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.
Paul: This is hard.
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.
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. . .
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: 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.