A generalization, or summary #2: Stress the paradox*

Do you think people are living on the plane of their true self in their adult lives?  I am certain they are not.  But this certainty comes from my belief that I am attuned to the defensive front and that adult psychological distress is akin to the Princess and the Pea**: Like the sensitive maiden who is discomforted by a pea buried beneath forty mattresses, we are exercised, restless in the present because of embedded injuries in the past.  They and their meaning are buried and we are not with them: We are dissociated from ourselves.

There is, then, this truer world, different from the one where we live, think and dream.  We come to therapy because we want our injuries healed.  But our injuries have become our life: our personality, pleasures, beliefs.  Our personality may be accommodating or driven or vigilant; our pleasures self-medicative; our beliefs a major part of our ego and compass in life.  Do we really want to change these or erase them from our self?

So we are not our real self in therapy, and we do not want to change our predominant self.  What is there left to do?  We must stress – put stress on – the paradox of healing, which is to reclaim more and more of our true self but never too much.  I am not afraid of reaching Primal*** depths, where a middle-aged person, now a child, cries for his mother.  What I am afraid of is one’s feeling-knowledge that he never became a living person because he faked a viable self from the beginning.  Who has this awful truth?  Let’s hope we never know.

Fortunately, the third dimension of this paradox is love, our intense presence with the client that leaves more than an imprint – an appendage in the person, or holding his shoulder or hand through the dark night, and for years to come.  A client recently said he felt it would be God’s terrible goof if we were the only life in the universe.  A humiliating loneliness.  Knowing there are others out there would be a critically necessary solace.  Similarly, knowing someone has joined us in our lone boat in the world, who is there for us, may be enough.

This is the three-sided therapy that, I believe, is the only kind that helps.

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* See also http://pessimisticshrink.blogspot.com/2014/04/pessimistic-therapy-laws.html.

** Hans Christian Andersen’s fairy tale.

*** The Primal Scream and other books by Arthur Janov, PhD.

 

Intervention tidbit #7: Answering anxiety

There is a lot that can be said about anxiety (including the prevalence and mystery of it) from theory and therapy perspectives.  I suspect the psychiatrists with their one-track minds would think of a “chemical imbalance” or something wrong neurologically.  A depth perspective sees anxiety as the present-day residual effect (the smoke) of actual caused fears (the fire) in the past, typically in childhood.  A branch, or root, of that view is that the earliest possible sources – prenatal, perinatal (birth trauma) – are prepotent and predominant.

The primal-oriented therapists would help clients pour out, through reliving unencumbered by the original shock and dissociation, the early unresolved fears – a violent father, a helpless and worried mother, a disturbing uncle, respiratory trauma at birth – in the manner of standard trauma therapy, the difference being the distance traveled: into the deep and forgotten past.  A key, I believe, to the help given is emotive expression, the removal of pain outward, out of the mouth, the musculature, activity, tears.  Expression is action – or will be so considered for today’s casual theory.

If a victim strikes back at a bully but makes no impact (physical or emotional), one could say that necessary action has been prevented.  The message (expression) has effectively been denied.  The same would be true for a verbal and emotional message: If our feelings are unheard by a solipsistic parent, are denied and ridiculed by an abusive older brother, are cried in solitude, there remains no action and the pain resounds within us: and we are weakened by its echoing.

We must emotionally act effectively, and – key number two – we must come close, as close as possible, to the original moment, the actual hurt.  This may sound like going into the past, but it is really just being who we are, the Self with its unresolution embedded deep beneath our current life.

This idea can be applied to those situational anxieties that are birthed in the present (setting aside the likely deeper roots of one’s capacity to be an anxious person).  For example, a client is highly anxious because his wife has found she is not mature enough to commit, and wants to return to playing around.  She talks of giving up the marriage, toys with moving out.  His fear is incapacitating.  Or, his character incapacitation grows his fear.  We understood that what will dissolve the anxiety is emotional behavior: Take action, take initiative.  Face her with your feelings with intense eloquence so that she can’t deny you.  Possibly move out first.  Explode family secrecy and reveal to both families her neurosis so that you don’t become the victim of their gossip and judgment, the “actee.”  It seems likely to me that much anxiety about present troubles can be handled so: Talk earnestly to the teacher; explain the raw truth to your creditors; summon a mandatory conference with your child’s bully’s parents and never back down.

I believe we will find that within nearly all anxiety lies a scenario of unexpressed pain and injustice, a stifled voice.  It is almost as if the anxiety is merely a different form of mute fears.  If we state ourselves, emotionally; if we answer the question mark of fear with action, we will have solved the past in the present, whether that past is ten minutes or fifty years ago.

 

For new therapists, and insecure old ones

I thought I might make a few observations about starting up a new psychotherapy practice in a new state.  I have no pre-established theme, insight or agenda in mind.  Just a matter of some casual looking outward and inward.  For one, I’m not really building a practice in the way a pioneer would – getting an office, cold-calling the insurance companies to begin the arduous process of getting paneled, advertising for clients in simple ways (Psychology Today ad) and effortful ways (giving talks or seminars).  I’ve joined a group practice where all that is done for me and the other clinicians.

My situation is that I essentially close my eyes, open my hand and accept whatever referrals (and insurance company part-disbursements) are given to me.  I suppose I could question how clients are distributed among the counselors, but it would be neurotic to suspect I’m being differently treated.  I was informed that “the new guy” will receive more of the psychiatric hospital discharge referrals, and that these people rarely keep the appointment (this has proven to be true so drastically, and so different from my experience in Ohio, that I wonder if the area hospitals do a terrible job of promoting the value of crisis follow-up).

So I see, from scratch, a fair number of more plausible ones not returning after Intake; a portion of these reacting enthusiastically or anxiously when I text-message them, and rescheduling; yet some of these still failing to show up.  And others who begin to engage without fanfare (that is, they don’t say: “Gosh, this is what I need!  Write me down for the whole year!), and return week after week.  I don’t know if their motivation is AA “one day at a time”-like, or if they’ve made an unspoken commitment to the long-term, like buying a puppy.

Is there anything to be said about this beyond the obvious fact that people are different, with different qualities of courage, need, commitment, desperation, loneliness?  Yes – but this is where my cynicism and hubris come in.  I sometimes believe that new, fresh-faced and possibly ingenuous counselors retain more new clients than I do.  I believe they will not have the initial gravity of approach, potential and confidence that I have at first contact, but that therefore they might put the nervous person more at ease.  I will admit that I do not know anything of the “atmosphere” produced by the many therapists who have a more “solution-focused,” “strength-based,” cognitive and here-and-now approach.  For their clients, the room may feel brisk, actionable.  Solutions to their problems may feel, agreeably, like a matter of thinking different or receiving delivered insights that had eluded them.  The atmosphere of my room – carrying the humor and compassion and standard questioning – is historical, almost immediately four-dimensional.  Before the first hour is over, most will get a sense that we will have to go exactly where they feel most uncomfortable.  Those not in denial may think, Yes, I knew this was going to happen.  But those who deny that there are roots beneath their eyeballs and their overthinking brain may turn away from therapy as they have always turned away from themselves.

Sometimes I wonder if there are ways, beyond my care and energy, that other therapists use to draw clients back again and again.  Do they say, “Let’s put you on the schedule for next week!” in a way that makes it sound like a necessity?  Are they better looking than I am?  Am I not a strong enough father figure?  I have known for a long time that some of my chronic clients are those who do and get and know only the shallowest work; that those I feel so poignantly about, knowing I can save them (I mean this in literal ways) may soon not return.  I admit, with embarrassment, that I’ve even wondered if these other therapists have some magical speech, delivered during the orientation session, that commits the stranger to the unique relationship (then I remember – I have that speech!).  Or that they are simply the “right” personality that wins friends and influences people.*

Whatever is going on, I’ve had to cultivate some serenity and remind myself of certain things.  I know what I’m doing – or think I do – and this has been corroborated by some long-term client friendships, complimentary Satisfaction Surveys and a good income.  People are terribly difficult to change – an empowering yet burdensome piece of knowledge that the cognitive therapists may think they grasp, but don’t.  People, myself included, are childlike, want free gifts and quick transcendence and feel – legitimately and profoundly and invisibly – that there is something wrong and undeserved about enduring weekly pain and self-searching just to feel OK in their life.  And, therapists are troubled people who daily feel the ineffable pressure at the border zone of giving more and better than they have ever received in their life.  I don't know that this affects the work.  Yet it must.

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* Dale Carnegie, How to Win Friends & Influence People, 1936.

The blind man

A few months ago I treated a young man – 20 years old – who was completely, existentially dislodged when I named the fact that feelings are primary substance, are in the body; they are not a waste product of our thoughts.  It is painful for me to imagine how barren a life he must have led up to now, killing his feelings and trying to rescue himself by thinking harder, repetitiously, brighter – thoughts fueled by nothing but denied desperation.  The client had been drug dependent for several years.  It was sad how fake he looked, with that euthymic smile and clever humor and words formed only in the shallows of his neurosis.  Apparently three months of intensive rehab hadn’t taught him the simple concept of self-medication.  Or he had quickly blinked it away.  Or it was presented in a sterile, biopsychiatric frame.  Because if he had learned it, he would have gotten some awareness that with drugs, he has been drowning the pain of his tortured childhood.

I’ve seen a fair number of people who are militantly cognitive, belligerent that thinking is the director of one’s ship.  Because there is something intense and defensive about them, they seem real, human, anxiously in touch with the feelings that they disparage.  This client, though, had no militancy or defense, and he seemed less real.  Somehow he had grown up to believe the terrible control his parents exerted – don’t move, don’t contradict me, don’t roll your eyes, don’t get C’s – was right or natural; had been brainwashed by them to believe he should exist in the slightest, dehumanized way.  When I told him that feelings are the ground of the person – babies are all feeling, they don’t think that “life’s a bummer,” they don’t tell themselves “this pain is really good for me” – he looked shifted and undone.  He heard me right away, was not defended against the idea that a big part of him, maybe the essential part, had been lost, his whole life.

Will the next step be to look a little further into the doorway, to feel – without the juggernaut intercession of his thought – all the pain and destruction his parents had caused?  That would be the simple truth.  And while I don’t often want clients to fall into the furnace that their childhood keeps – most clients are functional enough with adequate pleasures and defenses not to warrant being undermined – that was not true of this young man starting out on the long road of adulthood.  He would assuredly use again, despite his self-cheerleading.  But more, he had never gotten an emotional foundation on which to build a life, a certainty, a relationship, to care for a career and to maintain it.  He would need, critically more than any other need, to find his discarded heart.

This is a bit of a sidetrack, but I really wish clients could be cleansed of all the psychological smog they’ve absorbed over the past generation, coming from entertainment and editorials, the self-help literature, Dr. Phil and drug commercials.  I have yet to hear a client say, “I am 296.32” (major depressive disorder, recurrent, moderate), but many produce their labels – “I have clinical depression, I’m bipolar, I have G.A.D., I have Borderline Personality Disorder, I’m ADHD, I have a chemical imbalance.”  Thinking this and saying this, they are already disastrously in their head.  It would be preferable to tell me, “I don’t know what it is,” “I hurt,” “there’s this emptiness,” “I’m angry, but I’m sad, and nothing’s meaningful,” or “I can’t find the words for something – if it is something – I can’t understand,” or even to look at me silently.  These are the psychic ailments.  These would be people in touch with themselves.

The young man could possibly have made this sort of ethereal and profound statement, but he had been dragged for years through the torrent of abuse and repression then had run aground on a concept – addict.  Blind as he was to his caregivers' crimes, he might still have felt something, might have said, “I’m not really as happy as I thought I was.”  But he had lost the ability to feel – a risk of formative-age and long addiction and its causes, and its labels.

 

Wipe your feet

Maybe it’s time for a little free association, Freudian-style.  I look at the landscape, where nihilistic terrorism has become the wave trying to sweep over the world, and can only see false smarts and lip-service power in all the reacting action figures – government, politico’s, news wags.  To me they all seem like ignoramuses playing adult, acting somber.  For example, their newest buzzword, “radicalized.”  This or that lost soul or psychopath “became radicalized” at a certain point, and it is for some reason important to discover when this happened.  I am sorry, but a man or woman groomed, from childhood, to be interested in killing people did not “become” radical.  The seeds of inner death and destruction were always in the person.  The sick body-mind has simply found an enclosed idea system that reflects, explains and externalizes his inner death, and thereby stops his bleeding.

The intellectualized bigotry (I’m thinking of Sam Harris, but there are many others) versus righteous pussy-footing about the sync between Muslims and “radical Islam” and terrorism is, at the very least, so Groundhog Day-repetitious that the developed world should have bored itself comatose by now.  Where are the meta-thinkers who say – How are the grown-ups still arguing over this, whether bad people come from bad ideas?  Isn’t it obvious that sick people make and accept sick ideas?  I guess it isn’t obvious, as the intellectuals and movers-and-shakers – shaking in their boots – ponderously flap the same arguments every day.

Right now we’re watching all the idiots throwing hollow barbells and dropping anvils from second-story windows on these terrorist zombies, who in fact are the living dead.  But we are, on the whole, less so, so why can’t we accept the right understandings, find the right actions to eliminate them?  It’s almost as if impotence has become the statecraft of our day.

I don’t expect our “leaders” (I have always hated that word) to be motivated by psychological insight into the mass murderer.  Imagine them lecturing, at their bully pulpit, about aborted civilizations, the corrupt parents of murderers, delusion and group delusion, religious belief and ideology as the match that ignites buried pain and need and rage.  Nevertheless, their being more in touch with the psychic deep and unfixable sickness of the terrorists would get them to sweet-talk less, stand still as the pee puddles at their feet less, and act.
 

The macho, crazy men

I had written the following Letter to the Editor regarding Gail Collins’ December 4 online New York Times article on guns and the Senate, but the comment section was closed:

Therapists with experience often trust their instincts about a problem.  My instinct says there is a causal and emotional connection between the men in therapy (often there under duress) who say it is “weak” to cry, and the macho men who need several to many guns.  I strongly suspect they are all running away from some vulnerability.  The felt need for overprotection – a hard cushion around a soft Self – is the key, a need that comes from childhood painful injury and that like many emotional defenses (“I need alcohol to not feel empty or estranged”) grows an ideational offense (“I just love the taste of beer”).  In this case, “I feel hurt” turns into “I feel anger” or “I feel nothing,” and “I feel unsafe” becomes “I need and have the right to an arsenal of guns, to overkilling self-defense.”  Macho men – You are the walking wounded.

So I thought I’d expand on the idea here.  However, in the face of the most recent Muslim ideology gun massacre, it seems more important to get general, basic (and probably more boring), and talk about the human psyche’s ability to take a specific pain and turn it into global anger.

By “specific pain,” I mean the obvious: A little boy whose older sister, fooling around, holds his bedroom door shut so he can’t get out, is mad at his sister.  If his parents fail to punish her, he may be mad at them.  By “global” or displaced anger I mean that little boy, frustrated in justice, finds anger at his younger sister, takes false revenge on her.  And later, having grown up and accumulated many unheard and unhealed frustrations, finds all women inferior, frustrating, castrating, full-of-themselves – whatever.  It is this “ability” to misdirect and globalize a realistic target-response feeling, to make it irrational and delusional and self- and other-destructive, that is behind almost all violence and crime, from throwing the remote at the wall or an act of domestic violence, to serial killing and ideological terrorism and genocide.  All of it connects first to pain and the body’s diffusion of it into general suffering, later to generalized thinking and religious and philosophical beliefs.

How does thinking become so crazy, so stupid?  I only know that any defense we can use to be different from and above our inept and defeated child is useful.  And thinking – rationalizing, projecting, minimizing and intellectualizing – is (to stretch an Alice Miller insight) a defense mechanism of great power.  A critical problem is that ideas seem, to our feelings, to be one with, identical to, accurate perception.  This means they will hardly ever strike their owner as defensive, escapist, delusional.

An analogy to our wayward thinking is the person who is freezing to death and finds a huge, thick blanket under which he keeps warm and protected.  The blanket covers all – he is in the dark.  Someone comes up and suggests he cut a small hole in the blanket to enable him to see something of the world.  That seems to him a grotesque, insane idea: It would let the freezing, killing cold in.  The smallest hole would ruin everything.

A hurting soul who has found the strong blanket of global anger and condemnation cannot stand to look through a small opening of realism.  Turning the example around, it would threaten to warm his icy heart.  “Women are not all castrators.  There are many loving and decent women.”  “Americans are not decadent and evil.  They are people, like me.”  Ideas cover or kill pain, and if we question them – put a hole in them – we will hurt again.  Like the little boy whose parents did not listen to him.

 

Not in Ohio anymore

My first impressions of the counseling state of N_____ are influenced by my accoutrements (“I see by my outfit that I am a cowboy” – Smothers Brothers, possibly inexact quote).  One of them is the diagnostic assessment form used by the counseling agency that hired me as Independent Contractor.  It is a mere two pages and asks just a few basic, generic questions.  Past forms were intrusively detailed, giving a list of symptoms to endorse and explain, asked about hobbies, medical, friendships, strengths, weaknesses, risk taking, named illicit and other substance use to describe, specified abuse as mental, physical, sexual.  Etc.  And because the present Intake tool is so broad-brushed, I find myself seeing the client as predominately – and falsely – plainly human, not as the fused constellation, distillation, transmogrification of injured history that he or she really is.  To my surprise, my new approach seems preferable to me.

The old way led me to jump straight into the pus-filled heart of most clients, assuming – by my narcissistic ego – that I was right to focus on their poison, their walking dead or disabled.  But most clients don’t want to go there.  What would be worse than discovering, as adults, that their “older sister” was actually their mother (I recall such a case), would be to discover that ninety-nine percent of their life is running on, and away from, pain, that their functionality is an illusion that works – as it does work.  Sure, the classy-looking woman is a high-achieving professional with a lousy boyfriend.  But she really doesn’t want to know that she keeps him because she is needy of a man who can’t love her; that she avoids love.  It is far better, in session, to talk about his immaturity and lack of respect, and her children, in a breezy or serious way that assumes she is coming at them from an adult perspective.

My first impressions are also influenced by the incredible no-show rate of new applicants for therapy.  Though it’s only been a few weeks, close to seventy percent of those who set up an appointment for intake have no-showed and no-called.  Most of these are psychiatric hospitalization discharges, a population that we acknowledge wants to forget their problem as soon as they walk out the hospital door.  Still, the failure stats are absurd and make me wonder if there is something about this high-rolling state that raises its people to be flake-outs.  Give me time.

In the meantime, the weather is cold and beautiful and the ambiance is vacationy.  Palm trees, vibrant blue skies, stucco homes with tile roofs remind me of Sarasota, Florida, though where I am water is selective, scarcer and expensive.  I haven’t seen a bug yet.  Ha, Florida!

Future posts will, I think, be a surprise to me, as I feel it is time to investigate myself, you, and the field of psychotherapy deeper than I’ve gone so far.  I hope there will be more optimism, notwithstanding my piquant title.  Maybe my status here is a microcosm of this hoped-for change: I have plenty of time to think and be with all these no-shows.  That feels oppressive and scary, yet also balmy and imperially sweet – probably reflecting the molecular mess* that most of us are.

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* Search out this term to find several past blog posts addressing the messiness of the psyche.