I found a penny / on the ground (Peter, Paul and Mary: "Rocky Road")

At 71 (in a month), I'm seeing more clients than ever before: usually forty or more per week. But I've captured very few new insights (blog material) lately, and when I find one, I don't write it down. It just passes quietly into the time flow. I do remember an interesting one. A client told me that when he recently experienced joy – a once-in-decades rare mood that followed his reunion and weekend with an old girlfriend – he became scared to feel so happy, and "in that rare state, found himself 'wondering if I have a sense of self.'" Hearing this, I remembered once experiencing an incandescent lightning-shock emotion and finding that I'd lost my self. I discovered this explanation: Essentially, most of us lose our true, organic self – feeling – in childhood, from gradual repression, and then make an identity from our head. I am the strong one. I am the coin collector. I am the piano player. I am the smartest. My father is a policeman and can beat up your father. I am an attorney. We become a thought which we bend a positive feeling to, to feel solid, meaningful, "good," to be something. But when some time has passed and this new Self has become burnished and universal, then, if a child-rooted raw feeling floods us, it dissolves that thought-identity. In becoming solely body feeling for that moment, we become disembodied: light without its candle. We become for a moment what we should have been had our childhood survived. Loose in old age, I lobbed this personal tidbit to my client. And guess what? "Yes, that's me," he said.

There will be a few other insights, I'll wager, and yes, they are important to me. Knowing the self more is to, in some way, become the self which was, as I said, lost long ago.

I write the contradiction

My entire weekend was ruined – not a smile and only a frown on my old face – because one of the major insurance companies, Anthem Blue Cross / Blue Shield, has decided to establish the jackass, cringey pseudo-scientific documentation requirements that Medicaid has always specialized in. The client feels bad. Why? Her entire life was bent and broken from as earlier as age six, and nothing since then feels right, secure, happy. And it won't, there, at the very bottom. As soon as – age six, age ten, age three, age birth – we have to repress our pain, we lose touch with our self, and we never get it back. It's water under the bridge. We start living from our underground crushed pain and in our disembodied head, but never again from our one human energy source: our body and its feelings. The phrase "too late" identifies both the dysfunction and the nature of its therapy. I've said it before: Good therapy is too-late love.

So insurance companies pay for our efforts to return innocent feeling (along with its children: promise, curiosity, love) to the client. But we can't return her childhood and all the missed, unfelt experiences. So people, after a hundred years of substantial failure of therapy, reconceive the problem. We are sick because we think the wrong thoughts. Here are the right ones. Or because "trauma" dented the brain and we have to undent it by . . . TED Talks and EMDR voodoo. The problem is that we became a different person. Healing our soul ache would be like performing surgery on Jill when Jack had the heart attack, or like retouching childhood photos to make us happy.

Poor insurance companies. They don't want us to spend time trying to find the apocryphal time machine. So they need us to soothe our client: to be a friend, a parent, a teacher, a guru. They want us to convince our client that thinking different in the here-and-now can change our life. Some of us, though, know about changing the past a little. It involves Candace Pert's "molecules of emotion." It has to do with tears that, when they fall from our adult promontory to deep beneath the earth to the earliest pain in childhood, "dissolve the walls of the unconscious"* and enable life-grieving, grieving of our earliest losses. It can happen, sometimes, in a few sessions.

But 100% of the time, 7 days a week, 24 hours a day for the next 100 years, and at 10 on the Subjective Units of Distress (SUDS) scale, that's not what the insurance companies mean by "brief, solution-focused therapy." To them, the client is: "I can't drive on the Interstate."

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* Arthur Janov, The New Primal Scream, Chapter 15, "The Role of Weeping in Psychotherapy"

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.

A mother's quandary

The last insight, wisdom tidbit, fact, reveal – whatever we shall call it – that I named for the mother of a teenage client is the first one that some other therapists would, I suspect, have offered. Her son, whom I hadn't seen in three months, had only attended four sessions total. The last one included his mother. The boy and I quietly ganged up on her: Please tell your husband, the stepfather, to stop shaming, ridiculing, criticizing him. Recently, the mother returned, alone, to give me the backstory of her son's problems that included depression, depressive personality (where he preferred feeling miserable to feeling positive) and suicidal thoughts. Three years earlier, he had pushed a sexual behavior at a non-rape level, that may or may not have been consented to by the other person, that may have led to legal involvement but didn't. He was kicked out of school, went to a different school, was assaulted by another "behavioral" student, sent to a third school where his reputation followed him. He got a job but was harassed there, and quit. Many stresses, and they came home to an environment that was shaming since he was a toddler.

He was not motivated to get to school on time, or to do his homework, or to do his chores. We're all familiar with the term "old school." That means: It doesn't matter how you feel or how serious your problems are: You must toil and toe the line. Mother described the punishments levied to motivate him: remove his electronic devices and social media access. I said that may not be great at two levels: Punishment, in general, will make a child feel worse, and these are punishments one might administer to a 13- or 15-year-old, not to a young person about to turn 18.

I cited Thomas Gordon's concept of 'who owns the problem?', which could also be called 'who owns the child?' If a little boy's friend dumps him, it's his problem, not the parent's. Help him get his feelings out, respect and validate his feelings, help him brainstorm through Active Listening, but don't drive over to the other child's house and strategize with the mother about how to resuscitate the friendship. The principle that says 'the parent doesn't own the child' is a very difficult one for many parents to grasp. This is easily seen in another of Dr. Gordon's examples: A teenager is ditching important classes, a potential crisis that would activate the proprietary instincts of most parents. But should the parent force him to go by threat, have him monitored, stand over him as he does his homework, make him think? The child owns himself. See what his grievance, his pain is, which might go back years. Care about him more than the grade.

My client's mother had a solid rebuttal: She would get in trouble – Child Protective Services – if her son didn't go to school. A powerful argument as long as you leave out the "care" factor. Her old school mind also explained the removal of the boy's television from his room.

I recommended Gordon's book, with a "warning" that it may be hard to take, this notion that the child should be respected as much as the parent.

As the session ended and we were about to exit the office, something occurred to me by sheer, stupid luck: Stupid, that I had almost missed it in the fervor of psychoeducation and the mother's polemical intransigence. I said: "What it comes down to, the essence of everything, is that your son needs to feel loved." She paused for a fraction of a second then said: "Yes, he does. I wish I knew how to make him feel loved."

Best and worst clients

Maybe it's a peculiar way that clients are supposed to be reactive in therapy. It's not just mutually interactive – a conversation of surface and deep thoughts and feelings. It's not just where the client receives information and has an adult-plane emotional reaction to it, though an adult-plane understanding of the insight may trigger deeper understandings and feelings. It's not just the client's inner dwelling, his awareness of his problems and feelings, that is expressed in sometimes-long narratives and a few tears. None of these behaviors will shake anything loose at the core of his disturbance, of his self. The adult cannot heal the child.

Our worst clients will be those who remain on their adult plateau and who believe that's who they are. Many clients, then, are our worst. I believe this is mostly a factor of the modern psychology culture with its "here-and-now," happiness, mindfulness, everybody-knows-their-psychiatric-name conceit. Back in Freud's day, the rallying cry was "id." Serious men in suits and high positions (who were probably raping their daughters) lay on the couch and free-associated about their bizarre fantasies and sexual fixations. They descended to their symbolic and literal bowels and their dormant, itching psychoses. But shallow is deep today; feeling is commodity today, as Cole Porter might have sung.*

Our best clients are those who collapse in memory and tears and who, in that place, join with us in their worst, give us their pain. Bruno Bettelheim, who blamed "refrigerator mothers" for their children's autism, knew this: "I speak here of the child's private world. . . . Each of us is implying in his way that one cannot help another in his ascent from hell unless one has first joined him there."

I have a few good clients.

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* https://www.youtube.com/watch?v=r7NJ9ylAhos

Should I suggest that she get numb?

"Sixteen-year-old girl remains in a steady-state of disconsolateness, silent, glazed-eyed and bereft looking for much of the hour. This sometimes ruins to silent heavy tears. 'Carly' spoke more quietly than a whisper, said that she's been 'telling myself things that aren't true.' Initially not interested in disclosing what these things are, she later said: 'I tell myself that no one cares about me.' She knows her star-crossed girlfriend Runa cares about her, and can't deny that I care about her. But she believes (not merely 'feels') that neither her mother nor her father cares about her. Carly said that she skipped dinner and no one inquired after her. I talked with her about the challenges of making friends under the shadow of depression and fatalistic assumption. She acknowledged that at school she may wear an 'I want to be left alone' look. After all, she doesn't want to be there and might project an off-putting air to potential friends.

Challenge of the day, this young person. I have twice invited her mother to have a parent-only session. Her response to the first request was "busy," not even "maybe." Her response to the second request was silence. I've seen her father once in my office, once in the waiting area. This is one flaccid walking coma. He does nothing to challenge his wife's solipsistic childishness and meanness. "Perfunctory attention" should be his middle name. I believe my client: Her parents really don't care about her.

Her kind of negativity redoubles itself, though she comes back week after week and must sense my effort to mitigate her doom feeling. I wonder if a young female counselor would be a better interactor with her. Girl talk, collages, maybe a more delicate and discreet way of approaching her parents. I am delicate and discreet, benign and gracious, practically courtly, when it's a matter of keeping the child in therapy, not directly angering the parents. In the 1990s when I worked in rural Logan, Ohio, I might walk downtown (five buildings, maybe) with my teen clients to the book-snack store. The ambience of walking, caring, getting air had power and strength. In Pickerington, Ohio, the teens and I could walk in a miniature meadow -- a couple trees and a gentle grassy hill. These ways get us out of the box of therapy. Where I am now, we could only do the parking lot circuit of a medical park. So we are stuck on a chair and a sofa feeling and questioning the worst feelings.

Nine years ago when I started the blog, I would have ended this piece with a pessimistic or optimistic statement. Now, there's no reason to.

A working through with Dr. Herman and beyond

Why do some clients remain extreme forever? Extreme in their thinking and their emoting. Words of rage, lamentations of tragedy. Vicious voice, continual bawling. Actually, I don't know how common this is. I had a client, a man, who was apoplectic – furious tears and hatred – nearly every session. Another, a woman, who couldn't stop weeping about her father's abuse and mother's neglect. She was angry, too – wanted to strike her mother – but essentially she was tragedy and maudlinness apotheosized. I believe I know why the man was fixed in his rage. He had never reached the dimension of grief, the helpless and needy place where I could join him like a healing, repairing parent, beneath the powerful but escapist anger which I could not join. I would say that the woman was in the same boat, despite her "Hoover Dam of tears" each session. She mixed her grief with her rage, which buoyed it and kept it from landing in its deepest dimension: pure pain. She was a teenager but resisted being a child.

This explanation, though, doesn't address the matter of extremity. Most clients can cry or express anger. What made these two different, so "dramatic"? Was it the power of their trauma? The man had suffered continual sexual and physical abuse from two generations of family. The woman's father nearly broke her back. But we know that Post-Traumatic Stress Disorder manifests in triggered symptoms (flashbacks, hyperarousal, rage), not a seamless cataract, not a unitary "theme" of them. And that PTSD requires some symptoms of numbing – amnesia, the deadening of sensation and emotion. These two clients were never numbed. The answer, I believe, lies in the deformation of character described by Judith Herman in her "new diagnosis," Complex Post-Traumatic Stress Disorder.

These individuals' characters, their personalities, warped in an atmosphere of traumatic oppression in their childhood homes. Depth psychology is aware that children always change in homes where there is no empathy – the primary ingredient of physical, sexual and mental abuse. They become repressed, then depressed, the substrate of their eventual problems. They become symptomatic. But this will not transform their outlook on life, their personality, unless no escape of any kind is possible, no help for pain, no light appears. My multiply-abused client was never noticed by teachers, never helped by other family members or by the kindness of strangers or by the police who would sometimes knock at the door. The woman wrote a letter to the middle school she attended twenty-seven years ago, excoriating it for ignoring signs of her abuse, a suddenly crippled child. I can look – now – at these two adults and see beneath their behavior a pilot light of warped, alarmed personality. This is the wrong coloration of attitude that one wakes up with and falls asleep to, the eternal dark energy background of the person. It could never change over the years, the decades, because they could never grow. Growth requires ground. It may be rocky. It may be poor of nutrients. But it can't be a monolith of poison.

These clients, and people in the world like them, should be understood to have personality disorder. Though we must see them differently than we do those whose personality deformed in the crucible of the separation-individuation phases.

Pocket principles: Self-esteem

 

Self-esteem can be defined simplistically as “feeling ok about oneself without having to prove anything to oneself or to anyone else.” Or more vaguely and reconditely as Alice Miller did: being comfortable with, accepting of all of one’s feelings. It can’t be defined as Nathaniel Branden, “the father of the self-esteem movement,” defined it: a sense of personal efficacy – feeling competent in the world. That can’t work, because feeling competent assumes being competent (otherwise the person is delusional), and competency suggests activity extrinsic to the self. Children who are loved, valued, accepted for who they are by their parents will have self-esteem. They will feel ok in their own skin, “in their bones,” will in a way feel complete, “arrived.” They’ll be comfortable in social settings, won’t be intimidated by – or feel less than – bullies or powerful adults. They may experience fear in dangerous situations, but they won’t have anxiety: Anxiety comes when a child can’t unload his fear and confusion to a caring parent and becomes a repository of pent-up apprehension, like breathing in and not being allowed to breathe out.

The bad – or deterministic – news is that if the child isn’t given, or can’t receive, the gifts of love and respect and full acceptance in her early formative years, she won’t develop self-esteem and will never have it. This is her fate because the suppression and repression of feelings is the loss of self. With no self, there can be no self-esteem. She then must grow, as time passes, a non-self that is an adaptive persona. The only way to prevent this de-evolution would be to immediately, seconds or minutes or maybe a day after the emotional shutting in and shutting down, open up to someone and let the pain flow out. Once time passes, and the persona becomes the person, the real feeling self must remain buried. In his teens he will say: “I don’t know what I want to do after high school; and thirty years later, “I don’t know who I am.”

My sixty-three-year-old client feels “melancholy” because after her retirement she no longer identifies herself as a productive, contributing member of society. It is not enough, she feels, to be just herself, a person who enjoys her life. Good things – her garden, her grandchildren, an old friend – will be pleasurable for a few moments, but they cannot overcome the empty feeling of a self lost sixty years earlier. I want her to feel it’s all right to live, to be a "human being not a human doing," but that would require having compassion for herself, and that would require knowing what she’s feeling compassion for: the hurt, buried child. Few people would want to regress to that depth, return to the beginning of their life and grieve the worst grief possible.

Of course, human beings want to feel good about themselves and unconsciously run away from this critical loss. So they define self-esteem in shallow and magical ways. I can positive- and rational-think my way to feeling good. I can “follow my bliss.” I can accomplish good works. I can love myself and help others. None of these manipulations will touch the core wound.

I suspect that real self-esteem may be so rare that humanity will always need second-tier definitions of it. It's not a real self that has conjured them.

Make my day

There is a very unpleasant but solidly, comprehensively reasoned op-ed in today's New York Times that advises dropping all prosecution against Donald Trump and "allowing the political process to run its course." This could enable, we know, the greater chance that Trump will be president again. Here is the piece:  https://www.nytimes.com/2022/08/21/opinion/trump-fbi-republicans.html. I believe that only those of us whose extremely strong feelings (which we call principles and moral outrage) willfully blind us to reality will dismiss the sorry validity of Linker's argument. I am one of those willfully blind individuals who would prefer crash-and-burn and civil war to letting that sociopath run free again.

But is there any other way that wouldn't lead to war or prove that evil holds all the cards – and the asylum keys – and will hold them forevermore?

This question, not easy to answer, leads to some free association. (Freud's seminal technique requires all verbal diapers off.) The problem comes down to our sick Republican population that admires a sociopath because of its sickness. These millions control their party's politicians, people who seek power in low places. See what we are up against. Normally, the "man in the street," if asked, would say there is something slimy, probably evil, about a person who loves Hitler, Bonnie and Clyde, Bernie Madoff. And yet that same man, and his family, and his community, and his state, will smile upon Trump, the diagnosable sociopath (Antisocial Personality Disorder) and narcissist. These individuals are therapy patients without a couch, and they will never lie down because they have the most soothing and masturbatory defense mechanism in creation: rage sanctioned by their fellow partisans and leaders. They will never want or need to look beneath their rage to the hurt and pain that fuel it. It's their child, their childhood that has always been hurting, and they will never want to collapse to its tears.

The irony is that failing to go to the child leaves it in the seat of power.

Can we reach them? I've seen many men in anger resolution therapy (what "anger management" counseling should be). It's valid to say that since they have come to my office voluntarily, they are not those self-justifying narcissists and psychopaths whom therapy will probably not help. My clients know they have a problem with anger, that the cause is not essentially their wife, their boss, their genes, the universe, or the Democratic Party. They are willing to feel. I have yet to treat a man for anger who did not cry about the brutality of his father or about the barrenness of a life "grown up too fast."

Can we get these millions to understand themselves? No. There is no couch wide enough, no microphone loud enough to turn their attention – inward. If there's to be hope, it will be that the internal weather changes in them. Their scar tissue feels too hard. Their boiling subsides. And their heart wants to come out after a long storm.

Until then, I will hope that Merrick Garland drives a mountain-sized steamroller over their sorry asses.