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.

Grow Up, but Stay Small!








The other day, I had a weird experience. Well, that’s not totally true – it was an experience I’ve had many times before, but for some reason this time it struck me differently. Maybe because I’m getting older, maybe because I’m caring deeper, maybe because as you get older, you tend to hold on tighter to the familiar, to the old days, to what has been so precious.

A patient whom I’ve been working with for a while had her last session before she embarked upon a long trip that, somehow, I knew would be transformative.

As she got ready to leave, I found myself saying, “See you on the other side.”

She cocked her head at me and said, “Yes, and it may really be the other side.”

What did all that mean? I don’t know – I just know that something compelled me to use that phrase, “the other side” – something that ‘knew’ something that I didn’t know, until I said it.

And she clearly got it – and responded in kind.

One of those magical moments that give you a little zing up your spine.

What did I know? I’m not positive – I just knew. I knew that she would be ‘different’ when I saw her next. Different in a good way, an expanded way.

And that’s great. But it’s also hard.

Anyone who’s had children knows what I mean: you work night and day to get your kids through their youth, to help them grow up, to reach those all-important milestones: first day of pre-school (oh my god, the heart-rending cries!); first day of ‘real’ school; first sleep-over at a friend’s house; the Halloween costumes, changing through the years; junior high; high school; dates, driving, broken hearts, doing homework, passing tests, sex, college; and then, leaving.

I often tell the over-involved parents I work with that you have to think of yourself as a mother lion: nursing your cubs, catching their food for them, teaching them to hunt with you, hunting on their own, and finally – leaving.

Leaving: that’s always the primary goal, the purpose of the whole thing.


Sure, bonding is important, but this above all: it’s all about preparation for leaving.

So I tell the parents that, and they get it, and they try. They do the right thing and let go – let go of the baby they gave birth to, let go of the expectations, the hopes, the dreams they have (at least some of them), let go of the closeness they felt with that sweet, innocent little bundle of softness they brought into the world. They try to let go of all of that, but I know how hard it is.

And every parent knows exactly what I’m talking about when I say that every step towards growing up, every step towards leaving, is hard. No matter how proud you are, or how glad – it’s still hard.

You want to make a ‘deal’ with the child, or fate, or god: Can’t there be two of my child? Let my ‘baby’ stay the way he is, always be that cute, that close to me, that precious, that close, while the ‘other one’ grows up as I want him to?

Can’t there be two: one for me, and one for the world?

Kids are always embarrassed and annoyed when parents drag out the photo album to show family members, or new girlfriends, or grandchildren, pictures of Little Johnny in the ‘old days’. Mind you, ‘Little Johnny’ may now be the forty-five year-old owner-operator of a fleet of cement mixers, may have five kids of his own, a big mortgage, tax problems, arthritis and a cocaine habit.

It doesn’t matter: he’ll always be ‘Little Johnny’ to them.

He’ll always be Little Johnny because those early days of connection and innocence are a Big Deal to parents: to be that involved, that needed, that close to a fellow creature is a rare and miraculous thing. I mean, what else do you do in life that’s that important? It informs and shapes every aspect of your life, and every aspect of your life affects the child: your job, your marriage, your hobbies, your interests, how you feel about your life, your friends, your own past life as a child.

They all matter, they all form the child, because to the child, you are the only game in town: he or she is watching you intently, to find out what life is all about, to find out if things are okay, and always wondering, wondering:

What do you think of me?

Do you want me here?

Do you love me?

Am I a joy, or a pain in the neck?

Am I just another job, or a pleasure that is meaningful and real to you?

Do you like me, or just put up with me because you have to?

Are we alike?

Do you like being with me?

Notice that every one of those questions has “you” as the focus. To the child, you are his everything, his pole star, the one constant in life: you, you, you. And that’s heady stuff for anybody – to be that important, that much of a big deal, to somebody who really matters to you. Aside from being in love, that’s the only time one can matterthat much to another person.

Sure, it’s a lot of responsibility, but then it’s also a lot of power and importance.

Okay – back to my patient.

What does all this have to do with her?

Well, a lot, actually. If you’re being honest with yourself, and you give a damn, as a therapist, you begin to feel about your patients some of the things a parent feels about a child. After all, if the core of ‘transference’ is that patients are projecting onto you the things they felt towards their parents, and using the therapy as a crucible to work those things out, it follows that the same is just as true of the ‘countertransference’ the therapist feels back towards the patient: It involves many of the things parents feel towards their children:

How am I doing?

Could I be doing more?

Are they reaching their therapy ‘milestones’? (“Baby’s” first eruption of the unconscious, first being late to a session, first strong disagreement with you, first acknowledgment of the connection, first obvious pushing away from the connection, first obvious claiming of the self, first worry about losing you, first thoughts of leaving you – I could go on and on.)

(Note: just received an email from a former patient, who’s now a nurse, working with a difficult teen, worried if she’s ‘doing it right’, and saying that if she does get it right, “I feel I’ll be redeemed.” Well, there ya go – it doesn’t get much more ‘countertransfer-y’ than that, and that’s not unusual, folks! All helpers (including therapists!) are people, too – their own unconscious, their ‘issues’, are constantly triggered by all kinds of qualities in the patient. It’s not that a therapist shouldn’t have these things happening, it’s that a good therapist is AWARE of them, and works with them, and uses them to the patient’s benefit.)

Countertransference, as a general phenomenon, has of course been extensively documented and discussed. But what about the ‘normal’ parental feeling of loss, of sadness, of even hurt, even anger, even abandonment, that therapists feel when patients do get better? Many therapists – and I’ve supervised and consulted with many in my day – aren’t even aware of these feelings. Sure, they’re ‘all over’ the typical countertransference issues, i.e. the personal emotional reactions one feels towards another person whom you sit with closely for long periods of time:

My god, he reminds me of my cousin Saul – I never could stand him!

My god, she’s so hot – I can’t stop myself from flirting with her.

My god, he’s a died-in-the-wool Republican capitalist – how am I supposed to be sympathetic that he’s firing half his workforce to cut costs?

My god, her arrogant self-centeredness is so much like my father’s, it makes me want to yell, “You’re not the only person in the world, you jerk!”

Yep, bet on it, therapy patients: your very own therapist really does have his or her very own real feelings about you, feelings that come from ‘some time before’. Just hope that he or she is conscientiously noting them, claiming them in a conscious way, working with them, getting consultation about them if needed, and using this awareness to further the work.

What do I mean by ‘using’ this awareness? Well, here is an example from my own practice:

I had been seeing this big, beefy, fiftyish guy for quite a while. He was what you might call the ‘hail fellow well met’ type – a corporate salesman who had a story or a joke for every occasion. He made sure he ‘bonded’ with me about everything he could dig out of me: baseball (I’m always a sucker for being sidetracked by baseball talk, and I have to watch myself like a hawk!), talking about our kids, my interest in World War II (his father had won the Navy Cross as a Marine, and he figured out – correctly – that he could really ‘get me going’ on that one), old movies (don’t even get me started!), stories about how he’d gone marlin fishing in Mexico – you get the picture.

He was charming, he was funny, and the ‘lure’ was to just yak the session away with him every time, being ‘buds’. Except that, d’ohh, he hadn’t come to me to become best buds!

His marriage was falling apart, he was estranged from his grown kids, he was in trouble at work, and he had no real friends, even though everyone was his ‘friend’. He had grown up on a farm in rural Indiana – a lonely, isolated farm, an only child, with cold, distant parents. So his ‘solution’ was to shed all that isolation by becoming a big-city backslapper, bonding and hail-fellowing with everyone he met, ‘proving’ that he was no hick, and surrounded by people.

And the anger, the despair and the hurt? He kept it all stuffed down, deep inside. It’s a pretty well known dynamic that therapy patients will ‘use’ parts of themselves that they believe in, that they know will ‘work’, in order to get you to like them, to relate to them in ways they are familiar with, thereby maintaining control over the relationship. Unfortunately, if you allow yourself to ‘go for’ these ploys, both you and the client lose.

For example, sometimes an attractive young woman seeing a male therapist will ‘use’ her feminine charms to take a shortcut to connection and reassurance about herself: she ‘knows’ that her looks and her sexuality are strong suits, and if she can get the therapist to go down that road, it’s familiar territory. The only problem is, if the therapist allows this to happen, it is a betrayal of what the person came to therapy for in the first place. What she really needs is to have an experience in which another person (particularly a male, in this case) values her for WHO she is, not WHAT she is (i.e. an attractive ‘specimen’ – what shows on the outside).

Well, it was like that with this man: if he could get me to hang out and ‘chill’ with him, listen to his stories, laugh at his jokes, and be charmed by his charm, then he was on his own turf. But he came to me because always being on his own turf wasn’t working! He was alone, isolated, in trouble, and failing, at work and home.

So I had to head him off at every turn, frustrating and ultimately infuriating him: every time he would launch into another story, I would say, “But what’s happening right now – here?” When he would try to lure me into the weeds by talking about the time he got Ted Williams’ autograph, I (reluctantly!) had to drag him back by saying, “We’re not here to talk about Ted Williams.”

At first, he would just try another tack – a better story, a funnier joke. Then, when he saw that that wasn’t going to work, he would lapse into sullen silence, looking at his watch (translation: “I’ve got better things to do, and a lot better audiences than this!”).

One day, he finally said, “Look – whatever your game is, I don’t know how to play it.”

I said, “Of course you don’t – you’re not here to practice what you do know how to do. You’re here to work on things you don’t know how to do. Are you willing to trust me enough to hang in with this for a while, and see where it takes us? I love your jokes, and your stories. And, believe me, I’d love to talk about Ted Williams all day long, but it wouldn’t do a thing for you. I think you’re worth more than that – a lot more. And as for ‘playing my game’ goes – that’s not really accurate: what I’m suggesting is that we STOP playing games – your games – and see what happens. Sure, it’s uncomfortable: all you know is your game, and it works on almost everybody – hell, it works on me, too, but there’s more to you than jokes and stories, even though you don’t know it. I’m telling you that I know it – give me a chance to prove it. Okay?”

I held out my hand.

I wish I could say that I saved his marriage, healed his rift with his children, and raised the dead. But I will say this (with apologies to baseball fans everywhere): Stan became a Man. He actually became an organizational consultant (as he called it, a “therapist for businesses”), using his interpersonal gifts to help people forge workable and functional relationships. It was too late for his marriage, but he did remarry, a warm, big-hearted woman with whom he achieved genuine closeness.

He isn’t “alone in a crowd” anymore, and though nowadays everyone isn’t his ‘best friend’, he does have a few real friends, whom he doesn’t feel he has to entertain constantly.

So, am I ever going to get back to my original topic, which is the woman patient who’s going off on a trip which I know will ‘change’ her?

Yes, believe it or not.

Like a doting parent with a child who’s growing up, I want there to be ‘two’ of her: one to be the person I have come to know, respect and treasure, and the ‘other’ to be the one who goes off, has great adventures, expands her life in wonderful ways, and, maybe, comes back to teach me a few things!

But then, I will always have the ‘first one’ in my heart – the things we went through, the demons she faced, her journey to the ‘starting gate’.

Like the old song says,

Make new friends, but keep the old,

One is silver, and the other, gold.

Now she (and I) will have both: the silver and the gold.

She’s at the starting gate of her great adventure.

If you listen closely, you can hear them playing Call to the Post:

And . . . They’re Off!!!

See you on the other side.














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

Blue Star










Driving back from a fishing trip with my son, when he was maybe 10 or 11, I was playing some CDs I had made from my iTunes library. As usual, it included an eclectic mix of everything I like, from oldies to newies, from jazz to pop to rock, from Forties novelties (One Meatball), to the Weepies and Ray LaMontagne. He sat in the back quietly for the most part, probably rolling his eyes at most of it, although, having hung out a lot with me for most of his life, he does have an appreciation for my ‘old stuff’. I mean, how many kids can instantly recognize Robert Mitchum, Lauren Bacall, or even Whit Bissell, for god’s sake?

Well, as I say, we were driving along on the approach to the Richmond-San Rafael Bridge, and a song came on that I threw in because I had been checking out doo wop groups at the time: Blue Star, by the Mystics.

As the song ended, I heard from the back seat, “I liked that one. Could you play it again?”

Hmmm, I wondered what was going on. I mean, I could always rely on a laugh from the funny stuff, like Spike Jones, or those crazy ones by Louis Jordan – like, Caldonia! Caldonia! What makes your big head so hard?, or Is You Is Or Is You Ain’t My Baby?, which we had heard, and loved, in the old Tom and Jerry cartoons we used to watch together.

But beyond a basic shared appreciation of good music, our tastes diverged greatly. I mean – rap, hip hop, metal, techno, emo, schmeemo?  I’d rather be beaten with a sharp shillelagh, thank you.

“Sure,” I said, and set it up to play again. This time, I listened more carefully to the lyrics, while shamelessly checking the rear view mirror a couple of times:

Blue star, blue star…
Blue star that shines above,
You are the star of love.
My love is far away,
With all my heart I pray:
Oh, blue star, shine upon the one I love tonight.

The other stars all know,
 Just why I love her so,
And I will surely die,
If you don’t hear my cry,
Oh blue star, shine upon the one I love tonight.

In my dreams I see,
Her sweet lips are kissing me;
When I wake at home,
She is gone, and I’m alone…

Oh blue star, hear my plea,
And bring her back to me,
If you will tell me when,
Then I can live again,

Oh blue star, shine upon the one I love tonight.

And here’s what I saw behind me: he was in a kind of faraway, dreamy trance, a look I recognized immediately, and remembered well – the “Will I ever find my true love?” trance. It exists in a teenage half-life, somewhere between hope and despair. I mean, we all want the Blue Star’s help in pointing out the right one for us, don’t we? Sure, the song was outdated, the chords mundane, but the subject matter, and appeal, were, and are, timeless.

And for me as his Dad, it told me this: my boy was growing up, and soon he would want and need lots of things that I could not give him. Of course, he would have hotly denied any of this, with a snort; he probably wasn’t even consciously aware of it. That’s why it was so moving and poignant to me – the innocent sweetness of that unselfconscious look, at the very dawning of a new era of life.

Ever since then, I can’t listen to Blue Star without the emotional memory of that moment welling up inside me: that’s the power of connection, of meaning through caring. A song that was mundane and trite, became special to me, because it touched something in him.

And this same process also happens, and frequently, in my therapy practice. I get to witness those magical, dawning moments – moments that, sometimes, only I am aware of. And then later, when the feelings and thoughts are more accessible, I get to share them with their authors – and I do mean authors, because I see the development of a self (consciously or not) as a beautiful, artistic act of creative courage.

Why courage? Because daring to care again hurts, when caring always ended in pain before.  And it hurts to want, when wanting always led to shame and frustration. And it hurts to grow, because leaving the familiar always invokes fear — and guilt. It hurts to need, when needing always meant ridicule, or emptiness. And it’s hard to wish, when wishing always meant a slap in the face, or failure.

In the series Band of Brothers, about paratroopers in World War II, their slogan is “Currahee”, which we are told is an American Indian word meaning “We stand alone, together.” That makes sense: When you are doing something frightening and new, whether it is jumping out of an airplane into the midst of the German army, or opening the emotional scabs that are crippling you, you need help: not to do it for you – because you have to do it yourself – but to ‘stand by’ you as you do it, to hold a safe space for you, to be an experienced ‘Sherpa’ to help you to trust the experience, let go of old ways, and take the plunge into the new.

So what are these Blue Star moments? They are turning points. To a layman, they might seem ordinary, but to one who knows what to look for, they are magical:

A young male patient had been holding me at arm’s length for several months. Finally, one day we had this conversation:

Me: You know, James – I don’t bite.
James: I know.
Me: Then what’s the problem?
James: They don’t call me that, you know.
Me: Call you what?
James: James.
Me: What do they call you?
James: Different things.
Me: You mean, like, it depends on . . .
James: Yeah.
Me: So, what do I get to call you?
James: I’m thinking about it.
Me: ‘Thinking About It’? Sounds like an Indian name.
James: Very funny. Okay then, I guess you can call me Jay Jay.
Me: Hmm, Jay Jay. I’m honored.
James: You should be.
Me: I am.
James: And what do I get to call you?
Me: How about Gee Gee?
James: Asshole – okay, I’ll settle for Dr. B.
Me: Fair enough – you got it, Jay Jay.

And after that, I was always Dr. B, except when he wanted to tease me, and then he would put his head down, shoot his eyes up at me, and with an impish grin, call me Gee Gee.

Now, that was an honor. And a Blue Star moment. (Actually, the real Blue Star moment was the word ‘Asshole’: you don’t call a holding-at-arm’s-length therapist Asshole. When he first said it, I had to restrain myself from jumping up and giving him a fist-bump.)

Another example: a woman I worked with long ago – very strong-willed, very loud, very brash, and very opinionated, who, not surprisingly, was in conflict everywhere in her life. She was the CEO of a small company she had founded, a service company that depended on good will from its clients to survive. But she was constantly getting into disputes and arguments with the clients, mostly about meaningless details that she could have let go, but didn’t.

And most of all, she always had to ‘know’ the one right answer, the one right way – her way – to do everything. This was her idea of ‘strength’ – she saw people who weren’t as sure as she was, as weaklings and saps. She had also lost many good employees, due to her overbearing manner and refusal to back down in disputes – disputes which she caused, and which didn’t leave any room for a resolution which allowed the other person their pride or even their emotional space.

Our sessions would often take the form of a ‘test’: she would bring up a problem, such as why employees were leaving, or why clients didn’t renew their contracts. My ‘test’ was that I was then supposed to supply an answer – an answer, that is, that didn’t involve her changing her own behavior! This is what it was like:

Marsha: Why am I the only one who takes on any responsibility at work? I mean, there are a million things to do. Why is it so hard for people to just put down their damn coffee cup and dive in?
Me: Are you saying they don’t do anything?
Marsha: Oh sure, if I stand there over them with a whip and tell them word for word what to do, they do it. But it shouldn’t have to be that way.
Me: So, they don’t do anything on their own?
Marsha: Well, you’re actually catching on: for a minute there, I thought you were deaf.
Me: No – I’m pretty sure they can hear you all the way down the hall. Has it ever occurred to you that your employees are intimidated by you, or that they are afraid to do things on their own, for fear that you’ll criticize them?
Marsha: Criticize them? Now why would I do that, if they actually got it together and did something without my standing there with my whip?
Me: Well, one reason could be that they might not do it your way.
Marsha: You mean the right way?
Me: Um hmm – and what is the right way, Marsha?
Marsha (smirking):  My way, of course!
Me: The defense rests.
Marsha (shaking her head in disgust): Well, once again, you haven’t come up with a single workable idea to help me deal with the employees – or the clients.
Me: I’m just saying, if you gave them a little running room, a little more leeway, they might feel more empowered to do things on their own without fear of criticism.
Marsha (shaking her head No): Nope – you still don’t get it: if they would show a little more initiative, a little more intelligence, maybe I could back off and trust that things wouldn’t go to hell in a handbasket as soon as I walked out that door. But no such luck: they just sit there like Henny Penny and gabble on their cell phones like kindergarteners all day, unless I stand over them and hand-feed them the next task, and the next, and the next.
Me: I did give you an idea.
Marsha: You call that an idea? That’s no idea: that’s yesterday’s coffee grounds.
Me: I guess you’re going to have to stand over me with a whip, too, to get any decent work out of me.
Marsha: You got that right.
Me: Well, sometimes I might not have an immediate answer that meets all your criteria. But that doesn’t mean I’m not trying, or that what I’m doing won’t help you, maybe in ways that you can’t see right now. There are ways of knowing that aren’t about giving right answers.
Marsha (mocking): Oooh – deep thoughts!

Well, it went on like that, week after week, her testing me, and me ‘failing’, until one dark, rainy day, when she came in, looking totally exhausted, and flung her wet umbrella down at her feet.

Me: What’s going on? You look all done in.
Marsha: I am.
I sensed that she needed to have some time with her feelings. We were silent for a few moments, then I spoke again,
Me: Feel like talking?
Marsha (with a deep sigh): I’m tired – just so tired, of always being the one on the spot.
Me: You mean, like having all the responsibility?
Marsha: Yeah – keeping everything on track. (another sigh) But – what if it wasn’t me: would the world come to an end?
Me: I don’t think so.
Marsha: That’s good to know, because I don’t have anything left in the tank.


Me: So – what happened?


Me: Is there something . . .
Marsha (beating her hands down on the chair arms): I don’t know. I don’t know. I don’t know!


Marsha (Sighs again, then glances at me with an unfamiliar, almost childlike look): Can’t I just not know, for once?
Me: Of course – there’s still a place for you here, and in the world, whether you know or not.
Marsha (crying): Can’t someone else just take over for once?


Me: They could if you’d be willing to stand back from the wheel and let them steer for a while – and accept that their course might not be identical to yours.
Marsha: As long as we’re going in the right general direction, I’m too tired to fight anymore.
Me: Sounds like the captain is growing up.

Give that lady a Blue Star!

She later realized that she had learned something from all the times I had ‘failed’, but was still there for her: that I was still providing something, and that my not always ‘knowing’ didn’t mean I was weak, or that I didn’t care; there are things beyond ‘knowing’ that a human being can provide.

And still later, she learned that when her critical, demanding father ‘quizzed’ her at the dinner table every night, she felt that the only value she had was in giving the right answer. And she learned that she wasn’t the failure, he was, for only valuing that one thing about her.

And for Gee Gee (aka Dr. B)? He had the joy of welcoming an honest-to-god human being into the world.

So, the next time you’re listening to a friend’s problems, or looking in the mirror and wondering if you’re worthy, or driving along with your kid in the back seat, don’t wait for miracles: if you look closely, you’ll see that a Blue Star is already shining upon the one you love.













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

Secretariat and Me









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

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

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

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

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

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

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

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

They’re off!

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

Crowd: Here he comes!

Me: Who?

Crowd: Look at him go!

Me: Where?

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

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

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

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

Bedlam, crazed joy, roistering insanity ensued.

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

Then I heard the buzz around the infield:

Look at that time!

This is crazy!

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

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

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

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

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

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

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

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

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

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

And that’s the story of Secretariat and Me.










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