That’s The Way, Uh Huh, Uh Huh, I Like It

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So many people come in with complaints about depression, sleeplessness, resentment, bitterness, apathy. They blame it on money problems, drug and alcohol problems, marriage problems, job problems, marriage and job problems.

But here’s the thing: much of the time it’s really about ‘I’ problems. As in, they don’t really know who they are, or what their proper place even is, in this big, wide world.

Of course, they don’t usually realize this. What they do know (or think they know) sounds more like this:

1. What’s wrong with me, that I’m always dissatisfied with my life?

2. I have no reason to be depressed.

3. If I could just get that new job, for more money, I’d be fine.

4. If I could just get that new wife/husband, who treats me better, I’d be fine.

So sure, it would be easy to say to them, “It’s all in your attitude.” Then I could give them ‘attitude-adjustment’ exercises – you know, like homework:

List ten things you’re grateful for.

When you start to think negative thoughts, practice mentally ‘changing the subject.’ 

Update your resume, and start to network more.

Sounds good, huh? And that’s exactly what most people think therapy is: basically really expensive good advice, with a side of cheerleading.

Well, they couldn’t be more wrong.

Not to mention, it’s a set-up for yet one more failure. Because you give them their ‘assignment,’ and they either don’t do it (i.e. they’re a ‘failure’), or they do it and it “doesn’t make any difference,” (i.e. they’re a ‘failure’).

After all, they already knew what they ‘needed to do,’ before they ever came in to see you, didn’t they? I mean, any friend, spouse, or sidewalk superintendent could have told them to improve their attitude, get a new job, and learn to be grateful for what they have, right? If they could do those things, they would have already done them. And if all they needed was a little cheerleading, well, they could have gotten that from the afore-mentioned friends, spouses or sidewalk superintendents, couldn’t they?

So then what the heck are they paying a therapist for? Well, it’s not advice (though it includes advice), it’s not cheerleading (though it includes cheerleading), and it’s not assignments (though it often might include those, too).

So now maybe you’re saying to  yourself,

“Ohhh, I get it: all that Freudian hocus-pocus: talking forever about my crummy Dad and my crummy Mom, going over all my dreams in minute detail, reviewing the time the neighborhood boys called me a sissy, and dwelling endlessly on the fact that, since I was the oldest, they expected too much of me, or since I was the youngest, nobody took me seriously.”

Well, yes, while therapy may even include some of that ‘Freudian hocus-pocus,’ too, it’s a lot more than that. Because all of the hocus-pocus, all of the advice, all of the cheerleading and all of the assignments are taking place in the context of a (don’t faint!) Relationship.

Here, I’ll share with you a session with my patient, Paul.

Shh, let’s listen in:

Paul: Sure, it’s a ‘Relationship’: the relationship between my paying you money, and your showing up every week.

Me: Well, that’s true, too, but that’s not the relationship I was talking about.

Paul: Oh, you mean, like, the relationship between your pocketing the money and your acting like you care about me?

Me: Thanks for sharing, but no, that’s not really what I meant, either.

Paul: In that case, I’m fresh out.

Me: How about, the gradual evolution of your sense of yourself, in the context of our developing connection with each other?

Paul: (Mentally backing away slowly) Okay, now I’m going to call the men in the white coats, for you!

Me: But,what if it’s true?

Paul: Well then, I’d say that’s a tall order.

Me: That’s right, it is. Now maybe you can see why I might make a little more than a man-on-the-street advice-giver, and might even be worth it.

Paul: Hmm, can’t you just tell me what it’s going to look like after all this evolving takes place, and I could just act like that right now, and then we could be done with all this?

Me: I wish I could, but the fact is that it takes a human being a certain amount of time to do the things I mentioned – even if I’m really good at my job.

Paul: So you admit it’s a job!

Me: Well, yes, it is a job, but the ‘job’ part is not that I’m getting paid to fake caring, but to actually care, and not just to go through pre-ordained ‘steps,’ but to actually help you find your way to a relationship with yourself.

Paul: Hey, before, you said the relationship was between me and you!

Me: I did, but we’re ultimately concerned with your relationship with yourself – that is, being able to see who you are, to accept who you are, and to embody who you are, in the world.

Paul: Embody? Alright, now we’re back to mumbo-jumbo.

Me: Hey, before, you said it was hocus-pocus.

Paul: Smart-ass. There’s nothing worse than a smart-ass therapist.

Me: Except maybe a dumb-ass therapist.

Paul: You may have something there. (Pause) So, when do we start building all these relationships: with you, with me, with the man in the moon?

Me: We already started: this whole conversation has been part of it.

Paul: Damn, why am I always the last to know?

Me: That’s what we’re here to find out.

Paul: There you go again.

Me: I wasn’t being a smart-ass.

Paul: I’ll have to take your word for that. (Pause) So what do I do now?

Me: Just sit there and tell me what you’re feeling and thinking.

Paul: Like, dreams and stuff?

Me: Like real life and stuff.

Paul: You mean, like, now?

Me: Can you name any other time that it is, at this very moment?

Paul: Okay, okay, don’t rush me.

Me: I didn’t say we were in a hurry.

Paul: Well, you make it sound like I’m supposed to start spouting all this deep stuff, immediately.

Me: Is that how it sounds, to you?

Paul: That sounds like a therapist question.

Me: Would you prefer a train engineer’s question? Toot! Toot!

Paul: (Sighs) Well, this is all pretty confusing.

Me: You mean, understanding what we just talked about?

Paul: (Sighs) No, no: knowing what I’m thinking and feeling, right now.

(Silence)

Paul: This is hard.

Me: (Nodding)

Paul: I mean, what do you want out of me?

Me: So, it feels like a performance demand?

Paul: Yeah – exactly. Like I’m a kid at a piano recital, and I haven’t practiced my piece.

Me: And if you don’t play it well, you’ll be a disappointment?

Paul: (Ironic laugh) More like a failure.

(Silence)

Paul: In fact, my whole life feels like that.

Me: Like a failure?

Paul: Like I’m supposed to know how to do it, but I don’t, because I . . .

Me: Didn’t practice? (Note: I say this, not because I think it’s correct, but to act as a ‘foil’ that nudges him toward the real answer.)

Paul: (Shaking head) No – it’s more like . . .

Me: Like . . .?

Paul: Like no one ever showed me how, in the first place. (Two fingers going up to mouth, eyes blinking fast) Are you, uh . . . you know . . . allowed to say that?

Me: You mean, is it an excuse – a cop-out?

Paul: (Nodding) Yeah – I mean, it’s my failure, right? Not anybody. . .

Me: Else’s?

Paul: Because, they, you know . . . they . . .

Me: Were nice people, who took care of you?

Paul: Well, yeah . . . I mean, all the work they put into me .  . .

Me: You know, sometimes even nice people can screw up. I mean, you’re a father, I’m a father: have you ever screwed up, as a father?

Paul: (Laughing) Sure, I guess so. (Looking up) Why – have you?

Me: (Shaking my head) Oh no – never: I was always perfect.

Paul: (Laughing) You know what I mean.

Me: Yes, I know what you mean, and the answer is yes: I’ve screwed up a lot, and so does everybody. (Pause) Everybody. (Pause) You know, all parents do their best – but sometimes their best doesn’t work right, for a particular situation, for a particular kid. So, getting back to your question, yes, you are ‘allowed to say that,’ at least in here. And when you say something about your parents, or your childhood, we’ll both keep in mind that we’re not saying anyone is a monster, or evil, or a bad person. We’re saying that, in certain ways, you might not have gotten what you needed – not in all ways, but in particular ways – and that, yes, that might have caused you some problems.

Paul: (Nodding, slowly)

Me: So, can we agree to that – in here?

Paul: You mean, that when I say something, or remember something . . . that it’s not . . .

Me: Not a wholesale condemnation of anyone.

Paul: Or, saying they’re bad, or anything.

Me: Yes – but you’re still allowed to have your feelings about it, knowing that a feeling has its own validity, which can be separate from whether it’s right or wrong, factually. So, we can have the feeling world, and also the factual world, and we allow them both in here: they both have their own importance, and purpose.

Paul: Okay, so hmm, right now, I feel like your chair is too close to me.

Me: Do you want me to move it?

Paul: Umm, is that okay?

Me: With whom?

Patient: I don’t know – the gods of therapy?

Me: In here, we’re the gods of therapy. (Moving chair further away.)

Paul: So, you’re saying it can actually be the way I want it?

Me: Yes, it goes by you.

Paul: Is that what you mean by a relationship?

Me: It’s a start – yes.

Paul: Okay. (Pause) Now, what were we talking about?

Me: We’re talking about it right now.

Paul: Smart-ass!

(Silence)

Paul: Thanks for not being a dumb-ass.

Me: You’re welcome.

______________________________________

So, does that give you a little better idea what I mean when I say change happens “in the context of a relationship”? Now that Paul and I have begun to create that context, at some point it might feel right to ‘assign’ him homework, or be a cheerleader (say, connect with him between sessions), or talk about the ‘mental management’ of his worry, or his negative self-talk.

But if he doesn’t feel free to tell me why he’s not doing the assignment, or if he doesn’t even recognize, within himself, why he’s not doing the assignment, well, the whole enterprise will eventually collapse of its own weight.

That’s why I always make it a point to draw my patients out about what they need, and what they want, both in the therapy and in life. If I need to move my chair farther away, or closer, I do it. If I need to set up the therapy room the way they like it, I do it: some people like blankets and pillows; one woman wanted me to turn around the figure of the Maltese Falcon that sits on my bookcase, because it scared her. No problem. And, if, in walking from the waiting room to my office, they feel uncomfortable going first, well, I go first.

Does that mean I do everything they want? Of course not – if it’s a way to avoid the work, or run away from important issues, I challenge them. And if it feels like a ‘power struggle,’ then I’ll point that out, and we will work with it as such. But on the other hand, I don’t label every preference, or request, as a ‘demand,’ either: after all, it is their time, and their opportunity (maybe their only chance in life) to have it their way.

That reminds me of that particularly nasty psychological approach that views all problem behaviors as “manipulations,” forever asking the patient with back pain, or fibromyalgia, “So, what are you getting out of it?”

Or saying, of a child who is misbehaving, “He’s only doing it for attention.”

I always feel like saying back, “So why don’t you give him some attention, then?”

So no, I tend to see requests as needs, not manipulations; I think that, overall, most people are doing the best they can with what they’ve got. If we don’t understand why they do what they do, it’s not because they’re ‘just evil,’ or manipulative, but because our capacity to understand is limited.

In therapy, you’re asking people to do perhaps the hardest thing they’ve ever done: look at themselves honestly, without turning their glance aside, and in the presence of another person who is being ‘paid to care.’ The least I can do is actually care, and make them as comfortable as I can.

Therefore, if I can move around a few pillows, or give them a blanket, or turn around the Maltese Falcon, well, that’s a small price to pay, for what I’m asking them to do. If they’re willing to tell me what they need, I’m willing to do it.

Oh, and by the way, the Maltese Falcon didn’t mind a bit that I had to turn him around like that.

He likes being seen as big and scary.

He told me so.

 

 

 

 

 

 

 

 

 

 

 

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

Oddball In the Corner Pocket

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The first course: two poems by Alice Walker, to serve as antipasti for the soul (note: if you have the attention span of a hummingbird, I hereby give you permission to skip ahead to the entree without incurring my wrath):

Be Nobody’s Darling

Be nobody’s 

Be an outcast.

Take the contradictions

Of your life

And wrap around

You like a shawl,

To parry stones

To keep you warm.

Watch the people succumb

To madness

With ample cheer;

Let them look askance at you

And you askance reply.

Be an outcast;

Be pleased to walk alone

(Uncool)

Or line the crowded

River beds

With other impetuous

Fools.

Make a merry gathering

On the bank

Where thousands perished

For brave hurt words

They said.

But be nobody’s darling;

Be an outcast.

Qualified to live

Among your dead.

________________________________________

I Will Keep Broken Things

I will keep

Broken

Things:

The big clay

Pot

With raised

Iguanas

Their

Tails;

Two

Of their

Wise

Heads

Sheared

Off;

I will keep

Broken

Things:

The old

Slave

Market

Basket

Brought

To my

Door

By Mississippi

A jagged

Hole

Gouged

In its sturdy

Dark

Oak

Side.

I will keep

Broken

things:

The memory

Of

Those

Long

Delicious

Night

Swims

With

You;

I will keep

Broken

things:

In my house

There

Remains

An

Honored

Shelf

On which

I will

Keep

Broken

Things.

Their beauty

Is

They

Need

Not

Ever

Be

‘fixed.’

I will keep

Your

Wild

Free

Laughter

Though

It is now

Missing

Its

Reassuring

And

Graceful

Hinge.

I will keep

Broken

Things:

Thank you

So much!

I will keep

Broken

Things.

I will keep

You:

Pilgrim

Of

Sorrow.

I will keep

Myself.

_____________________________________

The other day, at the Chinese restaurant, I asked a good friend: “Am I an oddball?”

For a bare instant she contemplated her plate, then nodded, “Yes,” and popped an egg roll into her mouth.

Whew: I haven’t lost my mojo yet.

To really “be somebody,” you can’t be everybody, you can’t be a stereotype, you can’t be society’s personality du jour, you can’t be totally predictable, you can’t get along with everybody, you can’t be universally admired, and you can’t be all things to all people.

Being a person is hard.

In Finger Man, Frank Lovejoy’s (Casey’s) sister Lucille is in a ‘dry-out’ facility for alcoholics. This was the mid-Fifties, and dry-out meant cold turkey, complete with the DT’s or whatever other devils, terrors and hells came along for the ride. She is suffering – in pain and desperate, looking at the world cold sober for the first time in years; looking not only at what she has done to herself and her young daughter with her years of drunkenness, but at a future without booze, facing life straight, with nothing to soften it, nothing to blur it.

Lying there in bed, writhing in agony, Lucille says to him, “Casey, is there room in the world for people like us?”

Good question.

And here’s the weird answer, the secret ‘they’ never, never tell you:

There is room in the world for you, but ONLY if you’re being yourself!

And why don’t ‘they’ ever you this? Easy:

There’s no money in it.

It reminds me of a big oil company executive I used to see in therapy. Once, during a lull in the conversation, I asked him to be honest with me about why the big energy companies don’t pursue the development of more ‘sustainable’ sources of energy more vigorously. He laughed and said, “What – you think I’m a greedy captain of industry who doesn’t give a damn about raping and despoiling the earth? Look – I’ve got to answer to shareholders, and the truth about solar, wind, geothermal and all the rest of that shit is: there’s no money in it!”

And that applies to any field: look at psychotherapy, for example. Which would you rather market: something that is highly individual, quirky, takes years to learn, is deeply complex, and really more of an art form (i.e. traditional psychotherapy), or something that you can ‘package’ into one-size-fits-all modules that can be taught in a series of weekend workshops (i.e. behavioral therapies, EMDR, and the like)?

The same is even true for spiritual and religious practices. There are some things you just can’t ‘sell’. How would you like to attend a seminar where the leader says,

“Look, there’s this guy, Jesus, who had some truly amazing, transformational spiritual experiences. We have some information in this book, The Bible, which admittedly is speculative, about how he did it, and you’re welcome to delve into it all, but what you really need to do is to have your OWN transformative spiritual experiences. Of course we have no idea what that would look like for you, but, using Jesus’ experience for inspiration, please go out into the world and seek your soul. We’ll be right here to support you with soup, sandwiches and hugs, if need be. You may begin.”

The truth is that anything that is individual, quirky, unpredictable, spontaneous, intuitive and creative can’t be packaged or sold, and if something can’t be packaged or sold, there’s no money in it. Of course, the flip side of all this is that, when there’s no money in something, the nabobs and poobahs aren’t much interested in it, so it’s left pretty much unregulated, unsupervised, wild and free.

Which is to say that in the field of self-development, the bad news is, you’re on your own, and the good news is, you’re on your own.

When I was an intern at the UCLA Neuropsychiatric Institute, we each shared an office with another trainee. My fellow boarder was the kind of fussily self-important guy whom you just knew would go on to become a psychoanalyst (he did). Somehow, I always felt that, in striving so mightily to prove himself as a serious dude, he was acting ‘on top’ of a part of him that was, well, kind of goofy.

But it gets better:

Now, mind you, we’re talking the Dark Ages here – no computers, no Internet, no nothing. After we saw patients, we dictated our notes, which were then typed up mysteriously by the Typing Pool (a phantom room full of unseen women, somewhere in the bowels of the building), who, after a reasonable period of time, returned to us our notes made visible, corrected for spelling and punctuation, as need be, and suitable for presentation to the Panels of the Gods (the supervising faculty members, whose intellect and all-around majesty we could never hope to approach).

But to get back to the Typing Pool: understand, they were there not to interpret, but to take down ‘the record’ accurately. Theirs not to reason why, theirs but to type or die, and all that sort of thing.

Well, one day my office mate, I’ll call him Percy, dictated his final termination notes on a particular patient whom he had seen for some time, then sent them off to the Ladies of the Keyboard. Apparently, he was nodding off while he was dictating, because, to his shock and chagrin, when the copy came back, the last sentence of it read, and I quote:

I had high hopes for you, boy, but you were just a fucking oddball.

Well, it was funny – at first. And it was funny for the same reason it’s funny when Groucho Marx puts a whoopee cushion under Margaret Dumont: because of the comical juxtaposition of Percy’s officiousness with the bald primitiveness of his ‘real’ feelings about this patient.

But here’s the thing: I still think about it all these years later, and it’s not that funny, because it has all the earmarks of bad therapy: blaming the patient; an inability to respect the other person’s ‘otherness’; an assumption that the therapist’s ‘way’ would have worked if the patient had been what the therapist thought he was. I’m not saying Percy was a bad guy, or a bad therapist, only using this incident to point to a phenomenon that could — and does — happen to anyone, therapist or not, where ‘different’ equates to ‘weird.’

And the scary part is that, for so many therapists, this kind of thinking doesn’t go away with training and experience: it just goes underground and unconscious. If it were always this blatant and obvious, it would be less insidious, but it almost never is: therapists tell themselves they accept people for who they are, that they’re not ‘triggered’ by their patients, that it’s an even playing field for all.

But in reality, it’s like parents telling themselves (and their children) that they love all their children exactly the same: bullshit! That’s ridiculous and impossible – not to mention the reason for a great deal of psychotherapy, as people deal with the huge unspoken undercurrents of family life. Therapy is not just about ‘making the unconscious conscious,’ but making the unspoken spoken. To say something out loud, to claim it and admit it, is the beginning of all growth and change for the better. It’s what we’re helping our patients do – why shouldn’t it apply to us as therapists, too? It never really ‘hurts’ a patient for the therapist to admit to negative, judgmental or even hateful feelings about the patient, as long as the therapist uses reasonable clinical judgment about how to use the realization – whether to say it or not, and if so, how, etc.

But first, and most importantly, comes saying it to oneself. Without that, there is nothing – with it, the rest is just following your intuition and judgment.

And most of all, therapists need to know this: EVERYONE is an ‘oddball’ – and especially when they’re allowed to play out their individuality without fear, which is what should be happening in any good therapy. If you don’t get to their ‘oddball’ places, you’re not done, because the oddball in someone is the “there there.”

So, like Lucille in Finger Man, I have always hoped that Percy’s oddball did find ‘room in the world’ for someone like him.

To become a person, you must have the courage to stray from any path that can be sold, packaged and marketed.

Embrace your inner oddball, because without it, you’re just another product.

 

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

How Psychotherapy Ruined America

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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.

And Now, For Someone Completely Different

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I love “characters” – always have. I think that’s one of the reasons I love movies so much, because you get to see people who stand out from the crowd, people who surprise you.

I remember years ago, when I used to work at an alcohol rehab facility, there was this guy, Augie, in the program, from “back East,” who could have been straight out of the cast of Guys and Dolls. He used to talk about “hangin’ out on the stoop,” being a numbers runner out of a candy store, and collectin’ for loan sharks. Well, as he got older, all his children moved out West to a ‘better life,’ and they finally convinced him to make the move, too, because his health was failing. The ‘kids’ found a “wonderful, clean, safe” place for him –  a small trailer park in Rohnert Park, outside of the Bay Area.

It seemed ideal.

On paper.

Well, Augie was lonely, out of his element, and bored stiff. When he tried to talk to the ‘squares’ in the trailer park, they didn’t get him at all, nor he them. Finally, to obliterate the endless days, he started drinking, and didn’t stop until he was picked up one Sunday at two A.M. by the cops, comatose, in the middle of a busy street.

One day, and I’ll never forget it, in the group I ran at the rehab facility, Augie, who hadn’t said a word until then, suddenly broke down in tears and said, “Back East, I was a character. Here, I’m just a freak.”

I’m glad to say that, with help, Augie did stop drinking, and eventually moved to North Beach, where he could put his ‘character’ to better (and more appreciated) use among a slightly more bohemian crowd than the Rohnert Park trailer set. He became a bartender – and a sort of unofficial greeter and drawing card – at a local old-time watering hole, and stayed sober for the rest of his life.

The thing is, you meet characters when you do therapy too; like with movies, it’s one of the reasons I love this work – and once in a great while, you meet someone who’s a character and a therapist all at the same time. Someone like Nelly.

But first let me give you a little background. When you’re a therapist, you see a lot of therapists as clients. For one thing, they’re interested in therapy, for another, most of them need it (sorry, my esteemed but problematic colleagues!), and for yet another, they can sometimes come at the times you have available, the times other people cannot. And since patients talk about their work lives, and therapists’ work lives are about doing therapy, well . . . you hear a lot of funny, crazy, heartwarming, odd and puzzling stories – well, no, not all of those qualities in one story, of course.

But then, on second thought . . .

I had been seeing Nelly, a psychologist beginning a private practice in Oakland, for about a year. Sometime in the late Eighties, she had come to me to help her get through her last year at a local psychology doctoral program. Therapy supervision is a required part of becoming a therapist, and doing therapy and being supervised both tend to bring up ‘issues’ for candidates. In the case of Nelly, her supervisor, an older woman whom I knew of from my years in the therapy community, had “strongly recommended” that Nelly get some therapy herself, to help her iron out a few psychological wrinkles that had come up in her supervision.

Ah, Nelly, Nelly, Nelly –  I could go on and on with psychological jargon, to explain her ins and outs, but I’ll spare you all that and just speak in good old American:

Nelly was a real trip.

And I mean that in the fondest way. She was South American, and anything you can imagine about American stereotypes of South American women, well, Nelly was it. She was flashy, extroverted, ‘out there,’ funny, charming and at times overwhelming.

Think Evita Peron.

You’re getting warm.

Now think Charo.

You’re getting warmer.

Now think Carmen Miranda.

You’re hot!

Nope, Nelly was certainly not the traditional ‘therapist type,’ but she had some wonderful things going for her, too: a warm heart, a high, lively intelligence, and most delightfully, a great sense of humor, including about herself. Sometimes, during her therapy sessions, when she was proclaiming things, throwing herself around and ‘on a roll,’ I’d give her a certain look, and she’d throw up her hands dramatically and laugh, in her thick accent,

Jes, jes, I know dees: I am in Diva Mode, no? Bueno!

Well, jes, jes, she was in Diva Mode much of the time, but no one else could make Diva Mode as charming, or as fun, as Nelly; it wasn’t posturing, it wasn’t a put-on, or a pose, it was her. Most women therapists dress modestly, neutrally, even – well let’s face it, dowdily, only pepping things up with the occasional hoop earring, paisley scarf or long, flowing skirt – a friend of mine once called it, “the half-Gypsy look.” But Nelly – to her, skimpy was the norm, tight the standard, and short the rule. She wore high heels, low-cut tops, and things that dangled and clacked all over the place. Not to allure, or provoke – it was just Nelly being Nelly.

Well, you can imagine how her ‘personal style’ went over at the Elite Institute For Impressive Studies, as I’ll call the training program she was in. The Elite was “juuuuust a bit self-important,” to paraphrase Bob Uecker in Major League. They fancied themselves direct descendants of Sigmund Freud, even though the only thing they really had in common with Freud was a smelly couch.

The accepted ‘mode’ around EIFIS was low-key, inhibited, and intellectual, what some (not I, of course) might call “having a stick up your butt.” At EIFIS, it was always important to use jargon instead of plain English: you didn’t say, “The patient made me feel nervous,” you said, “There was a great deal of attributive projective identification going on in the transaction.” And as for expressing your own, measly feelings? Why do that when you could dress them up in fancy words and ten-dollar concepts, and put them in the mouths of Bion, Melanie Klein or Winnicott?

But, that wasn’t Nelly’s way – not by a long shot. She once scandalized her supervisor by reporting that, in the presence of a very virile young male client, she fanned herself and said, “Whew – you are one hot potato!” (Actually, Nelly thought the supervisor would be impressed by her knowledge of American slang!) Another time, she was working with a very repressed young woman, and when the woman asked Nelly, “What’s wrong with me anyway?” Nelly stood up, did a bump-and-grind on the office rug, and said, “Nothing – you just need a leetle more of theese!

Every practitioner needs to find his or her own way of doing psychotherapy – because at its best, psychotherapy is the most personal of art forms. But most people struggle to find their voice, that perfect amalgam of what everybody else is doing, and what they and they alone can do, the ‘way’ that they can claim as their own, signature style. And it’s best when they can use all the theory, tradition and lore – the stuff you learn in grad school – as a sort of armature on which to hang their own personal strengths, quirks and novel approaches.

However, in the case of Nelly, I’d say her only ‘struggle’ was in even allowing psychological tradition to find a seat at the party. She came to the profession with her own fully-formed ‘approach,’ which I always called psychoaNellysis – a mixture of Catholic philosophy taught her by the nuns, folk wisdom from her mother and aunts, reading (she claimed that if you just paid close enough attention, Jane Eyre would teach you everything you needed to know about life – oh, and that it was a much better book in Spanish), and life experience she had picked up along the way.

And by life experience, I do mean Life Experience: she had been married twice, once to a deadbeat sometime drug dealer, and once to a professor. When she was with the drug dealer, she had worked as a, how-you-say, call girl/masseuse/sex worker in Buenos Aires for a number of years, where she learned, and I quote, “many, many especial things about the mens,” and also an awful lot about what men think about women, from her customers talking about their wives and girlfriends.

Actually, there is a rather long tradition of women sex workers becoming therapists – I’ve worked with a number of them (as patients, that is) – although that fact might come as a surprise to their colleagues and patients. The truth is, many of the same skills are required in both professions: in fact, a young woman patient of mine recently laughed, “You listen, you understand, you make me feel more powerful, and I pay you – in some ways, you’re nothing more than a prostitute.”

To which I replied, “Then I’m going to be a damn good one.”

I’m quite sure Nelly was a ‘damn good one,’ in her day, and in fact it was one of her customers, a university professor, who told her that she was too smart to be making a living in bed, that she should, and could, return to school and finish her education, which she did, taking top honors in her university before coming to America for graduate school in the Bay Area.

I loved to tease her, saying, “You mean they have higher education in Argentina?” upon which she would launch on a rant about how superior Latin culture is to ours, saying about America, “Jew don’t even talk to each other! Jew don’t even look at each other! Jew don’t even touch each other!”

To which I would say, much to her consternation, “Yeah – and the Gentiles are even worse!”

Well, Nelly barely squeaked through her supervision at EIFIS, and once I even had to talk to the supervisor I mentioned before (at her request), to explain that when she was lively, extroverted and sassy with her clients, she wasn’t “acting out,” but just being herself, and that it wasn’t for lack of self-control that she did so, but rather that it was an integrated, grounded way of being that worked for her – and for her clients. And I might add that, somehow, clients almost always managed to get better under her care. The supervisor said, “But we wouldn’t let anyone else get away with this – it’s not consistent policy,” to which I replied, “Well, if anyone else did it, it would mean they were out of control, provocative and lacked boundaries, but with Nelly, it’s just her way. She’s coming from the right place, and her clients know it, so it works.”

To her credit, the supervisor, a diametrically opposite personality (someone who some, not I, might say had a stick up her posterior, too), did eventually agree that Nelly’s ‘way’ worked for her, even though if therapy students were to see one of Nelly’s sessions, it would have to be accompanied by a banner saying, “Kids, don’t try this at home!”

Nelly did graduate, and started a thriving and effective private practice – specializing in Latin women – and eventually even became a supervisor at the EIFIS, and I think everyone who met Nelly or worked with her was the better for having been exposed to her own special brand of flightiness, charm, warmth and wisdom.

We talk a lot about “diversity” nowadays – and by this we mean the inclusion of differing races, nationalities, creeds and genders. But we also need to treasure and protect the ‘characters’ in our society – people like Augie and Nelly – for they are a national resource that has much to teach us, especially in this homogenizing age of ours.

So, to all the characters out there, I say, on behalf of Nelly, “Jew can do it!”

 

 

 

 

 

 

 

 

 

 

 

 

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

Growing, Growing, Gone

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When I was a kid, my Uncle Rowe, my Mom’s younger brother, was the one who brought news of ‘worldly’ things to my immediate family. He was the one who was single, and therefore ‘out there’ in the contemporary world. Oh, my parents were out there too, but in the way squares are out there:

Dad was a court reporter, who hung out with attorneys ‘after hours’ at L.A. watering holes, a fact I could verify because my room was right next to the front door, and being a night owl, I was always up late, hence hearing him fumbling with his keys at the front door, then making multiple stabs at the keyhole.

And Mom – well, her ‘out there’ was getting lost in her classical records, and reading her books.

But my uncle was different. He was single. He went to parties. He wore stylish clothes. He smoked. He drank. He drove cool cars, like that snazzy red Triumph TR3, with the cut-down doors, so you could sit in the passenger seat, going 75 on the freeway, and reach out and touch the ground if you wanted to – provided you didn’t mind losing a finger or two. He was the one who once brought a young rooster to our house at 2:00 A.M., on his way home from a party. A party where, according to him, they’d had a lot of fun making the chicken smoke and drink.

Fifties party-cool.

Yeah – me, neither.

Oh well – I ended up ‘adopting’ the chicken, and kept him as a pet in the backyard for years. I called him Irving, and as far as I know, he never smoked or drank again.

My first successful intervention.

Cock-a-doodle-doo.

Uncle Rowe was also the first man I ever knew who was a good cook – no, a great cook. Like most men who actually cooked in those days, he wasn’t just an everyday, throw-some-bacon-and-eggs-on-the-table cook. No – he had ‘specialties’. Fifties-era specialties. You know, like scalloped potatoes. They weren’t good, they were knock-your-socks-off good. And like all his specialties, they had secret ingredients. There was always a secret ingredient, that he would never reveal to the women of the family. I mean, they’d ask, alright, but they’d just get that Mona Lisa smile and a change of subject, for their trouble. I can’t remember his other specialties, but if you were asked to his place for dinner, you were in for some fine eating.

Nothing predictable at his table. Nope, none of that Swiss steak and mashed potatoes stuff for him, with green beans boiled until they were mush. No, it would be steak, but with some kind of fabulous mushroom sauce on it, that brought the party to your taste buds. Or if it was lamb, it wouldn’t be that yucky, muttony slop with the weird gelatinous membrane on it, that my Mom made, that made you shudder and want to wash your hands for a week. No, it would be rack of lamb in sherry, with some kind of brandy plum pudding they never even would’ve dreamed of at Bob’s Big Boy – my gold standard for fine dining at the time.

Oh yeah, in keeping with his cool image, he lived in one of those sexy cantilever stilt houses in the Eagle Rock hills, overlooking all creation. I loved it, but of course, my father, who considered my uncle his arch-enemy (i.e. for the affections of my mother) always had to call it,

“That goddam crazy-ass, cockeyed shack of his. Every time you sneeze, you expect the whole damn thing to come tumbling down the mountain.”

Not that it matters anymore, but once I did corner my uncle and demand the secret ingredient for his scalloped potatoes. I think I needed to know, once and for all, that there actually was a secret ingredient, and that the whole ‘secret ingredient’ thing wasn’t all just an elaborate hoax he’d perpetrated on the family, laughing to himself the whole time.

Well, he did tell me. And there really was a secret ingredient, all along. I’ve never told a soul before this, but now that he’s gone, and his distinguished record as a fabulous chef is safe for all time, and his secrets buried with him, I feel that it can be told:

Angostura bitters.

Shhhhh!!!!! I still feel guilty spilling the beans, so please don’t tell anyone. So now, if you’re ever on a “Cheat Day” on your low-carb diet, and you’re scarfing down scalloped potatoes, you can smile genially at your host while thinking to yourself, “Haha, I know a way to make this even better – but you don’t!”

My uncle also brought us the ‘news’ from the outside world about the latest popular songs. Sometimes he even brought us the 45s, so I could put them on my little turntable and listen, again and again. He liked the mainstream hits, like Shrimp Boats, and The Tennessee Waltz, but he also seemed to get a kick out of the novelty hits that were so ubiquitous in those days – things that a kid like me could also laugh along with. Things like Raggmopp, How Much Is That Doggie In The WindowThe Naughty Lady of Shady Lane, Pittsburgh, Pennsylvania, Beep Beep, and my favorite at the time, because it was the craziest one of all:

Open the Door, Richard!

I mean, how could a little white kid living in North Hollywood not like a song with ‘call-and-response’ lyrics like,

I met old Zeke standin’ on the corner the other day – that cat sure was booted with the liquor.

He was what?

He was ab-nox-i-cated.

He was what?

He was in-e-bri-a-ted.

He was what?

Well, he was just plain drunk.

Well alright, then.

My uncle had dogs, too – he always had dogs. Well, technically, dog, singular. He was a serial dog monogamist, is what he was. When I was real little, I think I remember an Irish setter, a cocker spaniel, then an Afghan hound. Then, when I got older: we struck royalty. And by royalty, I mean a smallish standard poodle named Cocoa. Sometimes you just ‘know’ there’s something special about a dog. If you’re a dog person, you’ll know what I mean. Is it intelligence? Stance? Something in the eyes – an alertness, a noticing? Whatever it is, Cocoa had it. He was devoted to my uncle, and vice versa. I don’t mean he growled whenever someone other than my uncle approached him. Far from it: he was courteous, affable – to a point, accommodating – if need be, not overly possessive, and civil – as required.

But when it really came down to it, Uncle Rowe was his guy: Period.

He was regal, without being aloof, superior, without being a snob about it, cool, without making you feel bad. He could do tricks, and do them easily, perfectly, but unlike most performing dogs, with Cocoa you always felt it was more of an ancillary parlor skill, like Orson Welles also being good at magic, or Bill Clinton playing the saxophone. Somehow, you felt that when he did one of his tricks, he was stooping to your level, humoring your low tastes, but always, always, of course, with good grace. Sure, he had the whole gamut of de rigueur Fifties dog tricks: sit up, beg, shake, roll over, play dead.

But he also had a few more, high-tone, out-of-the-ordinary tricks in his bag, too, like the famous, poignant depiction of an Indian’s last ride, known as End of the Trail:

end of the trail

 

 

 

 

 

 

Well, my Uncle Rowe would say, “End of the Trail,” and Cocoa would pose JUST LIKE THAT, I swear to God; it would almost bring tears to your eyes, like if a mediocre stage impressionist was going along, doing his Jimmy Cagney and his Edward G. Robinson, and then suddenly slayed you by dropping into Charles Laughton as Quasimodo in The Hunchback of Notre Dame. I mean, it was like Cocoa actually got into character as he laid out into that iconic pose.

They were a good team, Rowe and Cocoa: Rowe was a little, fast, Mickey Rooney kind of guy, full of jokes, always moving, always on to the next thing. When I got a little older, I didn’t even like to be in the car with him driving, because he drove just like he lived: it was all herky-jerky, stop-start, and impulsive.

But Cocoa? He was a whole different matter: he was like Jeff Markham, Robert Mitchum’s private detective character in Out of the Past, when Kirk Douglas (his potential employer) was sizing him up:

Douglas: “You just sit and stay inside yourself. You wait for me to talk. I like that.”

Mitchum: “I never found out much listening to myself.”

Cocoa was like that: no wasted motion, no panic-moves, just do what you have to do and move on; a confidence and sense of self we could all aspire to. And, like I said, that regal quality, that grace, that you don’t run into too often in life, and when you do, you don’t forget it.

But Uncle Rowe – if you met him at a party, you’d laugh and say, “He’s a kick.” Always ‘on’, always the life of the party, always up on the latest, always bringing the news. And the sad thing was, as I grew up, I outgrew him. Yeah, I know, being the quiet, ‘deep’ type, given to meditation, cogitation, the dark side and all that jazz, I guess it was inevitable.

See, the good thing is, if you’re the ‘growing’ type, you’re always growing. And the sad thing is, if you’re the ‘growing’ type, you’re always outgrowing, too. Of course, “They” don’t tell you that – They don’t tell you much of anything, in fact. You just stumble onto it yourself, mostly. “They” tell you that if you’re a good boy and mind your Ps and Qs, it all turns out great. But the truth is, Life, with a capital L, is painful, too, and sometimes, cruel.

Things – well, they change.

And people? Well, they change, too.

And it hurts, sometimes, when they change – even whey “they” is you. Because every coming means a leaving; to find a new vista, you have to leave the old one behind. Yes, I know, I’m the one who’s always quoting, “Make new friends, and keep the old; one is silver and the other’s gold.” And that’s true: IF you can. I guess it depends on what you mean by “keep”: sometimes, it means you keep old friendships going for the rest of your life – and if you possibly can, please, please do, by all means. And if you can’t – well, then “keep” means respecting, treasuring, always holding a place in your heart for what someone gave to you, when you needed it, and what they received from you, when they needed it. You don’t “flush” someone, as a patient recently said he was going to do with all thoughts of his (soon-to-be) ex-wife; even if what happened with someone turns out to be hurtful, you try and honor them, even if only for the lessons you learned from them.

But, like I say, if you’re the ‘growing’ type, if you’re a truth-seeker, if you’re committed to lifelong learning about who you are and why you’re here on earth, you are going to outgrow a lot of people and situations, especially if (like me) you ‘started’ from a place, and a family culture, that was way out of sync with your true nature: it’s inevitable, unavoidable. But that doesn’t mean you ‘flush’ the old: yes, in a lot of cases it means the old ways, and the old people, won’t work for you anymore, and you may go through this cycle several times in your life – a current patient calls it ‘weeding’. Yes, it’s weeding, but, you see, weeding can be done in different ways. You can go along, ripping up the offending vegetation viciously, tossing it aside without a thought, except to loathe it for being in the way of your new plans, or you can do it mindfully, respectfully, seeing it as ‘all in the game’ of gardening, or in the case of your life, all part of the process of becoming who you are, and finding your way.

So yes, I know, now, that my Uncle Rowe was not ‘my type’, not someone I would hang out with a lot, at this point in my life, but that doesn’t mean I don’t treasure him and all that he gave me, at a time when I desperately needed it, needed ‘alternatives’ to the cult-like strictures of my family, needed a more relaxed attitude towards life, needed possibilities of ways to be, that weren’t in lock-step with my parents’ views of things, needed permission to appreciate, value, and laugh along with, the pop culture of the day, then and now.

So, I say to all of you, you who are sitting out there afraid (and guilty) to grow, afraid to change, afraid to believe in your own ‘differences’, afraid to vary from what has been laid down, in your particular subculture, as ‘gospel’, afraid to be a little crazy, a little fun, a little wild – to all of you, I say,

Open the Door, Richard!

 

 

 

 

 

 

 

 

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

I’ll Be There

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A fella ain’t got a soul of his own – just a little piece of a big soul, the one big soul that belongs to everybody. I’ll be all around in the dark. I’ll be everywhere. Wherever you can look – wherever there’s a fight, so hungry people can eat, I’ll be there. Wherever there’s a cop beatin’ up a guy, I’ll be there. I’ll be in the way guys yell when they’re mad. I’ll be in the way kids laugh when they’re hungry and they know supper’s ready. And when the people are eatin’ the stuff they raise and livin’ in the houses they build – I’ll be there, too.

These stirring words, spoken by Tom Joad (Henry Fonda) in the classic film The Grapes of Wrath, have a searing power because, like all great art, they resonate on several different levels at once. In the film, Tom Joad is planning to leave the family, and his mother wants to know where he’ll be. He is a young man whose family (‘Okies,’ in the argot of the times) has just completed an arduous trek to the West, escaping the grimness and despair of the Dust Bowl, for what they hope is a better life in California. It doesn’t turn out that way: instead of milk and honey, they find hordes of other displaced people just like themselves, from all over the country; they find the police of angry communities, trying to keep out, or beat out, these unwanted newcomers; they find greedy landowners, taking advantage of this desperation to get their crops picked for next to nothing.

So Tom Joad decides he’s had enough. He’s pulling out. He doesn’t have the slightest idea where he’s going – it’s enough to know that it’s not where he’s been. He wants something new, something different, and, like all young men, he wants a life of his own making.

And, like all concerned mothers, Ma Joad is anxious, and worried, about her son leaving the family. So, when she asks the question, she is simply distressed and wondering where he is going to go. But his answer ‘jumps the tracks’ to a place so universal it has rightfully earned a place of immortality in movie lore.

On one level, Tom is talking about what we would call his ‘spirit’: he is saying something transcendent:

The things (in this case, moral and political principles) that I stand for, are me. I am the spirit of fairness; I am the spirit of the fight for a decent life for all; I am joy, I am righteous anger, I am the spirit of every man who is trying to fend for himself, make a life for himself in this rough world. Where these things are, there I will be.

Compare to this passage, from The Little Prince, by St. Exupery:

“People have stars, but they aren’t the same. For travelers, the stars are guides. For other people, they’re nothing but tiny lights. And for still others, for scholars, they’re problems. For my businessman, they were gold. But all those stars are silent stars. You, though, you’ll have stars like nobody else.”

“What do you mean?”

“When you look up at the sky at night, since I’ll be living on one of them, since I’ll be laughing on one of them, for you, it’ll be as if all the stars are laughing. You’ll have stars that can laugh!”

And he laughed again.

“And when you’re consoled, you’ll be glad you’ve known me. You’ll always be my friend. You’ll feel like laughing with me. And you’ll open your windows sometimes just for the fun of it. And your friends will be amazed to see you laughing while you’re looking up at the sky. Then you’ll tell them, ‘Yes, it’s the stars. They always make me laugh!'”

So, on one level, Tom Joad is saying, “The things I am associated with, will remind you of me.”

But on another level, I believe he is, in effect, speaking on behalf of God, maybe as an agent of God:

I am everywhere, witnessing and representing all that is good, fair, and righteous – protecting the ‘little guy’, those who are not powerful and need my help, in their struggle to survive in the world.

In its overall meaning, this manifesto sounds like it could be from the Bible – perhaps Jesus addressing a crowd of people. In this majestic passage, Steinbeck is channeling, and appropriating, the same authorial ‘voice’ commandeered by Walt Whitman in Leaves of Grass – a kind of populist humanism that moves us deeply because it has always been associated with America, and with the idealized American character.

But what is left unspoken here, though nonetheless evident on an unconscious level, is yet another layer of meaning: that Tom (like Jesus) is leaving his immediate family in order to pursue a ‘calling,’ to right the wrongs, to fight the ‘good fight’, to speak to the downtrodden and devote his life to  his larger family – the family of man. The grandeur, the selflessness, and the eloquence of Tom’s spoken words, at the moment of his leaving, show a man transformed, a man transcendent, a man with an unshakeable vision. Like Christ, this is a man on a mission, and the mission is bigger than his personal life.

And Ma Joad unconsciously comprehends this, and it terrifies her, as well it should. One gets the sense that Tom will not be coming back home, ever – that he no longer places much, if any, importance on his own personal outcomes in all of this.

So, what does all this have to do with the process of therapy? A great deal, if you look closely.

First of all, a therapist is also an evangelist of sorts, one who pursues a vocation, to empower the unempowered, to restore functionality to the (emotionally) disenfranchised, to help people find an expanded sense of self, to rise above their limited, harmful, and sometimes abusive surroundings and be the person they were born to be.

Long ago, I had a friend, a fellow graduate student, whom I admired greatly. He used to say, “A therapist is a salesman – a salesman for mental health.” At the time I thought that statement was kind of low-rating the grand profession of psychology, as I saw it then. But now I see that he was right: a therapist is a salesman, because he is ‘selling’ the patient on doing the (hard!) work required to transcend the harm done by a difficult early environment, as well as selling a belief in overcoming whatever other barriers – social, neurological, biochemical – life has put in the patient’s pathway to self. Selling a belief in his own possibility.

Sure, you can know your theory, and be very experienced and well-schooled, but eventually, most therapy comes down to getting the patient to “buy in” to what you’re trying to do: after all, if the patient’s not there, there’s no therapy.

When therapy fails, why does it fail? Mostly, for not very dramatic reasons, in not very dramatic ways: the person decides they can’t afford it, they feel they don’t have the time, they don’t understand what’s happening, they don’t see why they should keep coming, it hurts too bad, it doesn’t make sense to them, they’re afraid of getting too dependent, they feel it’s not helping them in the way they first hoped it would help them.

These mundane, ‘ordinary’ reasons all relate back to what I just said: the therapist failed to ‘sell’ the person on the importance of therapy, to make him believe in it, to empower him enough to talk ‘out loud’ to the therapist about what his questions and doubts. The person was desperate enough, at one point, to pick up the phone and call for help. But now, perhaps the crisis has calmed down (temporarily), or resolved in some short-term way (a break-up, or staying sober for a few weeks, a new medication that is helping, or just ‘blown over’), and the reasons for spending the money, taking the time, and going through the difficulties of therapy, don’t seem as compelling. And so the person gradually ‘falls off the map’: perhaps they request meeting every other week, or once a month, or they say, “Nothing personal – I just feel like taking a break,” or “I guess it’s not what I thought it was going to be,” or “Thanks, I’m feeling a little better now. Maybe I’ll come back when/if things gets worse again.” But it is the therapist’s job to ‘sell’ the person on continuing for as long as it takes to really resolve the problem, or at least help the patient get to the point where the problem will not recur in the same way, as intensely, or as frequently.

Is this ‘creepy’? It can be. In the minds of many therapy patients:

You just want to keep me coming forever, for your own pocketbook.

A patient once accused me of using her as an ‘annuity’. And, to be fair, I think that can happen in therapy: the therapist gets used to meeting with the person regularly, they talk and talk and talk and talk about the problem, with the therapist spinning out, or spitting out, theories about why it all happened. Many, many patients have come to see me after having spent months, or years, with another therapist – talking, talking, endlessly about the problem, speculating about what caused it, only to end up with the classic patient’s lament:

“I understand perfectly what caused my problems, but I still have them!”

And I always ask, “And did you talk to Dr. _______ about all these feelings, all these things you were thinking, about the therapy?”

And the answer is almost always, “No.”

And this is a shame, because it tells me the therapist didn’t manage to convey to the patient that one, indispensable thing: that honesty and openness in the therapy relationship itself, is crucial to the success of the whole enterprise. And it also tells me that the therapist failed to help the patient feel safe enough to feel free to express these doubts, and questions, to him. And this is unfortunate, because a big part of why people end up in therapy is that their parents (and others) did not encourage them to express themselves honestly (especially about the parents) and didn’t make it safe to do so – so the patient’s silence in the therapy relationship in effect just becomes a repetition (and sadly, a confirmation) of the original hurt.

If there was only one thing I had the opportunity to emphasize to therapists, beginning and experienced, it would be this: to stress to the patient, from the very beginning, that it is crucial (and safe) for the patient to openly express his changing thoughts about the therapy process itself, whether those thoughts seem rational, or fair, or not.

One of the saddest things I hear (frequently) from patients in failed therapies, is that when the patient finally did try to express his frustrations, or doubts, or disappointments about the therapy, the therapist became defensive, angry and even attacking, such as the tragic situation I have mentioned elsewhere in this series of blogs, wherein the therapist finally erupted,

“You’re nothing but a borderline!”

So all of this is what I mean by the ‘evangelistic’ aspect of being a therapist: you’re conveying to the person that they can ‘get better’, but that it’s going to take a lot of work, and a lot of honesty, on both your parts. Can this lead to a conflict of interest? Absolutely! Consider this: you can be a good salesman with a bad product. Like I’ve said in previous blogs, there is virtually no way for a new therapy patient to know whether his new therapist is really ‘any good’ or not, so a therapist who is a good salesman (or even an unethical manipulator) could induce a patient to stay in a sterile, barren, or even harmful therapy situation.

But what’s worse is what happens time and time again: a good, well-meaning therapist loses a patient for lack of conveying to the patient how important, how crucial, it is to talk openly about the patient’s feelings about the therapy.

And here’s yet another facet in many of these instances of ‘quitting without a word’: the patient ends up feeling that the therapist just ‘let it go at that,’ instead of FIGHTING for the patient and the therapy.  And often, patients in these circumstances don’t even realize it until much later in their therapy with me, because it is only later that they realize they are (and were!) WORTH fighting for. So often, in retrospect, they will say, “Wow, now I realize that my previous therapist just let me walk away without a word, and didn’t really care enough to make me talk about it.”

And of course, one of the main reasons people seek therapy in the first place, is that they didn’t feel valued by their parents – by parents who didn’t connect with them, or fight for them, or stay there (emotionally) through disagreements and difficulties.

A therapy patient is a person who has lost his heart, and even the way to his heart.

Consider this quote from the author, Robert Walser:

A person who does not know how to preserve his heart is unwise, because he is robbing himself of an endless source of sweet inexhaustible strength, a wealth in which he exceeds all the creatures on earth, a fullness, a warmth that, if he wants to remain human, he will never be able to do without. A person with a heart is not only the best person but also the most intelligent person, since he has something that no mere bustling cleverness can give him . . .

And for a person who has lost his heart (and therefore, his way), the ‘prescription’ is connection. Here is what Walser has to say about that:

What a precious flower friendship is. Without it, even the strongest man could not live long. The heart needs a kindred, familiar heart, like a little clearing in the forest, a place to rest and lie down and chat.

And that precious flower, that familiar heart, that place to chat – that is psychotherapy.

Is saying such a thing heresy? Is it unscientific? Is it soft-brained pap? Here is what James McMahon, an esteemed psychotherapist and writer, thinks:

We write more and more esoteric journal articles and we quote each other and discuss theory with each other in conferences and meetings. But how practical is it all? How much does it help? What can we bring into our consulting room that helps us make true contact with our patients? I think it often actually stands in our way. We do the good work we do in spite of it!

Note that he says, “But how practical is it all?” He’s not saying, “C’mon, people, be nice; be kind and understanding toward your patients because it’s the right thing to do.” He is saying this:

To do anything that doesn’t constitute “true contact”does not work.

Why is this? Because working back through all the layers of pain and emotional damage hurts. And if you’re not ‘really’ caring or involved with the patient, it isn’t WORTH it, for the damaged part of them. They don’t know this, of course; they’ve already accepted, on some (unconscious)  level, that there is no such thing as ‘real caring’, or at least real caring directed towards them, and that whether you care or not is irrelevant, because the caring of someone else about them (even if it did exist) doesn’t matter.

What ‘matters’ (they think!) is for you to give them the magic words: words that ‘explain’ their problems, words that tell them the magic stuff to do about their problems, words that will magically undo the harm. Yes, they think ‘mere words’ are the answer, so your caring for them is not only irrelevant but quite possibly a pain in the ass that they wouldn’t know what to do with anyway. What they don’t know is that the child in them NEEDS someone to ‘hold them’ through the work of exhuming their lost self from the dead – that if there isn’t anyone ‘there’ to care and see them through it all, they can’t do it.

They don’t know that they can’t do it alone, and they don’t know that the fact that there was no one really ‘there’ is the reason for the whole mess. They don’t know this, but YOU DO. And if you don’t – perhaps you’re not suited to this precious work. Because the truth is, that the child in them can perform miracles, but only IF you hold their hand through it, and hold it the right way.

Is this the dreaded “dependency”? YES – it is temporary dependency, for a purpose, or what they used to call ‘regression in the service of the ego’. It isn’t an end point – it is a (NORMAL) stage of development that they will go through, using you, and then be able to do it themselves, just as other ‘normal’ people can.

After all, we don’t become disturbed that an infant, or a toddler, or any young child, is “dependent,” do we?  It’s NORMAL, FOR NOW, right? So why would you think that the process of therapy would be any different? Since normal development was sidetracked and stunted for lack of a reliable partner, the ‘cure’ is the appearance of a reliable partner, FOR NOW. Later, through going through it all with you, they internalize the functions of the ‘parental figure’, so that they can do it for themselves. This, not the dreaded (gasp!) dependency, is the real hoped-for outcome. And note, I don’t say that “understanding” is the real hoped-for outcome. You do NOT teach the patient “tricks” or “explanations” or “techniques” or anything else: you go through something with them, until finally the “something” is inside them, to stay. It’s just that the unreliable experiences people have gone through in early life (and sometimes later) “give dependency a bad name,” so to speak, so that any hint of really needing someone is terrifying. (And of course it doesn’t help that our entire society endorses this stance, as well.)

So let’s go back to Tom Joad’s speech in The Grapes of Wrath. What is really happening here, emotionally? He is moving beyond the small identity with his original family, to his membership in the family of man. He is expanding his small, personal identity (I am this guy, from this family, who is on the run from despair and degradation) to a larger identity, as a human being >> as a living being >> as spirit made manifest. And this act of expansion, this expanded IDENTITY (I am part of mankind, I am part of “something bigger,” I am spirit incarnate) gives him the ‘holding’ experience: I am not alone, I was never alone, I am a part of something bigger than me. And THIS ‘holding’ (just like the holding in the therapy relationship) is what gives him the courage to strike out into the world boldly, to prosecute aims that are bigger than “I want a job, I want security” (i.e. the things his family is seeking). This is a spiritual awakening – which really means an identity expansion and a ‘joining’ of a bigger family, not just the family of man, but the ‘family’ of living beings, and the ‘family’ of spirit.

The aim of psychotherapy may or may not involve an expansion that large, into the realm of the spirit (although it can), but it must involve an expansion beyond the stunted personal identity which was frozen by key experiences in the family of origin. And it always, always, involves an expansion of personal identity from a personality system that is motivated by FEAR, to one that is about the encountering, and the experiencing, and the expression, of SELF.

From fear, to self-manifestation.

And that takes a partner.

And that’s what psychotherapy is all about: providing that partner.

Because Selfing is a two-person job.

So, when someone struggles in to see you, heart-sick, soul-battered, and weary beyond telling, what you are really offering – beyond the theories, beyond the techniques, beyond the ‘expertise’, is simply this:

I’ll be there.

 

 

 

 

 

 

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