Failure

I’m thinking of two teenage boys, 16 and 18, who stayed in counseling for two and four years respectively, and whom I may not have helped at all.  It is exquisitely unpleasant to know this and to say it.  It feels almost automatic to add, “No, I’m sure I helped them in some ways.”  Possibly one of them would have dropped out of high school; possibly the other would have killed his father.  Sheer speculation.  The reality is that I can look back these four years and see two personalities that should have changed with weekly counseling but remained firm like a tight rubber mallet, spongy enough to bounce off all sorts of interventions without effort, genial, unperturbed.

For me, it’s easier to explain how therapy with a boy who is past his formative years is almost bound to fail, than to explain how it could possibly work.  Sour grapes?  Sour, contemptuous feisty grapes.  You either work out the pain, the core twisted caved-in-edness of his heart, do parent reeducation and emotional reconciliation between them; or you try to turn his mind to positive things: therapist’s mentoring and modeling, humor, the future, inspirational truths, surface détente with a parent.  I interlard more significant process with the positive approaches, and they sometimes work.  A teen girl, for example, who always wrenched in rageful anguish over her personality disordered mother has softened by some of my logic – “You are burning the mother bridge and the father bridge” – enabling her later to be inspired by the sight of friends’ harmonious families and to join her mom in some nice moments.*

But many children – maybe mostly boys – cannot dare have a soft spot.  Hurt early by a brutal immature father, by an abandoning immature father, falling helpless on the limp safety net of a passive mother, they grow new personalities and shells inner and outer.  You should have seen one boy describe, in a completely unprovocative and innocent voice, a two-hour fight with his father, his experience of “the anger that’s beyond mere violent,” and his fortunate avoidance of murder.  When these boys come in to counseling, they are like the Time Traveler sitting in his chair and seeing from a distance but never interacting in the adult’s, the counselor’s moment.

In these cases, I find myself of two minds: During therapy I ply my efforts, try to join a beautiful if painful song of closeness.  End of therapy, I wonder if I should have let him go years earlier.  That’s a dichotomy I have no solution to.

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*  I won't say how, but the young lady's release and healing reminds me of the ending of J.D. Salinger's lovely story, "For Esmé – With Love and Squalor."

Therapy dies (with addendum)

In the spirit of chips-fall-where-they-may honesty, I will name my suspicion that a fair number of my therapies fall into the trash bin of abort: They stop before the client therapeutically bleeds,* that is, before she does any great movement.  I believe this is because I often suggest a goal of radical change, of purging in a way, not just talking, not just having a feeling of relief.  Hearing this mows down a lot of them.

The ones who stay, stay long or medium long.  Should I worry about those whose names I can’t even remember, as they quit a few months ago after two or three sessions?  I’ve just written a ton of closings, and have a ton more to write (I do tend to procrastinate, sometimes leaving charts open after two years).  Where did they go?  Did they decide they don’t need help?  Did they put a band-aid over an artery cut and move on?  A couple of my brain cells, I’ll admit, wonder if I mesmerized them, did the voodoo by showing them some reality beneath the dream, naming the history under their floorboards for what it was.  Did this open up their brain cells in a positive way, or just come across as a little horror show?

There was actually a time when our little boutique’s Practice Manager asked me to name my specialties, to have the front desk ladies weed out the wrong type, and weed in the right type of client for me.  That didn’t last: I decided I wanted to see anybody who thought of counseling.  And so they flew hither and yon.  Or stayed.

If anything, this gives me a sense of equanimity, or maybe complicated serenity.  It’s like the world is going to hell in a handbasket – Yes, look at the terrorists, the diseases, the injustices and the death – and we play music to commemorate it.  But at the same time I wish they would stay.  After all, what do we have in this world but the intimacy, the communion?

 

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* This is the leech analogy -- https://en.wikipedia.org/wiki/Bloodletting.

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Addendum

After writing this post, I had doubts about its quality and asked a former client for his opinion.  Following is the bulk of his critique, which I feel is an eloquent supplement and enhancement to my article:

“Honestly, there were times at the beginning and in the middle of therapy that I thought what we were doing was stupid, or pointless, or too hard.  I used to wonder if, when we were sitting in silence in a darkened room, you were just judging me or thinking I was weak, or a hopeless case.

“Then it switched, and all at once it was like opening my eyes to a new way of seeing.  It still happens today – things that would have sent me into a shame spiral just cause me a second’s pause . . . those old ghosts reach up from the grave . . . and then I take my new ‘me-ness’ and reassert myself over the doubt and shame of childhood.  It purges a little bit more of the poison every time.

“I think that’s what happens to you.  You present the hard road that leads deep into the labyrinth, with no promise that they will come out, but a hope that they can.

“Fear kills hope sometimes.

“. . . if [the article] convinces one person who might be on the fence to keep going, then it’s great.”

A generalization, or summary

Isn’t it interesting that we have so many mental and emotional problems?  Look at their wide horizon: from mass murderer at one end, to me, where I have only two clients today, need more to support my family, but feel complacent, “good” to have little to do.  And the rest – adult immaturity, depressed and empty and worthless feeling, hating attitudes toward “the world” and innocent people, delusional certainties, body-centered fear (anxiety) and other physical ailments that have no clear cause and ruin one’s days and years, feeling out-of-place and “wrong” and like one should die or has never been alive, loss of all feeling except negativity and maudlinness, compulsion to serve others in order to feel good, solipsism (unable to see and feel beyond one’s self), numbness to and distance from one’s self, urge to wield power and accumulate power, absence of all interests, dedication to childlike dreams – salvation and immortality, subjectivity that trumps objectivity.

How do we have so many problems?  Or rather, Why are we not healthy, and why such a strange and subtle and multitudinous array of errors?  I believe we know the answers, which reduce to pain and the brain’s tendency to retain it and convert it to deeper injury.  This injury could be bad philosophy, adult incompetence, internalization or projection: self-harm or revenge in all their forms.

Life provides some relief from disturbance: the stimuli of experience.  Experience makes us ignore our poisoned roots and feel the here and now, momentarily or transiently or repeatedly.  It just has that effect.  So the prisoner in solitary confinement and the depressed man sitting in the park may “enjoy” a meal or feeding the pigeons.  An angry person may feel good about money in the bank, a traumatic one may enjoy a campsite under the stars.  Another relief is, of course, numbness, anything that quells pain: medicine and drugs, belief, hope, rationality, work.

Doing therapy feels good: It is experience-stimulus, self-medication, and it is my best: love, and saying “no” to the tyranny of my injuries.  It cannot cleanse us of our problems (maybe a little), but it can reach into the spaces between our roots, compete with them. 

https://www.youtube.com/watch?v=MlTbi7yQw9k

Confront a new psychopath

Dangerous, reckless, brilliant, or just jaded and lazy.  Was my work with a fifteen-year-old client one of these, or maybe some lucky-intuitive mix of them?  As he sat in clueless-looking silence, his adoptive father named his recent month of behaviors.  He would run – literally run – away from the principal to avoid being questioned by her.  He would skip class to sneak behind stairwells and coax this girl or that to be sexual with him.  Father described and labeled his son's frequent “manipulative” ploys, his repetitive “lying” against the evidence of school surveillance cameras, his plaintive and “charming” sympathy-winning looks and words, stealing at home, his bastardizing my advice – ‘find a special person to talk with’ – to justify sexual imposition.

When his father left the room, I wasted not a moment, grew some instant courage, and informed the young man that he was close to becoming a full-fledged psychopath.  I described his “underground” living in a place beneath the real world, a place of privacy and immaturity that cannot face honesty.  Some passages from Hare’s Without Conscience I read aloud, helping him see that while he wants to be a hider, his character has already been exposed to the masses.  Sociopaths are not geniuses and world dominators as in the movies, they are impulsive, can’t plan, fuck up.

I asked him to consider the stress that must come from having to remember chains of lies.  Then again – I said, correcting myself – good psychopaths don’t worry or get embarrassed about lying: “they simply change their stories or attempt to rework the facts so that they appear to be consistent with the lie” (Hare, p. 46).  Finally, I suggested that he not think of his quickly congealing life from a moral perspective – ‘you probably already have your own definition of good and bad’ – but from one of loss: You will lose all things human, live outside the human compass, bury all your feelings but for misery and revenge.

Do you, at your young age, want to be contemptuous of humanity until the end of your life?  Do you want to be a child forever who insists, in court, on a lie in the face of the universe-sized truth, or on your death bed?  Do you want to be a man?

Shaming, appealing to the best, humiliating, or throwing him the most nurturing, last-hope lifeline possible.  Was my work with a fifteen-year-old sociopathic embryo one of these, or maybe some lucky-intuitive mix of them?  Can one help by calling the bluff on a bluffer, a liar soul?  Can I help if I try to trick him into believing what may not be true, that the world merits his truthfulness?