Warning: Acceptance and Commitment Therapy

This morning, I took a three-credit Continuing Education seminar on Acceptance and Commitment Therapy (ACT), and it has ruined my mind for the remainder of the day. It is a therapy of dissociation from the body – how one actually feels – and from the impact of one’s injurious history. It is a therapy of dissociating from our dissociation – “looking at thoughts, rather than from thoughts,”* when thinking itself is likely to be a defense and escape from deeper truth – and living in some disembodied “value” that we must doggedly commit ourselves to. As a theory that fanatically endorses only the cognitive realm and only superficial “I want” intentionality, it must use abstruse terms of smoke: “ACT brings direct contingencies and indirect verbal processes to bear on the experiential establishment of greater psychological flexibility primarily through acceptance, defusion, establishment of a transcendent sense of self, contact with the present moment, values, and building larger and larger patterns of committed action linked to those values.” It numbs one’s mind with cotton like: “Self-as-Context: The sense-of-self that is a consistent perspective from which to observe and accept all changing experiences”; the “ACT question: (1) Given a distinction between you and the stuff you are struggling with and trying to change, (2) are you willing to have that stuff, fully and without defense (3) as that stuff is, and not as what your language says it is, (4) and DO what takes you in the direction (5) of what is vital and meaningful (6) at this time, and in this situation? If the answer is ‘yes,’ that is what builds . . . Psychological Flexibility.” In ACT, you are “distinct” from your struggles, your thoughts, your emotions. This approach’s proponents may not realize you must also be distinct from your values. But then what would be left to you?

It disturbs my reliance on human rationality that PhDs and counselors, researchers and promoters of “empirically based principles” can jump over all historical psychological knowledge, can be so lost in this man-made dimension to believe this garbage. The therapist will see you the way an ideological partisan sees a naïve and wanting soul: empty of substance but for how he can mold you into his ideas – “psychological flexibility,” “commitment,” “behavior change strategies” – which he will frame as your idea. Your pain and confusion will be shoved aside by “mindfulness,” then replaced by a “value” and its henchmen “goals” and the brute-force signed contract to push yourself toward them; depression and suicide, anxiety and identity emptiness be damned.

It’s frightening and lonely, for me, to think that clients are taken away from their true needs for help, are given this absence of care for their real self. Be aware that you will be walking into a scam that is worse than some product bait-and-switch: an existential scam.

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* This and the other quotes are from the seminar’s PowerPoint material.

Personal tenets, for any readers I've failed to trouble up to this point

*  I want my clients to become happier than they are, and happier than I am able to be. This goal – especially the second part – is not a virtue of mine. It’s actually my neurosis, coming from childhood when, early on, I ceased wanting anything for myself but derived some very transient but poignant (“vicarious”) pleasure from facilitating someone else’s happiness. That is not, however, the motivation that launched me into this field.

*  By the accidental way my brain works (in the same way I was aware of my atheism, within a lightly Jewish family, at age eight), and by chancing upon a good psychology book, I realized that the adult stage and character, as most people live them, are much less valid a reality than the child within us, the child we came from. I suspect that most people believe their adult is their replacement baseline, post-youth. Not true: It is merely the small boat riding in a deep ocean, dependent on that ocean, victim to it, give its meaning by that ocean. (The metaphor fails slightly, because you can take a boat out of the water. But what kind of boat would it be?)

*  If I had to name the essence of psychological dysfunction, I’d say it is the lethal contradiction between the injured, never-helped child’s needs, and the necessity to leave those needs behind. I use the term “lethal” without exaggeration. We might lose an arm or a leg, our health, and still have our spirit. But we can’t be a spirit with bright potential if we were not loved. I’ve seen individuals with youth, health, loving partners, the world before them, but they are in some strange, oceanic pain that says “Why am I here?”

*  I know that nearly everyone must have a delusion of happiness or contentment or serenity or “acceptance” or success – whatever their particular positive is – that rides over this darkened potential. It is for them, not the therapist, to come to question the delusion. However, I will show a woman her fake laughter, so surface yet profound a defense, because it can prevent all therapy and healing.

*  It is the same with “love” – also too often a delusion. Let’s put it this way: When you were a child, if no one ever took your hurt away – which is the job of your caregiver – then you will still be living with that hurt, within that hurt. Whatever the reason your caregiver didn’t reach it and heal you: that they didn’t or couldn’t is the absence of love, regardless of their intention or goodness, regardless of your belief or your forgiveness. We reveal at high risk this delusion of love. But in good therapy, people come to see it.

*  I would like my clients to grow, before too long, a deep relationship with me, though I know it often doesn’t happen. The great problem is that they can’t reach out to me, or let me reach them, because long ago they had to withdraw into themselves to prevent more suffering. And now that it’s time beyond healing the child – so they feel – it’s even more despondent to crack themselves open to their child’s heart. By “deep relationship,” I mean for a moment they feel I am important to them. A moment when they come out of their shell and don’t feel alone with their pain. I have to be the momentary parent. If not, they have never joined the world, are just in-dwelling with their tears or grief. That cannot heal. There is a bond, or there is absence of love and continuing sickness. No other possibilities exist in therapy.

Sabotage

Jimmy Carter,* in a recent article, referred to his father as “daddy.” I wonder – Do adult Southerners call their mothers “mommy”?

I’ve written throughout this blog, and have conceived in my sessions, psychodynamic metaphors such as “some people have a heavy emptiness inside them, an anchor holding them back.” “A splinter in the soul” that does damage despite the soul’s lofty plane. We are a “molecular mess.” Old-timers may remember the Dr. Joyce Brothers-type conception, “fear of success.” Janov wrote of “housewives”** who’d always leave a room or two in disarray, as a clean house, a completed task, would give them the feeling, ‘Is this all there is?’ In a way, many of us are like the father of the little girl, Twilight Zone episode 91,*** who falls through her bedroom wall into another dimension. Leaping in to save her, he is lost, floating, but then is lurched back to ground: A friend had been gripping his leg the whole time, but he had no awareness of it. Our past, the most exotic dimension, has us in its grasp, and we are not aware of it.

The explanations one woman gives for losing guardianship of her son to her terrible father! It’s as if her true north were quicksand. Another woman smiles wanly, tells me her mother has won custody of the grandson on spurious charges of bad parenting.**** And watch out: When she gives birth in a few months, her mother may come with CPS and snatch this child, too. Helpless to stop it! I see a woman whose theme song has been self-ruination: Friendships curdle, gifts are rescinded; her mind colludes with her body not to be able to work; plausible plans to escape the city are spoiled; people who’d given her a room change the terms and kick her out; her son won’t talk to her, but a couple months ago they were getting along.

The many people who lose or quit one job after another. Something internal stops moving, and they wander off.

My wife and I, professional people with a strong relationship and a nice set-up, are so bad with money that we could potentially get in trouble from ten different directions.

In a bad mood, I’d want to give all these people (except myself) a tee-shirt that reads: “The dog ate my homework.” Your life is excuses. Grow up, find a backbone! Grow some fucking anger! Take off your stupid diaper! But I know about self-sabotage. Its seeds, of course, are in our childhood. But it’s complicated: soul and splinter. Depression versus the desire to love life. A twenty-three-year-old cries and whines in that gut-twisting sing-song of a child. I’m all alone. So boring at home, nothing to do! Sister criticized him as selfish when he asked for help. We haven’t yet found the awful splinter that poisoned all four siblings (the parents have a lovely résumé), but we know he cannot grow up.

Even when we seem to hit all the milestones, we may look and see there is no path. The engine is revved in neutral but the road is a decline and we move. We feel good then bad within two seconds, hopeful then inert within two seconds; expansive, then old hates emerge. Probably no one knows what real maturity means. How much, what kind of youthful psychology can we manifest that’s actually adult, not regressive? How much is nothing but regressive? People gamble much of the day, play video poker all night. It’s neurotic. (But when James Bond sits at the baccarat table, it’s very sophisticated.) Grown men play macho, women talk serious but look frilly, men make money of prime importance, women don’t report sexual harassment, people in therapy reveal they are ninety percent child. The past is so embedded in the present that we see only one thing: nothing, our blindness.

I’m wondering, as I write, if any immanent past must be a saboteur. Mine is: Future seeking, forward seeking has and will always be prevented by my particular problems. The ruining woman has to show an invisible father that she is homeless forever and in pain. The job quitters need – absolutely need – to be taken care of. But what of people who seem healthy and moving, happy, serene, accomplished? Has their past held them back? I think the answer is like quantum mechanics, where there’s a very different truth at the deepest level. If we look inside, we will feel where we have never moved on. We will find emotions that have never “matured”: still the child’s that are still attached to child’s things, though they’ve shape-shifted: A craving to be seen has become a need to impress; day camp has become a resort in Vail; a need for touch has become an extramarital affair. We will find our anchors.

Are there any conclusions we can settle on? The past in the present, the brake pedal always pressed, some. Even “failure” can be a kind of success as it tells the truth, where success often doesn’t.

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* https://www.nytimes.com/2017/10/21/opinion/sunday/jimmy-carter-lusts-trump-posting.html. Maureen Dowd editorial – “Jimmy Carter Lusts for a Trump Posting”.

** The Primal Scream, 1970. Arthur Janov died on October 1, 2017 at the age of 93.

*** “Little Girl Lost,” 1962. https://en.wikipedia.org/wiki/Little_Girl_Lost_(The_Twilight_Zone).

**** See “Warning to grandmothers” – https://pessimisticshrink.blogspot.com/2015/05/a-warning-to-grandmothers.html.

Other therapy

One pleasant challenge in psychotherapy world is to find useful ways to work with those clients who can’t do a damned thing. I assume this happens infrequently in private practice, but it’s not uncommon in community-funded mental health centers. And I don’t think it’s rare among clients who choose an agency name out of the book (“New Directions,” “Horizons for Youth & Families”) rather than a specific practitioner’s name. To be unable – which often means unwilling – to work does not mean sitting there looking defiant or numb. (Those would be the court-ordered men.) It means individuals whose personality disorder prevents any contact with their actual state; those whose “attention deficit hyperactivity disorder” impairs them from sitting still on a feeling – or wanting to; those who are deeply uninterested in having self-insight but think therapy happens, just happens. And it can mean clients for whom I can find no entry.

I work with these people who’d best stay home or read a booklet of positive affirmations. They, after all, come for something: an obscure hopeful difference. I am good at obscure hopeful differences.

One thirty-something-stuck-at-twenty Borderline waxes euthymic (fake happy), producing constant homilies of love and improvement. She has a perverse former (boyfriend is thirty years her senior) and a mirage latter. During a well-earned break, I’ll find myself making droll faces, piquant raised eyebrows, asking “why is the sky blue” questions, spontaneously playing some youtube classical music. It’s good, or at least not bad, to discombobulate a balmy Borderline. Have no fear or criticism: She believes I’m as authentic as she thinks she is. Later I may reference her childhood kidnapping and rapes and mother’s breakdowns and father’s effeteness, and make sure she understands that her very bad moods in the midst of very good moments come from this past. Else she would also feel lost.

An ADHD client with cancer is not able to hear anything I say other than questions about her health and treatment and her family. Odd as it may sound, I make money just by listening and offering the kind of eye contact that shows “I see you.” In the past with her, I tried psychosomatic theory, how to use it, suggested feeling her father’s “meanness” and brutal authority, and crying now. These were rejected by being unheard. I now support her frightened positivity with reasons for positivity, which I believe exist in our inner baby.

Mary the undiagnosable. In The Fountainhead, Rand’s character Gail Wynand introduces his newspaper’s staff to a man whose face is so nondescript, one can’t remember it while looking at it. Week to week, month to month, I couldn’t remember Mary’s childhood history but that at age three, her mother abandoned the family. Other facts about being the less-favored child, sibling rivalry, teen rebellion, always fell out of my mind, though I reviewed the chart periodically. She may have been bipolar, but that couldn’t be ascertained: On rare occasions she would have a hellish tantrum, destroying an apartment. In time, she would alienate everyone in her circle in ways she could never grasp. She used methamphetamine through her later teens, twenties, thirties, then it waned. She was sabotaged by a transient psychotic or psychosomatic interloper: One arm stopped working, or she was convinced it had. She could no longer keep a job. Like many complexly troubled women, one insult – of physical capacity or of a relationship – began the unraveling of her competence and energy: “That’s when I fell apart.” Always on the verge of homelessness, she found this and that neurotic man she remembered from her past, moved into his place, moved out. Maybe this was my purest therapy, as I had nothing to grasp but the smoke of her dependency and depression, her childlike voice, the lightning flash of her tantrums. What had happened to her?

She attended every week, always with a sad and confused story. Sometimes she lay on the couch and just rested. I once played her a program of classical lullabies.

While therapy at its deepest is those supplies the child needed when she was first hurt, we are on a different road now and have to live without essential healing of our past. I believe I have shown that if a therapist even slightly introduces the past then moves on, the client will feel a deeper more embracing reality in the room which subliminally gives her some gravity, some mastery, some childhood friendship immanent in the friendly adult conversation.

Snake Oil Mental Health and Counseling Services

I think Nevada, or at least Las Vegas, must be a different animal when it comes to mental health practice. Back in Ohio, one would know of unqualified or neurotic managers or department heads, more rarely an agency director who, rumor had it, “didn’t know how to run a mental health center.” Generally, the feeling of most places was viability, solidity. But Vegas – it seems to be the Bermuda Triangle of hiders and charlatans, fake smilers, crooks and the weirdly ambitious: people who left their crime in one state; new CEO’s with old rap sheets and complementarily, a litigious bent; psychiatrists one can google for scandalous court cases, baby-talking Prussian generals; owners who roll out the welcome mat to the new therapist but have no clients; the echoing whisper of “insurance fraud.” What is it about this area? I work with a population of low-functioning clients,* with résumés of misery and life blaming and slip-and-falling whenever a success approaches. But they don’t go and open mental health centers! It’s these other folks, a kind of plastic elite species who are pastors of storefront churches on the side, a plumber franchisee with Tony Robbins-type gusto, a beautician who probably liked therapy in her earlier life.

Honestly, I have little idea. Is it easier to post a shingle here, akin to an on-line medical degree from Fiji? Burned a few times, I began opening my eyes wider during searches. Gauche, perfumey agency names with “thrive,” “heart,” “infinite,” “angel,” “blessed,” “keep faith,” “tender loving care,” “never give up,” “aloha,” popping up biweekly like those weeds that look like flowers. Ugly, generic websites with Japanese-translation verbiage; no staff listed, no reviews; no Internet presence after two years but an NPI number. Perversely, their Indeed.com ads would often be four to six inches long: tedious, torturous details of job functions as if a counselor must be led by hand and cattle prod through his day. And most ads specifying “one year experience,” at the most two. I have twenty-plus years’ experience. Am I the leper?

My only guess is linked to the fact that in Ohio, mental health treatment is either private practice or local government-based. In Columbus and vicinity there are many state- and local-levy-funded centers and branches. The heads are operations experts or individuals who rose through the ranks of social services – therapist, department head, clinical or administrative director, CEO. They are employees with personal, clinical and professional association's ethics and governmental oversight standards under their belt. Nevada, as far as I understand, does not have this system. There are some state-run or -supported facilities such as the state psychiatric hospital, a domestic violence shelter, one or two outpatient offices. Everything else – where you go for therapy for depression and anxiety and trauma, personality disorder, a sense of meaning, marriage, loneliness and self-esteem – is a twinkle in the eye of some individual with a dream. A dream of what? Medicaid money, I’m guessing.

 

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* Year 2021 Update: Note that this well-meant insult doesn’t apply to my current client list: I have moved on.

A little summation at sleepy 4 a.m.

There is a conflict between “there is nothing new under the sun” and “everything is new under the sun” for each person and each generation. What wrong and right ideas haven’t been known in the past? Life’s meaning and meaninglessness, power-hunger and other success, parenting, abuse, love and loss, conflict and tyrants and conscience, religious beliefs, disbelief, violence, group-think and iconoclasm. These ideas have been said. People don’t learn. Families don’t learn.

The human race has always written the same self-help books over and over again, has always made the same errors over and over again. We stake our life on our neighborhood gods. We believe in political parties or somebody’s idiosyncratic concept wardrobe such as socialism or capitalism. We’re alarmed a billion times by the same stories.

Why is it so hard for people to know what makes sense? Why is there universal lip service to the good values such as love and cooperation? The answer is that most persons and generations are sick, and sickness bends the mind. The sickness comes from pain and injustice and loss of self in childhood. Every problem stems from these. When we’ve scarred over our organic self, our answers can never be right. Or they can never stay right.

We can hardly imagine what we, the world would be like if all were healthy. I almost picture the Earth leaving its orbit and taking off through outer space, going somewhere, always joining new mysteries. As it is, we stagnate more than we should. We get nowhere, ever, like the animals and plants, but by the mercy of blind evolution.

Somehow it doesn’t seem right.

Theory platform #2: Paddock, the Las Vegas shooter

I wondered if I had anything new to say about the Las Vegas shooter. I do feel it’s too soon to try to generate an authoritative diagnostic opinion, as more facts continue to come out. (Just today, some tv profiler said that Paddock liked to tie up prostitutes and ‘make them scream,’ that he was a 9/11 conspiracy theorist, and that he ‘liked to take credit’ for his father’s crimes, whatever that means.) And facts – more and more and detailed ones – are critical in actual, as opposed to DSM-5 Manual, diagnosis.

So for now I’d just like to say that it’s fine if the shooter didn’t state a reason for his atrocity, didn’t leave a manifesto, hadn’t joined one of the ideological hate clubs. Because any explanation of those sorts would be no different from what any troubled person in therapy offers as his understanding of his problem or behavior: It would be a rationalization, an intellectualization, a cognitive escape or cover over the real motivation.

Which is a feeling. A complex feeling that either finds its right causes or cleaves to the wrong ones.

A client says, “I don’t like people. You can’t trust anyone.” Though he’ll pay lip service to making an exception for the therapist, he really does feel a general angry frightened alienation. But he is wrong. He dislikes people because he was, forty years earlier, an inconvenience to his partying mom, a complete nothing to his absent father. No one ever gave him reparative love, and he had to close the wound by killing hope. He won’t know this without therapy – and honesty.

A “white supremacist” speaks of his own superiority when it’s crystal clear in therapy that he has never had a good feeling about himself in his life. Maybe a grandfather gave him some time, the only non-punitive attention he got. But a baseline pain lived beneath that. Why couldn’t grandpa’s attention heal that? Because it didn’t address it. Later, he needed his mere existence, not his accomplishments, to be important – his whiteness – just as a child actually does need his value to be a given to his parents: They love him simply because he exists. But the client won’t know he’s just a child wanting to be loved for who he is.

Paddock does seem somewhat Asperger’s-like with his adolescent-stage lack of social harmony, his penchant for numbers and detail. He seems Schizoid: the glassy eyes and isolative affect in his junior high school photo, his apparent lack of a need for affiliation. He may have been born a psychopath, one of those “callous and unemotional” children* like the “bad seed” in the 1956 movie.** All these “types” can be understood to be based in loss of emotional connection, needful connection whose starvation causes pain.

Look at pain. It has different natures in different early environments. If it came in hellish birth trauma – being born in crack cocaine withdrawal and screaming for six months*** – any capacity for bond will be burned away. If it was less deadly, was succored soon after birth by a loving, not-solipsistic mother, it may flow deep beneath a bountiful land and emerge only during moments of quiet or loss later in life. If pain strikes and accumulates in childhood, we will have so many of our clients who try, then sabotage themselves; need love, fall into unloving relationships; feel hopes and dreams, and watch them evaporate before their eyes; be caring, but then coarse and rejecting.

I suspect the shooter’s end-of-life script was his birth template: some trauma that killed his heart but drove him on, like Janov’s “sympath”**** character. He was “soul murdered”***** at the starting gate. With no strand of bond, or maybe a vagrant molecule of it, he would not see people as hearts but as bodies that are both impertinences and appurtenances. And as he drifted into old age, that necessary quiet, he’d feel the worst possible pain: what he never had but which other people do: love and humanity.

Kill it, before you die from it.

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* http://healthland.time.com/2013/05/07/psychopaths-callous-children-show-dysfunctional-brain-responses-to-people-in-pain/, and other links and youtube videos.

** https://en.wikipedia.org/wiki/The_Bad_Seed_(1956_film).

*** The history of an eleven-year-old psychopath I treated.

**** http://cigognenews.blogspot.com/search?q=sympath. Excerpt from "Janov's Reflections on the Human Condition" blog:

“What we have found is that very early events in life determine the settings of our nervous systems. What sways the two key nervous systems – both under the aegis of the hypothalamus – is the kind of biologic and neurologic reaction that is forced on us and our brains while under specific kinds of threats very early in life, during gestation and birth. There is the struggle-and-succeed syndrome, the sympath, and the struggle-and-fail syndrome, the parasympath. This latter gives up easily and smells failure. Not so the sympath who tries and tries and does not give up. And when a new patient struggles to feel even when he is not ready, we generally have a sympath on our hands. The parasympath comes in listless, down regulated, worn out, unmotivated and depressed. He sees no point in anything. This is where the therapist needs his full capacity to meet the challenge. Should he be encouraged? These are the questions we take up constantly in our staff meetings. We often bring the patient in and ask him what works. He sometimes knows and sometimes does not. With long-time patients I ask them if I made a mistake and what was it? I get good answers and I learn.”

***** There are two or more books with this title. I’ve read Shengold’s -- https://books.google.com/books/about/Soul_Murder.html?id=pBRBAQAAIAAJ.

Janov, in memoriam

Dr. Arthur Janov, the creator of Primal Therapy, has died at age 93. Though a bit poetic and speculative, it makes sense that he lived this long, as he was an exemplar of his understanding of healing, of release of the pains that cause our psychological problems. He deserves to be – he is in the pantheon of brilliant thinkers who could understand truths that later seem logical to so many people (though they still may understand only the surface of them). He saw that we are holistic in mind, body and time. We are also what we were. We are roots – birth and childhood – and we are the trunk, branches and leaves that grow from those roots.

We know the world of people is, in the main, lost. Our human brain holds pain which bends, corrupts, blinds us, or rather grows blinders to self and others. And then that brain passes that pain on to the next generation. Part of this lostness is to form psychological ideas that are “self-medications” – no different from so many big ideas like political, religious and ideological ones. Therapies that believe we can think our way to a healthy body-mind, can hope health into existence. Magical thinking, magical doing. Dr. Janov could see what a child knows better than his parents usually do, that we are responding to the injuries that remain virulent inside us.

Our need for survival, and to answer our obscured birthright of happiness and love, is tenacious. Even many of those psychotherapists who see our source in pain and starved need put that fact aside, in a box, and focus on the here-and-now and “positives.” What a disconnect! What a displacement of fact and necessary act. If we are hurt, we must go there, to the dark, to ‘where we are wounded,’ as Arthur said. I will never see my clients otherwise – as obvious to me as something exists.

I do see some things differently from the doctor. It is probably fair to say he was optimistic while I am more pessimistic. I believe that despite all the potential opening up and pouring out, we must remain a default of defenses, our same self, and that we cannot recover from our developmental stopping point. Am I more realistic than Janov? I think so. But he may have been better for people. Because ultimately we do need to have love, believe we can deeply recover.

What a great man he was!