Another day, another marital session

All marital therapists have seen couples who have an infinite need and capacity to argue trivia, running juggernaut fashion over everything we do. They throw knives and acid at each other, hurtful, soul-murderous. I approach this gently. Actually, with a velvet glove holding an anvil hand. “Please see if down deep, you actually like the other person. I don’t mean ‘love.’ That’s too easy to say and do. I mean like: admire the character, the person of your partner.” Too many couples got together without the actual like.

Another necessary approach: What is the buried splinter, either in your marriage or in your childhood (likely both), that poisons your heart in the here-and-now, makes you always painfully bent, and finds its reason in your spouse, the “identified patient”? The splinter could be simply that you don’t feel loved: She is absent the capacity to give much. It could be distrust starting in the death of self-esteem in childhood and resonating paranoid fashion into your adult life. It could be the splinter in your childhood that stopped your growth and makes you feel, unconsciously, un-adult. That will cause pervasive problems. Or the childhood splinter of unmet need, where nothing in the present can make up for it. Therefore – she must be a failed need-meeter.

I worked with an interesting case of such underground venom. Following a War of Attrition session so irrational and hateful I could only answer it with Hendrix’s see-the-bunny “re-romanticizing” technique (ignore the pain and leap straight back to the original feelings and good times), the couple came in in loving harmony, holding hands, eyeing each other with respect. We went to the childhood splinters, possessed by each, saw how they trolled in the now. All was good. With two minutes left to the hour, with no warning the wife disinterred an ancient grievance – a lie he had told, while they were dating, about talking to another woman. He had apologized for the lie a number of times. And here, eleven years later, she brought it up with feeling and a peremptory, gnawing voice.

An idea came to me out of the blue; that is, by loose association and not from anything I knew about the clients. So I could not assume it was correct. I thought of those individuals, cited by Janov, who drop out of a doctoral program just before they would graduate. I thought of my father, who left Johns Hopkins medical school before finishing. There was Janov’s observation that many “housewives” (from the 1960’s) would clean the house but would leave a room undone – having something still ahead of them – because to complete a job to satisfaction and still feel “Is this all there is?” would be to know the empty depression of their lives.

This has been too-casually called “fear of success.”

I suggested to the woman that in the face of goodness and fulfillment, does she create sabotage, as seemed to be happening in this session? For many, I said, happiness, completion, to “have arrived” feels strangely wrong. It brings up the incomplete, the pain that still lies beneath. This is because the goodness is essentially a lie that says “I am fine and can move on” when in fact you still hurt at the core of your soul and would be leaving yourself behind to move on.

I thought this might be a sterling idea that could, by luck, be an epiphanic truth for her. Instead, she said: “Yes, it’s true. I’ve always known that about myself.” Hearing this, it was her husband who was “epiphanied.” He hadn’t known this about her, or (of course) that she was aware of it.

Session ended, with the implicit homework to know more about and master this self-sabotaging.

Let's psych out the therapists

I.

I am chary of asking other therapists whether they sometimes feel stuck and, after a while, useless with a client (or any number of clients). Three reasons: 𝛹 By asking, we’d be rolling out the red carpet for another therapist to think she’s better than us, and we couldn’t stand that. 𝛹 Since we feel we already know everything that matters (analogous to people’s certainty that they have the right religion, difference being that each therapist becomes his own religion), we don’t really believe we can be taught.* 𝛹 And – just me – I know that the typical therapist isn’t dealing with the dark, subterranean, sometimes intransigent muck anyway, and he will believe his surfacey and mind-massaging “cognitive” approach is making real headway. When it’s not.

So sadly I’m alone with my thoughts, deflatedness, anger at people and human nature, rational­izations. And intra-brainstorming.

S. Levenkron writes about a desired “crisis of healing” where the anorexic girl, having long and stubbornly clung to her “special thinness” identity for dear life, finally crashes the defense and succumbs and regresses to being reparented by the therapist.

But how often does this happen? How often, instead, does nothing help, or unknown factors help, or the therapist sends her to the hospital or a specialty eating disorders clinic? Defense, also known as self-medication, is identity for many people. It is their armor, their fantasy beneath which is the ungrown, unhappened self. When we question defense, we can be asking the person to disappear.

II.

There is a very subjective factor at play in therapy. We know so little of what the client is made of, really, what sits at his formation and what churns deep within him (some of which bubbles up in true or masked form) – far different from what his tongue says – that our assessment of his improvement depends primarily on our own psychology. We may feel he has improved short-term or long-term because we want to or need to feel it. Essentially, our self-esteem determines the phenomenology of his improvement – in inverse ratio.** He may, at moments of clean happiness, feel an undertow of darkness. Have we helped him? She may experience fewer episodes of anger. But is she better, or has she learned mindfulness or forgiving or insight tactics, which require difficult and depersonalizing work to maintain? The young man, age 13, has improved grades. Is he really growing up, or is he just temporarily cushioned by our support?*** The very suicidal woman stays alive after therapy is over, though the feeling is not completely gone. What really have we done?

We try hard, and deserve to feel we have helped.

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* Maybe twice in twenty years have I asked a Cognitive Therapist her take on a client. And in those same twenty years, while many fellow counselors have known I practice a more feeling-centered, regressive approach, not a single one has ever asked me a question about it. Let’s hope we’re very good, because we’re pathetic.

** That is, the lower our self-esteem, the more we need to believe the client has improved or healed; the stronger our self-esteem, the less we need to believe it.

*** Here is an interesting passage in Masterson: “In my own studies with adolescents who are not able to function successfully on their own, I noticed that a few who seemed to improve with treatment while in the hospital reverted to their pathologic behaviors shortly after leaving. The latest follow-up studies indicated that they have never recovered.” “How to explain the fact that they survived childhood without a clinical breakdown, broke down in adolescence, then seemed to repair it in the hospital, but fell apart on discharge? As described in Chapter 2, as the self emerges from the maternal image it internalizes or ‘takes in’ both the image of the mother and the auxiliary functions she had performed for it. These functions (reality perception, impulse control, frustration tolerance, ego boundaries) contribute greatly to the capacity for autonomous self-activation.” “The fact that this image and the associated functions had not been internalized in these patients was disguised during childhood because fate was kind and did not expose these children to excess separation stress and because there is an ‘umbrella of dependency,’ which allows the child to depend on external parental authority to help him function. In other words, the child is not expected to function autonomously. However, adolescence removes the umbrella and exposes the growing child to tasks of emancipation and the need to function autonomously. At this point, his underlying difficulty with self-activation emerges in a clinical syndrome. The teenagers in my study seemed to improve in the hospital because the presence of external authority figures on whom they could be dependent reproduced the earlier childhood environment. They appeared improved, but the changes could not endure when the support of the therapist and the hospital was removed.” (James F. Masterson, M.D., The Search for the Real Self, chapter: “Fear of Abandonment,” pp. 52-53.)

My motivation

I have never liked the idea of being a high-volume therapist – seeing lots of clients. Yes, in the past I’d see six to eleven per day. A corner of my brain felt “good” about the money (because it made my wife feel secure) but I felt like a mass producer of widgets and was uneasy. And I suffered the acute awareness that the greater the number, the more who’d be getting just the conventional counseling – talk, pontificate, laugh, vent, cry a spoonful – that I can’t love. The fact that a correspondingly greater number would benefit from meaningful depth work somehow didn’t impress.

Fairly soon I’ll be re-activating one of those Psychology Today therapist ads. Forgive me: They are all so fluffy, generic, sweet, unoriginal, Stepford-wifey, not to mention that everyone is prettier than I (maybe I need a more professional photo!). My ad will be a little different, with a sharp focus on depth, feeling-centered process. Seekers stirred by the words of older-fashioned life-changing therapy will call. Still, I will not want too many. The essential reason: I don’t see psychotherapy as a job, a career, a business. I don’t like jobs, careers, businesses. This isn’t a calling. It’s a necessity. Who I am is good with just a few meaningful contacts in my life. Here’s a way to understand that: How many good mothers does a person need? How many children?