How Psychotherapy Ruined America

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

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

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

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

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

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

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

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

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

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

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

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

First YOU – then everyone else.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

Rocky Road (Part II)

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A while ago, I wrote a blog piece called Rocky Road, about a folk song, not a road. Well, this is about a different rocky road, but still not a road. This one is about coherence, elegance, fittingness, and grace: the quality that would have inspired my mother, when looking at a living room, to nod approvingly, and say, “It’s pulled together”.

Today, my daughter, who’s in the music business with Sony, and the songwriting business with herself, in L.A., told me about a ‘pop’ song on Youtube that she wanted me to check out. I watched and listened. It was odd, unusual, fascinating and even a bit disturbing, but it held my attention from start to finish. It definitely wasn’t my ‘thing’, but I definitely appreciated it. I fished around for a way to describe its merits, and finally emailed her the following:

Well, it’s like this: you can eat almonds, then marshmallows, then chocolate ice cream, and it’s all pretty darn good. But when you eat rocky road ice cream – that’s something else again, something a whole lot better than the sum of its parts. This song has an artistic vision that’s cohesive and consistent, with a real authorial ‘voice’ to it. It’s pulled together. It’s rocky road.

And that’s the goal of the kind of therapy I do: to help people become someone, some particular someone, who’s cohesive and ‘of a piece’ – pulled together. But why do people need this, and how do they get to the point where they need it?

Well, think of a baby: what does it do all day? It just babies around, needing things, blurting out whatever is going on inside it, drinking when it’s thirsty, eating when it’s hungry, and then peeing and pooping it all out. That’s its job, and it’s good at its job. So far, so good.

But then storm clouds appear: Mom gets mad for some reason when I poop, Mom gets nervous when I crawl near her special vase, Mom looks really tired when I cry too much, or ask too much, and her mouth turns down when I don’t respond the right way to those stupid noises she makes (later I found out they’re called Words – big deal); so I try not to poop, but mostly it doesn’t work, I try not to ask too much of her, but what am I supposed to do when I can’t do things for myself? And I try to smile like she likes when she makes those stupid noises, but sometimes that makes her mad, too – especially when her mouth makes a circle and she goes “NO!” Jeez, if saying “NO!” makes her that mad, why does she keep doing it?

The whole thing’s crazy to me, but it’s the only game in town, so I try to work with it the best I can. Trouble is, after a while I get so caught up in trying to ‘game the system’ to get goodies and smiles instead of “NO!” and loud voices, that I kind of forget my insides – I forget what I feel, what I need and, well, I kind of come unstuck from who I am, inside, so I’m more drifting around in search of not getting in trouble than I am being Me. Being Me didn’t work – drifting around did – kind of, so I became a better drifter than a Me. And, after awhile, I kind of forgot the Me anyway, so I didn’t mind it that much.

Drifting isn’t really that bad, once you get used to it. And later I found out that most people really don’t mind you not being a Me anyway, as long as you do the stuff they want and expect. It’s kind of like wearing a magic suit: as long as you have the magic suit on, you can ‘pass’ for real, and no one ever really checks your id anyway (no, not Freud’s ‘id’, I mean your identity, though come to think of it, no one really ever checked Freud’s id, either, but we’ll let that go), so you’re good to go.

Then, when you get to school, the whole thing works even better: the kids who get in trouble are the ones who are too much Them, whereas the ones who can play the fake-Me game hardly ever get in trouble, and since they don’t stick out too much and do individualistic things that draw attention to themselves, they don’t get teased or picked on very much either. And if they are tempted to revert back to being Them, all they have to do is look at what happens to the weirdos who aren’t smart enough to hide out in their magic suits. Boy, nobody wants that, right?

So, you pass along smoothly, grade to grade, until graduation. Uh oh – now people suddenly start asking you stupid questions – things they never asked before: What are you going to do with your life? What are your PLANS?, and things like that. Holy cow, what’s with the sudden interest? No one bothered you with that stuff for years and years, and now, boom – suddenly, they HAVE to know? But, not to worry – as it turns out, they don’t really mean it: you can just go to college and they don’t bother you for a few more years. Yeah, some of that Me stuff crops up in college: stuff like your MAJOR, and having to do a lot of schoolwork that seems meaningless, but mostly you can just pass your classes and put it all off, and it works pretty good. The magic suit still protects you, and besides, now there’s drugs, alcohol, sex, music, movies, and relationships to distract you from You and to distract other people from bugging you about You. Whew.

The real trouble starts after all that – when you enter the Real World, which, as it turns out, isn’t all that Real either, but here’s the rub: now you find out it isn’t enough to just Get By. Sure, you’ve still got, maybe, a Job, maybe a Relationship, and maybe even Kids, to distract you from You, and to keep everyone else off your back (since you’ve done the Regular Thing and gotten a Job, a Relationship and maybe even Kids, they shut up and leave you alone), but as the years go by, you find yourself wondering: What am I doing in this life? How did I get into all this? What’s wrong here? I still play The Game, I still wear the Magic Suit, but somehow, it doesn’t work for me anymore – it isn’t enough. And the last time you said “this isn’t enough”, Mom got really, really mad, if you can even remember back that far.

You find yourself wondering if, maybe, you made a mistake by detaching from your Me and wearing the magic suit all those years: but what choice did you have?  You had to survive, didn’t you? And how could you possibly have known that, one day, just coasting wouldn’t be enough? But damn – by now, you’re so out of practice being a Me that you couldn’t find your way back with a dowsing rod, a GPS unit and Daniel Boone to lead the way. You’re Lost, is what you are.

You wish you could just sleep through the whole thing, but you can’t even seem to sleep right anymore, so you get up and pace around for hours. You try drinking, but that just makes you feel like hell the next day. You try smoking some weed, but no matter how good you might feel for a while, you have to Come Back – and when you do Come Back, you’re even further behind than you were when you left. You might even try an affair, or overeating, or overworking, or getting massages by cute girls with ‘happy endings’, but here’s the problem with all of these ‘fixes’: they might change your relationship to reality for a while, but they don’t change REALITY. And reality is – you’re lost. You’ve lost your connection to yourself, and you’ve lost your way back to who that person ever was.

You realize, now, that it’s not about pleasing everyone, or being good, or doing the regular thing, or blending in, or not standing out, or having Mom smile.

It’s about Your Life.

Shit!

So, now what?

That’s where I (or someone like me) come in.

I’m a patient Daniel Boone, a friendly dowsing rod, and a GPS with a heart. I’m Howard, the maddening old goat of a prospector in The Treasure of the Sierra Madre. Together, we set out to look for signs of Gold – your lost Me. We talk, feel and pay close attention until a trail emerges, a trail an old buzzard like me knows how to follow. In the meantime, I don’t get mad if you have to poop, I don’t smile just because you act like you like it when I say my stupid noises (Words – remember?), and I don’t turn my mouth down just because you need more than I can give at the moment: we’re after Gold, not the fool’s gold of feeling good temporarily, or the relief of not facing hard things, or the comfort of coasting along. I’m interested in You – not in you doing things the ‘regular’ way, or the ‘right’ way, or the way everyone else does it. I’m interested in helping you find your way, and Your way.

At first, it sucks. It sucks to sit with feelings, and needs, you long ago decided were “stupid”, “embarrassing” and “weak”. It sucks because you have no idea what’s happening, it sucks because you don’t know what to do, and it sucks because you hate not knowing what to do, and being bad at things, and man, you are bad at this.

Of course, that’s when your friendly local therapist says, “Naturally – that’s why we’re doing it.”

Shit – who’s on first?

So, you sit there with tears in your eyes, or anger boiling up inside you, or sadness pressing down on your shoulders, or all three, and you ask me, “So, what am I supposed to do?”

And I answer, “You’re doing it.”

What the hell!

You think, the heck with this guy – where’s the instruction manual for this shit?

There isn’t one. Turns out sitting there and feeling whatever you’re feeling is actually supposed to DO something, but the son of a bitch won’t say just WHAT it’s supposed to do, or WHEN. Damn, where’s that Internet site again – the one that says that Cognitive Behavior Therapy can get rid of this stuff in just a few weeks? Jeez, for the first time in your life, you’re asking for homework, and the guy won’t give you any! What has your life come to?

So you sit there some more, feeling, talking; it’s weird, but it actually feels kind of better: not all the way, but you can see that maybe this guy isn’t just lying to keep you coming to therapy and wasting your time: maybe there is some kind of “process” (oh, he LOVES that word!) that is going on, that might actually change your life. And it is starting to feel like, maybe, this guy is on your side – not that you asked for that, or need it, or really care, mind you, but, well, he seems to actually care about you and how you’re doing, and he never uses stuff you tell him against you, like you thought he might at first.

This guy is weird – this whole thing is weird, but you do feel better, and you think you’re learning things about yourself, though you almost never actually talk about your ‘stuff’ directly, and he never actually ‘teaches’ you things, exactly.

The whole thing is just – weird.

So, like the greenhorn would-be prospectors in The Treasure of the Sierra Madre, he drags you up hills and down dales, as cactus and brambles tear at your clothes and dangerous animals lurk in the dark, but you keep a goin’ until the hills and dales seem to flatten out a bit, the scary animals seem less frequent and less scary, and you actually begin to see signs of Gold – real gold, not that quick-fix, tin-plated, phony stuff that the suckers believe in.

And you think, “The Gold doesn’t look like I thought it would, either – it looks, well, more like ME. This is not what I set out to look for – I wanted instructions, and tips, and brilliant insights. But now I, myself, seem to be coming up with instructions, and tips for myself, and some not-too-shabby insights about myself, to boot. After all, I am the expert on Me. Imagine that.”

So, after a while, after you’ve worked hard, and stayed on the trail, and suffered some bramble scratches and cactus scars and maybe fought off a few wild animal attacks, you look at yourself and you realize,

I’m of a piece, I’m pulled together, I’m a Me.

I’ve got good stuff inside me: nuts, marshmallows and chocolate. But I’m a lot more than my pieces:

I’m Rocky Road!

 

 

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

Understanding

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The Blue-Footed Booby

 

Understanding is the booby prize…
— Fritz Perls

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

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

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

What’s wrong with me anyway?

Why am I like this?

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

Always: WHY.

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

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

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

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

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

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

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

Indeed.

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

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

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

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

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

The patient needs an experience, not an explanation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

 

 

 

 

 

 

 

 

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

Dive! Dive!

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

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

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

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

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

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

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

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

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

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

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

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

Doing What You Came Here For

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I place on the altar of dawn
The quiet loyalty of breath,
The tent of thought where I shelter,
Wave of desire I am shore to,
And all beauty drawn to the eye.

May my mind come alive today
To the invisible geography
That invites me to new frontiers,
To break the dead shell of yesterdays,
To risk being disturbed and changed.

May I have the courage today
To live the life that I would love,
To postpone my dream no longer
But do at last what I came here for
And waste my heart on fear no more.

A Morning Offering, by John O’Donohue

 

You have been given the gift of life – and, if you’re lucky, a bunch of decades to do your thing.

Alright, what is your thing?

Checking your Facebook page 500 times a day?

Acting like everything is okay when it isn’t?

Fitting in, so nobody gets upset?

Keeping so busy that you never have to be with yourself?

Doing just enough to keep out of trouble?

Putting your head down and just repeating what you did yesterday?

What if you looked at yourself in the mirror every morning, and said,

Well, for cryin’ out loud, here I am again. They gave me another whole day. For all I know, it may be my last. What am I going to do with it? What could I do that I would look back on tomorrow and say, “Kid, you took that precious day and did a pretty good job with it.”

No, I don’t mean being a ‘do-gooder’, though, sure, that may be one thing you could do with it. I’m talking about living from the inside out – ‘manifesting’ (eeww: buzz word alert) who you actually are, out in the world. What is it to be you? I’m talking about coming up with an active answer to the complaint, “I never get a chance to really do what I want to do. I never get a chance to be who I really am.”

Sure, maybe you’re a jeweler and all you ever wanted to be was a newspaper reporter. Maybe you’re working in a day care center and you’re really fascinated by numbers. Or maybe you’re like most people, and you don’t KNOW ‘who you are’. It doesn’t stop you from feeling that you never get to BE who you are, though, does it? You still have that vague unease that you’re not really being YOU, even if you have no idea what that would look like – it still feels frustrating and unsatisfying, doesn’t it?

I can hear some of you saying, “Hey – we can’t all save the world, buddy.” True, but fortunately that has nothing to do with what I’m talking about. I’m talking about incremental steps towards letting the cat (you!) out of the bag – small steps for tiny feet. It might start with this exercise:

I always wanted to _______________ (fill in the blank).

I wish just once I could ________________.

The people I really admire are ______________.

I can hear the classic comebacks:

If wishes were horses, beggars would ride.

You can wish in one hand and spit in the other, and see which one fills up first.

Yep, I get it. Just wishing alone does nothing. But wishing can lead to more than ‘nothing’: most new things start with an idea, a wish, a concept, a drive, a desire, a ‘vain’ hope – and then, by allowing those things to rattle around in our heads and hearts, they lead to a wish, dream, concept, drive, desire, and hope, that is more realistic, that is a first step, that is a revised version of the original dream.

The hokey saying, “dreams plus effort equal success” is not so crazy after all – because the primary thing holding us back from reaching some version of our dreams is that we give up before we start, mostly because, at the start, we can’t envision the modified version we might end up with. If you talk to people about their lives for a living, as I have done for decades, you begin to hear things – like the fact that, at the beginning, most people had never heard of what they ended up doing for a living. And, if they had, they might have rejected it because it was not “what they dreamed of”.

It takes emotional work to process a dream. Let’s say you start out wanting to be a famous performer. Of course, you know the odds against you are astronomical: you may feel you’re talented, but not that talented – so you give up, accepting “reality”. Now, what would happen if you continued with your dream?

Well, just as a representative example, this was the sequence of events for a woman I worked with, we’ll call her Josephine,  who dreamed of being a performer:

1) You take singing and guitar lessons – you do pretty well, but nobody ever suggests you should go on American Idol.

2) Nevertheless, you do develop your singing and playing ability, and your performance ‘chops’, to the point where you are able to perform at local open mikes. You get some pretty good responses, but again, no one says, “I’ve never heard anyone as good as you, Josie”, either.

3) Hanging out at the clubs, you get to know more and more people in the music scene, and also land a few paid gigs at local spots. It is gratifying, and some people really like what you do. You meet an agent who is in the audience at a local club you are working, and she’s a really cool person. She doesn’t offer you anything, but you talk a lot together, and it’s pretty interesting. Maybe this thing could actually work.

4) You get a better gig, but it’s on weekends, out of town. You are hostessing at a nice restaurant where you live, and on weekends you can make pretty good money, even though hostessing is a million miles away from what you really want to do. But you can’t afford to quit your job just to pursue one gig out of town. What do you do?

5) For some reason, you call the agent you met at that club – you end up talking to her for two hours. She talks to you like a Dutch uncle (aunt?) and says, kindly, “Josie dear, you’re an amazing person, but to tell you the truth, I don’t feel you have what it takes to make it as a performer.” She’s nice about it, but it hurts, bad. But on the other hand, there’s something about her that you trust, so you can’t just dismiss what she’s saying.

She does say, “You should call me sometime, when you’re feeling better. We should talk.” (Whatever that means.)

6) You cry – a lot.

7) You cry more – a lot. (Hopefully you have good friends. They help – a little.)

8) When you get off work late one Saturday night, you suddenly remember that the agent said to call her sometime, when you’re feeling better. You check: Hmmm, you’re feeling better, marginally.

9) You call her, hoping against hope that she has reconsidered her death sentence of you, and wants to work with you on your performance career.

10) She doesn’t want to work with you on your performance career – but, she does want to talk to you about something else. She’s a top agent in town, and has noticed that you are good with people, and know a lot of folks locally around the music business by now. She is trying to expand her business, and, maybe, could use someone like you. Of course, you would have to “start at the bottom”, but she feels you might have it in you to grow into a significant role in talent representation one day. You’re flattered, sort of, but inside you’re still really wounded that she didn’t want to talk to you about you-know-what. But, you tell her you really appreciate her time and comments, and you’ll have to think about it and get back to her.

11) You sulk alone. You sulk with friends.

12) Hmmm, you sigh a lot, but it kind of makes sense, what she said: you are a good judge of others’ talent, you are good with people, and you have always liked helping people pursue their dreams, even if you can’t pursue yours.

13) You cry.

14) (Sigh) You call her, and say you’re willing to talk more about it. (Sulk)

15) You do talk more about it. It’s starting to sound like a possibility: Your friends say, “I can totally see you doing it – helping people like that.”

16) More sighing – after all, if you accept this, it means throwing away your ‘real’ dreams, right?

17) Secretly, you’re getting kind of excited about this whole thing: “Wow, I could work for a talent agency: I’d still get to be around performers, watching them, helping them, and I always thought I had a good eye for talent.”

18) Last-ditch sighing, last-ditch crying. First-ditch excitement – all mixed up together.

19) You make a decision: you’re going to do it. It’s not as much as you’re making hostessing, but it’s in the field you love, and the potential in that field is a bit greater than in the field of guiding drunk people to their tables.

20) You have a new dream: Being a talent agent. “Gee, now that I’m a ‘professional’, I have to get some real working-woman clothes. This might be fun!”

Okay, I can hear you (you, reading this – you know who you are) saying, “Oh sure – he came up with an example where it all worked out, but what percentage of the time does that happen? My Uncle Moe wanted to be Enrico Caruso, and now he’s a broken-down bum on Skid Row. Dreams, schmeams.”

Folks – this is the way it REALLY happens, not pie in the sky. No, not every person finds work that is a perfect fit, and yes, this story would sound very different if Josie were a man, say, but I have helped many, many people “evolve” their dreams. And note: in the example I gave, Josephine did NOT “achieve her dreams” – but pursuing it did lead her to people, and circumstances, that made it possible to develop other dreams, that were achievable. And she had no thought whatsoever, at first, that being a talent agent was a possible (or desirable) dream for herself; and if I had been prescient (or stupid) enough at the beginning to say, “Josephine, you should be a talent agent,” she would have been hurt and angry, and rightfully so.

Does this mean,

Buy my new book: Twenty Steps To a New Dream, now with detailed instructions on how sulking can lower your insulin level and burn carbs! 

No – of course not. Every single person has a unique path to follow. You cannot ‘know’ beforehand what someone’s path will be, you cannot know beforehand what it will lead to, and it would be arrogant and disrespectful to try to, but you can know beforehand what, basically, needs to happen – that following a dream, with a lot of support, will lead to something meaningful and authentic, even if the path involves a lot of sighing and crying and rejection. Sure, it might hurt sometimes, but sighing and crying are not end points – they are only emotional way stations: if you are willing, sometimes, to sit with the sighing and crying, and have someone who believes in you (a therapist, in the case of those I have worked with), you will move beyond sadness and disappointment, to a new formulation of yourself and your possibilities, and all the emotional processing you have gone through will bring a maturity that will serve you in good stead in your ‘new’ dreams, a maturity you would never have had if you had instantly achieved your dreams (see Woods, Tiger), or if you had stayed home and never pursued them at all.  With a dream, anything might happen; but without a dream, you don’t have a chance.

So, the next time you stand there in the morning and look in the mirror, ask that sleepy guy or gal you see before you, what he or she can do to make sure the day isn’t wasted. It’s been said: “A dream is just a dream, but a goal is a dream with a plan and a deadline.” Jeez, I don’t know about all that: dreams, plans, deadlines –  why not throw in a bag of peanuts and a partridge in a pear tree, too?

But a dream paired with some courage and some help: now that’s a plan!

Where does your plan start today, sleepyhead?

 

 

 

 

 

 

 

 

 

 

 

 

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