This is What Happened

Someone asked me to write this. Sort of.

They asked me if I could state, in tangible terms, the kinds of healing that I have seen take place in my work as a therapist.

And I can’t. Because it didn’t and doesn’t somehow seem to be my prerogative to codify or co-opt my client’s experiences to say how I think they have been healed, or not. That is up to them to define. I have no idea what they think has helped about therapy unless they tell me.

Sometimes they point to powerful defining words – for good and ill – that  I said, years, even decades earlier, that I have no recollection of ever saying.

I do this to my psychotherapist too. If you’ve read my writing over time you’ve seen me do it, and you should know he is a very good sport about it.

Is healing always even the goal?  Sometimes the goal is just surviving.

Some weeks, it is an extraordinary accomplishment and more than enough that we are all still here, and still pursing hope, meaning and connection and living out of our values in the face of  life’s suffering.

Certainly I’ve seen people transform their lives in front of me: Leaving abusive scenarios behind, finding love, healing relationships with partners, becoming parents and more attuned parents, getting through school, sorting through confusion, negotiating and resolving crises,  mourning deaths and other unfathomable losses, facing down fears, coming out of all kinds of closets, changing careers, owning their true identities, at first managing, and eventually shedding symptoms and anxieties.

But I don’t think these accomplishments were because of me. Sometimes the client does though. When they thank me, I try to stay gracious and not too self-effacing and accept their gratitude as a sign of appreciation of my sticking near them through it.

But often that is all I am doing. Staying near. Bearing witness, and letting what I am seeing change me. Staying out of the way, and trying to clear some thickets here and there that may be blocking their true path. Babysitting their most vulnerable needs until they are ready to value and care for them on their own. Making a dark time a little less lonely, and a little less terrifying. Normalizing some stuff that they worry is crazy.  But the growth is theirs and may have happened without me.  Maybe I made the unfolding a little easier. So I try to accept the gratitude – but it always feels strange to do so.  Like a plant thanking me for its growth and harvest  when all I did was water it once or twice a week.

But here is what I can talk about – and will try to do so briefly. Briefly. Ha!

I will try to talk briefly  (that is hilarious) about almost thirty years as a client in my own psychotherapy.

I arrived in New York City in the year after my 21st birthday, to work in the theater and to  be near a boy – who I thought was a man,  a few years older than me – but I see now was just a boy. The boy fell in love with someone else, and for some reason didn’t tell me. I don’t know why. We weren’t living together, we weren’t committed – perhaps he felt bound by an underlying and crushing dependency that I barely contained – as I lashed  myself tightly to any peer, friend, lover that I could, hoping to survive the sinking ship of a family that I had left behind. Perhaps he feared that if he left he would sink me. And  he was kind of right. But he still should have left for the girl he did love rather than making me feel increasingly crazy, confused, burdensome and complaining about my “jealousy problem.”

I had other problems, certainly. I had inherited them. My father had come from a deeply abusive, very wealthy and epically pathological family – and spent his life trying to expel his pain with unnecessary surgeries – over  20 times under the knife – narcotics, religion and rage. He remarried to a woman with three sons who became his real family and I was at best a tolerated guest. My mother had left him when I was ten, after falling in love with our parish priest, who was also a terrifying narcissist, and ultimately “defrocked” by the Episcopalian diocese.  He also eventually left, taking the house out from under us.

So maybe that is why the boy was scared to leave me. But he agreed to go to couples therapy. So we went. We were matched at a fee for service clinic with a young man fresh out of his internship, maybe about the boys age – 25 or so – much older than me,  so I thought. I don’t remember much of these sessions, except that they eventually  helped me to tell the weak scared boy to go, for Gods sake.

And then I sunk. Which was necessary. Which was practically mandatory – because I thought, up until that loss, that the life I had inherited was sustainable. That it was wacky, funny, unconventional perhaps, but I was sure it was all fine.  And that life would keep unfolding that way and that I could keep making a funny story about it at cast-parties after rehearsal, and that there was no harm done.

And suddenly, it was clear to me that something had happened again, that I never ever ever wanted to happen again, and that there was plenty of harm done. Plenty.

I began seeing the 25 year old therapist myself twice a week. I began noticing that I had symptoms, which I had never noticed as symptoms before. I would spend hours getting dressed, unable to see myself accurately in the mirror not because I was fussy about clothes but because I  unable to tell what I looked like.  I was not a night owl, I had regular, and pretty severe insomnia, terrible nightmares, intrusive memories, flashbacks, night-shame from my increasingly obviously not-so-normal childhood.

I began trying to tell the kind young therapist the story so far – to recount, recall  and reorder for myself  what exactly had happened. I came in to each session and told some other part of the story. I told  him, and myself for the first time what it actually felt like, parts of the story that I had ignored, the distressing, disturbing, terrifying, traumatic memories that swirled in my head instead of sleep. There was no familial or social relationship that would have listened. And my own shame and dissociation made it impossible to tell even if there had been.

This was it. Psychotherapy created the space for me to locate myself in the middle of a swirling tornado of chaos and confusion.

It took me years to tell it all. I barely noticed the young therapist because the need to tell it all was so overwhelming.

At the end of seven years, I said: “I think I am finished telling you what happened.” And I noticed that he was still in the room. And that he hadn’t left, or become terrified himself, or ever once looked away. That he had stayed through all of it. That I finally had a witness, who had heard the whole story, who had traveled from my first home, and then after my family exploded, back and forth, between my parents houses with me – who had made it through with me, and this meant that perhaps, I had made it through as well.

Then there was the present to deal with. How would I protect myself and how could I exist outside of the chaotic family that I loved and was attached to? How could I separate and individuate – and jump into the void and all the unknowns of adulthood  from a platform so unstable? How had I been and how would I continue to repeat this story?  How had I projected it on to others? How was I, without realizing it, recasting the characters from the original script in my adult narrative? How could I do something new, create something healthier for myself? Would I even recognize, or be attracted to available relationships when I encountered them? Would I always over-adapt to compensate for the wounds of others?

The flashbacks receded. I slept soundly through the night most nights. I could get dressed and leave the house easily enough. The panic attacks faded away. I don’t know when. I wasn’t paying attention. I didn’t come to therapy for symptom reduction. I came to save my soul.

And eventually this (although for many years this was too terrifying): How did this all show up in my relationship to my therapist himself?  How did fear, distrust, anger, injury, paranoia, anxiety, chaos affect my ability to see him clearly, to connect to him? I began to actively use the therapy as a chance to watch the slow-motion replay: I could see my error, my out-of-bounds, my avoidance, my need, my indirection, my suspicion, my fear as it effected my participation, my attachment, my authentic presence in  therapeutic relationship right in front of my eyes. I saw what triggered my reactions and over-reactions, and learned  that forgivable acts can activate memories of unforgivable ones.

This felt like a super-power, x-ray vision. With this discovery I was suddenly able to see myself, and others  – and assess if I was giving what I should, if I was receiving what I needed. I could sense balance and imbalance, sustainable mutuality, and untenable lopsidedness in my relationships. I began to seek out others who could sense and speak of this too.

My joys and sorrows were increasingly responsive to the real events and stressors in my daily life – and less and less and less  about an unprocessed past bleeding out all over a messy present. I created reliable, loving, respectful relationships with friends, and chosen family in the present and the salvageable and loving members of my family of origin.

I mourned for all of those I had to let go.

I took up the profession for myself somewhere along the line, graduating from social work school just after I turned thirty, and eloped, marrying a man I had met five years earlier, the summer before graduation.  And I continued in therapy to deepen my examination of how my limitations and history were activated and projected into the therapeutic relationships in my own office and to keep my relationship with my husband and my in-laws – another family! – growing and healthy. And that parallel process – of being a psychotherapist – and being a client – strengthened and healed me even more.

And the relationship still exists, and always will. I don’t know how a 25 year old boy was able to contain a deeply traumatized 21 year old girl. But he did. And we have grown up together, and practiced parallel to each other now for over twenty years. I see him when life permits or requires. And that is less important than all that is absolutely permanent between us.

So: Can I say, in tangible terms, how I have seen psychotherapy heal, as a psychotherapist?

I guess the answer is yes.

Skin Deep

Because skin is so nuanced in its response to environmental circumstances and psychic fields it serves as a barometer for physical and psychological well-being.
~ The Book of Symbols – The Archive for Research in Archetypal Symbolism

Extroverts are fueled by extensive social interactions in the external world while introverts are agitated, overwhelmed, and made anxious by such experiences, no matter how they appear on the skin’s surface.

Introverts are fueled by intensive contact with their own, and other’s internal, intimate subjective processes, while excessive focus on internal experience can unskin an extrovert leaving them feeling naked, exposed, anxious and uncomfortable.

My clients may imagine that I am an out-going, expansive and social creature – because, in our culture, extraversion correlates with being “well-adjusted” confident, and happy. But those who know me well, or who have seen my Meyers-Briggs know where I really fall on the continuum.

Introverted, highly sensitive, thin-skinned – any and all of those are accurate – I have developed some externally successful compensatory mechanisms that I wear as a protective hide in group and social settings: Because I like words, and have a lot a language at my disposal, I can be funny sometimes (humor is one of my favorite social shields). I am a good idea-person, a supportive teacher, an empathic healer and mentor. In groups, I am expressive and excited about new ideas, notions, theories, and problem solving.

Because I have a lot of thoughts to offer – usually drawn from reflecting on and by myself in private spaces – I can sometimes find myself pressed by the collective into leadership positions.

I am, in point of fact, a peevish and brittle leader: Non-intimate relationships and group dynamics can too easily drain and distress me even as we focus on solving a problem together or addressing a collective task at hand. When our work is over, I have a hard time understanding what a brief, curtailed, surface relationship might want from me or why they would want or expect anything at all.

To paraphrase C.G. Jung: Intensity is my aim, not extensity. (~ C. G. Jung, Psychological Types – General Description of the Types Ch. 10)

Non-intimate social events and groups can make my skin crawl and my feet itchy. Any chatty, surface engagement requires that I set aside significant recovery time afterward. It is depleting enough for me to take part in these processes that unless I calibrate my exposure, I can become fatigued, burdened, impatient, and plain old cranky due to the amount of energy it takes for me compensate for my inherent nature. I end up spending all my fuel and taking in little – because I only truly refuel in private and personal spaces.

Most frogs…have permeable skin that can easily absorb toxic chemicals. These traits make frogs especially susceptible to environmental disturbances, and thus frogs are considered accurate indicators of environmental stress: the health of frogs is thought to be indicative of the health of the biosphere as a whole.(web source http://www.savethefrogs.com/why-frogs)

I, and other introverted souls are biopsychosocial indicators. We are among the first poisoned by contaminants in the psychological environment. We sense too easily, and too intensely the unspoken, unconscious agendas, hostilities, resentments, hungers, wishes, at play in any social, non-intimate gathering.

Everything enacted in the room and yet unacknowledged seeps inside me. At any given community meeting, class parent gathering, cocktail party all the unnamed, unspoken affect rings louder in my ears than any verbalized dialogue, as I take in a mouthful of toxicity that I would be too impolite, off-putting or downright bizarre to spit out:

“Excuse me, but isn’t it interesting that you chose to cut Harriet off here, just as she was elaborating on her point? Did the two of you quarrel earlier in the evening? I’ve noticed that even though you are smiling, that something about your tone makes me uncomfortable, or even feel scolded… Is there something I have done previously that offended you? Perhaps we were discussing something that was unsettling or threatening to you? I can’t tell what the subtle tension in the conversation is about, but it felt hostile somehow, and I’d feel much more comfortable if you could talk about what may be angering you directly. Oh! and could you please pass that red-pepper hummus? So yummy!”

Instead, I quip and wise-crack, or try to talk, talk, talk, on top of the bubbling, oozing, latent content that bombards me and threatens, like quick-sand to swallow me whole. I keep my eyes peeled, sometimes ending a conversation too abruptly as I lunge for the nearest exit attempting to save my hide.

(The introvert) is always facing the problem of how libido can be withdrawn from the object. The object assumes terrifying dimensions, in spite of conscious depreciation… But, therewith, the introvert severs himself completely from the object, and either squanders his energy in defensive measures or makes fruitless attempts to impose his power upon the object and successfully assert himself. But these efforts are constantly being frustrated by the overwhelming impressions he receives from the object. It continually imposes itself upon him against his will; it provokes in him the most disagreeable and obstinate affects, persecuting him at every step. An immense, inner struggle is constantly required of him, in order to ‘keep going.’ Hence Psychoasthenia is his typical form of neurosis, a malady which is characterized on the one hand by an extreme sensitiveness, and on the other by a great liability to exhaustion and chronic fatigue. (~ C. G. Jung, Psychological Types – General Description of the Types Ch. 10)

This porous-ness requires that I reside primarily within the realm of intimate one-on-one relationships, with brief, purposeful and well-planned trips beyond this membrane. I am my happiest, most fulfilled and generative in interior spaces.

So, to live in the world of other human beings: I became a psychotherapist.

I can’t count the number of times thick-skinned folk say to me: ” I have no idea how you do the work you do! I couldn’t stand listening to other people’s’ feelings all day!”

Frankly, I don’t want to listen to much else.

Psychotherapy is the only job I could find, other than perhaps, living as a sponge on the sea-floor, where being such a pore-bearing creature gives me a significant professional advantage.

I connect to a single person, in a private space (or a natural space if we are on a walking session). We engage in inherently private processes, sharing excruciatingly personal or subjective details about our innermost perceptions. Where else would I be allowed, professionally mandated in fact, to offer my internal impressions back to the person who evoked them – and to have that returned in kind?

Skin is a responsive tactile boundary between self and other and the inside and the outside of an individual.
~ The Book of Symbols – The Archive for Research in Archetypal Symbolism

And, it is also true that the very same people who try my patience, drain and exhaust me in the world at large, are the very same people who I would undoubtedly feel bottomless patience, expansive empathy, warm affection and deep admiration for if we were to engage in the intimate processes of forging a therapeutic partnership.

It’s a pretty good gig for those who need to live in the interior-lands.

The finest clothing made is a person’s own skin, but of course, society demands something more than this ~ Mark Twain

A neighbor recently sent me an email which stated that of all her neighbors, I was the one that she felt least connected to, and that she found this distressing. (Was this for real? I was flabbergasted. ) She felt that whenever she encountered me that I was always in a rush, that I never seemed to want to stop and chat. (Chat? What on earth about? ) Moreover, she said, that even factoring in differences and variations in personal privacy, she had determined that I was insufficiently social, and that as a result, our relationship (Did we ever have one? I couldn’t think of a single instance when I had laid eyes on her in the past year) was in need of repair. How would I feel in her circumstance? (What circumstance exactly? The one where my neighbors want nothing more from me than a brief, cordial greeting? “Relieved beyond all imagining” were the only words that came to mind)

An extrovert, in external conversation, frustrated and injured that a confounding introvert was withholding much needed social contact. An introvert, misunderstood and in flight from an extroverted pursuer, in an internal monologue about the internal need to avoid extraneous social contact.

I forwarded the email to my more extroverted husband, who responded easily and effortlessly and who has made a point stopping and chatting more. No skin off of his nose.

The thick-skinned and the thin-skinned misunderstand each other all the time. It is not easy for us to comprehend each other. Our experience of ourselves and others, internal and external worlds is inverted. It is too easy to assume our own way of being as a template, and pillory or pathologize those who live inside or outside of their skin differently than we do.

Yet, we all live along a continuum of inner and outer spaces, some cluster toward the center, others distributed toward either end. We are all needed for our species to find balance. Our varied skills and awarenesses are incomplete without our complement. And ultimately the margins that divide us are as narrow as the skin of our teeth.

“Skin the rabbit!!!” my midwestern farmer grandmother would exclaim as we raised our arms high over our heads and she peeled our dirty play clothes up into the air before our evening bath. A false, active, social self stripped away, a true, vulnerable, private, home self set free.

Home and home-like environments are where the introverted return to refuel themselves, when supplies are running low. Retreat into natural environments is also extremely nurturing for the introverted.

One of the communities where I am most comfortable in my skin is a group of community gardeners. We focus on planting, watering. Our hands are dirty. We are unconcerned about external appearances. We sweat and work together. Our conversations focus on our common interests, our shared labors and our personal relationship with bees, seeds, sun, sky, vegetables and flowers. We have internal experiences outside together.

In Winnicotian theory, some of the aspects that Jung might classify as indicative of introversion, are framed as a developmental, maturational achievement: This is Winnicott’s Capacity to be Alone, which is above all the capacity for people to be alone together. To be in the presence of another person – simultaneously wholly in your own skin, and wholly present with the other, who is also wholly in their own skin and wholly present with you.

Not surprisingly many introverted people find their way into my office, and probably into many other therapists offices too. They want to find partners, to raise families, to secure non-toxic work, and ways to be connected to the community at large, to be of use, in ways that suit them. Many have internalized a culturally endorsed, critical bias against their own way of being.

Extroverts come to therapy fearful of their “people pleasing” tendencies, their need for stimulation, their difficulty being alone, their fear of intimate spaces.

And ultimately the psychotherapeutic process creates a space where intimacy can happen, in self-regulated doses, as we examine and accept our own and each other’s inner and outer layers, as we learn somehow, at last and over time, to get under each other’s skin.

copyright © 2013
All rights reserved Martha Crawford

Keeping Secrets

Kalli was the secret-keeper of Maldinga. Every day the people of Maldinga straggled through the woods to the clearing where Kalli’s cottage stood. They came one by one, never in two or threes. And one by one, they told Kalli their secrets.
~ Kate Coombs, The Secret Keeper.

Almost two years ago, when I began to talk to friends, colleagues about writing on-line – I could see it made people uncomfortable.

“How are you going to do that?”

“What if your clients read it?”

“I wouldn’t want my therapist to have a blog.”

At the time, the questions and comments struck me as strange: therapists publish their narratives all the time, in books and journals easily purchased or subscribed to on line. They give presentations in public settings, to other psychotherapists, and to the interested public, often filled with extensive case information and histories, whose names, occupations, sometimes genders and personal details are obscured to protect their client’s confidentiality.

Early one morning Sheld the baker came to the cottage. He gave Kalli a basket of fresh rolls and a copper coin. Then he whispered, “I sell loaves weighing less than full measure.” Kalli nodded and caught his words in her hand. After Sheld went away with a sigh, Kalli opened her hand again. The secret was now a small gray rock, like a stale bread crumb. Kalli went inside and tucked it into one of the hundreds of tiny drawers that lined the walls of her cottage. ~ Kate Coombs, The Secret Keeper.

“But aren’t you supposed to stay anonymous?”

“Why don’t you write under a pseudonym?”

Anonymous? With a secret identity?

You mean like Batman?

Clients have seen me in public spaces in hundreds of different ways: putting out my garbage in my sweat-pants and slippers, sweating with my hair in a headband on my morning run, bickering with a sassy kid at school drop-off, dining with my husband on “date night,” in line buying tickets to see a stupid romantic comedy that I am half ashamed see at all, in my bathing suit on the beaches of Cape Cod, in public restrooms in department stores, looking like a foolish middle-aged woman practicing martial arts in the park, picking up my prescriptions at the pharmacy, and at rallies for causes they disagree or agree with.

Such public encounters reveal things about me clients may not like or feel comfortable with. It has never crossed my mind to try to be anonymous, to disguise myself, or cauterize my own needs or interests outside of the office, or in any public setting.

Anonymous
1: of unknown authorship or origin
2: not named or identified
3: lacking individuality, distinction, or recognizability
~ Merriam Webster

I don’t move through the community in drab camouflage, and I made no vow to live an unidentifiable life.

I am not a traditional Freudian, and have never, at any point in my career, aspired to be a “blank slate.” I don’t think it’s even possible.

Although I try not to intrude my own agenda into my clients’ experience, or make them tend to my needs in anyway, the notion that it is possible to “keep myself out of the room” seems to me a mystifying illusion.

Therapists are always “in the room” whether they admit it or not.

I am not required by my profession to live in anonymity – I am mandated to maintain confidentiality.

When confidential information is used for purposes of professional education, research, or publication, the primary responsibility of the clinical social worker is the protection of the client(s) from possible harm, embarrassment, or exploitation. When extensive material is used for any of these purposes the clinical social worker makes every effort to obtain the informed consent of the client(s) for such use, and will not proceed if the client(s) denies this consent. Whether or not a consent is obtained, every effort will be made to protect the true identity of the client. Any such presentation will be limited to the amount necessary for the professional purpose, and will be shared only with other responsible individuals. ~ New York State Society for Clinical Social Work Code of Ethics

I don’t publish identifying information about any client, or any extensive material about any single case history or study. I have tried to fictionalize cases, and blur out identifying specifics entirely. I have created studies of clients in aggregate, noted typical clusters and trends among the clients I have seen over the years, made note of cultural trends, and tried to use my imagination to put me in the midst of cases that I have never met or heard of. I try to speak about the universalizing aspects of the therapeutic experience, my own therapy, my own experience of the work.

I strive to meet my ethical requirements, hyper-vigilant in adherence to the spirit and letter of my ethical mandate. I would never publish anything that would put my clients in harm’s way – that could ever put them at risk to be recognized. And I believe I have done that, at least, successfully.

But is that enough?

Strangely, two years into writing I am revisiting these questions anew, after a synchronicitous cluster of internal and external events, among them several enquiries and comments from other therapists that have made me wonder again why I write. I have been repeatedly asked, and am asking myself about the effects this kind of writing has had on my practice itself and on the clients in my care.

The truth is I just don’t know.

There were so many secrets.
A small boy didn’t like his new baby sitter.
The grocer’s wife had hidden ten gold pieces under a tree root.
A plain girl loved a handsome boy and dared not tell him.
The miller’s son had stolen a coat.
The tailor had left his widowed mother alone and come to Maldinga to seek his fortune.
The mayor’s daughter was sneaking about, keeping company with a young rascal.
~ Kate Coombs, The Secret Keeper.

Publishing my words in public requires clients to trust me even more with their wounds and sorrows and shames.

Most clients have made no mention of it, and I assume have never read my writing, or feel no need to discuss it with me. (If you are one of these, reading this now, and have not brought it up, I hope you will consider this an invitation to address together anything, positive or negative, painful or pleasant, that reading this may activate)

I have told a few clients about it directly, so that they do not feel ambushed or frightened or betrayed by finding out about it in some other manner.

The vast majority of those who have found it or been told of it have expressed positive feelings about it, feel that reading serves as a transitional object between sessions, or gives them access to ideas that may not have entered our therapy directly otherwise.

But that doesn’t mean that it will continue to feel that way. There may, one day, be an essay that agitates, annoys, or distresses. Or words read previously that are experienced differently at a later time, in a different self-state.

I let every client who enters my office know that over the course of treatment I expect to make errors. And although I will always try to protect them from any severe clinical harm, or negligent malpractice I will undoubtedly fail and stagger, causing them pain and discomfort at some point. I may mis-respond, misunderstand, or miss my own blind-spots. I may even re-injure pre-existing wound.

I am sometimes disappointing to both clients, and to myself.

And although I’ve accepted that as inevitable to the mechanisms of the therapeutic process and my own fallibility: it still causes me deep sorrow when it happens, no matter how or where: in or out of the office, on the street, or online.

And as I’ve written about elsewhere ( http://wp.me/p1AOzF-k ) I’ve also learned that powerful therapeutic opportunities for repair, for forgiveness, for re-working, and for corrective experience can lay dormant, almost invisible, curled up within these painful failures.

There is no doubt that publishing my experiences as a therapist, in any format, coupled with my capacity for error and mis-attunement can cause discomfort, and could even potentially disrupt valued therapeutic relationships.

Some have discovered it on their own, and yearn to see themselves in my writing, and feel sorrow that they have not found themselves there. Others, have encountered aspects of my identity, that they do not like, and would rather not know.

Some feel overstimulated, overwhelmed, ashamed at having googled me at all, and try to keep it to themselves – sometimes their dreams have let me know. Still others see themselves in the universalized or imagined scenarios I write about, and hope/fear I am speaking of them specifically.

There are times when we are called to meet deeper obligations that require more from us, beyond the professional guidelines.

Obligations to clients, as well as obligations to ourselves:

I have, and will, make errors in this public space, just as I do in the office.
Even as I scrape off every bit of identifying data, avoid any extensive case discussion, and do my best to disguise all the content, writing about my work carries the capacity to hurt, but hopefully never harm, people and relationships I care deeply about.

I can fail to disguise a reference sufficiently to serve a clients comfort level, or “make up” a scenario too close to one that I have consciously forgotten but remain unconsciously preoccupied with. I can overlook a single word that might sting and intended to edit from an earlier draft. I can leave a client out of a discussion they would want to be included in, or include a reference, no matter how disguised, that activates a sense of exposure.

I can misread how I will be read, or mis-read.

And, as always, our best intentions can diverge from their real outcomes.

One day, in Kate Coombs lovely children’s story, the Secret Keeper turns cold and tired from keeping so many secrets, and stops answering the knocks on the door from the burdened villagers. With their encouragement and participation, she discovers a way to transform the heavy, hard secrets, into meadowlarks, butterflies and rose petals. These re-formed, transfigured, secrets are released publicly, before the gathered village, deepening the both Secret Keepers connection to the village at large, the villagers understanding of each other.

I don’t write or publish to market, practice-build, to make money, or for professional reputation: and although I don’t write for my clients, I always write with them in mind. I believe they are absolutely entitled to read anything I have written, if they so choose, and hold me accountable for it.

I publish what I write because I believe in what I do, and believe that being transparent is necessary to empower clients as full and equal participants in a process that is too often cloaked in disempowering mystification.

I write because I am full to bursting. I have spent so many years hearing stories that have whitened my hair, broken my heart, vicariously and directly traumatized me, inspired and consoled me. Stories such as these can fill your drawers, accumulating until they turn cold and heavy.

I write to ethically make use of what I have experienced and absorbed, and learned vicariously from others – and if I did not, I suspect I could sink into a vast ocean, a sea of other peoples’ pain and trauma, triumph and intimacy, joy and loss.

I write to let other practitioners and younger clinicians know what life in this field feels like, to share some of what I have learned, and to transform some of what I have held as single secrets, as individual stories, into something that can be released to the larger community to help us all understand each other better, and the culture and era we are embedded in.

I write to wrest meaning from it all.

I will stumble and I will mis-step, and I will do all that I can to make reparation.

But writing itself has become an integral, essential part of my practice.

I write to continue working, so that I can keep on keeping secrets.

copyright © 2013
All rights reserved Martha Crawford

Portrait of the Psychotherapist as a Young Artist.

Someone just asked me how I decided to become a therapist.

It’s a question I am asked from time to time. I’ve answered different ways at different times of my life, and understood my trajectory toward this point in different ways.

This is my answer for the moment.

There is of course, a longer, far more complex narrative, of which I am only partially aware. I suspect the unconscious processes, both personal and collective, that set me on this path began the day I was born, or maybe even before.

But there was, in fact, a moment when I actually decided, or perhaps realized, that this was the path I intended to pursue.

I had majored in Theater and Philosophy in undergraduate – and had dropped out, smack in the middle of my senior year – giving my parents a total heart-attack (and completely in keeping with their own history of totally impulsive shenanigans) and certainly disappointing many of my professors in both majors who believed in and supported me.

Why? I only knew that I couldn’t do it any longer – continuing to work to finish my undergraduate degree felt “wrong” and utterly intolerable. In fact, I felt that I somehow needed to “save” my final semester, and any graduate schooling for “later.”

That was the best explanation I could muster.

I could not invest any more energy consolidating the identity I had cobbled together out of scraps and left overs. I could not would not stack one more brick in the construction of a jerry-rigged persona. It would either work or it wouldn’t based on whatever effort I had already put in. “I” was held together with spit and duct tape but I was either “good enough” as is, or I wasn’t. It was time to find out.

I had started therapy the year before dropping out – and was certainly the most annoying, defended, overtly resistant patient that had ever presented voluntarily in a therapists office. Her obvious empathy annoyed me. I didn’t want someone to empathize with my “troubles.” I wanted someone to say I was going to be just fine, I was following my heart and that these instincts certainly meant something important. I wanted her to assure me that there were many roads to happiness, and that I was sure to have a bright future ahead of me if I stubbornly followed my intuition, and so to not be afraid. She said none of those things. She looked concerned. I hated her more than half the time. The rest of the time she scared the shit out of me.

I got a mindless gig in a nearby restaurant, relieved and happier in obedience to the pressing internal mandate. I gazed down on the ceremony from high up in the amphitheater the day my dearest friends and my class graduated without me – without a drop of regret. I had no desire to flip my tassel.

I left that state and that therapist the first chance I had, and never looked back.

The next seven or so years are a blur. I did a brief stint in a regional theater and eventually moved to New York with hundreds of thousands of other 20 year olds to act and act out.

Here is what I remember: the East Village & Alphabet City, waiting tables, various very bad boyfriends, auditions, panic-attacks, bar tending, head-shots, grief, acting gigs, mourning, the Equity Actors union waiting room, flash-backs, and scraping by.

I found my second and final therapist – and used all of my personal resources just to show up regularly. I offered up my cash tips from my black half-apron pockets for what seemed to have become my central task in life: Therapy. Twice a week. I didn’t know why it felt like I was living life in a giant pin-ball machine – buffeted from one misery to the next – and worse: I had the terrible, unshakable sensation that whatever the crap was playing out – it had all happened before.

And I wanted it to stop.

Of course it had all happened before – but I had no idea what a “repetition compulsion” was – I just knew I hadn’t liked it the first round either.

I was pursuing acting as a career. I worked in the restaurant industry. But, it was clear as crystal that showing up for therapy was my real job.

Somewhere in there I met a boy, a stable and kind boy, and would eventually move in with him. His parents had been holocaust survivors, and he seemed completely undaunted by my little shit-show. He remains undaunted and steadfast to this day.

This next part is aesthetically humiliating but true. I paid what must have been seven bucks at the time to see a matinée of the Prince of Tides. I went alone. I remember very little of it. The therapist, played by Barbara Streisand is bad – probably as terrible as the movie, and also bad as in naughty. Does she sleep with a patient? Or just the sibling of a patient? Not that that is okay either. She is categorically a bad therapist in a bad movie – but, I experienced a strange overwhelming confluence:

Here was an actress, playing a therapist. Something shook loose in my head. An actress, one known to have had a lot of psychotherapy, was acting as if she was actually a therapist.

Hmmmmm.

When the movie finished, I spent another seven bucks and saw it again. I next went straight to Samuel French theatrical publishers and bought every little paperback copy of every play I could find with a therapist in it.

It was in the early nineties that I purchased my own first book on psychodynamic theory. The title caught my attention as I had been reading Joyce: “The Portrait of the Artist as a Young Patient” by Gerald Alper.

The first paragraphs of the preface sent me straight to the cashier to smooth out a stack of crumpled bills from the bottom of my backpack:

“The artist who appears here belongs to a special population of struggling, non-commercial, artist-patients rarely seen in the private office of a psychoanalytic psychotherapist (as is the case here) for the compelling reason that they cannot afford a normal fee”

and further down the page:

“Here is the common, recurring profile of the artist as patient: someone in their mid to late twenties, more likely female than male…. generally not indigenous to New York City, but arriving and settling in from the Midwest and even California, an aspiring actor, actress, dancer, musician, painter, singer or writer; generally unemployed in his craft and having to fall back on part-time survival work such as waiting tables in restaurants (almost unanimously despised) predominant presenting problem of depression (often narcissistic) work inhibition, creative block, paralysis of initiative, and day to day functioning accompanied by frequent feelings of inner deadness”

Yikes. Was he supervising my therapist?

In it, he discusses his caseload of young artists, in the 80′s, surviving and suffering and acting out in the East Village, in the ten block radius around my fifth floor walk-up.

I had no idea at the time if it was a “good” piece of clinical writing or not – and had never heard of any of the theorists he referred to – Kernberg, Kohut, Winnicott, and Bateson’s’ “double bind.” The book felt like a cold slap: pathologizing, harsh, objectifying. But, absolutely no less objectifying than the restaurant managers or casting directors that dismissed, criticized or hollered at me every single day. The case examples seemed off-point, and unlike any peers I could identify with. Little was discussed about the complexities of creative processes, or career building. No stories of hope or big breaks.

Just stories of symptoms and dreams of loyalty to a creative process going no-where. No Where.

Yet, Alper was clearly familiar and compassionate toward my tribe of misfits when he discussed us in aggregate. All of us thin-skinned folk, hoping to make a creative living off of the utter sensitivity of our exposed, raw nerve endings, bruised and battered by brute contact with the pointed corners of unyielding reality.

Many of us trapped, feeding the insatiable appetites of demanding patrons during the day, while unable to satisfy our own deepest hungers.

He even describes the “waiter’s nightmare” which haunted me for many years:
“gigantic outdoor cafes, peopled by hundreds of clamoring patrons, situated thousands of feet apart”

Re-reading it now for the first time twenty years later, clinically, it’s not my professional language, or model, and doesn’t speak to my practice or approach. The book is too focused on psychoanalytic diagnostics for my taste – all artistic processes redefined as a cocktail of healthy and pathological narcissistic processes – artist’s relationship to his talent/creativity: narcissistic, to the audience: narcissistic, and all artists and participants in the creative act: narcissistic. Kohutian, Kerbergian, or Winnicottian – it seems unnecessarily reductive of what, in my view, are essentially numinous, spiritual, unconscious processes of the psyche.

Of course, there is always danger of inflation and deflation when wrestling with archetypal content and the Unconscious. But in my work over the past 15 years with the same struggling creative population – too many writers, actors, musicians, playwrights, dancers to count – I have come to think of the suffering artist much more as an “identified patient” in a disordered environment. They are the Cassandras, the too willing scapegoats, the canaries in our coal mine. They feel the toxicity in any system first – and often respond before they know what they are reacting to. Artists struggle to give it voice, shape, movement, and symbol so the rest of the community can confront the shadow content that would otherwise be ignored, repressed, disavowed. The artists I have seen, seem to me, not narcissistic enough. Too willing to be dismissed as flakey, as failures, too willing to absorb the collective toxins, take them into their own systems to metabolize, and transform them into something beautiful or communicative or confrontative. Eternally, masochistically hopeful that they can make the deaf hear, the blind see, artists do so at costs to themselves they don’t always recognize.

A little like therapists.

Yet, Alper was clearly a caring and compassionate therapist, and the parallels between creative and clinical inspiration and artistry are not lost on him. Alper mentions that he was a novelist before becoming a therapist, and describes the pursuit of a career in psychoanalytic psychotherapy as a “decision to try and earn a living doing the thing we most love.”

Twenty years ago this was perhaps the first time I had the notion that 1) I had a not-so-common sensitivity, receptivity, and a relationship to my own unconscious processes, and 2) It was actually a skill set I had developed – as well as a deficit. Also, 3) that this skill set was maybe even directly transferrable to work as a therapist.

The same year, I was working on a piece of experimental theater – “workshopping” some obscure German Expressionist piece, with a group of other wounded waiters I knew. The two “producers” had hired a “director” with some family funds – and we were using psychodramatic exercises, along with our own significant trauma histories to “flesh out” the sparse, strangely translated text. Putting all our horrors “on their feet” and improving our way through our worst and cruelest “high-stakes” memories. Beatings. Abuse. Discovering suicided family members. Psychotic breaks and involuntary commitments. Drug overdoses.

We thought we were being brave and creative. Now, I can see that it was just so obviously, and on every level: A Very Bad Idea.

When the final actor had exposed his own darkest living nightmare for others to enact, I heard the director whisper to himself:
“This is good…. we can use this….”

That night, I called an old dear friend: She had walked through her own house of horrors – and wasn’t all the way out yet, but she had managed to get her MSW a year or two before and was, as a result, way more gainfully employed than I was.

“Use this??!!” I hollered into the phone, back when people talked on phones. “Use this?! Is this what all actors are doing all of the time!? Use this!! This SHOULD NOT BE USED! This shit is SACRED unto ITSELF! We should only respect it and sit near it and bear witness!”

The first eight words of her response changed my whole life:

“You don’t have to be an actor, you know. There are lots of actors who would kill to be getting the work you complain about.”

“Wait?! What did you say?!!?!? Excuse me did you say: “I DON’T have to be an actor?! I don’t have to be an actor..… “

I thanked her and hung up. Called someone and quit the hot German-Expressionist mess. The next day I ordered catalogues from every social work program in the city. And called my would-be alma mater to figure out how the hell I was going to finish my degree seven years after dropping out.

Interestingly enough, I found out that my credits were on the brink of expiration, and if I had waited even a few more months, I would have had to start my Bachelor’s degree over. As it was, I transferred some credits back – and completed some research projects for independent study credits: One on the history of the Yiddish theater on the Lower East Side, and another on the Psychology of Creativity, extensively citing my favorite book du jour: Portrait of the Artist as a Young Patient.

One year later: I had tied up my loose ends, and enrolled in a clinical social work program.

So it is with deep gratitude and thanks to my chaotic inheritance, my first half-detested therapist, my disappointed professors, several bad boyfriends, every restaurant manager I ever was oppressed by, my husband, my final and current therapist, a sadistic director, Gerald Alper, my dear friend Julie, a Very Bad Idea, and of course ladies and gentleman, the Incomparable Barbara Streisand, that I exist as I am now:

A psychotherapist, no longer young,
but in many ways walking the same path,
practicing the art of psychotherapy,
with some success and some failures,
still struggling to remain loyal to the inner guidance of my own psyche and the creative process.

copyright © 2012
All rights reserved Martha Crawford

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