Unfunny humor #1: Got up on the wrong side of the couch

I recently conducted an awful therapy session. Both words – “conducted” and “awful” – apply to the fact that I didn’t leave any room for the 15-year-old client to speak. This was his second hour in my office, his first appointment following the Diagnostic Assessment, the “getting to know you” session without mother present. And I lectured the entire sixty minutes as he kept himself conscious – probably in a state of apprehension – by pure brute force.

For those unaware of the common sense plain vanilla instruction given to new counseling students, they are taught that something is wrong if the counselor is “working harder than the client is,” and relatedly, that we should listen much, much more than we talk. I knew that over twenty years ago. And while there have been many times since school when I’ve provided a client strong and critical psychoeducation at length, I’ve always owned the core truth of these injunctions.

So what happened this time?

It is probably true that I had a “chemical imbalance” – https://www.youtube.com/watch?v=ARZ2Wv2BoFs, meaning a dysthymic mood substrate caused by the confluence of some negative life circumstances. This put me a bit off-kilter during that fateful afternoon.

But mostly . . . During the previous week’s Intake session, I had listened to the adolescent’s mother describe his tendency to spew pompous intellectual clouds yet be unable to “attend” in class, grasp what teachers were saying. He was failing or doing poorly in all classes except sports. Both client and his mother agreed that at least one teacher didn’t like him, and worse – that she sabotaged him by speaking in an unprofessionally foreign accent. While mother and father – self-described as rule-following, conventional folk – would pro forma tell him he was “lazy,” what she wanted from me was to determine if he qualified for ADHD. At one time he had purchased Adderall from another student, and it had “helped.”

Throughout that hour the boy was mostly silent by fear or condescension (I couldn’t tell which). He had a girlfriend, was already into sex, was into working out, and wanted to become a nuclear physicist. Math was his worst subject. He couldn’t do it, didn’t like it.

I came into the second hour with a kind of futile sense, a sense that this mini-man wanted to see himself as Attention Deficit Hyperactivity disordered, needing pills. God help me, I may have been wrong. I had the feeling that he was born opaque, the Perpetually Clueless – much like the Somatoform clients who present with an absurd physical distress (“My hands have tingled for the last two months. Now my feet are starting to tingle. I can’t work”) and whose feathers are mightily ruffled when the therapist suggests psychological stress. (These clients are sent to the shrink by their eye-rolling family doctor.) That feeling came from the vibe that his family had always seen itself as a solid object of normalcy, where parents know best, there’s a “straight A” daughter, and the requisite life passage of grandparent dying.

And . . . I picture him now, and again there’s the feeling that this teen muscle sex boy cannot have insight. After all – blaming his failure on the teacher’s accent? Blasé about math and wanting to be a scientist? The hairdo of a Romeo? Parents whose cachet is to be the statistical norm? I know I felt stuck, and therefore had to use my ice pick and drill.

My cattle prod and drill of interior information.

ADHD is a nonsense diagnosis. There is no disorder of the brain. Children can’t concentrate, are fidgety because of stress, which comes from the home environment, the family. I quoted Breggin's Toxic Psychiatry*:

Andy, remember, had been diagnosed as ADD, meaning that he lacked the ability to focus his attention. The real “attention” problem Andy had was the attention he wasn’t getting from his father – the good, loving attention and consistent, firm discipline he needed as a normal, energetic child. A better diagnosis for Andy was DADD – dad attention deficit disorder. Mom was also missing out on attention from dad, causing her to express hostility toward him and to cling too closely to Andy. She was suffering from HADD, husband attention deficit disorder. The couples therapy for Mom and Dad dealt in part with their own childhood experiences. . . .

I talked depression and the inability to focus; depression’s connection to loss of feelings, feeling lost when there’s lack of empathy, lack of empathy from decent but distracted parents; the true self with its desire, fire, its true north that disappear when there’s no one to express to because they can’t hear you. I talked about the past, his past (generically). I asked (or dared) no-insight-boy to look inside, be aware of where he came from.

And he stayed awake. . . .

If there are lessons here, they would probably include – * Don’t think cynical of your client at the very beginning. * Listen first: Even if it’s a fallback, it will give you gold for when you’re back in shape. * It’s still OK to realize that “ADHD” is a dumb-as-shit abuse concept by the professionals; and that * even glamorous teenagers should know they have depth.

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* Peter Breggin, M.D.'s Toxic Psychiatry – Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the “New Psychiatry,” St. Martin’s Press, 1991. Excerpt from p. 276. I accept Breggin's statement that the concept of “chemical imbalance” was created by Eli Lilly and Company to sell Prozac.

Good riddance

The forty-two-year-old man and his fiancée were two out-of-phase yo-yo’s bouncing off each other. He clung, she withdrew. He distanced, she tickled him back in. The most recent recycle brought him to therapy. This was true love, he said, unlike his earlier eleven-year marriage that flagged about half-way in. Now, when things are going well, when “she is saying everything I want to hear!”, it’s beautiful.

This was a man who didn’t seem to know anger, who was equable and harmless, super-reasonable as a cushion accommodating all weights and sharp edges. At first I wanted to see the clinginess and softness as personality disorder. There was also the deep somatization that takes repressed pain and emptiness and turns them into gastrointestinal disaster. But later it became clear that we had someone who, in his formative years, had been bled slowly in a warm scented bath and now had no power of autonomy or spirit.

At the beginning of therapy he had mentioned that he’d been an “unruly” child, but that his parents had knowingly directed his negative energy into sports. Once he used the word “control” to describe their coached sublimation; later he could not remember why he’d used that word: Everything about them had been warm and affable, fun and involved, helpful and wise. They’d been sixties hippies, playing the great music in the house, involved in political movements, practicing the best-latest parenting psychology.

Yet . . . there was his long adult-stage depression, the dry and faded marriage, the acute neediness like a second adolescence. There was the arbitrary career field, the staying too long by “doing the right thing” for the children, the seamless docility in sessions, the sudden life-endangering illness. And the personality that could not see a single errant atom in his parents or his childhood, his sibling relationship, friendships or school. Pliant or curious, though, he was willing to look for something in his past, and tried to write his parents a letter.

“I can’t find a thing.”

I believe we could find some things, if we tune our radar to benign causes of lifelong dysfunction.

Client and his sister, young children, were taught to meditate and found the practice enjoyable. It became a bedtime ritual. So our theory – which he found plausible – is that empathy was replaced by the parents’ culture and their self- and outer focuses. The child’s feelings were lost beneath the eraser of meditation, by their curvature into football, were tempered by mother’s psychologizing and father’s grand dedication to altruistic causes. Client and his sister had no idea that they were disappearing in the music.

Children have fire and need their fire. Maybe it’s most fatal not when they are subject to clear abuses, but when they are bathed long-time in peace and good lessons, other people’s passions and lyrics, the atmosphere of not being you. The question of what is “good” and “bad” comes into play. My client was good – and gone as captain and inventor of his life.

Maybe the childhood unruliness was the most precious thing in his life, that he’ll miss forever. To help my client would be to cause him an ocean’s disturbance of obscurity. He’d have to wonder what fire there might have been, what philosophy his child would have chosen, what feelings and desires were meditated away. And if he will become angry at his enlightened, dedicated parents.

A dependent personality*

Most therapists are treating the wrong person: the mental construct, the walking house of cards** built of buried truth (childhood pain and need) and all the dissociative escapes from it. Our client is like someone who has evaded his torturers by changing his face, identity, his whole life, and now is a different person living in a wrong place. Like a Jew who converted to Christianity to survive the Nazis. A more accurate analogy is the man who, at death, is reincarnated as another human being: No one knows about or remembers the person who’s been lost.

Psychotherapy is aware of the false or unreal self and the as-if personality.*** But as far as I know, only Primal therapies focus eagle-eyed and consistently on the buried – not the surface – psyche. For most other clinicians, talking to a tragic Dependent Personality Disorder may be the one way to witness an unreal or derivative soul.

I remember a 45-year-old Dependent woman, who in two sessions revealed the complete replacement of her Self by her mother, the sickest of all narcissists whose family had always caved to her imperial personality’s delusion of perfection and infallibility. The client had of course melted into her mother’s solipsistic cushion as a baby and infant. An immature parent whose eyes are mirrors reflecting inward cannot see or touch the child as a separate being, react to or act with her as an independent reality. The entire relationship and atmosphere must make the child a living echo and a complaisant object. Like someone sucked into an enveloping whirlpool bath, she would grow up perplexed and ambivalent in surrender to the sensual danger.

As a middle-aged woman, my client could not imagine not calling her mother about any occurrence in her life; could not conceive of choosing something that was not her mother’s edict: “If I don’t do things the way my mother feels they should be,” would make her a “shameful” person. “I have to be a certain way, look a certain way.” For a Dependent personality, the concept of choice is strange. In her heart, there seems to be no reason to choose something outside of the authority figure, and no means to do it. This is the crux with two prongs: Following a powerful person of will feels natural; and there is no magnetic gold in her psyche that cleaves to desires. There is no center that wants, though there might be the meta-self that “wants” to want, to be strong, to have self-esteem.

So much therapy that fights a self-medicative behavior, such as alcohol addiction or a nest of compulsions, assumes the person will be better off when the behavior is eliminated. But if we look at the self-medicative Dependent personality – submerging, from cradle on, so fully into someone else – we have to wonder if this is true, if in the absence of the dependency there would be a person left at all. In another form, this is a question that has never been handled solidly by psychological theory: Is there some substantial “real self” that can emerge full-blown or be returned to its developmental path, once the dysfunction has been cast aside?**** What if all deep dependencies mean something about the insubstantiality of the person’s ego? What if the loss of any dependency – partner, substance, narcissism, intellectualism, money, work, power – is the returning to a pre-Self state, an emptiness, an egolessness?

This is most easily seen, or guessed, in my client. If she abandons her mother, her dependency, by cutting back on phone calls or failing to get her judgment of a piece of jewelry, she will become the abandoned two-year-old whose “psychological birth”***** did not happen. She will have no core, and the only thing that will mask this is the anxiety of a grown woman. There will be no seeds that grew, no rebellious energy.

I remember that she asked me, after two strong sessions, what therapy will be like when it begins. She did not grasp that it had already begun with her understanding of her mother’s shaming and absolute power, with a reading of the Power & Control Wheel that described her husband. It was an odd inertness, opaqueness: I believe she could not really question her life. That would have required being, in some small strand, independent of the answer, which was her disappearance into the unreal self of others.

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* DSM 5’s criteria set for Dependent Personality Disorder: “A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, as indicated by five or more of the following: * Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. * Needs others to assume responsibility for most major areas of his or her life. * Has difficulty expressing disagreement with others because of fear of loss of support or approval. . . . * Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). * Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. * Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. * Urgently seeks another relationship as a source of care and support when a close relationship ends. * Is unrealistically preoccupied with fears of being left to take care of himself or herself.”

** "House of cards" metaphor by Paul Vereshack – http://www.paulvereshack.com/texts/Vereshack-Help-Me-Im-Tired-of-Feeling-Bad-2012.pdf, p. 54.

*** Alice Miller’s conceptualization: “Accommodation to parental needs often (but not always) leads to the ‘as-if personality.’ This person develops in such a way that he reveals only what is expected of him and fuses so completely with what he reveals that one could scarcely guess how much more there is to him behind this false self. He cannot develop and differentiate his true self, because he is unable to live it. Understandably, this person will complain of a sense of emptiness, futility, or homelessness, for the emptiness is real.” (The Drama of the Gifted Child, revised 1997, pp. 11-12.)

**** James F. Masterson, M.D. believed the real self can come out of hibernation and be set on track once “confrontation” has done its job of disputing-away the Borderline’s defenses and accessing the “abandonment depression.” See Psychotherapy of the Disorders of the Self.

***** Reference, Margaret Mahler – http://www.amazon.com/Psychological-Birth-Infant-Symbiosis-Individuation/dp/0465095542#reader_0465095542.