Saturday, July 19, 2014

Counselor, stifle thyself

How do I write about my quietly subversive and duplicitous relationship with psychiatrists, without jeopardizing my present and future relationship with them? I am not against psychotropic drugs. While I do believe in the potentially higher quality and greater staying power of psychotherapeutic healing, I am no purist. These drugs enable greater functioning, sometimes save people’s lives, and often make them feel different, or feel less, which is usually what they mean by “better.”

Maybe the biggest axe I grind comes out of the conflict between my therapy approach and medication’s and psychiatrists' effect on clients’ attitude about it. Simply put, a number of clients stop coming to see me after they’ve been started on depression or anxiety meds. They don’t ditch counseling when taking antipsychotics and bipolar meds. Why is this?

I will offer to work to mitigate depression and anxiety through depth process. This means digging to the roots and reasons of pain, sometimes staying with and working and crying through childhood agony. Medicine on the brain makes that drastic stuff feel unnecessary, and maybe distasteful. I remember a young man, in 1999, who felt at all times a moribund depression but prepared for therapy – and much of his day – by presoaking in marijuana. By session time he hadn’t the slightest interest in any emotional work: His depression – already a repressive entity – was given a dirty pink coat of paint by the chemical mellow. There was no work to do.

With psychotic and bipolar clients I rarely offer to try to undermine their disturbance, for different reasons. Bipolar is, per Alice Miller, a double-defense package (“grandiosity is the defense against depression, and depression is the defense against the deep pain over the loss of the self that results from denial”*), and so is more deeply entrenched than most mining can reach. Plus, clients are even more likely to believe the biological, not psychodynamic, theory of mania: It looks “chemical.” And while psychosis should, I believe, also be understood to have causes in childhood tragedy,** it is too desperate a problem for community mental health – with its thin walls, concrete Objectives-based treatment plans, easy-listening culture and creamy strength-based mission statements.

I’ve said “I will offer to work to mitigate” depression and anxiety. Often, admittedly, the process will in time moonwalk from sublime to pedestrian if the client proves unable or unwilling to “go deep.” When it does, counseling remains acceptable, does not goose the sleeping giant of medication effects. But it’s in the interim zone, when he or she is in a place of disturbing discovery – first efforts to peel the onion – when the allure of chemical amelioration can turn heads, and leave me an empty chair.

I can’t and don’t confront the psychiatrist about this wrong done to a client. Obviously He, the doctor, is master of the mental health universe. And, She is so lofty not to be ruffled when I occasionally mention published cautions about Paxil withdrawal, or the need to monitor one’s own medicated feeling, or in a reckless moment cite Breggin’s “chemical straitjacket” or “involuntary intoxication,” a concept that has exonerated perpetrators and punished pharmaceutical companies in criminal cases. And yet . . . walking this line, after so many years I have finally come under fire. A perfect storm occurred where my loose lips, the client’s impressionability or ambivalence, and a doctor’s disdain for depth psychotherapy, all collided.

Out of the blue, good therapy clients would consult with the doctor and come away condemning child focus or Empty Chair or my tendency to give information, sometimes at length. Disclosing painful stories of their mistreatment by parents, they would complain to the nurse practitioner or psychiatrist that I had determined their parents were faulty. The weeks or months of complex, heartfelt, empathic and eye-opening process would disappear, replaced by their lamentation about therapy. I could not understand how people I had served with intense effort would, in a sense, betray me – until I discovered the three-fronted storm.

I feel, wanting to be powerful and therefore to have agency, that I brought this on myself. A minority of people want to fight their human nature, which is to be solved and soothed quickly. Psychiatrists may allow but not embrace psychotherapy whose implicit requirement is – be open to feeling, not medicated against it. In the future I will suppress my meds talk but for some basic theory that says “feeling is healing.” And if I ever challenge the doctors again, it will be after I win the lottery.

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* Alice Miller, The Drama of the Gifted Child, 1997 edition, p. 34.

** See Modrow, Breggin and Harry Stack Sullivan, R.D. Laing, Theodore Lidz – the old guard.


  1. Hi, I'd be curious to know how common it is for clients to be willing to "go deep." I've known more than a few people who tried that sort of therapeutic approach, and they all seemed enthusiastic for a while but eventually stopped going, and all reverted to previous behaviors. It seems like "going deep" may work for those who have advanced degrees in this field (and a few others) but simply isn't going to work on the "masses," who generally lack self-awareness as well as a desire to do critical analysis and then use that analysis to change behaviors that have become habit. I'm really interested to know about your clinical experiences. And in case you are interested, I'm a historian who attended grad school right after "psychohistory" became discredited. One of the historians I studied with tried to figure out a psycho-social approach to history. However, even before that, as a teenager, I had access to my father's college psychology textbooks, so I've been reading about the subject for decades. Thanks for your time.

    1. Thanks for writing. I wasn’t aware that psychohistory was discredited -- -- though I only know about it from de Mause’s angle which, exotically Freudian, is too abstract (not testable) to be discredited. My academic background is a plain-vanilla counseling program, but my hard-knocks and self-taught background is in the drastic (, cool ( Primal Therapy. (Earlier blog posts reference it.) This leads me to always look to radical healing via feeling change, before giving up and moving on to insight or other more conventional ways. In general, Primal-related approach does more than “use analysis to change behaviors.” It causes deep feeling / deep grieving which in itself outlets pain, changes chemistry, and equates to behavior change. And to be sure, this doesn’t happen that often. In fact (as this post says), I don’t fully accept the validity of full-regressive therapy.

  2. Thanks for the link. Perhaps the feeling in the mid 80s was that psychohistory was discredited. Being a grad student, I wasn't about to question one of the most distinguished professors in the dept. on something with which I had just come into contact. I did get explanation, though, which was summed as up as "proliferation of interpretations," meaning that anybody could make any kind of claim about a historical figure, such as delayed Oedipal Complex. It may be that it has been revived and is less Freudian, for all I know.

    I'd still be interested in knowing about what you would say your "success rate" is with the "going deep" approach. Having been exposed to intrusive and sometimes violent relatives since I was very young, I've mostly tried to avoid "toxic" people, which provides me with a sense of relief. Interestingly, when I was very young my father bought boxing gloves for children and would let me "beat him up" as he acted like Muhammad Ali ("rope a dope" while he was kneeling).

    Have you seen any of Glenn D. Wilson's lectures on youtube? Because my parents were so immature, I think I developed an "impersonal" kind of orientation towards others, which he mentions in one lecture. Recently (about two years), I realized my brother seemed to have Borderline PD and/or what used to be called Abrasive Passive Aggressive PD, and so I had to cut off contact with him. He had done this for many years (both he and my father enjoyed acting very infantile so that they could be abusive and then act offended if you called them out on it), but I "drew the line" because he was modeling this behavior to his daughter, and I refuse to be part of raising a kid with major problems, even in such an "indirect" way. Thanks again.

  3. I believe (that is, I see evidence) that most clients change for the positive, to some degree. It is rarely a “primal re-make,” which I doubt in most cases exists even though Janov’s literature is pretty voluminous about it. The rare client will say (as some have) that the work has “saved my life,” though many are thankful (one or two run away and try to get me in trouble). And when so, the process was more likely a fusion of deep acceptance and supportive education (that may include deep exoneration, self-compassion) and drastic, re-living-level Empty Chair rather than Writhing on the Mat (primal therapy). I see by contrasting cases – that is, those clients who stay in their escapist intellect or who will not challenge the toxic umbilical cord tying them to the comforting prison of “bad object” parents – that most people come to grasp their intrinsic value and their need to wrest autonomy from their past. Some, but not enough of them, reach the furnace of healing grief beneath the ice layer of their depression, and outlet pain. That is, they experience some revelation and feeling change. I’ll always go by the idea that “people change when they feel different” (not just know different).


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.