The strangest Mother's Day: Follow-up to a pathologically existential client (see previous post)

Adapted from progress note:

As my client has been working on, or at least thinking seriously about, his existential distress – identity and personal and career meaning – for several months with no relief from its desperate poignancy, it seemed necessary to dive into the radical ends of intervention. Intervention #1: He has remained toxically regressively attached – in slavery and hope – to his shaming and physically abusive (and complicit) parents and cannot feel himself, cannot feel free. His starved bond with them has served as anchor and quicksand, making him incapable of feeling, in his bones, autonomous. He would have to “say goodbye and good riddance” to them, reject and disown them, turn away. Only that could make him feel that he could make a clean, fresh start, breathe the air and see a horizon not polluted by them. Intervention #2 was the exact opposite, contingent on the nature of his relationship with his mother. (Father is understood to be a lost cause.) If he can remember any moment from his childhood where he felt his mother’s selfless love, and can remember her clear expression of it, then going to her, in regression and a child’s need, for a re-supply (as it were) of it, could enable him to move on into his adult life. “If it exists, you would need to rejoin your mother’s love.” Internalized, late but forever, that love would make you free.

Neither intervention would apply to individuals whose self-esteem was highjacked but not killed by their parents: Those who live and struggle for the smile of contingent approval their entire lives. While much more successful in prestige and material, these individuals won’t be helped. They have survived on false love while the others have survived on no love. They could only fall and crash, in therapy, the latter could only climb.

General and specific observations in retrospect

A surprising number of clients say they have no identity, don’t know who or what they are, lack a sense of self-meaning, have not the slightest feeling of a true or right occupation or career. None of them could be helped by Existential Psychotherapy – Yalom or any of the others. Presently, one forty-year-old man is in a state of depressive panic about this. The others say it but don’t feel it deeply. I could throw a hundred college catalogs at them and they would find not a single subject of interest on which to build a next phase of their life. Though I do try this, and think of various approaches to stir their potential or their original core, I know I am not a good inspiration for them. That’s because the profession of psychotherapy was not a true north of mine but was the unexpected heroin – self-medication – that saved me and replaced me, thirty years ago, at the very moment of my crisis of being. On a walk, I had found self-awareness for the first time in my life and saw that I was nothing. Rather than collapse in the truth and in help, which would have been right, the idea of helping others as unmade as I was struck me exactly as God suddenly appears to the most wretched of souls in their despair. It was my salvation. Becoming a therapist became both my forever meaning and my forever self-loss.

I can’t wish this on any of my clients, and none have found it on their own.

Theory and practice have proved very divergent. The way of healing is not to make yourself think different or to open your eyes and see a truth. People love to, need to, believe that a new idea or fact will change them, will rewrite their chemistry. It can’t be. We need to return to our sick roots in childhood, grieve that pain and give it to a parent-figure. True therapy is reparenting.

I don’t know anyone who has done this.

I recently asked a college senior to stop smiling and being her snazzy bouncy self when we both know there is a dark underground in her. How can such a helium-filled persona feel right? I asked. She gave me an explanation having to do with women’s debased status in specific sciences. My oafish reply was that most young people already have to be fake to convince themselves that they want to be adults with forty-hour work weeks and a level of initiative and unsupportedness that will never feel right. Why add another layer of unreality to that? Then I remembered that reality would have killed me at 22.

We let the matter rest.

Adapted from a Progress Note: “‘Sal,’ a pleasant, intelligent client of four months, actually exists on a different plane of reality that completely blocks emotional awareness and the reception of psychological information. He provides copious facts of the world (religion, sociology, etc.) for unknown reasons and acts as if everything introduced by this clinician is something he already knows. The different plane of reality was forged in his pathologically adultified childhood, where he was both hard worker and caregiver to almost a dozen children in his blended family. He has grown, self-medicatively, a mindset and philosophy that knows nothing of children’s reality but is goal-, work- and spirituality-centered, which he has instilled in his children. Though they are hard workers and players, “successful,” there are apparent flaws in his system. As examples, he acts as wise guru, not victim, to his Borderline Personality-disorder wife, does not let himself feel her poison which has pervaded the family for two decades. His daughter ‘doesn’t care for’ gay people, but has been inculcated to have rote respect for their rights as individuals.”

One of my most decent and engaged clients who will never be reached.

Why do these clients keep returning, week to week, month to month? One might think they’d be scandalized or too bored. I believe they feel the warmth of my optimism rooted in the pessimism of human nature.