Friday, May 20, 2016

Snark and the hypothesis


I picture saying to two therapists I know: “My clients, for the most part, get better. Yours (pointing a professorial finger at one) get listened to, and yours (sliding the finger over to the other) get cheered up.” One of these therapists is elderly, and sees many older-middle-aged women who have a sunken Titanic-load of physical and emotional disorders, histories, crises past and present, hysteric process. These victims are a hallucinatory purple, oozing red. They return to therapy week after week, sometimes month after month, ooze and talk and get listened to. How do I know they don’t get better in any significant way? If the therapist had proceeded to work into any of these wounds, the clients would have left much earlier – improved or escaped. Deep trauma work? Confronting the family toxicity? They’d probably scram. Teach, or even mention psychosomatic pain and disorder?* Scram like lightning. The younger, ebullient counselor whose laughter could be heard through the wall much of the time, did have a certain practical program in her tool belt: She presented clients with the goal of six sessions to “work through” the presenting issues. Cheering up, by New Age or Cognitive therapies, the client can work only if two factors are in place: The client has to be mesmerized or distracted by feel-good fluffery; and the therapist has to actually believe this is what therapy is about. There is then peace and self-satisfaction. The same is true of the listener: She must believe that this is the height of what we do.** Ignorance is both bliss and success.

I am snarky because more than a handful of clients depart after one or two sessions and I have never figured out why. (Those who pass through that two-session gravitational boundary may soar into space for a long voyage.) So I have to consider the likelihood that they are turned off by my premise that there is real damage, it needs to be known and faced, and there is work to be done.

And yet . . .

Could I become positive, see the client in a different way that is deep but does not get stuck in his or her wound? Should a therapist see the client as predominately healthy, resourceful, or as being more potential than actual? That is a lovely thought, and I admit that as I get older, through my sixties, the desire to see the world as beautiful and people as good and essentially whole is compelling and musical. But what if I’m spiritual in a cosmic-psychological way, and believe that this universe of ours needs the scales of justice to lean to truth not a dream? There is an error embedded in the universe, where emotional injury changes and limits everything, bends each self, has darkened our long past and a long chain of futures. If we don’t recognize this, can we ever change it? We all want to laugh, be happy, especially if we’re alone, especially if we’re with our partner. But it’s too fragile if this happiness, even this love, is not based in our ground as it is. Human beings are too in-time, too historical, to live on a joke, a plane of “mindfulness,” a feel-good moment.

When my wife and I are very old, I will speak to her in the most gentle way, much more sweet than bitter, some pains that may never be named ’til then. We have not been perfect to each other – an equality – have not been able to give each other everything, and some of it is silently cataclysmic. It would not be a “kindness” to her to ignore something that underlies everything, from the beginning of our dear relationship. It would be a deeper intimacy to name it. But the same must be true of anyone’s life: We should feel and give words to our depth, because it is feeling that is always there, and therefore meaning that is always there. We shouldn’t run away from it. Even in therapy.


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* Dr. John E. Sarno, The Divided Mind: The Epidemic of Mindbody Disorders, states that the psychosomatic client will not accept that diagnosis from a mere counselor or psychologist, as the medical symptomatology is itself a defense against emotional insight. Therefore, the “news” must come from a medical doctor (your problem is not fundamentally medical”) – much more convincing to the client. 

** This therapist does see some young children and adolescents. Twelve sessions into the therapy, a teenage girl began cutting. Barring early personality disorder, this very probably means she continues to feel isolated and unable to get the best words for her pain out. This appears to say there is something wrong with the therapeutic listening. On the other hand, Levenkron’s experience is that as a disturbed teen gets close to her “crisis of healing” (collapsing into the necessary nurturant-authoritative dependency), there may be regression.

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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.