Tuesday, August 28, 2018

Son of Bad Supervisor


Years ago, mistakenly feeling superior, I completed the coursework to be a counselor supervisor. Slogging through that literature was living in the hell of pure boredom: chapter after chapter, PowerPoint and workshop of the most emasculated, packing-peanut jargon and oversight boilerplate possible on earth, short of farce. The aim of the material, for the most part, was to have me inflict many layers of diapers on the counselor trainee. Don’t be sexual with the client. Be genuine. Self-reflect. Be ethical. Learn the theories. Identify misconceptions. Know the client’s world view. Explore supervisee’s feelings. Explore boundary issues. Be multiculturally competent. Be evaluated periodically and as needed.

The end result of my knowledge, the supervised intern, would be a gingerly hatched egg with no compass, a map with nothing on it, an extremely light suitcase, and a fear of jail (really, just malpractice and doom).

I have never wanted to do it again. But I do enjoy challenging and distressing students.

What do you think it means to be a therapist? How have you dealt with your own psychology? How far have you gone in it? What do you think psycho-emotional problems are?
Here, if he or she has drunk from the communal well and says “cognitive errors,” I will probably reply . . . .

Jesus, no. Do you believe the client is too stupid to think right? He “thinks,” if you want to give him that compliment, because he feels. He feels because that’s how we receive the stimuli of the world. A child isn’t sick because she thinks it. Let’s look at what feeling is, and what it does to us. Let’s look at the kinds of mental slippage that we call “thinking,” and how it often has little to do with the world.
That would start the ball rolling. We’d then sit at a pub, have some drinks or a water, and slalom in the mess of human misery.

Therapists are the fortunate few. People “feel” helped by all sorts of lights and voodoo, even when they’re not. Especially when they’re not: Real help is painful and fearful, and may not feel useful. While lite help – pushing reframing and sanguine thoughts, encouragement, humor, some tears, general psychoeducation – sugars the client’s mind, directs him away from his deep sharky ocean.

Student counselors are, admittedly, the best at this. They are enthusiastic, empathic, mostly ignorant, attractive, happy to be titled therapists or psychotherapists or counselors.

I have never liked using those terms. They’re a little embarrassing, as it can never not seem pompous. “II know the human psyche. And then I’ll know yours!”*

If I had the chance, I’d influence the intern to question herself uncomfortably by sending her feeling eyes into her past, by lightly landing on the billions of microscopic emotional satellite dishes – residing in the gut and chest and throat – that comprise the body’s awareness of its history. If we know the dumbstruck facts of our nature, we’ll be comfortable with and allowing and inviting the client to know theirs. Psychotherapy is not primarily a skill or an art you learn. It is the gradual undoing of self-assumptions, of one’s comfortable persona, where investigation brings somber sobriety and knowledge and catharsis, which equals clarity, which equals more-lucid empathy for the other. It’s a kind of de-evolution of the self, yet we become more.

Interns sometimes don’t like that supervision includes moments of their own therapy. Maybe that’s what separates the young men from the boys, the young women from the girls.

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* Inspired by one of Johannes Brahms’ witticisms: “During a rehearsal of a quartet of his, the violist asked if he liked their tempos. ‘Yes,’ said Brahms. ‘Especially yours.’ http://www.slate.com/articles/arts/music_box/2006/10/classic_putdowns.html.

Sunday, August 26, 2018

He is the world


It will be bitter brain candy when, in the near future, studiers of Trump chew on this question: Why was this president able to be nothing other than – to be blunt a lowlife?

Many psychological facets of the man are known or obvious: his narcissism with narcissism’s insecure “inner child”; his immorality and amorality; an organic “tilt” or imbalance that prevents peace, makes the baseline of frustration and anger; his lack of subtle intelligence; his primitive goals of money and power; his instinctive need to proactively defy humane feelings and principles. Psychologists and others may explain his complacent degeneracy as the simple fusion of these factors. But there remains another factor, which necessitates a different explanation: the global, public arena in which he practices, that would lead others in his position to mitigate or conceal themselves. Most power-hungry narcissists would take into account either shame, or a felt or strategic need to impress, or the goal of having a less-embattled path to success, and would show lip-service decency or compatibility. The fact that Trump is oblivious to these possibilities alters the conclusion of a mere fusion of ingredients and points directly to the base of his psychological abyss: Here is a man who is so psychically alone, at the level of birth or perinatal flaw, that he could not be part of the world. He had to be the world. I acknowledge that this is a feeling it will take science a long time to find under the microscope.

With no other consciousnesses around him to consider, in his psyche, there can be no reason to accommodate or struggle.

James Gilligan, M.D., psychiatrist to maximum security prisoners,* described how a criminal’s excruciating transparent sense of shame – someone’s eyes looking into his soul – is a common provocation for murder. One man, in his twenties, killed and cut out the eyes of a woman who had known of him in high school and who’d been aware of his prestige as an auto mechanic. One day she noticed him walking down the street and offered him a ride: He had not been able to repair his own car. Sitting in the passenger seat, he could not stand her seeing him, knowing his worthlessness. My theory is that Donald Trump is so fundamentally disconnected, so solipsistic and averse to the world of people, that he lives even beneath the shame of some of the most damaged criminals. He could not feel shame despite millions of eyes seeing his soul. Nor could he, the world incarnate, care about strategizing, about working with “friends” or colleagues or adversaries to realize his aims. He would frustrate members of his own party, alienate allies, burn those who cared about him. All would eventually be destroyed as he continually constricted to his aloneness, his birth imprint. I suspect that Trump’s alignment with Putin and the “very honorable” Kim Jong-un is essentially an affirmation supply: no bond at all, but a support of his sense of life as carnivorous, adversarial, alien. I don’t doubt, though, there is a strand of him, the empty child, that leans on an unloving father figure.

It may be that molecular strand of need, which he senses, that is enough to make him feel alive inside,** and prevent a murdering character.

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* James Gilligan, M.D., Violence, Vintage Books, 1997. I no longer own the book and may be mis-remembering details of the murder scenario.

** “Some [prisoners] have told me they feel like robots or zombies, that they feel their bodies are empty or filled with straw, not flesh and blood, that instead of having veins and nerves they have ropes or cords” (p. 33, Violence).

“Provisional commentary”: I may have a very wrong impression of Gilligan, but I came away from his book thinking that he doesnt recognize the existence of psychopaths. His many examples of murderous prisoners all fall on the spectrum of the wounded abused, those who had a human heart that was injured in childhood, enabling their desperate behavior. Compare the first few chapters of his book with the first few of Robert D. Hares Without Conscience, that describes unrepentant, incorrigible, lizard-brained psychopaths. One would think these two experts live in perpendicular universes, one where good youth are bent by tragedy to murder, the other where an inhuman species walks among us. My article suggests the slight continuum difference between a Trumpian narcissist and a card-carrying psychopath: the molecular strand of need that did not burn out in a troubled birth.

Saturday, August 25, 2018

Change, part two, part two*


Therapy in the contemporary era is mostly counseling, and counseling is mostly conversation and tears with the adult artifice in the chair. Sweet dreams and a soft stroke on the cheek to clinicians who are “there” for the presenting client and his or her presenting problem. That is difficult work that is easy, with both parties taking a mineral bath or maybe walking together, contemplative, through a dusky and moody meadow. All of us, I am sure, have heard that our presence – the relationship – is the prime conduit of help; we with our wise words and silences.

But every once in a while the lucky therapist helps – or simply watches – a client crack his entire persona world and crash into his deepest death-like pain: the killed child, who lost love and could never move on after it, but to scream in a timeless void. When this happens, he is no longer in the room. The walls have disappeared; he has no therapist. Sometimes the therapist, so caught up in the client’s first-time understanding, also feels he is not in an office, is in a dimension of utter meaning. And the man or woman changes then and forever.

I can remember only three occasions of this. The first time was in Colorado, sixteen years ago, when a man paced my office like a cougar on the prowl, neck veins bulging, rage a time machine transporting him back to childhood. After the epiphany – his father transformed his identity by making him the younger siblings' role model – he said that he hadn’t been aware he was in an office, in a room.

And then: A retired lawyer who was irritable at his kind wife. He wanted to know why. With no preparation but the suggestion of an exercise and the provision to bow out, I asked him to sit back, close his eyes, and picture himself on his death bed with mere hours to live. “Now, in your imagination, look up and see your mother standing at the side of the bed. Look at her face. There is so much unsaid between you. Feel the presence of all the unsaid between you – all the things you have never told her, all the thoughts and feelings you have never expressed. If ever you would be able to reach your mother, it is now. If ever she would hear you, it is now. Talk to her. Tell her.”**

He immediately started talking to her. His voice seemed to fade. I contributed some of my most judicious silence. He continued to talk, fade. Another silence. The pattern repeated, though I’m sure that by the second or third crest he no longer knew of me. And then it happened that he voiced a word that meant every devastation of his childhood, of his life. Again and again, the word. If it’s possible for a therapist to feel non-existent, a glorious non-existence, in the presence of a client who is alone in the greatest truth of his life, that is what I felt.

I’ve described this only for the purpose of asking: What is better, to be with the client, our “gold standard,” or to be gone while alone, he finds himself?

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** Excerpt from Nathaniel Branden’s “the Death Bed Situation,” The Disowned Self, 1972.