Pessimistic therapy laws #5: Therapy conversations are better than almost all other kinds

All the people in the world stranded outside therapy offices should be jealous of our conversations. Everything they say eventually reveals, in hindsight, its emptiness, its missed truth. Salutations, jokes, politics, religion, art, obituaries. Pillow talk, Shakespeare, prejudices and hatreds, philosophy and poetry. Parental lessons, campfire songs and ponderings. Everything but science. In an absolute way, all of it is breezes flying high above a fire. People are bleeding, lost, blind, stuck, and not knowing it they live lives of noisy desperation, moving their tongues about anything. In therapy we look at our question marks, we look for the buried or huddled in a corner child. We question ‘what is love? What do you really feel? What am I?’ We search with compassion the humanness that others call weakness, failure, guilt, lazy, mental illness, crazy, evil. We stop the ride that is the world we never made and are still, looking both inward and at our widest possible horizon, like a physicist peering through a telescope all night, after midnight.

We give love without needing, we reparent, we respect, we find a truth or two that will support and last to the grave. We find realer and realer layers of the person, sometimes down to the seed that bore her.

After therapy, other conversations are icing on the cake. Without therapy, they are icing without a cake.

In-house #8: The Socratic two-step

Sometimes, in an expansive mood, I will set aside the diagnostic interview and ask a client: ‘What do you think therapy does? How do you think therapy helps?’ I always expect the question to jazz him or her: to urge discovery, to shine a light into an unknown cave. It’s a good question because some people have no clue and come for magic, and now they have to get real about themselves. Or they speak the clichés and memes du jour – “sounding board,” “receive guidance,” “learn coping skills,” “cognitive therapy,” “neuroscience,” “get my feelings out,” or more rarely, “learn about myself.” If so, the next question would be: ‘Do you think that changes a person?’ Silence ensues. I want to put them on the spot. Why shouldn’t they be able to figure out the answer? These questions nearly compel a deeper reality than anything the client’s mind has brought to the room, or that the mainstream of psych or Dr. Phil offers. They will realize their answers aren’t good enough. That “coping” or guidance or talking isn’t dislodging depression; learning psycho-facts and even insights doesn’t whisk away the sludge of identity mal-ease. “Expressing feelings,” as they understand it, can indeed seem helpful. But they’re not talking about anything outside of their adult life. They don’t know that –

“We scream before we cry, cry before we speak, and speak before we can organize conceptions about what we have and don’t have. Each of these stages of expression forms part of the skill of communication. Crying is a language – a primitive one, but nevertheless a very human one. The history of neurosis is the history of misery and the need to cry out this misery. Crying is not only an expression of general hurt; it is also a vehicle that carries us back through time to those specific traumas that were buried long ago by the processes of repression. It is tears that break down those barriers and help us on that voyage through time when we were hurt and could not cry. Tears wash away our pain and unmask the unconscious. This is not a metaphor but a biological fact.

“Tears of early loss are the solution that dissolves the walls of the unconscious and liberates encapsulated pain. . . . .

“Deep weeping as we see in our therapy is not hysteria but a unique new category that involves healing. It is the first convulsive phenomenon to be related to the healing process. Here, the adult brain gives way to the child’s brain, travelling back to an exact feeling, an exact moment and scene where crying should have taken place but did not – tears suspended in time by the agony of the experience. The regression from the adult brain to the emotional brain and then to the ‘pretear’ perinatal brain is the exact reverse of cerebral development.

“Tears, by and large, are uniquely human. We differ from animals in our ability to cry and tear. Crying is a curative process. I do not believe that one can cure either mental illness or a host of serious physical ailments without it. For some reason, however, this natural function has become opprobrious. We shush our children and deride them as “crybabies,” consider it grown-up not to cry, and believe it is a sign of weakness to give in to tears. So we block out this innate, biological process and then pay the price, because along with that blockage goes a host of other suppressions and dislocations. It is not just wispy tears that are blocked, but basic biological functioning.”*

When a serious or exceptional client asks herself the question, she will feel the ominous question mark of her life. She will feel that there must be some form of help, because pain moves like a slow river, like osmosis, beneath the hard crust of personality. She will feel that something has to change deep within her. This understanding may put her in a place to feel the core feelings of her formation. That’s her childhood meaning.

She is ready for depth therapy.

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* Arthur Janov, PhD, The New Primal Scream, Chapter 15, “The Role of Weeping in Psychotherapy,” pg. 318.

ESA letters: Dogs on a plane

There was once a wild pet hair, and it made me respond to an Indeed.com ad for therapists to write Emotional Support Animal (ESA) letters. I’m a therapist. I love my dog. I enjoy writing client advocacy letters (to support a woman’s returning to college following a breakdown; to support a man in a visitation case, etc.). Apparently these factors combined were enough to spark my profit motive. I sent my résumé with a cover letter:

Curious. I was a therapist in Ohio for 17 years, Colorado for one year, and now Nevada for the past two years. At no point prior to Nevada did I see a client who requested an emotional support animal. In Nevada – everybody and his half-step-niece wants one. As you – I hope – know, the need for an emotional support ‘other’ is obscure and potentially complex. I knew a Child Protective Services manager who brought her teddy bear to and from work every day. Did she ‘need’ that support? Might therapy have helped against this dependency? Valid questions.

I have written more ingratiating cover letters than this, but it was right enough to elicit this response:

Here at [Emotional Support Animal Letter Company], we’re always looking for more great people, so we’d like to get to know you.

Your application for the Licensed Mental Health Professional position stood out to us and we would like to invite you for a phone interview.

You will meet with our founder and CEO, _______. The interview will last about 20 minutes and you’ll have the chance to discuss the remote contractual therapist position and learn more about our company.

Later that night, I may have dreamed about pope-therapists blessing dogs in restaurants and in apartments sans pet deposit; and about therapists betting their license that clients are so feeble and unbalanced as to need furry courage to go places and be places. When morning came, I read a few psych-based articles on the problems of these letters, then wrote back:

Following my short wave of curiosity, I must bow out of your candidacy process. It took little contemplation for me to realize that while a ‘self-medication’ is often important or even necessary – whether it’s alcohol, chocolate, intellectual pursuits or the company of a dog – it is not in the interest of depth therapy as I practice it to prescribe them. However, I appreciate your interest.

For humor’s sake, here are the two rejoinders I received approximately half-an-hour later:

We received many applications for the position of contractual licensed mental health professional. We reviewed your application and decided not to invite you in for an interview with the hiring team.

We appreciate the time and energy that go into submitting a resume, cover letter, and application. Thank you for investing the time to apply to _______.

We wish you success in your job search and in your future endeavors.

Within minutes, from a different principal of the company:

Good luck to you . . .

Have to admit, just two emails from you . . . and you wore me out.

I rounded it out with –

I appreciate your dis-inviting me to interview after inviting me to interview. This, along with my letter to you declining your initial offer of interview, provides me documentation that my name and license will not be used by [Animal Letter Company] for purposes pertaining to your business.

The issue of Emotional Support Animals and clinical letters is a qualmish one, an arena of misuse and abuse by both client and clinician. In my imagination I picture hundreds of people, thousands of them, everyone going about with dog on a leash or Shih Tsu in a handbag, cat in a basket, guinea pig in a pocket, parrot or iguana on a shoulder, fly in a matchbox because they are lonely or nervous to be out in the world. I am perplexed, or actually, paradoxed. On the one hand, it can seem like Monty Python therapy (“Pardon me, my good man, but is that an especially obsequious ferret on your head?”). On the other hand, of course almost all of us need some dependency object or person, or thought or hope, or music or résumé, or food or money, or prestige or job, or narcissism or therapist. Why shouldn’t we lean on an animal friend? The crux for therapists is that “First do no harm” and be no enabler: We should question addictive needs, not cave in to them. Rehab questions alcohol, therapy questions codependency. Shouldn’t we question the claimed need to attach an animal to one’s bosom? I believe therapy should see a continuum of help toward a continuum of goals. Best would be “healthy happiness”: promoting autonomy not dependency and victimization; intervening for self-esteem based in one’s core feelings and needs, not on external rewards. If the person is not able to reach autonomy, has a dependent nature, we may still help her create self-supporting boundaries, some limits to a parent’s or spouse’s incursions.

In one article, a normally nay-saying psychologist explained her decision to write an ESA letter. The tragic woman had “no reason to live” but for the companionship of her pet. That was a situation that I believe any clinician would agree with. For the old woman, it was gold-standard therapy, the best and necessary to be done. In less dire cases, we should ask the brutal question of self-medication via dog or cat or peacock versus psychiatric medications, therapy, catharsis and teddy bear. Not to mention confronting a client who is twitchy, likes Bowser and is trying to pull one over on us.

What if the dangerous Narcissist has stopped caring?

My substitute for socializing is to toss an occasional dart or lima bean (healthy but bland) into Comment sections of different online magazines. Here is a recent mini-series at MotherJones.com:

The president, we learn, has “doubled down” on his claim that millions of people illegally voted for his opponent, even though the claim has been officially debunked and had no sense or evidence behind it in the first place. I see this kind of doubling down in therapy with the occasional Delusional Disorder client. (Delusional Disorder is a discrete psychosis, where the person is insane in a limited area – a wrong and irrational or impossible belief – but mostly has his senses intact.) For example, one man was absolutely certain that the government sent submicroscopic “nano’s” through the air, to infiltrate everyone’s mind to read us and influence us. He was contemptuous that I didn’t have the courage to accept his evidence, which nonsense he cited from session to session. A psychotic delusion is a cognitive defense mechanism that – cumbersome or painful as it may be – protects the person from an even more devastating feeling. This is D. Trump.

There is a pathological zone where the two – liar and delusional – meet in the Narcissist. If he were simply lying, then he’d be capable of saying or at least thinking to himself – Yes, I didn’t win the popular vote; I’m not uniquely special; I’m not a competent president; I have gutter morals. But he, I submit, is totally incapable of going there even in his own mind. His belief in the superiority of his Self is the entirety of his ego which, as with all solid Narcissists, malformed at the starting gate of his life. Without such a belief, Trump’s sense of self would disintegrate and he would have the breakdown of breakdowns.

I’d like to know everything about Narcissism and Trump, but it wasn’t meant to be. Fact is, Trump baffled me when, speaking to his beloved base rally a couple weeks ago, he wondered aloud if maybe he isn’t as good at being president as he is at business. “Theory” would suggest he couldn’t possibly admit he wasn’t the best. But actually, a Narcissist needs to be perfect only in those areas he convinces himself are meaningful to him. For example, if a Narcissist isn’t the best at tennis, he drops the sport and convinces himself that it’s not what matters to him; that if he actually wanted to be the best, he would be. So Trump’s rally statement likely means that he has now convinced himself that the presidency isn’t his pride, isn’t highly important to him.

If there are psychological thinkers interested in extrapolating from the Trump known to the likely, I’d invite them to accept the validity of my logic – that Donald Trump has psychically demoted the presidency to a failed supply,* probably mixed with bitterness – and speculate on what might follow this disenchantment. Two possibilities, one ominous and the other terrifying, come to mind. Turning his gaze back to his glory days of business predation and gold-plated things, he would abandon to Congress and Cabinet the nuts-and-bolts work, such as the recent tax code revision, then grouse in victim-speak about the crying shame of it. Or, he would give his betrayed soul undiapered license. A first strike against North Korea. A nihilistic trade war. Immigrants, hopefuls and Dreamers the target of his full racism. Stumping for the killing of drug dealers. Increasing his intercourse with Putin for the sake of future business and the narcissistic supply of power reflected. His juggernaut of undermining the integrity and reputation of our country, insulting his betters, spitting on democratic and humanistic ideals.

What if, having lost his fantasy of a presidency that didn’t cave to his narcissism, he has given up? Will we be in less danger, or beyond danger to disaster?

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* “Narcissistic supply is a concept introduced into psychoanalytic theory by Otto Fenichel in 1938, to describe a type of admiration, interpersonal support or sustenance drawn by an individual from his or her environment and essential to their self-esteem.” “Psychoanalyst Otto Kernberg considered the malignant narcissistic criminal to be coldly characterized by a disregard of others unless they could be idealized as sources of narcissistic supply. Self psychologist Heinz Kohut saw those with narcissistic personality disorder as disintegrating mentally when cut off from a regular source of narcissistic supply.” – Wikipedia

Source of truth

Children don’t know a lot about the world, and they shouldn’t. If one of them did, I believe it would be very wrong. Picture a six-year-old boy traveling the world with his well-to-do parents. He’d see all sorts of personalities, people’s behaviors that would cause him excitement and confusion, maybe love, maybe hurt or fear. If his feelings were respected and not conceptualized or corrected by his parents, he would “know” that something felt wonderful (an old person dancing). He would “know” that something felt very hurtful or wrong (a man in anger kicking a dog). But would he know the kicking was “bad” or “evil”? He might only feel the sadness of it. Conclusions would be hard to come by for this child – for any child – until either his innate neurology and chemistry blended with experience over time to eventually produce a feeling-conviction, or until his parents told him, then and there, what was “true.”

If his parents so informed him, this would be wrong: He would be absorbing them, not truth. He would be internalizing either their uniqueness or what they absorbed from their parents. Experience from his own platform over time would be the only valid way to know.

But what if he’d been born to pain that no one ever saw or helped? Birth trauma, mother smoking during the first nine months, born in respiratory distress or in cocaine withdrawal, “cooking” inside a hyperactive or anxious or Borderline or suicidal or schizophrenic mother, placed in an incubator exactly when the maternal bond needed to spark, mother’s illness, epidural anesthesia, father’s Prozac or psychopathy, her reaction to husband’s cheating, his dread of parenthood, malnutrition, prematurity. Can we doubt that this child, this baby, would see and learn the world through pain? Would be unreceptive or conflictedly reactive to loving touch, maybe even find it torturous the more he needs it? Would be generating enduring feelings and thoughts that sanction his pain and isolation? Nothing good and gentle would soothe the inner fire. The opposite: It would give him “emotional bends” – a sense of fatal decompression. He would need the harsh, explosive, sharp, cold, alienating, isolative, negative to feel he is right in the world and to drown out, like white noise, the roar inside.

His knowledge, his truth would be his own. He may be arrogant. He may be narcissistic.

Harry Harlow said that “primates love early or they probably hate forever.” I believe this is true of human beings, with the difference that we can hide from ourselves and from others.

We begin life in love, which is right and true, or in pain, which is wrong and true. These two states (though there can be mutual pollution) are the basis for each person’s nature and future. Her capacity for happiness, her definition of happiness, her feelings, attitudes, beliefs, absolute certainty of what is a fact. But we can hide from ourselves. He can believe in love but feel his burning deadness and hatred inside. He will be living an outer truth that is illusory and an inner truth that is strong.

We feel love, care, compassion only if we were born to it, or if we have the courage to feel the pain of knowing they should have been.