Yours truly

How should a therapist work with a client who is floating in life and in his life, who feels bad or just not good, who has forever ignored all matters of his personal psychology, who may have never thought there may be "causes" of his plight – "it's just who I am" – and who comes to therapy as if to a witch doctor, hoping not for "answers" necessarily, but for a magical fix?

It is probably hard to believe there are people this cosmically obtuse. But that was exactly me in my twenty-eighth year when I visited a psychiatrist-therapist, feeling something that I could not understand. And a new client, 23, presented to teletherapy with such stark opacity that I was reminded of myself of forty-three years ago. This led me to think, for the first time in my career, about how a therapist should approach someone so blind that he does not know the unknown exists.

When, however, I picture my own abjectly living-dead persona in therapy, I have to wonder if that may not be so different from other people, people who know the labels of psychology, and that they have "symptoms," but don't know they were made this way, that their childhood was wrong, so wrong that it made them to be wrong. I wonder if being told that "you were not always like this" or "no, your depression started much earlier than ten years ago" might be awe-fully disturbing: the knowledge that they are not an entity, not an identity but a disease process.

If I had been my therapist those many years ago, knowing what I have learned since, I would have been extremely careful, exquisitely dainty in approaching the subject of existential disease. I would start by addressing the now:

Can you think of anything in your life right now that may be contributing to your bad feeling? I would not ask for a "cause" as that would send him into thinking not feeling.

Young me: I don't know. A woman – my girlfriend and her two daughters moved into my apartment. I moved to Roanoke a month ago. I wouldn't have said "girlfriend" first, as that would have had the feel of commitment, and I was a man in space.

Therapist me: How long have you known each other?

Y.M.: Three weeks. I would have felt nothing, and I mean absolutely nothing amiss about this.

Th.M.: (Very polite pause.) Did you feel ready to move in, to live together, after three weeks? I would have been pretty sure that this would be a shocking question, as the client didn't blush or look confused when he said it.

Y.M.: (Stirred quietly, like the butterfly's beating wings that cause reverberations reaching to the antipodes of the world.) I don't know. (Trying to be dryly humorous, not to drown): I don't think I registered a feeling. I'm sure I was a contributing part of the decision.

Th.M.: (Realizing that this client may not have a Self and therefore no capacity for decisional feeling, but that his desiccated persona of cleverness may be what speaks to me.) We may have reached something useful already. What do you feel about your girlfriend?

Y.M.: (Very troubled, somewhat out-of-body trying to find my way in.) She's vivacious, and quite a beauty.

Th.M.: Do you know what you feel about her?

Y.M.: (A pause in which I try to look deep.) That's a difficult question. Should it be?

Th.M.: (Realizing that this wasn't mere "alexithymia," an inability to recognize one's feelings or to have them. This was a lost person, one of those who was a child lost in an adult body. Knowing that to say, "You don't know who you are," or even "You are not in touch with your feelings," would likely cause him to not return for another session, that it would be best to meet him where he was.) I've noticed that some people are very thinking-oriented. They may try to understand things by analyzing them. Do you think that's you?

Y.M.: Well, I thought that was everybody.

The great challenge that would strike the therapist: Introduce the client to the world of feelings and to his felt history. This couldn't be talked about. It would have to be experienced. A person blind from birth couldn't be told about sight. He would have to open his eyes to a world he'd never known. The young man would have to feel the meaning of his life in an epiphany. This would return his heart to him and cause it overwhelming pain at the same time. This did not happen to me in my sessions, as there were only three, and the therapist was as blind to my need for reincarnation as I was. It happened fourteen years later, now alone, as I took a walk in a strange town.

Th.M.: Talk about your childhood. And as you do, try to remember how you felt. Sit back, or even better, lie down on the sofa and just talk. Remember. Remember.