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

16660334_s

 

 

 

 

 

 

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

7016607_s

 

 

 

 

 

 

 

 

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

30640890_s

 

 

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

First YOU – then everyone else.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

The Marquis de Carolina

4485488_s

 

 

 

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Oh, just notes. Ideas.”

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

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

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

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

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

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

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

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

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

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

“Yep, that’s what I’m saying.”

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

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

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

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

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

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

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

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

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

He cocked his head again. “She white?”

I laughed, “Yeah – she’s Hungarian.”

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

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

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

“Like another lifetime, you mean?”

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

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

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

“Just what?”

“I stay away.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Where Are They Now?

16525480_s

 

 

 

 

 

 

 

 

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.

Caring.

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.

Private Wisdom

13737538_s

 

 

 

 

 

 

 

Ralph Waldo Emerson had this to say about the giving of advice, and the drive within each of us to offer it – thinking, as we do, that we are offering a wondrous gift:

Although this garrulity of advising is born with us, I confess that life is rather a subject of wonder, than of didactics. So much fate, so much irresistible dictation from temperament and unknown inspiration enters into it, that we doubt we can say anything out of our own experience whereby to help each other.

All the professions are timid and expectant agencies.

The priest is glad if his prayers or his sermon meet the conditions of any soul; if of two, if of ten, ’tis a signal success. . .

The physician prescribes hesitatingly out of his few resources, the same tonic or sedative to this new and peculiar constitution, which he has applied with various success to a hundred men before. If the patient mends, he is glad and surprised. . .

The judge weighs the arguments, and puts a brave face on the matter, and, since there must be a decision, decides as he can, and hopes he has done justice, and given satisfaction to the community . . .

And so is all life a timid and unskillful spectator. We do what we must, and call it by the best names. ‘Tis little we can do for each other.

We accompany the youth with sympathy . . . but ’tis certain that not by strength of ours, or of the old sayings, but only on strength of his own, unknown to us or to any, he must stand or fall.

That by which a man conquers in any passage, is a profound secret to every other being in the world, and it is only as he turns his back on us and on all men, and draws on this most private wisdom, that any good can come to him.

Or, in perhaps less lofty terms, I offer this delicate observational plum, from a former patient at the Memphis V.A. Hospital, circa 1971:

Hell, Doc, you may think you know everything, but when it comes to me, you don’t know shit.

And to think, he knew that without ever reading Emerson!

But we all know it, don’t we, without having to consult Emerson, Freud, Dr. Phil or even Dear Abby; we all know that, when it comes down to us, other people, no matter how smart they are, don’t really know shit.

When I, as a therapist, have to write something about what I ‘know’ on my website, or on a referral site, or to a potential new patient, what do I say?

That I know all about relationships, mood disorders, substance abuse, career issues, loss, life transitions, and a long laundry list of other things that people struggle with? That I have a tremendous amount of experience with almost any issue that might come up?

Or that, when it comes to your life, your experiences, and what keeps you up in the middle of the night, I really don’t know shit, but that I promise to listen hard, respect you, and try my heart out, and that, together, maybe we can chase some of the shadows away and put you on the path to a better life?

Which would you rather hear? Right: you want EXPERTISE, not the old college try, don’t you? I mean, when you’ve got a mysterious skin rash that’s been making your whole life hell for months, and you finally haul yourself off to Dr. Whitesnow, the (expensive) dermatologist, for help, you don’t expect to hear,

“Dude – that’s gotta hurt!”

Hell, no – you want him to fix the ‘affected area’ with a gimlet eye and start rattling off fancy-sounding terms and unpronounceable potions that will fix you right up, don’t you? You want sureness, exactitude and precision. I mean, that’s how we tell we’re in the presence of a pro, isn’t it? We want white hair, a deep voice, and a little, knowing chuckle as the Doc says,

“Sure, son – seen it a million times, and every single time, it’s been Dermaticularis Aureolitica, commonly known as High Mountain Rash. Have you been on a ski trip within the last six months?”

And you slap your head and say, “Oh my god, Doc – of course, now it’s all so clear: it all began that weekend we went up to Mammoth. But how did you know?”

And he chuckles again, benignly, as he peers at you over his half-glasses. “Son, when you’ve gotten your medical training at Harvard, interned at Johns Hopkins, are a Lifetime Fellow of the International Dermatological Institute, have an Endowed Chair in Dermaticularis Aureolitica, and are the Director Emeritus of the American College of Rashes and Bumps, you just know.”

You’re feeling better already. “So, you think I really have this, this, uh . . .”

“You can just call it D.A. if you want – we do. And yes, that’s definitely what you have, son.”

See – that’s what we want: expertise, advice, certainty, for god’s sake!

But, uh oh, now he says, “However, there’s often a psychological component to these things. So to be absolutely sure, I’d like you to see a colleague of mine, Dr. Schleppinger.”

Oof!

Did he say, Psychological Component?

You mutter, “Sure, Doc,” imagining you’re going to be sent to someone who maybe has a sub-specialty in the Low To Mid-Mountain Rash variations of D.A. or something. No problem. But then he hands you a business card:

“Leo Q. Schleppinger, Ph.D. Consulting Psychologist.”

Oh shit – here we go! I must be a real mess if they’re bringing in the witch doctors! I thought I was going to be treated by experts, not some clown who’s going to ask me when I first started liking girls, or what it felt like when my pet rabbit died when I was five. Am I going to have to look at ink blots and tell them this one looks like my Uncle Fred – the one who always wore ladies’ hats? Am I going to have to ask my mother whether my first word was boo boo? Damn it to hell, I came here for expertise – for advice, not mumbo jumbo!

So, you dutifully nod and tuck the card away in your shirt pocket, thinking, maybe it won’t be that bad – maybe he’ll do hypnosis or something, or some ‘technique’ that’s over and done with in three visits, like your friend Hap, who stopped smoking with that guy who just ‘put him under’ and told him he didn’t need cigarettes anymore.

Yeah, that’s it. You think, maybe I can ask him to help me sleep better, while he’s at it, or stop snoring, or lose weight. Hey, this might not be that bad after all: three sessions and I’m a new man! He’ll just wave his fingers in my face like in those old Abbott and Costello movies, put me in a trance and say, “Rash, rash, go away – come again some other day,” and bingo bango, it’s gone!

You call the guy and set up an appointment for Wednesday at 6:00. You have to leave work a little early, but it’s okay – you told your boss you have an allergy appointment. You know, like with a real doctor. Heaven forbid anyone finds out you’re going to a nutcracker! But, nutcracker or not, you smile to yourself: wait till they see the slim me, the rash-free me, the good-night’s-sleep me.

The new me!

By Wednesday late afternoon you’re walking on air. It’s hard to even concentrate on your work. You think, “Gee, I wonder if it’s like at a cafeteria: just point to the stuff you want, and it’s done! One from Column A, one from Column B: stop snoring, lose weight, feel happy all the time. Hey, maybe he can make me want to go to the gym again, like I used to! As I do my reps, I’ll chant, “Advice! Expertise! Hypnosis! Advice! Expertise! Hypnosis!”

Wow, by this time next year, I could be ripped!

The traffic’s miserable. It’s a rainy night and suddenly everyone’s a student driver. And you’re starting to get a little nervous. Heck, that cream the Doc gave me is already helping my D.A. – why the hell do I have to go to a head-shrinker anyway? Just so Dr. Whitesnow can cover his ass, in case I have a nervous breakdown and sue him? In case the rash, in one patient out of a million, is actually an early sign of an impending meltdown, and I’m the one in a million? Did the Doc see something that he didn’t tell me? Something that made him think I’m actually going off my rocker? Something that cries out, “Have this guy put under observation, quick!” Something that you only pick up if you’re the Endowed Chair of the . . . what the heck was it again – The Fellowship of the Pimple, or something? Damn, now I can’t even remember a conversation I had just a week ago. Am I losing my memory? My mind? My mind and my memory? Wait, maybe that’s good: if I can’t remember anything, I wouldn’t remember that I went out of my mind, would I? Maybe I’ll end up one of those happy lunatics, content to sit and fill in coloring books in the day-room of the Shady Grove Home For The Mostly Gone. Would my wife come to visit me, or would she take up with that neighbor that’s always giving her the eye – what’s his name? Herb, Hubie, Harv – dammit, I can’t even remember my wife’s future lover’s name anymore. Herk, Howie . . . Oh yeah – Joe. Well, I was close, wasn’t I? I wonder if this Schlossinger guy can bring my memory back? But then, would I even want to remember going crazy and losing my wife? It is Schlossinger, isn’t it? Oh no, here we go again: Schlepperdink? Schlerdenbaum? Hell, what’s the difference, as long as it’s Advice, Expertise, Hypnosis!

With a start, you snap out of it and see the sign: Midtown Professional Building. That has a nice, solid ring to it, and that helps, some. Doesn’t it at least show that this guy is accepted in the company of other professionals? That they’re not ashamed to be seen with him, or at least not ashamed to pass him in the halls once in a while? Or do they even see each other in the halls? Do they eat together? Do they compare notes, and laugh, over meatloaf and mashed potatoes?

I just saw this guy who couldn’t even remember my name! What’s more, he couldn’t even remember the name of his wife’s future lover! Can you believe that? He came in for a rash, but we all know a rash like that is just a big red danger signal, flashing: Stop Me Before It’s Too Late! Say, pass me those rolls, wouldya?

You sit in your car in the parking lot, watching the rain make its way down your windshield, thinking, “Should I even go in? If he thinks I’m gonna sit still while he prods and pokes around in my mind, only to make fun of me over meatloaf, well he’s got another thing coming! He can take his Psychological Component and . . .”

But then cooler heads prevail (seeing as how you’re now under observation as a split personality), and you decide, fair is fair – at least give the guy a chance to actually abuse you, before you hit the panic button and count him out. And Dr. Whitesnow said the guy might help, and after all, he has a full head of white hair, so he should know: give the new guy a fair shot. I mean, he might not be that bad: maybe he’ll confine his lunch comments to tamer stuff, like the ink blots and Uncle Fred. I mean, maybe the other guys at lunch won’t even want to hear about some guy’s rash, while they’re trying to eat, right?

You scan the impressive name board in the lobby: Samuels, Sapperstein, Schaum – yes, there it is: Schleppinger! He’s right up there with the legitimate doctors, so he can’t be that bad, can he? At least he’s got his name up there on the fancy board, in the company of decent people. Let’s see – Room 444. Not too low, not too high – that’s good. Didn’t your high school locker number used to be 444? That’s a good sign. Hey, maybe this whole thing will pan out after all – especially if I get ripped.

You enter the elevator and push 4. You ride up, and the doors open. Not bad – they have carpeting on the floors, not too worn, not too garish or anything, just regular-looking, like decent people might have. Of course, he probably didn’t do the decorating himself, but still, it doesn’t do any harm either: decent carpeting goes with decent people, doesn’t it? You bet it does!

On the way down the hall, you repeat your mantra: Advice, Expertise . . . and dammit, what was that third thing again? Gotta hide that memory loss – that’s a dead giveaway. Oh yeah – Hypnosis! See – I’m fine!

The waiting room’s okay. At first all you could see is Vogues and Elles, but then, thank god, you root around and find a couple old Sports Illustrateds under the pile: you grab one of ’em, quick, and make sure you’re reading an article on the Detroit Lions when the door opens.

“Mr. Quigley?”

You put down the magazine (making sure the Lions page is still open and visible). “Yeah – that’s me.”

“I’m Dr. Schleppinger – pleased to meet you.” He offers his hand. Older guy, looks like maybe once upon a time he had a body, but if he’s doing self-hypnosis for his own gym workouts, it sure isn’t working. But all in all, not bad – no beard or anything, no sandals with socks or anything else suspect, if you know what I mean. For a second you consider going to a quick fist-bump to mess with him, but that’d only look weird. Gotta be careful. Firm handshake is best: keep it simple.

You’re ushered into one of those offices where you can’t tell if the guy’s a shrink or an anthropologist. Couple of weird masks on the wall, some Navajo-lookin’ blankets here and there. No pictures of Tom Brady or Peyton Manning, that’s for sure, but we’ll let that pass. He may not have an endowed chair, but at least he’s got a Barcalounger.

“So, Mr. Quigley – what can I do for you?”

You go blank. Think, think: you can’t show that memory loss right off the bat, you fool! What’s my doctor’s name, for the love of god? Say something – anything!

“Uh, that guy – you know, the one with the white hair, says I’ve got D.A., and I’m here for my Psychological Component.”

You can’t believe that just came out of your mouth.

He leans forward, brow knitted. “Excuse me, Mr. Quigley. Did you say the D.A. referred you? Is this in reference to some legal matter?”

You’ve got to do better this time. You take a deep breath. “No, no, Doc. It’s this rash that I got while I was skiing. He says it’s Dermococcus Auroriata, or something, and that I’ve gotta be checked out for a nervous breakdown.”

Now he’s leaning back, scribbling notes furiously. “Have you been hospitalized before?”

“Yeah, I had a real bad strep when I was in college, and, well, they thought, you know, just for precautionary . . .”

“No, I mean for your psychiatric condition, Mr. Quigley.”

You panic. “What psychiatric condition? Look, Doc, you’re just supposed to check me out for the D.A.”

“What does the D.A. have to do with why you’re here?”

Now you’re getting mad. “It’s the whole reason I’m here, man. There’s nothing else wrong with me but this rash.” You roll up your sleeve to show him the red bumps up and down your arm. “And if you want to laugh about this over lunch – well, so be it.” That’s tellin’ him!

“Why would I laugh about it over lunch?” He stops scribbling and puts down the pad. “Look, Mr. Quigley, maybe we’d better start all over. Why are you here to see me?”

“Didn’t you already talk to Dr. Whitesnow? I thought all you guys were thick as thieves.”

“Look, Mr. Quigley, whoever Dr. Whitesnow is, I’ve never met him, or talked to him. So let’s just pretend I know nothing about your case, especially since I don’t know anything about your case. Now let’s just take it from the top. Please calm down and tell me why you’re here.”

“Now you’re talking. That’s the first thing you’ve said that makes any sense at all.”

“I appreciate your confidence. Now, if you’ll just tell me the whole story, from the beginning.”

Okay, so here’s the deal . . .”

You fill him in on how the rash was making your life a living hell, the visit to Dr. Whitesnow, about D.A., then about the dreaded Psychological Component. “So you see, Doc, what I want you to do is basically the same kind of stuff they did for Hap, but including the rash.”

“Who’s Hap?”

“My neighbor, who was hypnotized out of smoking, by one of you guys. I’m sure you must know him – I can’t remember his name.”

“And I would know him, of course, because we’re all thick as thieves?”

“Well, sorry about that one. I just meant . . .”

“That’s okay, Mr. Quigley, but the fact of the matter is, I’m not the kind of thief that does hypnosis.”

“Then why am I here?”

“I thought you were here to get help with your rash.”

“Well, I am, but if you don’t really even know how to do anything . . .”

“Did Dr. Whitesnow tell you I do hypnosis – or that that’s what you need?”

“Well, no, but . . .”

“So your knowledge of psychology comes mostly from Hap?”

“That’s not exactly what I . . .”

“Are you willing to talk to me about what I actually do, and how it might help you? You know, kind of get a second opinion, other than Hap’s? I mean, especially since you’re already here and everything.”

You’re calming down a bit. This guy’s kind of a nut, but not really a bad nut. It couldn’t hurt to stick around and hear him out, could it? “Sure, fire away.”

“Is it alright with you if I ask a few questions first? Sometimes I like to find out a few things about the patient, before I start offering solutions to his life – you know, even if only to keep in fighting trim.”

Maybe this guy’s alright, even though he doesn’t really know how to do anything. “Look, Doc – I’m sorry I shot my mouth off before. I guess I was pretty nervous about this whole thing. I mean, a Psychological Component can’t be a good thing, can it? And I’m sorry about the meat loaf, too.”

“I can let the meat loaf go, if you can let it go that I’m not thick with Hap’s hypnotist.” He stuck his hand out. “Deal?”

You shake hands. “Deal.”

Forty-five minutes later, you walk out feeling a lot better, though you can’t imagine why. The guy didn’t do anything, really, didn’t say anything, really. He didn’t even do any of the Big Three: no Advice, no Expertise, no Hypnosis. Kind of a fraud, but a nice fraud – the kind of fraud you don’t mind coming in to talk to again.

You do come in again to talk to him, a bunch of times. It comes out, somehow, that you’re a pretty angry guy (who knew?), that you resent the hell out of your wife (that’s what she always said, but you always thought she was a damn liar), and that you hate your new boss – you know, the young punk they brought in to replace the old, ‘good’ boss; the new kid with an attitude, who said he needed to ‘get to know you better’ before he knew how to work with you. Yeah sure – let’s get together and bake crescent rolls, kid! Imagine the nerve! The stupidity!

Well, anyway, after you talk to this Schleppinger guy a while, you find out a few things about yourself: you never talk to anyone, never trust anyone, and treat your whole life like it’s fifteen rounds with Mike Tyson.

Like I say – who knew?

And worst of all, no Advice, no Expertise, and no Hypnosis – what a gyp. But the guy was okay after all, you think to yourself: the rash is gone, and I don’t even mind my boss so much anymore, especially after Doc S. suggested I tell him I’m willing to try and talk it through – no, not baking crescent rolls or anything, but you know, just kind of getting a fresh start. And my wife – she says I should have done this years ago, that I’m acting like a human being again. She even told me to tell the Doc, ‘Thanks.’ I mean, the wife and I even started having . . . . well, you’re all big boys and girls, you know what I mean, right?

But the thing I never could figure out was – what took the Doc so long? I mean, why didn’t he just bring in the heavy artillery right at the start: you know, Advice, Expertise, Hypnosis? Why beat around the bush, bobbing and weaving all that time, when he just could have hit me with his best shot, right off? I don’t think he’s the type to just drag it out for the money – no, I don’t believe it’s that. I still don’t get it – he could have just told me off right at the beginning:

“You’re being an asshole – stop it!”

You know, something like that – something direct, so I would have known where I stand right away, instead of pussyfooting around the truth, playing ring-around-the-rosy with me all that time.

I still didn’t get it, so on our last session, I asked him, straight out: “Hey Doc, you know I really appreciate everything you did for me and all. But I just want to ask you, how come you didn’t just come out and tell me right away that I was angry, that I was holding my wife at arm’s length, and that I was being unfair to my boss?”

His answer made no sense, but I’ll tell it to you anyway, just for the sake of completeness.

Well, at first he started quoting Emerson at me, something about “profound secrets” and “private wisdom” – you know, the kind of crap you’d expect from a guy like that. No offense, but you know what I mean: I wanted a real answer.

Well, I cut him off, quick, and said, “Look – can’t you just cut the crap and answer me, in the most plain English you can think of, why you didn’t just tell me all about myself, right off the bat?”

Well, he nodded slowly – you know, like it was gonna kill him to speak English. Then he just shrugged and said,

“Who knew?”

See what I mean? Kind of a nut, but like I say, a good nut. So, the whole thing worked out pretty good, in the end.

Oh yeah – except for one thing:

I never did get ripped.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Do You Believe In Magic?

31166438_s 

 

 

 

 

 

 

 

 

One’s destination is never a place, but rather a new way of looking at things.

— Henry Miller

Everyone in therapy wants to change. We hear it every day, from new patients and old. They come in with a problem, that frequently sounds like this:

“I’m ________________ (fill in a way of being), but I want to be __________________ (fill in ‘better’ version of way of being). Where do we start?”

It reminds me of an old comic strip I used to read (maybe Dixie Dugan?), in which there was a character that obtained plastic surgery. I can’t remember whether the person wanted to hide, or just look better, but I do remember the premise was this: plastic surgery can make you look ANY WAY YOU WANT – all you have to do is point to the right picture, and let’s go!

Otherwise known as magic. People love magic. Another favorite magic fantasy is hypnosis. I can’t tell you how many people have said to me, “Can’t you just hypnotize me and make me different?” Magic lurks everywhere in our society, but we don’t always call it magic.

How about,

“Lose ten pounds from your thighs in two days, without having to diet!”

“Send $29.99 for step-by-step instructions on how to have power over women!”

“Make up to $5999 per month, from home: no sales, no calls, no products!”

“Take my weekend seminar, and never be shy again!”

I love magic, too – hell, most of art is based on magic, on teleportation: it ‘transports’ you. For two hours, I can watch a movie and be somewhere else; for days I can read a book and be someone else; I can watch a music video and be swept up in the energy, or sadness, or joy, or wildness, of a song. We all want to be somewhere else, someone else, and we want life to be ‘different’ than it is – better. We want all things to be possible, and in art, in fantasy, all things are possible.

We don’t want to have to work for it: we want it good, and we want it now.

Sounds like a child, doesn’t it?

Mommy – I want a pony!

In a movie or a book, as soon as little Johnny says, “I want a pony,” we know that somehow, some way, he’s gettin’ a pony. In real life – not so much. One of the things we like about movies, about books, is that the story makes sense, it ‘goes’ somewhere: almost like there’s a ‘God’ watching over the whole story – because there is: the director, and the writer! We want there to be a God, a Higher Power, watching over us, too, but all too often, when a child in real life says, “I want a pony,” the response is:

“Do you realize we live in a city?”

or

“Do you think we’re made of money?”

or

“Get real, dodo!”  (Sadly, the ‘signature’ rant of the parent of a patient of mine.)

And this is assuming that there is even anyone there to listen. More often than not, and so very unlike ‘the movies’, our wishes are met by the other person’s being preoccupied with their own issues, or distracted, or even cynical. We express a wish, and are told, as in the old English nursery rhyme:

If wishes were horses, beggars would ride.

So we learn that to wish for something unrealistic leads to being mocked, put down, or ignored. We learn that this is for ‘babies’ (though for many of us, it wasn’t even okay as babies!).

Why are people so ‘mean’ about irrational wishes? There are several reasons:

For one, most likely they never had anyone to treat their ‘irrational’ wishes with respect, either, so there is no role model for this; also, if you don’t get something yourself, you have no way of accepting others needing it.

For another, people feel that to ‘encourage’ irrational wishes is to lead the child (or person) down the wrong path: i.e. our job as parents is to teach the child about real life.

Further, it makes parents (especially those who actually care) feel inadequate:

Jeez, now what – how am I supposed to get this kid a pony?

And inadequacy feelings lead to anger:

You made me feel inadequate, so to show that I’m not inadequate, now I have to make your wish seem ridiculous, and paint you as a spoiled baby.

In fact, the skillful handling of irrational wishes is one of the most important jobs of a parent. Unfortunately, most parents are unprepared for the task. So the child learns to ditch all of the elements of ‘wishful thinking’, and it’s a case of throwing out the baby with the bathwater, because in wishing lies great power.

Almost all meaningful change starts with a wish:

Why can’t I be taller?

I want to be rich and famous.

I want to be young again.

I want to love my life.

Yes, these are all either irrational, or certainly not reachable by mere wishing (i.e. magic), but is the recognition of irrationality the ‘end of the line’ for a wish? It doesn’t have to be, and much, much, is lost if it is. For a wish – even if it’s a wish for ‘magic’ – can be just the beginning of the ‘line’, not the end, as most therapists can attest to. Wishing, hoping, dreaming, are direct pipelines to what’s inside of us, and fantasy is one of the most profound (and useful) of the signal qualities that sets us apart from the rest of the animal kingdom.

But how do we use it?

As I mentioned earlier, parents spend an inordinate amount of time “drumming into” their kids that you have to be realistic in life. So it’s safe to assume that most people, by the time they’re even young children, actually “know” the score:

You can’t attain anything without work.

Money doesn’t grow on trees.

Don’t wish your life away.

Wanting something, or even deserving it, doesn’t mean you’re going to get it.

Okay, so they know these things, on some level, but what does that actually mean? Well, in most cases, what it means is that, while they’ve learned these (admittedly) valuable lessons about reality, they may also have learned to suppress their irrational wishes, maybe even lose touch with them.

Then what?

Well, to most people, having ditched everything irrational, all that’s left is the humdrum, the ordinary, the boring – that is, going ‘straight’. But somehow, a lifetime of being good, of being realistic, of not wanting more than you can have, of settling for the regular stuff, doesn’t seem that thrilling, that exciting, or worth fighting for.

And there’s something else, too: living life that way doesn’t seem to fit with your insides. You hear a great song, see a great movie, read a great book, and you feel something inside you – something above and beyond the normal, the safe, the regular. It makes you want more out of life than just playing it safe and being good, and it makes you want more out of yourself than just falling into that long, grey line behind everyone else.

And what about those ‘weird’ feelings that come up inside, especially when you’re young – the ones that no one really talks about? Wanting to hurt yourself, or other people? Sexual feelings, or desires, that aren’t the ‘norm’? Crazy thoughts, about all kinds of stuff: running away, experimenting with drugs and alcohol, living an ‘alternative’ life, being different? You’ve been taught that these things are ridiculous, wrong, bad: yes, you understand all that, but the thoughts, the wishes, are still there. Are you supposed to just squash them, push them away, and march along with the crowd, acting normal, keeping your secrets inside?

Whom do you talk to about it? Your school guidance counselor – the nice one, who’s  trying to get you ‘on track’ for college and a ‘good future’?

Nope.

Your parents, who would just be worried – and mad, that you’re going against everything they’ve tried to drum into you all these years?

Nope.

You keep it to yourself. Maybe smoke dope alone in your room, late at night, trying to get away from all the pressures to conform.

And if you’re already an ‘adult’, already grooved into regular life, what do you do? Well, variations on the same theme: maybe drink alone in the living room, late at night. Maybe have an affair, then feel crummy about it. Maybe try to lose yourself in sports, activities, interests, raising kids, work.

And maybe, just maybe, see a therapist, to figure out:

What’s wrong with me?

Well, very often what’s ‘wrong’ with you is that your dreams are under lock and key, exiled deep in a bunker inside of you. And even if you somehow got access to them, you wouldn’t know what to do with them anyway. You’re not really going to run off and join the French Foreign Legion, or become a hobo, or immediately act on any of your dreams, anyway, so being in touch with them just hurts, right?

But a therapist knows what to do with your dreams. When we can haul them out, together, and take a look at them, in a safe and accepting environment, they can work for you, in ways that might surprise you. It is possible to lead a life that doesn’t feel staid, constricted and boring – and sometimes it isn’t that different from your current life, but it requires the therapist doing what your parents couldn’t: letting your dreams ‘breathe,’ so that they can interact with, and be affected by, reality, without being mocked or squashed. They need to evolve, and, like growing a plant, this involves water (attention), good soil (a safe environment), and time.

How does this work? Well, it could look like this:

Sometime in the mid-Eighties, Harry, a big, burly guy in his early forties, came in to see me. At first glance, he looked like he should be the owner of a bustling Italian restaurant, or maybe a ‘mad’ sculptor (a lovable mad sculptor, that is). But what was he?

Yep – an accountant.

He told me that he came from a very difficult family background, in which his father was an alcoholic, his mother (“She was wonderful”) died when he was seven, and his ‘mean stepmother’ (yes, they really exist!) was always yelling at his father for being a weakling and a failure.

So where did this leave Harry? Well, on his own, mainly, unless his father wanted someone to make a ‘milk run’ to the liquor store for him, when his stepmother wasn’t looking. Not only did procuring a bottle of whiskey for Dad bring him a “Thanks, old boy,” but even a pat on the head and sometimes a quarter: “Here ya go kid – stuff yourself with Snickers.” When you’re starving for attention, even a pat on the head and a couple of Snickers can be a big deal.

There was no planning for Harry’s future, no encouragement, nothing but staying out of range of his stepmother. One day in high school, Harry was called in to the office of the school guidance counselor: the infamous Miss Magreblian. Apparently it was a requirement that every student had to see her once a year.

Harry dreaded it.

She was a tall, reedy ‘spinster’ lady in her fifties, with “not an ounce of fat on her, and a face that would stop a clock” (Harry’s exact words), and she had a reputation for being mean and scary. But she wasn’t mean or scary to Harry. He thought maybe she felt sorry for him – Harry remembered she once came up to him in the hallway and said, “Do you even have parents?” telling him that she had tried to contact them, repeatedly, for some reason, and struck out. His Dad had never been to any of his schools, not once, and his stepmother – well, it was best to keep her away from any part of his life.

He sat there quietly at Miss Magreblian’s desk, while she leafed slowly through his records and his test results, until she finally put the paperwork down and looked at him, with a small, pitying expression. Then, she sighed heavily, and said,

Harry – here’s the deal. You come from nothing and you’re probably on your way to nothing, but I’m going to say this anyway, because I’m supposed to offer you guidance, whether you use it or not. You’re not a bad kid – not a particularly bright kid, either – but all in all, you might make something of yourself, because you’re mostly quiet and get your work done. And I’m guessing you get it done with no help from anyone, either.

Harry squirmed in his seat, unused as he was to being talked about at all. Even though her words kind of hurt and made him uncomfortable, he also liked it, a lot, that she was acknowledging his existence. He nodded, “Yes, Ma’am.”

She sighed again, and went on, chewing her pencil thoughtfully between words.

So, here’s what I think: as I’m sure you’ve figured out by now, the world revolves around money. Now, there are two ways to get it, legally. First, come the people who are smart enough to make a lot of it. Then, come the people who help the smart people take care of what they’ve made.

She paused, chewing thoughtfully again.

I’m thinking you’re the second kind – the helpers.

Harry wasn’t sure if he should be insulted or grateful. They sat there in silence for a moment, until he managed to sputter, “So, what does that mean – you know, about me?”

She waved her hand at him. “Quiet – I’m thinking.”

Wow, imagine that: someone was actually taking time to think about him. He knew, somehow, that her next words would shape his whole life. He noticed he was holding his breath.

Finally, she tapped the pencil on her desk, decisively, three times. “An accountant, I think.” She paused, chewing the pencil again, and looking at the ceiling. “Yes, that’s it.” She carefully placed the pencil back in her desk tray, with finality. “Harry, I don’t know if you have it in you, but that’s what you should shoot for. If you don’t make it – well, you’ll still have a college education to fall back on. And a quiet kid like you, who does his work, can always manage to scrape by.”

She looked at him with a not-unkind expression. “I think we’re done here.”

So that was it: the gods had spoken. He was supposed to be an accountant, if he was smart enough, and hard-working enough, to make it. If it wasn’t exactly thrilling, at least he knew she was right about that money stuff: anyone who could help the smart people who made lots of money, take care of it, would always have a job, somewhere.

Well, Harry rode that interview for the rest of his life. He did attend a local community college, then transferred to a state college, majoring in accounting. He graduated – not with honors, maybe, but he’d had to wait tables practically full-time – and eventually, went all the way through and became a CPA. He got married, had three children, owned his own home, and had a German shepherd he called Miss M, in honor of you-know-who.

All in all, a “nice life.”

So what did it mean, that one day he walked into my office for the first time and said, “My life isn’t enough”?

That his whole life was a sham, or a mistake, or a mess?

No – to me, it just meant that he had reached the next stage: the stage where he could take all that he’d worked for thus far (successfully), and add to it. He had enough experience now, enough self-esteem, to recognize that fifteen minutes of guidance, given him twenty-five years before, was not enough to carry him through the rest of his life.

Sadly, I find that many therapists are too eager to ‘rip into’ their patients’ lives, to dismantle them (“How could you stay with him after that?”), to tear them down, like malfunctioning engines. Instead of helping to build on what is already there, they assist people in creating major, unnecessary drama and pain. So often, the ‘problem’ is not the existing family relationships, or the existing job, but an inability to access what is inside, and put it to good use, in a way that also preserves what the person has already built up over so many years.

The Wizard of Oz is a classic example of what I’m trying to say: Dorothy leads a (purportedly) ‘drab’ life on a drab farm with drab people, until she has a kind of spiritual awakening, that enables her to ‘see’ her life in a new, colorful, richer way than before. The real problem, ultimately, was her inability to appreciate what she already had, rather than the seeming drabness of her surroundings and people.

And yet, if Dorothy had come to therapy at the beginning, many therapists would have in effect agreed with her initial ‘take’ on the situation, and recommended leaving the farm as the solution, i.e. that she “had a lot more ‘going on’ than the other people on the farm, greater dreams, and more potential” – needs that (supposedly) couldn’t have been met on the farm.

But what was the actual solution? It was Dorothy’s ‘stepping up’ to take a more empowered view of the people on the farm – her own view: instead of being the little, passive girl who lived amongst all these ‘big’ people, who were beyond her ken, she (or at least her unconscious) stepped up to see each of them as they actually were – flawed beings, each of them needing something specific to be complete. In seeing these ‘adults’ as merely human beings, like herself, she was able to join them in the human race, to feel like we are all in the same boat. And ironically, in seeing all of their flaws, she was able to see them (and herself) in all of their beauty, as well.

And so, in the end, she didn’t have to leave the farm after all, in order to be her real self: she merely had to step up (where she was) to a more empowered self, and a richer, fuller, inner and interactional life.

So, the therapist’s job is to help people find, and follow, their own ‘yellow brick road’ to inner consciousness and empowerment – not help them run away to what A. A. calls a ‘geographic cure.’ Someone once said, “Wherever you go, there you are,” and that’s true, as far as it goes. What’s more true is this: “If you’re not ‘there’ here, you’re not ‘there’ anywhere.” Movement in space isn’t the answer – movement inside is the answer.

So, the next time you “wish for a pony,” take a closer look (maybe, with some help): you might already have one!

And Harry? Well, in therapy, he ‘remembered’ that he’d always wanted to sing in a barbershop quartet. These days, you might see Harry on the weekends, in a church, or a retirement home, or even on a stage, singing Sweet Adeline, with three of his closest friends. I went to see them once, and they won a local barbershop contest.

Harry came up to me later, with a big smile on his face, and said, “It’s like magic!”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

I’ll Be There

hobo

 

 

 

 

 

 

 

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.

October, In the Rain

IMG_0774

 

 

 

 

 

 

 

It’s October, in Upstate New York.

Turning leaves.

Raking leaves.

Burning leaves.

And this year, I’ve got a front-row seat for all of it. I’m in Cooperstown, New York. I’m sitting here in my cottage on the shores of Otsego Lake, looking out my window at the lake, through the soft rain that’s been falling all afternoon. Looking at the flame-orange and yellow foliage on the trees – their last, glorious act of defiance, before winter pulls down the curtain on the show. But what a show!

I came here to worship at the Baseball Hall of Fame. It’s located here because, back in the Thirties, a group of guys got together and decided to say that baseball was invented here, by a guy named Abner Doubleday – a Civil War hero. Well, long story short, but d’ohh, it wasn’t, and everyone knows it. But here’s the deal: whoever thought of locating this thing here in Cooperstown was a genius. I mean, if they needed to say that Christ was raised from the dead in Cooperstown to get the darn thing located up here, it would’ve been worth it. Because this place is so utterly beautiful in the Fall, it’s practically criminal. After seeing all this, I feel like every other burg in America should be arrested for impersonating a small town in Fall, because this is IT.

I mean, if there was an All-Star game for the seasons, this place would have to represent Fall, hands down:

And now, ladies and gentlemen, put your hands together once again and welcome your unanimous selection for the season of Autumn: Cooperstown, New York!

All that Fall stuff, and Americana, too. As far as the Americana part of it all, well, I guess it’s understandable: once Cooperstown was chosen as the site for the Hall of Fame, it was committed to keeping its old-time flavor, and that’s as it should be. I mean, you will not find a McDonald’s on Main Street, or a Wal-Mart, or a Taco Bell. I did find a Price Chopper store, but it’s kept discreetly out of the way, like an embarrassing relative.

So what it comes down to is this: Cooperstown is what we, in our modern cynicism, would call a Theme Park. But is that so bad? Hey, we need Theme Parks! I remember, years ago, when I was on a business trip in Florida and visited Disney World in Tampa. And they had this thing called the World Showcase, and it had areas that were supposed to look like Germany, and France, and they did! I mean, heck, I knew it wasn’t Germany, or France, but it did kind of give the feel of those places, and I enjoyed it. And, in the original Disneyland, my favorite part is the one that’s supposed to look like the French Quarter in New Orleans, and you know what – it does look like the French Quarter in New Orleans, and if you hang out there in the evening, and have a couple drinks, it’s like being in the French Quarter. And no, that’s not a bad thing, it’s a good thing.

And for that matter, aren’t our whole lives kind of like a Theme Park? I mean, we decorate our houses to give the ‘feel’ of something or other, don’t we? It’s not like the visitors to our homes actually look around the living room and think, for example,

“Wow, the Bernsteins really ARE the leaders of the Arts and Crafts Movement in America: they live a life of aesthetic perfection, because I can see that that special celadon vase with the dragonfly imprint goes so well with that painted tile on the south wall over there.”

And how about the way we dress? Do people actually look at a woman and think,

“Oh my god – she’s the living embodiment of Dior! And she has accessorized so perfectly that it takes my breath away! She must spend all her time in Paris at the feet of the masters!”

I don’t think so. All we really want is a momentary Theme Park: “Oh, yeah, you’ve got the right idea. You go, girl!” That’s good enough for us, right? We’re going for an impression, a ‘feel’, not a full-on identity. We’re, all of us, impersonators, to one degree or another.

And in that sense, Cooperstown really does its job. Baseball, more than any other sport, celebrates and treasures its old times and its old players. Even the casual baseball fan knows something about Babe Ruth, Lou Gehrig, Ted Williams and Willie Mays: the really famous guys. And the Hall of Fame is a shrine for the casual fan, because it’s about the Really Famous Guys. The average Joe who makes the pilgrimage to Cooperstown wants to look at a plaque, turn to his wife and say, “Oh yeah – I know that guy!”

Yes, there is a fantastic library, which is a fabulous resource for the hard-core guys: the writers, the researchers, the people who are sitting up nights obsessing about  OPS+, and the research facility also houses a staggering amount of memorabilia, artifacts of the game, that tell the story of baseball in the objects that have been associated with it. Rotating group of these artifacts are on display in the ‘museum’ of the history of the game that you can walk through at your leisure and ooh and aah over: baggy old flannel uniforms, tarnished trophies, the battered catcher’s mitt that Mickey Cochrane once used, the cap that Casey Stengel wore at a Yankees’ old-timers’ game, the bat that Babe Ruth leaned on when he said goodbye to us forever.

It may seem childish to ‘outsiders,’ but to anyone who loves this beautiful old game, these are holy relics.

But back to this lovely little town and looking at the lake through the rain. This little town’s job is to be Evocative, and evocative, even if it’s only ‘theme park’ evocative, is wonderful. It reminds me of a movie I saw a long time ago, called Bachelor Party. Nope, not the Tom Hanks one. Definitely not the Tom Hanks one. The 1957 one – one of those ‘prestige,’ social commentary jobs, written by Paddy Chayevsky, that were so prevalent in the Fifties, with Don Murray, E.G. Marshall, and Jack Warden. At one point, one of the characters tells the story of going out with a woman who asks him, “When we go to bed, please, just say you love me.”

So it’s kind of like that for me here: I don’t care if the people who work in the cute little diners and shops on Main Street actually aren’t wonderful human beings in their ‘real’ lives, whether they forget their kids’ birthdays, cheat on their taxes, or sometimes shoot up something stronger than aspirin; I just want them to LOOK LIKE they’re nice people, so I can get into that evocative space that this place is all about. I want to float along Main Street and pretend, if I feel darn well feel like it, that I’m back in the 1950’s, or even the 1900’s.

Just SAY you love me, Cooperstown!

So I went and saw a life-like statue of Ted Williams, I genuflected to Stan Musial’s bat from the 1946 World Series, I rubbed the bronze plaque of Babe Ruth (I noticed that Ruth’s is the only one that is  worn absolutely smooth, from decades of spontaneous affection), and I even listened to Abbott and Costello’s ‘Who’s On First’ routine once again.

And now I’m back in my hotel room, looking out at the lake, and the rain, and thinking. I’m thinking about how, in some ways, we are all impersonators. Yes, we admire those Hall of Famers because they actually got out there and DID it, in the big-time.

But real life isn’t that simple, or substantial: a lot of life is about how we’re SEEN, and how we’re seen matters to us, a lot.

Perception.

A therapist lives with the issue of perception all day long:

How is the patient seeing me?

How does the patient see the therapy?

How is the patient seeing himself?

How does the patient feel about his life?

Because there is very little actual difference between the life of a person who is severely depressed, and the life of the same person when he/she is feeling ‘better.’ The difference is, mostly, perception. Are you actually functioning much better, in real terms, when you’re feeling good about yourself and your life? Are you actually doing a better job at work, functioning more maturely in your relationships, making more money, being a finer human being, making the world a more worthwhile place?

No, not really.

You just feel like you are. But that makes all the difference.

After all, on Monday, a patient might feel like a loser, a failure, and a bum.

On Tuesday, he starts taking Prozac.

The next Monday, he comes in beaming:

Life is good.

I am worthwhile.

I look forward to each day.

What happened? Did he have a spiritual awakening over the weekend? Did he find a four-leaf clover? Did Jupiter align with Mars? Nope – he started taking a little round pill before bedtime each night, and he feels differently about himself and his life.

Perception.

Why is it that one person, with terminal cancer, can feel calm, settled, and appreciative of life, whereas another person, who is perhaps privileged, healthy and in the prime of life, can feel desperately miserable and tortured?

Because it is not so much what is going on in the patient’s life, as it is his or her relationship to what is happening. What a therapist does can be very complicated, steeped in convoluted theory, and infinitely challenging, but it all ultimately boils down to two basic tasks:

1) Teaching the patient a new way to ‘hold’ the facts of his life.

2) Creating a safe place for him to do so.

Each and every therapist will accomplish these things differently, and differently with every patient, but the success of the therapy will primarily hinge on these two jobs.

And how do you accomplish those two jobs?

Ask me later.

Right now, I’ve got a lake to watch.

 

 

 

 

 

 

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

Grow Up, but Stay Small!

shutterstock_111483011

 

 

 

 

 

 

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.

Leaving.

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.