Friday, January 31, 2014

Long chain enema bag

December 2013 was a poor month for me, and January 2014 was worse.  I’m an independent contractor therapist working at a boutique offshoot of a community mental health center.  My position, on a cup-half-empty day, could be likened to a cold-call salesman hawking enema bags.

“Knock, knock.”


“You know you want to feel better, more ‘regular’.”

“By far, that is true.”

“Then please – shove this up your ass.  For the next three to six months, maybe a year.”

The vagaries of client attendance are well known to all clinicians, but there may be a little extra looseness for those in my position.  Per-unit income, no salary, no benefits.  No broad opportunity to be one’s own marketer.  New intakes are disbursed somewhat haphazardly, somewhat tendentiously, among all the workers; inflation – more hires – means fewer for each.  Bad economy, people lose insurance.  I believe, additionally, that I may be a demographic magnet for special suffering.  As the male oldster here, I see more middle-aged folk, and more men of all ages.  They have mental health problems, which sometimes include lack of sense of responsibility to make and keep appointments.  And with the younger men, their issues (1) should be solved quickly; (2) are their wives’ and children’s fault.

Another factor is an argument that I’ve invented and therefore pay serious heed to.  “Aren’t” – you say – “the counselors who see young kids in the same boat or worse boat?  Aren’t youngsters rabidly against self-knowledge and improvement and sharing their feelings, and resistant to coming in?”  While that is generically true, I believe a greater force at play is the parents’ need to have their child be the patient, the one with the problem.  This is consonant with Breggin’s observations about NAMI:

“In turn, the parents too often tend to reject responsibility for their children’s emotional anguish.  This phenomenon may well explain the positions taken by the National Alliance for the Mentally Ill (NAMI), a national organization of 100,000 parents of disturbed offspring, whose informal rallying cry can be characterized as “We are not to blame.”*
This being so, the parent is passionately, nobly and consistently motivated to bring her child to therapy.

Yet beyond all these pernicious and self-pitying parameters, I believe that I carry an extra, unique burden.  It is one that can make me feel like the gentle wanderer in Peter, Paul & Mary’s song, Long Chain On  This crown-of-thorns is my particular way of seeing psychology and doing therapy; that is, my primal-related, regressive, feeling-centered approach.

As Paul Vereshack says, “the brain hates pain.”  And as Ralph Klein, M.D. notes in Psychotherapy of the Disorders of the Self (though he is speaking of borderline personality), the “patient does not come into treatment in order to ‘get better.’  Rather, he or she enters treatment primarily to ‘feel better’” (p. 217).  My underlying approach asks the client to question almost everything about himself short of the deepest birth trauma.**  To question the defensive behaviors, the defensive beliefs, the defensive personality.  And to feel the results.  And to stay with and work through the feelings.  Though I encourage clients to “get therapeutic momentum” by attending weekly for a while, looking inward causes them to stop the momentum of their running life: the self-evasions, the delusional happy beliefs.  They sit in a quieted pool, and if things go well, they sink.

People are dysfunctional because of injury, the injury is usually child-deep, and deep means a kind of surgery is needed.  The difference is that this surgery occurs week after week, and the patient must remain awake for it – more awake than she has ever been since childhood.

So I do feel like the song’s wanderer –

            I got my hammer and chisel,
            Offered to set him free.
            He looked at me and said softly,
            “I guess we had best let it be.”

– who could relinquish the chains of a methodology that carries people to places they both want to and don’t want to go, but can’t really relinquish them.  We therapists are embedded in our psychohistory exactly as profoundly as a poet is equal to his verse.  Both professions have frameworks and rules and “ethics” (can you call a poem a sonnet if it has seven lines, a loose rhyme scheme, no pattern of stressed and unstressed syllables?), but are transmuted by the idiosyncratic content of the practitioner.  Most psychotherapists want to minimize the dark parts of their soul, appreciate the intoxication of positive and rational (yet sometimes irrationally hopeful) thinking, and they want their clients to join them.  I have a history that formed a severe allergy to delusion, deception and distraction, to ignoring the elephant and the trichotillomanic child in the room.  I, also positive and hopeful, want my clients to join me in the intoxication of deep reality and clear sight, in the strength accruing to accurate judgment.  Or, if not to join me, then at least to see there is a difference.  I really can’t go anywhere else in my helping: That would return me to the child still alone in his room, watching the powerful people blindly walk by, and pulling out hair.

All in all, it’s actually a pretty light chain.

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* Peter R. Breggin, M.D., Toxic Psychiatry, St. Martin’s Press, 1991, p. 34.

** That is left to “orthodox” primal therapy.

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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.