A revision of "the relationship"

Pardon my lack of energy to look this up, but I’m quite sure that in the original (and possibly the present) Primal Therapy, each therapist saw only one client over the course of a three-week intensive. The client, lying on a mat in a semi-darkened, soundproof room, could reach super depths for an hour or two or three or more – as his inner need compelled – every day for those three weeks. I never paused long enough ’til today, my sixty-eighth birthday, to realize that this is perfect. I’ve known – as any depth therapist will know – that the fifty- or sixty-minute hour is an arbitrary convention that has nothing to do with success. People in the throes of painful truth can be frustrated by it, certainly those I’ve worked with who may not fall into their dungeon until the last few minutes of the hour.

Ideally, I’d like to go even further: have only one client for an hour-and-a-half or longer, two or three times a week over the course of a two-to-five-month term, pre-contracted but revisable. That’s because, to contradict James F. Masterson’s solidly respectable insistence that psychotherapy is a professional not a friendship relationship, it should have the undercurrent of a friend, or rather a soul-meet, relationship.

I believe this to be true even though the client typically wouldn’t want it. He doesn’t want, for the most part, the one person who cares and sees him the best to occupy that place in him where his parents failed to be.

Let’s question the wishful thinking that the client can be changed outside of a deep, core, abiding relationship. There’s the trite blather about how even Cognitive Therapy – the injection of therapist-approved improved thoughts into the benighted – works through "the relationship," but that requires the most superficial definition of a relationship possible, consisting of what? Benevolence, good cheer, respect for the person’s wrongheaded feeling and thinking? People are injured because their original relationship was not right. It was abusive or distracted or absent, was the parent’s neediness for enmeshment or love or revenge. What the person will, then, always need is the original symbiosis that evolves, over time, to its internalization and to separation and messy independence – the adult.

Clients don’t come in for this process that some would call reparenting, though it is closer to rebirthing. But they can be excused for not knowing what the hell is best.

Are we our feelings?

I just completed a short webinar, “Calming the Emotional Storms," for year-end professional education credits. This consisted of a mini-palette of techniques and principles in Dialectical Behavioral Therapy, while the presenter made the disclaimer that she uses DBT to treat a variety of problems, not just Borderline Personality. Here were the main topics: role of mindfulness in emotion regulation; importance of naming and validating emotions; opposite to emotion action (where one forces a behavior that is “opposite” to what the destructive emotion would naturally compel); nonjudgmental stance; accumulating positives; cope ahead (creative visualization). As this was an interactive seminar, I typed in a comment as the presenter talked about assuaging painful emotions. I said that therapists may need to have the client question her naming of a feeling, micro-explore what her actual experience was. For example, she may feel “guilt” in wide swaths of her life, yet the therapist will point out that it can’t be guilt she feels, as “you didn’t do anything wrong.” What has happened is that in her remote history, “someone made you feel bad about yourself.” The webinar presenter did not understand my meaning. It was literally too deep for her agenda, which was the manipulation of emotions as surfacely experienced in order to feel better. She thought I was merely in favor of “validating” the client’s feeling, not x-raying, revealing, transmuting it.

But the presentation brought me back to a perennial question or conundrum; actually, one that I have neglected to inspect through the two decades of my practice: How much of our feeling do we accept as who we are and how much do we reject?

The webinar used “shame” as an example, basically channeling President Coolidge’s comment on the preacher’s attitude about sin: “He’s against it.” One shouldn’t drown in it, the DBT folks might say. But I think of shame as, according to Donald Dutton, the primary factor in a boy’s life – injected by his abusive father – that will lead to his becoming domestically violent later on. So if I am working with a perpetrator, don’t I want him to feel the buried-but-alive shame that grew a toxic and barbed wire surface that hurts people? Yes. I would not DBT it away. But this wouldn’t be just a matter of “staying with" such a terrible feeling. It would also be the “working through” – grieving long and hard a childhood.

Other feelings: Does someone “feel” suicidal? Or does he feel awful – maybe cavernously empty – and then allow fatalistic thoughts to give definition to the feeling? I want someone to feel the worst,* to let it pour out into the caring vessel of the therapist. But not if the dire thinking remains clutched to the body emotion. Then there would first have to be a surgical separation of thought and feeling. Anger, too. The “opposite to emotion action,” according to Emotion Regulation skills, would be to resist the “urge” to “attack,” and instead “gently avoid” and “be civil.” But brute-forcing nobility and passivity will not mitigate anger. I want the person to feel the full chemistry of it. There will be profound frustration, profound hurt – the child's hurt – within it. The anger is legitimate, but it is just a devolution of the other feelings.

In our daily lives we will have countless moods, each of which will feel to be our true nature during its moment. I, myself, have experienced infinitely more transitory moods and emotions following my epiphanic defense-busting and newfound health twenty-six years ago, than I had felt in the forty-two years before it. Are they “me,” as they seem, or just waves upon a deeper and abiding ocean? One mood state feels like my identity forever. Should I somehow reject it, waiting for a better one? Is there a deeper Self, or just a chain of feelings loosened, a broken-open kaleidoscope? As they seem.

I’ve written before (“Our thinking”) about thinking as a prosthetic support that grows when pain and absence of identity-feeling have made it impossible to move well into adulthood, to carry out our lives. We have reversed, as Vereshack described, the feeling-thinking axis to be cognitive-heavy people, unlike children. I have to wonder if this means (though this would be a conclusion of “pure logic” not clinical research) that most of our feelings must be negative and unsustainable, thanks to our history as birth-traumatized and injured children. If we need to live mostly on the terrain of our beliefs and philosophies (as corrupt and rationalized and delusional as many of them are), wouldn’t that mean we can’t trust our sickness to hold us up?

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* Paul Vereshack's on-line book: “THE CENTRAL PARADOX of all experiential therapy emerged, which is that, when we move to the absolute feeling centre of the most painful and the worst that has ever happened to us, barriers within the mind collapse, the pain is experienced and an emotional completion occurs.”

The F Code

I don’t know about other therapists, but after twenty-plus years of trying to understand clients in all their uniqueness, I find myself still gravitating to the brand-name labels, matching each person to a disorder or two: depression, anxiety, PTSD, etc. After awhile, the labels turn translucent and he or she becomes only pain-based and developmentally ungrown, whether it’s fear, or loss of feeling and identity, or child’s psyche stuck in an adult body and time.

One antidote, I suggest, to seeing the client as owning or being a disorder is the Intake form’s symptom list. You’d have to be inept to think that a client who checks fifty to ninety percent of the following conforms to any disease entity:

Crying spells, always worried, work difficulties, stomach upset, feeling grouchy, nightmares, excessive drug use, trouble sleeping, feeling lonely, loss of weight, not enjoying things, suicidal thoughts, feeling inferior, loss of sexual interest, no one understands me, unable to relax, can’t concentrate, feeling fearful, don’t like being alone, lack energy, feel like hurting someone, excessive medication use, wake up too early, buying sprees, feeling embarrassed, survived a traumatic event, money problems, relationship concerns, lacking in confidence, shaky hands, excessive drinking, poor appetite, depressed, feeling panicky, irritability, shy with people, muscle twitching, nausea or vomiting, can’t make decisions, can’t make friends, headaches, abusive relationship, binge eating, very restless, anxious inside, weight gain, impatient with people, low self-esteem, no need for sleep, gambling too much, unwanted thoughts / impulses, change in medication, unable to have fun, feelings easily hurt, sexual problems, can’t hold a job, always tired, feeling tense, problems with children, problems with parents, poor physical health, fighting and quarreling, dislike my body, full of energy, overly ambitious, easily excited, quick-tempered, guilty, angry, hopeless, feel rageful, excessive overeating, isolate / withdrawn, cutting / self-harm, racing thoughts, increase in sexual desire, repetitive behaviors, memory problems.

Or the client who says: “I’m a hot mess. I’m totally neurotic.” Or “Purpose. Time Management. Boundaries.”

I’ll admit, in weirdness and embarrassment, that I gradually transition from mild anxiety to relief when a client, narrating his childhood and adolescent history, proceeds to pile on one mess after another of birth crisis, traumas, abuses, “thirteen different elementary schools,” foster system, being bullied, neglected by immature parents, returned to them, series of mom’s brutal boyfriends, child's adultification, incest to drug partying to acquaintance rapes, starved souls turning different from youth on. By the time he’s named the full smorgasbord, I’ve relaxed, knowing I’m looking at no disorder names, only deep lostness that needs to be found, deep wounds that need to be brought out. Had he delivered one problem or one main childhood event – “I panic, I have social anxiety, I have depression, my parents split up when I was three” – I’d feel a little unmanned: Do I have the corresponding one masterstroke to heal it?

The fact is that every single client is this smorgasbord. A simple way to see it is to picture one circumstance – dad’s spending all his time at work and at the gym – and consider his daughter’s injury and adaptation to it at home, when with her friends, at school, in her feelings as she tries to go to sleep, in her emotionalized thoughts about herself, her fantasies, in the weight of her social presence during the day, in the way of being with her mother, in time-as-scar-tissue and determinations over weeks and years, in the person she has become. A single circumstance becomes countless identities and symptoms embedded in her everywhere, forming her life. Now picture three or five or ten or a hundred losses of attention or love early on.

Our office’s symptom list is one page, three columns. If there were many more such pages, you know the client could fill them all.

DSM F-Codes: May they die a lonely death.

Having no agenda is the right agenda

My experience is probably no surprise to any feeling-centered depth therapist, but I want to mention it as I’ve had two worthy moments in two sessions in two days. A twenty-seven-year-old man and a twenty-seven-year-old woman. Both presented as opaque, one appearing not to have, one denying, any depth (“there is no ‘child’ in me”). The man actually looked intellectually deficient, with his flat mannequin expression, surface sentences and dully watchful manner. The woman, bright (studying physics in grad school), chatted nicely but kept her frozen smile and anxiety on guard, to prevent any entrée to her feelings.

This is not to say they were emotionally mute. Anger and anxiety were their “presenting problems,” and they could describe basic symptoms and a narrative history.

It was time to bludgeon them in order to forestall any more time wasted in sessions. I mentioned the Focusing process, described in an earlier session, to “subliminally” attune them to the feeling zone. Then I asked them to sit back or lie back, eyes closed, and dwell inward, letting any feeling coalesce. Sit in it for a while. Then (after some untimed silence), make a doorway that lets the feeling come up and out in words. Both clients complied and sat back in complete silence for a long time, five or more minutes. Somehow that was all it took to enable them to fall into a never-known place. The man talked to his parents about their killing him with rejection immediately upon their divorce. He then talked to his wife about his sense of failure and his failure to her. I could see he was in an almost-hypnotic place, and at the sweet-spot perfectly gifted moment when he had painted the doom he was giving his family, I suggested he tell her what he can do “instead.” He spoke words to save himself: what he would do now to change, what he would do for them. It was actually thrilling to witness it.

The woman, after her period of silence, lost her guard and said to no one how she had fucked up her life and how it has taken all these years to create some solidity. She decried that her mother had never been a strong and wise resource for her. She told her how desolate it had been when she graduated from high school and there was no parent “to tell me what to do,” what to do in college or with her life. Afterwards, we understood how regressive this was, she still was, the child needing to be told. Something she had never realized.

Though I’ve done a hundred similar processes over the years, somehow I don’t recall doing this simple one much at all. But it’s probably the right way to go, maybe most of the time. No subject of the hour. Just go inside, close your eyes, sink, and stay there for a long time until your real life finds you.

Honing the idea a little:

A few years ago I wrote a post (https://pessimisticshrink.blogspot.com/2016/01/theres-no-place-like-home.html) proposing that the deepest and most moving therapy could be based on the client’s questioning himself: Who am I? He

“would sink into the question miles deep, in head silence, before letting a response emerge. This is because we can read the pieces of our real self – all the elusive and quiddity truths of it – by presenting the body with open-ended questions. ‘Who am I?’ ‘How is my life going right now?’ ‘What do I care about?’ ‘What does “care” mean to me?’ The body knows – because it owns – the infinitude of historical feelings that make the facts, far more than our idea-generating, safe-guessing head knows what’s ultimately real.”

But now I believe even that is too much of an agenda. Start with nothing, only a place of comfortable discomfort, and with all the time in the world. (Or so it comes to seem.)

A second honing:

An hour of mostly silence can be vastly superior to half a year of talk.

Thoughts on doing therapy with prisoners

Why would, why should someone be a prison therapist? Why might violent offenders be appealing from a psychological perspective? Many (possibly most) people in the general therapy population entertain violent and destructive thoughts occasionally. Is there some valid reason to specialize in one cohort that occasionally acts out these thoughts or impulses? For that matter, is there some valid across-the-board differen­tiation between those who think and those who do?

I looked up James Gilligan, M.D., his book Violence and an interview. Prison psychiatrist for twenty-five years “as if to the manner born,” Gilligan said that he was inspired by his abusive childhood to want to understand and prevent violence. These aims wouldn’t require, though, decades of immersion in a maximum-security prison population.

I asked myself these questions when there was the possibility that I’d be getting into this work. Picturing the violent men who got caught, I found these thoughts:

* If an ex-convict were free in the general population but for the parole requirement to attend counseling, I’d look to see if there was one of the personality disorders that feature solipsism and lack of empathy. I have seen these men and have tried to work with them, but after a “valiant effort,” there proved to be no hope. A twenty-seven-year-old rapper with a long criminal résumé was solicitous, complimentary and docile each week. A veritable winsome wight, chirping delight. Until, maybe four or five sessions in, he showed to be an act. If he were in prison, would he be the same? Or might the fate of long-term incarceration get him to see things differently, turn his heart inward?

* No: The men are trapped – yes, like animals – in an artificial world. (Gilligan notes that in the history of criminal justice, long-term incarceration of malefactors is a relatively new phenomenon.) I don’t believe that any inmate, but for the most intellectually impaired or psychotic, would ever feel this entrapment was right or deserved. Who actually feels in his precious soul that his behavior, whatever it was, deserves society’s consequence – the revenge of victims or the laws of strangers? If I’m working to dive to some depth with these men, wouldn’t that sense of injustice be a buoy yanking them to the surface? How could they do the most vulnerable wounded-child work when already feeling the helplessness of not owning their lives? (Gilligan’s interviewer commented on an unwritten prison rule that men shall not cry unless it’s over their mother’s death.)

* It’s a diamond-hard certainty that these are developmentally immature “arrested development” human beings, belying the “mastermind criminal” cliché. To use violence, whether it’s throwing the tv remote at the wall or stabbing someone, means the person has reverted to or has never surpassed an earlier primitive stage of the human growth cycle. A baby should throw a tantrum and break a toy or bang his head. A seven-year-old should insist that kicking a hole in the door is “not my fault!” An adult, with a mediating neocortex and a secure base upon which to have grown, should restrain himself, understand his agency in the situation, know his feelings and describe them in words.

Summary (more or less): Many of these men will be the unrepentant personality disorder; they will be bent, a priori, by the feeling of injustice of their situation; they will be, at their molecular ground, immature, the stunted inner child. A psychotherapist or social worker does not, I’m guessing, seek to work in the prison setting with the goal of focusing on the several scattered gems of deep heart, whom passion briefly sent on a wrong turn.

Still, just as one marries for oneself not one’s partner, so I could work in that realm for myself, for a kind of personal growth, for the enjoyment of striving for therapy magic. Maybe I would fantasize: Prison is just life in microcosm! Do we really have freedom, even with a limitless horizon and passports for the acquiring, even with no alarms sounding, even with money and a car? Maybe the men and women in cells are essentially like me and you. Or, a terrible fantasy: What if I were an inmate? I imagine that I tracked down my old junior high school bully and destroyed him. Would I want to talk to a therapist?

Yes. I think it would feel like a kind of escape.

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Addendum: After conjuring up these notions, another one occurred to me. I remembered that Gilligan painted the image of prisoners living in their own individual hell. They would “feel like robots or zombies, that . . . their bodies are empty or filled with straw, not flesh and blood, that instead of having veins and nerves they have ropes or cords." I remembered that a goal of mine would be to help them feel more human.