childhood, until ultimately coming back to the center-point of normal adulthood (we hope!).

So far so good. But here’s the thing: these corrective principles, which were developed in a particular context (psychotherapy) to help a particular kind of person, don’t stay put. They leak out into the mainstream willy-nilly, out of context, and get appropriated wholesale, and applied across-the-board, by all.

And in my generation, that admittedly did sometimes take the form of “Turn on, tune in, and drop out,” or “Do your own thing.” The older generation saw this as an abnegation of responsibility to others, a rejection of what they had worked (and fought) so hard to preserve, and a justification of self-absorbed ‘navel-gazing.’

Here’s one small instance of what I’m saying: I started my career in the Seventies, working in alcoholism rehab. I worked with people struggling with substance abuse, but naturally my help was also needed by the ‘significant others’ of these addicts and alcoholics. You’ve probably wondered to yourself at times – why would someone stay with an abusive alcoholic or addict? Who are these people who would sign up for continued pain, disappointment and suffering that is virtually guaranteed? Well, the answer is complicated, but many of these people are the kind I was describing earlier: people who have a hard time knowing what they want, have a hard time asking for what they need, and on some level, for them it’s more comfortable, and more familiar, to focus on the needs of someone else, to continually ‘monitor’ someone else, even if it means living on a roller coaster of fear and dread.

For these people, the Al Anon program was developed. With group support and a spiritual program, it helps people focus on (and meet) their own needs, and learn to balance themselves inside, rather than looking to the addict for a stability that is not there, and therefore focusing on and resenting the addict. And a few years later, along came Melody Beattie and others, who developed the concept of Codependence (see Codependent No More, for example). This gave a name (yay: we all love a name!) to this phenomenon I described earlier, i.e. that of being a ‘good person’ by orbiting around another person’s life and (seemingly) not having many needs oneself. I won’t go into the concept any further, because I’m just using it as an example, but like I say, this concept ‘leaked’ out into mainstream society and has been picked up by anyone and everyone.

So now, I frequently hear extremely self-centered people, when asked to do something for a friend, a partner, or even a dying parent, say,

“The hell with that: I’m not going to ‘co’ her anymore! What about me?”

The concept of codependence, a perfectly useful one in the context in which it was developed, has been lifted, stolen and appropriated for constant misuse by narcissistic, self-absorbed people in all manner of situations.

Likewise, the whole idea of Self (as developed in, yes, psychotherapy), and the need for under-Selfed people to ‘correct’ by putting themselves first sometimes, has been swallowed whole by a society that is increasingly self-absorbed. I am not proud to acknowledge that it was my ‘generation’ that was first called the Me Generation – and with some justification.

But you have to understand, at that point (say, the Sixties), it was a necessary corrective to the so-called Greatest Generation before us, who, by necessity in most cases, navigated the Depression and the World War II era by emphasizing self-sacrifice, non-expression of feelings, self-sufficiency, and modesty in all areas of life. Ask a World War II Medal of Honor winner about his feats, and he will invariably say,

“I just did my job. The real heroes are buried in Normandy (or Iwo Jima).”

And that modesty, that self-deprecation, is a very special quality – one I admire with all my heart. But, ‘we’ – i.e. my generation, and all the people who entered psychotherapy beginning in the Sixties – felt we needed something more than being the father who worked his ass off, then looked down at his shoes and refused to talk about anything real, or the mother who tirelessly slaved for her family, without an expressed life of her own.

We needed more out of our parents than that, and more to look forward to than a life of duty and self-sacrifice, and this is where therapy was of tremendous help – in claiming these needs without guilt or shame, and in providing a safe framework for finding a more meaningful, richer life for ourselves.

But as helpful and as transformative as therapy was, it was inevitably hijacked by society. By the Sixties and Seventies, you started hearing therapy talk everywhere, like “guilt trip,” “ahh – she’s got a complex about it,” “that’s just your family shit,” and “you’re so paranoid.” And today, people throw around terms like bipolar, transference, regression, personality disorder and borderline, without a thought. They use them for name-calling, for labeling people, and for excusing all kinds of inexcusable behavior.

So, I wanted to write this, in public, as a therapist, to say in all honesty that sometimes, when someone says, “Therapy just teaches people to be selfish,” or “Since you got into therapy, it’s all about you,” well, sometimes they’re right.

And sometimes, when people misuse therapy talk and therapy concepts to justify meanness or obliviousness to the needs of others, well, it makes me feel bad, and I do feel that therapists have had some part in creating a country of self-absorbed people.

But you have to understand that therapy, and therapy concepts, were necessary as a corrective to a generation that was silent, undemonstrative and sometimes too self-sacrificing. And therapy was – and is – necessary, now, for people who feel disenfranchised, lost or unheard. It’s a damn shame that the therapy world was hijacked, distorted, oversimplified and misused for the wrong purposes, but I’m afraid that that’s the fate of every philosophy or practice that comes down the pike, from democracy to existentialism to Christianity.

All we, as therapists, can do is honor the guts and vision of those who developed these amazing concepts, and try to stay true to their use in the right context and for the right people, because self-absorption and the justification of selfishness is never the ultimate outcome of appropriate psychotherapy.

My experience with people has been that, though their ‘pendulum’ might swing towards selfishness as they work through their problems, it always swings back as they consolidate a true sense of themselves, and ultimately leads to a generosity of spirit and a sharing of the human experience that would have been impossible without the crucible of psychotherapy.



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

The Marquis de Carolina










“They say Caesar was born in a caul. Well, I was born in a Chevy, but it don’t seem like that count for nothin’. He get ‘Hail, Caesar!’ and all I ever get is ‘Hail no!'”

Thus began my association with Curtiss M. Jones, the self-styled Marquis de Carolina, drug dealer, man about town, “love machine,” and pimp extraordinaire. He once described himself to me as “da pimp de la pimp,” and while his “wordiage” (another of his terms) may have run slightly afoul of the style guide, he got full marks for originality, and his meaning, as always, was crystal clear.

Curtiss (“don’t forget that last S!”) was a sometime outpatient in the North Carolina V.A. Hospital I worked at one summer during my training days. He was a Vietnam vet who had suffered a ‘service-connected disability’ during his tour of duty. I still don’t really know whether his manic-depression (now gussied up as ‘bipolar disorder’) was really brought on by what he went through in Nam – he used to say it was, or it wasn’t, depending on his mood and how he felt about me at the moment – but the fact is, when he went away to serve his country, he had a 3.75 grade point average at his inner-city school (he once showed me the report cards, which he’d preserved carefully, like holy relics, in a sealed plastic bag), and was aiming for college, and when he came back, he was a changed man.

This may sound like a crackpot theory, so feel free to toss it out if it doesn’t make sense to you, but oftentimes, when people suffer from psychiatric conditions (bipolar, oppositional-defiant, Tourette’s, even ADHD) that temporarily hijack their ‘regular’ mind or behavior to a raw and more coarsened place, their day-to-day personalities eventually start drifting in the direction of their ‘altered’ states.

Maybe I can explain it this way: let’s say you’re an actor, a person who is normally quiet and unassuming, even reserved, and you win a role in a play, as a rowdy, roistering truck driver. You play this role over and over again, until finally, you find yourself beginning to incorporate aspects of this truck driver into your ‘civilian’ behavior. Your girlfriend says, “Did you just call me ‘Babe’?” Your friends say, “What’s with the Brooklyn accent?” You’re calling AT&T to discuss your bill, and you hear yourself shouting, “I wanna talk to your boss’ boss – now!” It’s not that you’re becoming someone else, really, it’s more that playing that role has pulled out of you parts of yourself that might otherwise have remained relatively dormant.

Well, I think this happens with state-shifting emotional conditions, too. Even if you’re normally a quiet guy, once you’ve stayed up all night long three days in a row, in a hypomanic state, calling everyone you know, yelling at them for hours on end about your plans to save the world – well, it changes you. Once you’ve ‘gone off’ and shouted at the school principal that she’s a “crazy, stupid bitch,” you change. Once you’ve punched out a co-worker because you thought he was listening to your thoughts – you change.

Yes, you revert to your regular self between episodes, but it’s never the same: there’s something lost, some innocence or inhibition, some buy-in to society’s norms, that can never be completely restored to mint condition – a certain figurative loss of virginity, that can never be put to rights again.

And this is what I think happened to Curtiss, during and then after Vietnam. In his hypomanic states, he ‘became’ a certain kind of character – loud, brash, flamboyant, maybe a caricature of people he had known and seen in the ghetto where he was raised – and he gradually became that persona, even in his normal state.

And once he became the Love Machine, The Marquis de Carolina, I think he stayed there because it gave him a kind of shield to put up against the pain of what he had lost: the bright young man on the way up and out of the ghetto, the sensitive, unsure man who had no concept of how to carry off who he really was, into adult life.

And beyond a certain point, it was too late to go back, too late to be that kid anymore, too late to do anything but go forward as the ‘new’ Curtiss, the pimp de la pimp.

We would talk in the little, threadbare office that I – as the punk kid trainee – was allowed to use. He would give me that pimp-ass jive, and I would try to turn things around in a more therapeutic direction. I usually failed. But I always liked him, and I think he at least got a kick out of me.

Well, one day, during free time in the big day room, while the other guys were watching TV, Curtiss grabbed a cup of coffee and came over to knock on my door while I was doing paperwork in my cubbyhole.

“Hey, little chief – what’s the haps?”

“Hey, Curtiss – nothin’ much. Pull up a chair.”

He folded his big, lanky frame down into one of the straight-back, utilitarian chairs that were ubiquitous at V.A. hospitals, and scooted it over to me. “Whatcha scrabblin’ down there, little chief?”

“Oh, just notes. Ideas.”

He cracked open his Zippo and fired up a Parliament. Being a Southern gentleman, of course he offered me one, too, knowing I’d refuse it – then took a deep drag on it and arranged his coffee and beanbag ashtray just so. (God, I miss people smoking, even though I never had the habit myself: there was a certain gentility, a languorous ritual to it all, a kind of ‘styling’ to how you lit up, how you held it, how – and when – you knocked off the ash, even how you stubbed it out, that we don’t have anymore, to our great loss, in my opinion.)

Well, anyway, as I say, once Curtiss ‘set up shop,’ we began. “So, exactly what’s the deal with y’all’s bein’ here, anyways?” (The “y’all” referring to me and my fellow trainee.)

“Oh, it’s just a chance to make a little money, and get some experience over the summer, between classes.”

(Flick of ash, another long draw) “So, what kind of classes you talkin’ ’bout? Figurin’-people-out classes, or how-to-talk-to-people classes, how-to-tell-people-they’re-crazy classes, or what?” He gave one of those wonderful Bill Russell cackles, if you happen to know who Bill Russell is, and if you don’t, you’ll just have to make do with Samuel L. Jackson.

“Well, so far there’s mostly a lot of learning about the history of psychology, a lot of memorizing old guys who were important, a lot of terminology, famous experiments – that kind of thing.”

“What for you need to know all that shit, little chief? That’s not even about crazy people.”

I nodded wearily. “You got that right. But you see, we’re trying to get Ph.D.’s, and a Ph.D. is a research degree: that means you got to know the history of psychology as the science of human behavior – not just all about crazy people.”

He nodded back, skeptically. “So when do the crazy folk come in?”

“Later – next year, after we pass this big test about all the stuff I just told you about.”

“Sh-ee-it, boss.” (Understand – in the South, ‘shit’ is a three-syllable word.) “You got to be kiddin’ me: you mean they put you through all that, before you can even get to the crazy people?” He coolly got a new Parliament going from the glowing end of the old one – like I say, a lost and most wonderful art.

“Yep, that’s what I’m saying.”

Curtiss shook his Afro back and forth sadly. “You got it baaaad, brother.” He thought for a moment. “So, y’all ain’t yet even learned how to be with crazy folk, have you?”

I smiled. “Well, technically, I guess you could say that – yeah. Officially, I’m just sort of faking it until I learn the real deal.” I took a swig of my Coke, and lowered my voice, confidentially. “Now, I’m counting on you to tell me when I fake bad, okay?”

He gave one of his rich, raspy, Parliament laughing-coughs. “Sh-ee-it, little chief – you fake good, for a white boy! Now, you take some of them staffs been around here for years, supposed to know all they is to know about crazy folks: god damn it to hell, they talk to you, it sound like a robot:

‘Hell-lo, Mis-ter Jones. Would you like to share with the group how you’re feel-ling to-day?’ 

We both laughed out loud at his spot-on impression of one of the very uptight staff psychologists.

Then he went on. “And here, you never even studied crazies, and you talk like a human bein’, and like I’m a human bein’.” He paused, thoughtfully. “Shit, little chief, all you been doing is studying, and after this, y’all just goin’ back for more studying.” He rubbed his chin. “You know what, I should set you up with one of my girls – show you some fun, show you what life really about. My treat – what you say?”

I could see he meant it – and meant it as a genuine gift. I was flattered. “No, Curtiss – that wouldn’t work. I’m married, you know.”

He cocked his head, frowning protectively. “She cute?”

I nodded, “Yeah – she cute, she real cute.”

He cocked his head again. “She white?”

I laughed, “Yeah – she’s Hungarian.”

His mouth flew open. “Son of a bee-yitch! I was with a Hungarian gal one night. Heard her on the phone with her Mama once: they talk crazy talk! Couldn’t make out a word of what she sayin’, and I know some Spanish, some Gook, even a little Frenchie.”

“Did you take French in school?” (Yes, my clumsy attempt to shift to a ‘therapy’ mode, but don’t judge me: I hadn’t studied crazies yet, you know!)

His eyes softened and turned thoughtful, as he fired up another Parly and toyed with his lighter. “Long time ago, chief. That was a looong time ago.”

“Like another lifetime, you mean?”

“Like another person’s lifetime, I mean.”

“It must be weird to feel that disconnected from your old life, and your old identity.”

He took another deep drag, contemplating the holes in the acoustic ceiling tiles like a sailor searching the stars for his bearings. “It used to. Now – I just . . .”

“Just what?”

“I stay away.”

“You mean, from the memories? The way things used to be?”

“From the whole thing.” His right foot started beating fast time. “I got my girls, I got my V.A. check, I got this place, I got a place to live, I got every fuckin’ thing I need.” His voice was suddenly defiant, steely.

He was smoking fast now – hard, his zippered Italian boot pounding time on the dingy linoleum of my cubbyhole. I could feel his anger flare, and I knew he’d hit a wall – we’d hit a wall. I scrambled for a way to ‘reserve’ the emotional space we’d just shared, keep it safe and available for future reference, like those report cards in their plastic bag.

I watched him for signs, but his face was a mask now. And a shield like that can’t just be peeled back like Caesar’s caul.

He suddenly turned to me, that big, jive “Marquis de Carolina” smile pasted back on the mask, and said, “That’s it, alright, boy – we gotta get you laid, before you go on back to where you came from, and all that studyin’.” He pulled out his “little black book” and read, as he flipped the pages, licking his fingers studiously between flips. “Sophia? Naw – too black. Maria? No – too ugly. Carrie? Yeah – she the one for you, little chief. Smart, and pretty – and she likes to talk a lot, like you.”

He looked up at me. What we did before, what he let me see, was gone baby, gone. “What do you say to Carrie, boy?” My lack of enthusiasm pained him. “I am doo-in’ you a favor here, boy! You need some action, before they turn you into a sci-en-tiste, little chief.”

I felt sad. I felt like crying. I was only beginning to learn myself as an ‘instrument,’ learn myself as a young therapist: I had the capacity to feel other people’s feelings directly, especially if they didn’t want them. My body collected unwanted feelings like some people collect stray cats. Of course I didn’t know this then – I just felt sad, guessing that maybe it was because I had failed in helping him. He was right: I hadn’t yet studied being with ‘crazy folk,’ and had no idea, really, what to do even with my own ‘stuff.’ I was awash in his rejected emotions, and in my own confusion about what had just happened, with no way to right the foundering ship.

I must have been staring straight ahead like a dope as I felt all this, because suddenly I heard his voice saying, “Don’t feel bad, little chief. For a guy who ain’t studied crazy folks, you do good – real good. I just know, some day, you’re gonna be a big chief.” His eyes went to the ceiling again, his hands fishing his shirt pocket for his Parlies. He paused, licking his lips, then cleared his throat. “See – it’s, uh, it’s just that, for me, it’s too late, little chief. You got here too late, is all.”

I’m pretty sure I had tears in my eyes, and I think I heaved one of those stifled sighing-sob things, the kind that’s not crying, but not not, either. His eyes were glistening, too as he flicked them at me. And in that moment, we knew each other. I saw things in him that he didn’t want to know, and he saw things in me that I didn’t even know I had, yet. It was deep – something beyond patient-therapist, beyond black and white, beyond V.A. hospitals. An instant in time, but forever.

He turned to leave, the big smile back, and gave me a little half-salute. “Later, big chief; the Marquis, he got to go.”

I lifted my Coke in his direction. “Hail to the Marquis!”

I thought about the Marquis and me all the rest of that afternoon – the magic of it, the specialness of that one moment we’d had – and I wanted more. I knew I was gifted – to feel things, to know people, to see who they really were, but I also knew that my gifts were raw and undeveloped. I had a lot more work to do, to make that magic happen again and again, but moments like this made me want to hurry up so that I wouldn’t be “too late” the next time.

After work, I locked up and walked to the parking lot slowly, through the heat and humidity of the North Carolina summer. I got into my car and headed for the tunnel and home. On the way, I watched the people in the cars around me, looking ordinary and normal. But I knew better now. What were their secrets? What were their shields? Was I ever really going to be good enough to be a big chief?

As the rush-hour traffic came to a halt, my eyes fastened on the old, beat-up green car in front of me. It had that familiar ‘bow-tie’ logo on it, the letters spelling out ‘Chevrolet.’

I smiled, remembering the Marquis’ story about his birth, and thought to myself, sometimes even a beat-up old Chevy can be a pretty classy ride.















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

Light Unto My Lamp










The Lamplighter is one of Robert Louis Stevenson’s most famous, and most endearing, poems, from his classic, A Child’s Garden of Verses. Stevenson was a sickly child, ‘banished’ to his room, alone, for long stretches of time, away from the society of his peers.

But, here – read it first, and then we’ll talk some more:

                         The Lamplighter

My tea is nearly ready and the sun has left the sky;

It’s time to take the window to see Leerie going by;

For every night at teatime and before you take your seat,

With lantern and with ladder he comes posting up the street.

Now Tom would be a driver and Maria go to sea,

And my papa’s a banker and as rich as he can be;

But I, when I am stronger and can choose what I’m to do,

O Leerie, I’ll go round at night and light the lamps with you!

For we are very lucky, with a lamp before the door,

And Leerie stops to light it as he lights so many more;

And O! before you hurry by with ladder and with light;

O Leerie, see a little child and nod to him to-night!

Lovely, isn’t it? And haunting. You can just picture the young Stevenson, poet and literateur-to-be, the scope of his world reduced to his bedroom and the street outside his window, the endless hours marked by the regular cadence of activity on the street, the coming of darkness, and then, finally, Leerie’s nightly rounds.

Mary Shelley gave her famous novel, Frankenstein, the subtitle A Modern Prometheus, in honor of the godlike miracle of vivification that Dr. Frankenstein performed with lightning. But for the small Stevenson, Leerie must have seemed a modern Prometheus as well, bringing flame, as he did, to the darkened streets of Edinburgh on a nightly basis, magically replacing the foggy murk outside his bedroom window with the warm glow of the flickering streetlight.

And little Robert lay there wondering, probably, if he would ever again leave his room, and maybe, too, about those things a child should never have to wonder about: permanent infirmity, continued isolation, and possibly, death.

What do you do in that kind of situation? You make, by necessity, a ‘world’ of your small world. You watch, and wait, for the rhythmic, the predictable happenings that mark the tedious hours, happenings that assume enormous importance. So much importance that even a (hoped-for) momentary nod from a lamplighter becomes a signal daily event, a blessed pinprick of light in the vast darkness of a child’s loneliness.

Stevenson even immortalized his sickroom ‘world’ in this poem:

When I was sick and lay a-bed,

I had two pillows at my head,

And all my toys beside me lay,

To keep me happy all the day.

And sometimes for an hour or so

I watched my leaden soldiers go,

With different uniforms and drills,

Among the bed-clothes, through the hills;

And sometimes sent my ships in fleets

All up and down among the sheets;

Or brought my trees and houses out,

And planted cities all about.

I was the giant great and still

That sits upon the pillow-hill,

And sees before him, dale and plain,

The pleasant land of counterpane.

Is this a boy who is content to lie in bed, a passive observer of life? Is it even possible to read this verse and miss the longing embodied in the references to the active, daring life of soldiers and sailors, or the poignant irony of Stevenson, in enforced bed rest, calling himself “the giant”?

Growing up, attending various schools, he was eager, desperate, to push his way out of the narrow confines of not only the sickbed, but the boy’s world of Edinburgh that circumscribed his life. He wanted ‘out,’ but then again, he also still prized, and needed, the “pleasant land of counterpane” where he had once lived. Like a prisoner of war who, once released, finds the ‘real world’ too fast, too loud, too demanding, too changed, Robert still clung to the old, the small, the familiar.

But is it possible to hold on to the old, when the world is changing so fast?

Stevenson certainly hoped to: here is an excerpt from his essay, A Plea For Gas Lamps, which he wrote years later, clearly influenced by his continued affection for the fast-fading age of gas lamps. In this passage, he compares the ‘new’ electric lights with his beloved gas:

The word ELECTRICITY now sounds the note of danger. Such a light as this should shine only on murders and public crime, or along the corridors of lunatic asylums, a horror to heighten horror. To look at it only once is to fall in love with gas, which gives a warm domestic radiance fit to eat by. Mankind, you might have thought, might have remained content with what Prometheus stole for them and not gone fishing the profound heaven with kites to catch and domesticate the wildfire of the storm . . . but where soft joys prevail, where people are convoked to pleasure and the philosopher looks on smiling and silent, where love and laughter and deifying wine abound, there, at least, let the old, mild lustre shine upon the ways of man.

So young Robert found ways to prize and treasure his ‘small world,’ but at the same time, I think The Lamplighter shows you that, for Stevenson, watching wasn’t enough: He wanted the power of the lamplighter, too! He wanted to make a difference. He, too, wanted to ‘bring the light.’

But how was he supposed to bridge the huge gap between being a sickly child, confined to his bed, and becoming a force in the adult world, like Leerie?

He wanted to be somebody!

And not just any somebody: his own somebody!

He didn’t ‘just’ want to go into the family business, as he was expected to, although, ironically enough, the family business was ‘bringing the light’: Robert’s father, and other close relatives, were noted lighthouse designers. No, Robert, though limited and betrayed by his frail body, imagined something grander than designing lighthouses. He imagined himself bestriding the ‘big world’ in seven-league boots, running away from his real life as a frail boy in his cloistered bedroom.

It seems clear that young Robert felt the soul of an adventurer stirring within himself, but also that he knew, from early on, that he didn’t have the body of one: an identity out of sync with itself, two warring camps, each insisting on its own way.

But how does one resolve this internal tug of war – something that is far more common than you might imagine? Well, I could give lots of examples from my practice, but let’s use Stevenson as an example. For Robert, an artistic type with a literary bent, one of the ways is to work on the issues by using fantasy.

Is this the internal tug of war that haunted Stevenson? Forced into a small world by childhood illness, trying to make something worthwhile, something memorable, something meaningful, out of his limited resources? Then, as an adult, expanding his world hugely, almost ‘counter-phobically,’ by taking trips – no, not trips: voyages, that were certainly uncharacteristic of people of his time, traveling the biggest of the Big World, with seven-league boots. But was this far-flung travel, this enormous striding of the bigness of the world, the ‘corrective’ that he sought, to his childhood confinement? And finally, in writing of his travels, did he become a symbolic Leerie, bringing that larger, far-flung world to ‘light’ for his readers, illuminating them with tales of his voyages and adventures?

Hear his ‘protest’ of following in the family footsteps, in this poem:

Say not of me that weakly I declined
The labours of my sires, and fled the sea,
The towers we founded and the lamps we lit,
To play at home with paper like a child.

Does the phrase, “like a child” jump out at you, like it does me?

I hear, in this poem,

“I’m no f________child! I’m not weak!”

He wants us to know that, although he didn’t do the ‘right thing’ and follow his father in the lighthouse business, he is not a nothing, not a failure.

There was an enormous displacement, and discontinuity, in scope, that his life spanned: shut-in, to world-wide traveler. Was this the split, the disjunction, that so haunted him, the basis of Dr. Jekyll and Mr. Hyde? That enormous gap between the small world and the big world, that lay inside him, yawning and unbridgeable? Did he wish that it were possible to bridge that gap by taking a magic potion?

Did he say to himself, as many, many of my patients have said to me,

Can’t you just knock me out and give me something, so I wake up changed?

Well, that is what Dr. Jekyll did, isn’t it? The fantasy of getting to the ‘other side’ just by taking something – kind of an alchemy by ingestion. Well, what were Stevenson’s alternatives? There was no psychotherapy, no real way that personal help from another person could bridge that gap. So what could he do? The well-known ‘Geographic Cure’ was an obvious attempt to get there. This tremendous yearning is even on display, very clearly, in his most famous writings: what is the plot of Treasure Island, after all? A young boy is basically ‘transported,’ willy-nilly, into a pirate’s life! He (as the character Jack Hawkins) goes from the Small World of an ordinary boy of those times, into the Big World of swashbuckling adventurers, from the ‘good boy’ world of young Robert Stevenson, to the ‘bad boy’ realm of a buccaneer!

But let’s go back to The Lamplighter for a moment, to the time before this child, Stevenson, lost his innocence, and when those yearnings were right out in the open, for us to see. What is he really saying in this poem? That he is lonely, clearly. That the nightly coming of the lamplighter is a boon to him, and something to hold on to, to look forward to, clearly. But there is more here: he is saying to the lamplighter, isn’t he:

Please be with me.

Please notice me.

Let me ‘apprentice’ with you, the art of lamplighting (and therefore, be my bridge to the big world)

Take me with you!

And, maybe even,

Get me out of here!

And that’s what we all want, isn’t it? A way to magically be transported (with care) to the adult world? The irony of psychotherapy is that, while most psychologically ‘healthy’ people already know, and assume, that they have to make use of other people in order to “get there from here,” most psychotherapy patients have learned, somewhere along the line, that it is THEY who are ‘deficient,’ that somehow, they just have to get it together, try harder, snap out of it, concentrate, stop fooling around, face facts, stop dreaming, get with the program, and BUCK UP!

What they don’t know is that it takes HELP from other people, to do this. That’s why they come in (reluctantly) to therapy and say, “Tell me what to do,” not “Help me.” They want explanations, shortcuts, techniques, or maybe at worst, pills, to ‘get there.’

What they don’t want is an actual relationship (ick!) with another person (eeewww!).


Because, as we all know (All together now, big breath – now hit it):

That’s WEAK!!

There now, don’t you feel better, getting it all out?

Cue the marching girls! Cue the brass band! Cue Stars and Stripes Forever! Because independence is the American Way! Not needing is the American Way! Flying solo is the American Way! Doing it on your own, by your lonesome!

And needing? Shoot – that’s just .  . . just . . . well, it’s just plain Communism! Weak-kneed, bleeding heart, sob sister, boo hoo, poor me, pity party, oh-dearie-me-I’ve-got-the-vapors Communism!

And here’s the ultimate irony: for all our jingoistic, teeth-gnashing, fire-breathing, gun-toting, saber-rattling defiance of England, the ‘Mother Country’ we broke away from; for all our proclamations, declarations and disputations, we (like all rebellious children) ended up a hell of a lot like our ‘parent’ after all, in the things that matter.

We just didn’t notice.


What is it you see all day long, from therapy patients who have ‘sworn’ to be totally different from their parents, and from patients who divorce one person, and swear they’ll never, ever, hook up with anyone ‘like that’ again?

Exactly: the rebellious son of a cantankerous, controlling father takes up a defiantly ‘alternative’ way of life, grows his hair long, wears outlandish clothes, and then proceeds to become a cantankerous, controlling ‘alternative’ man.

And the woman who will never, ever, marry a man like her short, long-haired, uninvolved alcoholic plumber ex-husband, ends up marrying a tall, short-haired, uninvolved alcoholic stock broker.

And America, the country that shouted long and loud that it wanting to be nothing – nothing at all – like its stiff-upper-lip, don’t-talk-about-your-problems, keep-it-private, act-like-everything-is-okay-even-if-it-kills-you, look-fate-in-the-eye-and-spit, don’t-let-’em-see-you-sweat ‘Mother’ England, ended up . . .

Need I go on?


So, what can we learn from the life and works of Robert Louis Stevenson, that we can put to use here, on ‘our side of the pond’? Well, it’s not very sexy, but is it too much to suggest that running away (i.e from the ‘Hyde’ parts of ourselves, and from our lives) doesn’t work? That, while we are fascinated (understandably) by Treasure Island as an adventure story, it’s not really much of a model for life? After all, we Americans have our own Treasure Island, don’t we? I mean, isn’t ‘our’ own American archetype, Huckleberry Finn, really just Treasure Island on the Mississippi?

Running away makes a compelling story line for a book, but it’s the relationships, not the geography, that make these books, and our lives, truly memorable and rewarding.

Because it’s not running away that really lights our lamps – it’s running TO.

And, when Stevenson died, in far off Samoa (“I’m NOT home in bed!”) he requested his poem, Requiem, to be engraved on his tombstone:

Under the wide and starry sky,

Dig the grave and let me lie.

Glad did I live and gladly die,

And I laid me down with a will.

This be the verse you grave for me:

Here he lies where he longed to be;

Home is the sailor, home from sea,

And the hunter home from the hill.

And what does this scream? “I’m a hunter; I’m a sailor; I traveled far and wide. I’m not a little boy, lying in bed at home: I’m a man!” It not only sounds more like an epitaph for John Wayne, it actually was recited by John Wayne in a war film, in an impromptu memorial for a lost Navy comrade. But it’s clearly what Stevenson wished for himself –  the more empowered, more uninhibited man he felt stirring inside himself, and that he wished he could embody, or at least unleash at will (paging Mr. Hyde!).

But you can’t just jump out and ‘be somebody else’ – it takes a foundation, a continuity of self, to actually be the man Stevenson envisioned himself to be. Fortunately, these days we have psychotherapy and other means of obtaining help from others, to assist us along that trail from child to adult, and from chronological adult to true adulthood. So let’s really rebel from England, and be a people that embrace not only independence but all parts of ourselves, and our fellow human beings as well.

Because while in books you can be transformed magically from a child in a sickbed to a cabin boy on a pirate ship, in real life it takes hard work and help to manifest your inner buccaneer.

So set sail on your own bold voyage, get all the help you need from the wise and the adventurous, and raise high your own Jolly Roger. Yo ho!







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

Where Are They Now?










When you’ve been a therapist as long as I have, you have legions of former patients. And you wonder about them, these people who once looked to you, to help them transit the dark night of the soul.

Patients often ask me,“What’s the hardest part of your job?” And I just know they’re thinking that the hardest part is sitting there, listening to people’s problems all day long.

Or else being ‘responsible’ for solving my patients’ problems.

Well, it’s not.

People bringing me their problems is an honor and a privilege, and I’ve always felt that way. No, the hard part isn’t listening to people’s problems, or being responsible for them: that’s just my job!

Actually, there are two ‘hardest’ parts:

One is when I’m much more ‘into’ their therapy than they are! It kind of sucks to be thinking about them all week between sessions, imagining what they’re going through, trying to make psychological connections that might help them, worrying about them, and wondering how they’re doing, and then they cancel a session, or forget, or seem totally uninterested, like they’re just going through the motions. Yes, I understand that it’s all par for the course, that their lack of interest in their own life and growth is a symptom of “what they’ve got,” and just more grist for the (therapy) mill, and that’s why I don’t resent it or feel cheated.

But is it hard?

Yes – it’s hard.

And the other ‘hardest thing’ is when patients leave. I mean, sure, I’m proud as heck when someone finishes their therapy and is launched out into the great unknown, or even when someone isn’t really finished ‘cooking’, but decides they’ve done enough ‘for now,’ and wants to try it on their own a while. But like a parent whose child leaves home, it also feels bittersweet.

In the movie Dark Passage, Humphrey Bogart plays a man who is wrongly imprisoned for life in San Quentin, for murdering his wife. He escapes and is hiding out in San Francisco, in the apartment of Lauren Bacall, a woman who is sympathetic to his situation. Finally, he decides he has to take off on his own to try and prove his innocence. But his face has been on the front page of all the newspapers.

He is riding in a cab, trying to figure out where to go to next, when the cabbie recognizes his face. When the cabbie asks him where he wants to be taken, Bogie, feeling defeated, sighs, “Might as well make it the police station.”

The kind-hearted cabbie says, “Don’t be like that – you’re doin’ alright.” Then he goes on to say he has a friend who is a plastic surgeon, who could change Bogart’s face. Bogart is skeptical, fearing that it will not only cost a fortune, but that the surgeon would then “keep after me for the rest of my life,” i.e. blackmail him.

The cabbie says, “Nah – he’s a friend of mine.”

Still skeptical, Bogart finally agrees to be taken to the back-alley office of the plastic surgeon, who, though he turns out to have been “kicked out of the medical association,” and is kind of a scary-looking old geezer, is actually a fine person, and a fine doctor, just as the cabbie had said.

He operates on Bogart, and finally, early the next morning, it’s time for Bogart to leave, his face swathed in bandages. The surgeon shakes Bogart’s hand and says, wistfully,

 The artist in me wishes I could see what a nice job I’ve done, but I never will. Goodbye, and good luck.

Bogart agrees, pays him, and leaves, forever.

Well, that’s the way it feels, most often, when a patient leaves, quits, or even just drops out of sight: the artist in me wishes I could see the results of my work, both now and in the future. But more than that, I care about them, and just want to know how things ‘turned out’. And some patients do check in occasionally and give me an update, so I’ll know how it went.

But, mostly, I never will.

And that’s hard.

Do other therapists feel this way? I don’t know – I’ve never heard another therapist talk about this, though I imagine they must wonder, too, about the lives of the many people that they were so intimately involved with, for a while.

But, me – I wonder: where are they now?

The woman whose boyfriend got her involved in a dope-smuggling ring, who had to leave him, quietly, in the middle of the night, before she got busted, but was always afraid of him tracking her down and hurting her.

The married doctor who fell in love with a Venezuelan nurse when he was in Doctors Without Borders in South America.

The race car driver who injured both knees so badly in a skiing accident, that he couldn’t even work the accelerator or brake pedals on his family car anymore.

The traveling salesman who had a normal life in the Bay Area, but was a secret cross-dresser on his frequent trips to the Midwest.

The teenage boy whom – in a secret, two-hour emergency session in the middle of the night – I talked out of killing his father.

The girl who, late at night, compulsively ate bowls and bowls of cake batter, cut her own wrists up terribly, and stole Demerol from her mother’s medicine cabinet, who went on to become a Nobel Prize-candidate professor.

The little, abused, ‘poor white trash’ girl in Tennessee who, on the Information subsection of the WISC children’s intelligence test, successfully gave all the correct answers: but they were the correct answers to the FOLLOWING questions – questions I hadn’t asked yet, questions she couldn’t possibly have seen before, or known about.

The teenage girl at a group home I once ran, whose mother had ‘pimped her out’ to her men friends, for a price.

Sure, I wonder, sometimes, about high school friends, or people I worked with at various places along the way, or old girlfriends. I wonder, but it’s not the same. You see, I wasn’t privy to their most intimate private lives, wasn’t responsible for their emotional well-being, wasn’t in charge of their ‘recovery’.

No – wondering about former acquaintances is a different kind of curiosity, more of an, “I wonder what happened to old what’s-his-name?” rather than the deep, committed feelings I have toward my former patients. No, the closest I can come to describing it is that it’s more of a parental concern: like the plastic surgeon who operated on Bogie, I not only feel a continuing sense of responsibility, but a personal ‘stake’ in the outcome – whether it’s a testament to, or a sad commentary on, my work.

But is this a sad thing? A negative thing? No – not at all: I WANT to feel I had an effect, that I made a difference, and most of all, that I tried my best, in life. That I didn’t just ‘mail it in,’ squandering my skills and just getting through time without putting the precious gifts of life and talent that I have been given, to good use.

And I feel strongly that the best way I can put my gifts to use, is to help other people learn to use, and appreciate, theirs.

There is an old song with the words,

Why was I born?

Why am I living?

What do I get?

What am I giving?

These are the questions we all should be trying to answer. Sure, maybe in the final analysis they’re “unanswerable” questions, but we must TRY. Because life shouldn’t be for just ‘getting through’ – it should be treated like a two year-old treats a Christmas present: the process of unwrapping it is just as important as what’s inside. The two year-old revels in trying to undo the ribbon, in tearing the wrapping paper apart, in opening the box. He is present with his presents, noticing the colors, the textures, the faces of his parents, the smell of the Christmas tree, the whole ‘gestalt’ of Christmas morning. Christmas should never get ‘old,’ whether you’re a parent or a child: like in the song lyrics above, it is about “What do I get?” and “What am I giving?” And those questions are about a lot more than gifts and presents; they’re about the purpose of life itself: getting and giving.

And a therapist should treat each patient like that two year-old treats a present: really ‘being there’ for the unwrapping, with senses at the ready to take in the (emotional) colors and textures. Making space for each person, each session, to be ‘new’, not standardized, not ho-hum, not predictable. If you’re sitting with your patients and feeling bored, feeling that it’s all predictable, that you’ve seen it all before, feeling unchallenged, then it’s ON YOU to shake things up, to dig deeper and find what’s new, what you didn’t know, what you haven’t seen before.

Because, if you’re really paying close attention, there’s no such thing as a predictable person, a boring person, a ho-hum person: it’s YOU who has become predictable, boring and ho-hum! Sure, you could be FEELING bored or ho-hum with someone, but then it’s up to you to use this information for the patient’s benefit, not as a way to excuse yourself from full participation, or to check out. You must ask, WHY is this boring? WHY is it ho-hum? What is ‘dead’ about this patient, that you are allowing to go unchallenged, unquestioned? What are they telling you, here and now, that you are failing to register, or respond to?

Is it because they were treated in a ho-hum manner, and they’re unconsciously ‘pulling’ to recreate this same relationship dynamic with you, in the here-and-now of the therapy session? Are you just going to ‘go along for the ride,’ checking out and participating in a re-enactment of the old damage, without bringing it to everyone’s attention?

Is it a way to (unconsciously) ‘tip you off’ as to how they feel in life? Bored, ho-hum, uninspired? Here, they’re giving you a ‘front-row seat’ to their insides, and are you just going to let it pass by without comment, without saying, “Wow, you must feel so dead inside.”

To which they most likely will say, “How did you know?”

And the answer should be, “Because I’m paying close attention to what you’re telling me. Because you matter.”

Once upon a time, a young executive, who was ‘dead inside,’ asked me, cynically, about the session, “What are we actually doing here, anyway?”

And I responded, “Buddy, I don’t know about you, but I’m fighting for your life!”

It shocked him – that I wasn’t ‘playing the game’ of ho-hum, a game that he was used to, in his personal life and at work – a very common game, unfortunately, in our society. No, in therapy, I don’t allow ‘ho-hum’ to be the mantra, or if it is, I challenge it. We don’t ‘mail it in’ in therapy – we WORK, even if the work is to sit with ho-hum, and explore the hell out of it, until ‘something happens’ – something REAL and alive, even though the ‘something’ is often unwelcome or scary feelings: ‘unwelcome,’ ‘scary,’ and ‘out of control’ are fine – we can get through them together, like slogging through a muddy bog, on our way to where we’re going.

But ho-hum is not fine: it is saying ‘No’ to the life you’ve been given, like being handed a treasure chest and saying, “Not interested: cart it off to the City Dump.”

Yes, I understand, sometimes ‘ho-hum’ is all a person can do, their only possible response to how they’ve been treated, or the hand that life’s dealt them. I get it, I understand, but I can’t join them in ho-hum. Sometimes, on our journey together, I have to ‘carry’ the caring, for both of us, until they can catch up.

You, the patient, can afford to not care (temporarily, I hope) but I can’t: it’s my business to care, to have you matter, to make you matter, even over your own objections.

And I do – and caring has its consequences. When things, and people, matter – when you care about them, you can be enriched by them, you can feel the joy of connection, you can both ‘give’ and ‘get’ in equal measure. But you can also be disappointed, you can be hurt, and you can feel loss when you lose that connection.

Just as it’s wonderful to have a patient dare to do new things, to finally be herself, and to feel, at last, truly alive, it’s also hard to care deeply and have a patient leave therapy, without a word, or cancel five sessions in a row without responding to your calls, or start seeing another therapist without even telling you about it.

It’s hard, but it’s worth it.

Because caring means being alive, just like in the lyrics of that song, that end,

Why was I born to love you?

But see, that was a ‘torch song,’ where the singer was lamenting how she was, unfortunately, fated to love this guy who would always hurt her. So, I’m hereby taking it on myself to change those lyrics, just a little, for my own purposes. They are now:

Why was I born? 

To love you.

And that’s it exactly: that’s why I was born, that’s why we were all born:

To love you – whoever ‘you’ are.

To love and be loved – that’s about what it amounts to. That’s why we’re here. It feels wonderful, it feels crummy, it’s the highest high, and the lowest low. But it’s alive.


Try it sometime.

And, oh yeah, I almost forgot. Where are all those patients – the ones I wonder about?

Not really as far as you might think.

They’re right here, in my heart.





































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