Friday, April 18, 2014

Two case histories

I once worked with a teenager for over two years, and in most of that time, especially toward the end, I had difficulty accepting that he was as determinedly steeped in futility, dysphoria and negativity as he was.  It hadn’t just been the happy moments in session, where we shared some hysterical laughter, that made me think he hid the sun behind a glum cloud, or tongue-in-cheek.  It was also his rationality – knowing that life after 18 and liberation can be more delicious than anything he’d experienced.  And his normalcy that related to adults nicely, was not regressively stuck on his parents, was modestly forward-looking, and spoke of his crushed spirit in an affable and wise way.

I was solidly aware that this young man’s history had put all the right notches in his soul to bring him to this state.  Included were a parent’s abandonment, formative years of physical and mental abuse, early bullying, severe reversal-of-dependency with the other parent, and very premature autonomy where he fed and got himself off to school, with no “raising.”  And I was forced to admit that the pleasant, mature surface he carried hid within not an ounce of initiative other than to fly to the flame of self-medication.  Still, were a giant of a manly man to swagger and bellow – “I’m a coward, so watch out!” – my confusion over a paradoxical impression would not have been greater.

Most therapists, if not most anybody, will grasp that the mystifiers causing my client’s deceptive impression were his intellect and an inability to feel pain in my presence.  The depression was experienced at home, but in my office it was only referenced.  In three years there had never been a tear, or a child’s expression, or even a request for help.  Only, pure defensiveness so well established at an even earlier age that it had seeped into the deepest part of his psychic foundation and couldn’t remember how to feel challenged.  There had been, actually, one moment at the beginning of therapy when I allowed my frustration at a child’s precocious defeatist philosophy to come out in a harsh tone.  Fourteen years old, he had shown fear, probably of another abandonment.  I quickly finessed, he recovered, and that was the last time his reality showed itself.

Did therapy help him?  Yes, but I hate to say that I believe this possible delusion is true: More good happened in the final hour than in all the time before.  And I hate, again, to say that after that one frightened confrontation, followed by dozens of efforts to impale his sick mantra against the wall, I became both fearful and resigned about revealing the real child under his cover, and never deeply pressed his emotions again.  Until, that is, the last session, when my own childhood and lifelong fears of facing a boy, a man, a male, had to be put aside.  That’s when I could offer him, by pushing aside my own guarded empty place, a hand and more intimate sincerity than anyone had ever given to me in a lifetime.

The circle would close, of course, if I could bring my father back from the grave then do something even harder than that – wake him up – and have a father-son moment.  The kind of moment that makes a boy feel OK to be the boy he is and later, the man.

My heart leaps up when I behold
    A rainbow in the sky:
So was it when my life began;
    So is it now I am a man;
So be it when I shall grow old,
    Or let me die!
The child is father of the man:
And I could wish my days to be
Bound each to each by natural piety.

(My Heart Leaps Up, William Wordsworth, 1802)

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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.