Brief, solution-focused heart surgery

I’ve been seeing therapy clients four to six days a week for twenty years, so I felt appropriate when a frightened Counselor Intern asked me: What do you talk about after the first session? How do you keep therapy going week after week?

When I heard the questions, my first and shameful reaction was to wonder what my nemeses in spirit, Cognitive Therapists, do after they’ve pointed out the illogic or irrationality or catastrophizing or “musterbation” of the client’s thinking. That should only take a session or two, shouldn’t it? Though I’ve gone to Cognitive-themed workshops over the years, I’ve never gotten any sense of the paradigm’s ability to create depth or continuity. Nor have I ever been able to fathom the chutzpah of a modestly intelligent counselor’s belief that he or she can correct “thinking errors” in other adults, can open their mind to a long-elusive, just-missed, or too-stupid-to-figure-out life-changing truth.

The fact is that despite my disdain for that severed-headed approach, I am envious of any therapist who would laugh in the face of the question: “How do we run the show?”

Except that –

I’m sorry, the majority of you: The answer is not that the client determines the hours. For one, many clients would just talk on and on from their surface tension (angsty) and defenses (euthymic), or they would die in the water, an emotional clot rising to the surface, with nothing to say. Two: They do not know how to solve their problem. The internal gravity of their wound will be resisted over and over again. They will float above it forever.* And three: It is extremely likely they do not know what their problem is. Their problem is not a fact, but a feeling. And the feeling is not in the here-and-now. It is their child that has not moved on, has not grown.

So for you who laugh at the questions, there’s a better-than-fair chance that you are doing things wrong and are not helping anyone beneath the palliative and mutual self-delusion plane.

I have a belief, pretty much unarticulated until this writing, that the emotionally investigative process (that is: “therapy”) should be limited and self-limiting by the client. I suspect that this belief lowers an unconscious curtain on my therapies at a certain point. Once the client has reached a motherlode of her childhood wounds – grasped them stripped of the adult rationalizations and “knowledge,” cried them, grown a backbone astride them – it is time to leave her to her own life. Her foundation will be somewhat cleared out, deepened. Her house will have open windows, a stronger front door. A term of therapy may be three or four months, but probably not longer. She shouldn’t continue to live in the regressive subterrain. But neither would she flap on in her adult persona.

This would be to acknowledge, or tip our hat to, the fact that we can’t not be a nebulous and partially grown person living in our own individual world. (There is only so much and so little we can do.)

One of my most grateful clients, an artist, attended weekly for almost a year. There was horrendous child abuse in his roots. We worked directly on that – insight, catharsis, abreaction, some “primal scream” – for a short while. The rest of that year was urged, I believe, by a peculiar place in him that wanted his truth to be recognized with care and some perceptive feedback. That may have meant that he was strong enough to let his child come into the room many times, though our conversation was often what you might call “refined”: philosophy, creativity, the psychological soul. He was unique in my experience. Most clients cannot knowingly live in their past and in their present equally. They shift to the unknowing.

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* That is, until Freud’s “interminable” has been reached.