Hard Times


Let us pause in life’s pleasures and count its many tears,
While we all sup sorrow with the poor;
There’s a song that will linger forever in our ears;
Oh hard times come again no more.
Tis the song, the sigh of the weary,
Hard Times, hard times, come again no more
~ Hard Times lyrics by Stephen Foster

I didn’t mean to write this, or intend to write anything – it is probably unwise to publish it, but I suppose I will anyway. Frankly I’ve been thinking I should take a break from writing altogether for a bit.

I’m just not so filled with easy inspiration, or reassuring confidence, or heart warming feel-goodisms.

My husband and I are in midlife and are, like many of our peers, sandwiched in between caring for our elders and our children. All of whom, for the time being are in significant and legitimate need of our support through some more and less challenging medical realities. Testing, appointments, evaluations, treatments, follow up, referrals. We are in the thick of it and it looks like we may be for a while.

A summer which felt like it was ripe with openings, fortune, potential and new growth crashed into a shocking and frightening fall which will unavoidably open up to a tiring cold winter.

It happens sometimes. We’ve faced such things before, and will again. I’ve seen and supported clients and friends and neighbors as they’ve passed through similar hard times.

Just as all human beings do.

But psychotherapists are supposed to be invulnerable, no? Fully actualized? Enlightened? Able to absorb anything that comes their way?

And who would want to see (or read) a psychotherapist in the midst of hard times?

Better to source out some therapist who is perky and happy! Who feels in control of life! Who can make you feel better!

Yet, sometimes life gets heavy. Sometimes there is work to be done. Sometimes we are pulled in many directions. Sometimes our choices are narrowed down by circumstances beyond our control. Sometimes a great deal is required of us. Sometimes, despite our plans and intentions, our possibilities restrict themselves to a very few or none at all. Sometimes our external freedoms become constricted. Sometimes the wolf is at the door.

So, for me, this isn’t a silly, playful, easy season filled with boundless, bouncy energy.

I am sometimes weary. I am sometimes overwhelmed. Sometimes I want to run. Sometimes I am incredibly proud of myself and my ability to keep moving, to get done all that I need to, and stay connected to myself and others. Sometimes I want to spend a day in bed with the covers over my head. Sometimes I am swelling with appreciation for the tender comforts around me, the honesty and intimacy and contact that the relationships in my life, personal and professional, offer me whether they know it or not.

Sometimes this season has offered me glimpses of deeper truths, timeless ones, that transcend and soothe through the rough and jumble of the road I am on for the moment.

I am all right. I’m okay just as I am. Where I am feels healthy and appropriate. To be too cheery right now would be denial of reality, a self-deception, and would pull me further away from the phase of life and the external challenges I am passing through for the foreseeable future. But certainly not forever.

Many days you have lingered around my cabin door;
Oh hard times come again no more. ~ Stephen Foster

Happiness doesn’t last forever, but nor does sorrow, and neither does trouble. All states have gifts to offer, lessons to teach, blessings to bestow.

Things get heavy sometimes. Its just a fact.

Sorrow has its season.

Even for psychotherapists.

Energy retreats, retracts, and peace can be found in small, still moments, in quiet spaces deeply internal. Fake smiles, chit chat, false reassurances would make me less present, banish me, send me away, exhaust and deplete me more and make me abandon myself, thinning out my resources to connect to others.

“How are you?” Some clients routinely ask – usually I respond, honestly, “Fine! How are you?” Now my response is more subdued, but still honest. “I’m okay. And you?” or “I’m hanging in. What is happening in your world?”

Though her voice would be merry, ’tis sighing all the day,
Oh hard times come again no more. ~ Stephen Foster

To do this work I need to be in contact with myself, and I need to stay in contact with myself, and remain loyal to my own energies, even when it is not comfortable.

Through my professionally arranged face, through my slower, quieter responses, through the circles under my eyes, (which can betray me – no matter how much “concealer” I apply) some still feel the shift in my energies. Some, especially those who come for time limited short term work, to focus on a single issue, or who use therapy as a problem solving space, take it as their cue that it is time to finish up, assuming that if I am offering less, that it is a signal that our work is complete.

Some clients know part of the story, as medical appointments for family members have caused me to cancel, reschedule and rearrange appointments more than I have ever before. Some know the whole story because they dream of it, or read me so closely, and so hard that it frightens them more not to be told what is happening.

Some don’t know anything, or know a little, but need me to protect them from thinking too much about me – as it is hard enough for them to stay loyal to their own experience.

Some become angry with me, without knowing why, because they sense, unconsciously, in their pre-verbal places that part of my psyche is working on my own challenges and conflicts. For those who had depressed or preoccupied early caretakers it is especially threatening, as they are sure that if they sense any dip in my energies that I will become unable, unavailable, to sustain my caring, loving attention.

There are those who are immersed in much harder trials, more consuming, more traumatizing, more violent conflicts, more emergent circumstances and more acute crisis than mine and it snaps my perspective into place, as I move my own experience further down the triage list – and immerse myself in the need that is in front of me with the skills I have accumulated over many years.

Some, who perhaps I have enabled by being more active than was necessary when my tank was full to overflowing, are being given more space to take up the reflective, interpretive work as their own, as I hold back to listen more, perhaps offering less direction or guidance than I might in a more buoyant time.

And there are many moments through my workday which lift and inspire me: A client falling in healthy reciprocated love. Another who feels ready to marry. The birth of babies through hard pregnancies, the courageousness of a client trusting me enough to share the ways that they do not yet trust me. The bravery and integrity of another in the face of danger. A piece of creative work shared, beautiful and transforming. The incredibly powerful, awe-inspiring imagery of dreams. Undeniable growth, accomplishment, achievement, mutual admiration, appreciation. Closeness in all forms, shapes and sizes.

While we seek mirth and beauty and music light and gay,
There are frail forms fainting at the door;
Though their voices are silent, their pleading looks will say
Oh hard times come again no more. ~ Stephen Foster

And then there are actual gifts that come with hard patches.

When the ability to engage in the Extraneous is eliminated, the Essential reveals itself more quickly and incontrovertibly.

Priorities become crystal clear. And when you trust your exhaustion, you know that it will steer you away from the superfluous, unnecessary.

And when you feel alive and engaged you know you are in the presence of something vital and healing for all involved.

I can feel when I am barking up the wrong tree almost instantly. I can tell when it is better to wait something out, rather than bang my head against the wall. I can spot any opportunity for relieving contact with the healing processes of Life as they move continuously between and around us all.

I have more compassion for myself: if I have a harder time organizing, scheduling, getting my bills done, or it takes me a beat or two longer to understand what is playing out in the room, I know that I am doing my best. I accept and take responsibility for my errors without being tempted to punish myself for them. I am doing what I can do. I can model self-compassionate behavior, a way of being that is less concerned, for now, with pushing past limitations than accepting them.

I may now have less energy for heroic maneuvers, for flashy interpretations. I will not be leaping over tall buildings in a single bound or pulling a rabbit out of a hat in the season ahead – I am currently unable to be seduced by inflation or grandiosity, it is just too tiring – and life is simply too humbling at present. I cannot over-extend, bite off more than I can chew, or take on anything that could prove to be too much later.

I am in exquisite and direct contact with my own needs, and the fact that I am finite.

I treasure and value the impact and the necessity of stillness like never before.

And I understand “self-care” less as a discreet activity or a scheduled event and more as an on-going way of being, moment by moment, in the presence of people who need me – as I negotiate the balance between their needs and my own and attempt to honor them both.

We will all pass through such times. And we can receive something from them as well. And if I can do nothing other than try, and fail, and try again to model an experience of being simultaneously intact and overwhelmed, of staying in caring and compassionate relationship to myself, my family and my clients, perhaps, through hard times that is more than enough.

Never to ask for easier circumstances, but for greater strength, and to accept gladly, (when they come) rest and ease along the road. ~ Pierre Ceresole

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.

Suspended

“We are lost, afflicted only this one way;
That having no hope we live in longing” I heard

These words with heartfelt grief that seized on me

Knowing how many worthy souls endured 

Suspension in that Limbo

 ~ The Inferno of Dante, Robert Pinky translator

 

The position of the (hanged) man: upside down, head below, hanging by one foot…. plunges us into the heart of the problem of the relationship between man and gravitation, and the conflicts the relationship entails. ~ Meditations on the Tarot: A Journey into Christian Hermeticism, by Anonymous

 

I’m not sure what, if anything,  will come of this.

Its all up in the air, and it could leave you hanging too.

 I sit with my clients and listen as they move through their daily lives. Building careers, raising families, moving among and around weekly rhythms – work, commute, dinner, home, therapy appointment, weekend. The world is comfortably, or perhaps even oppressively predictable. The ground underfoot becomes a well-trodden path. The disruptive power of the Unknown, of the Unpredictable, seems reduced to a piffle. Lives are ordered. Choices are made. Cause and effect rule the day -  if x , then y.

Our sense of agency and ability to structure ourselves can appear inviolate. We imagine that we have the tiger by the tail, and that tragic, upsetting, disruptive things happen only to other people, to a colleague you don’t know too well at work, or a friend of a friend, or to the person whose photo is splashed  across the cover of of the NY Post being held by the stranger sitting across from you on the subway.

When suddenly, in a split second, the rules of every day are suspended. And we can find ourselves in a whole new world. A instantaneous slip into an alternate universe, one we did not choose and would never have picked if the choice was offered.

But it wasn’t.

The table turns in a flash – and any expectations that the next day will be better, or even vaguely resemble this one are disrupted. Crisis erupts or we fall into it, it flips us upside down – a job loss, a change of fortune, an unexpected diagnosis, a natural disaster.

Entrapping uncertainty can also creep up slowly:  we can find ourselves bound, against our will,  in long, excruciating waiting periods, slow builds, protracted searches for something or someone that may never be found, precarious processes with unclear prognoses. States where any and all  predictions might be reasonable – and our need to know what might come next is thwarted.  Incrementally or violently pressed into Life’s Waiting Room we thrash and writhe, or go limp and sleepy – we do all we can to escape this In Between Place where Life is neither feast nor famine, neither fish nor foul, neither here nor there.

This is the sorrowful state of souls unsure….

Who, neither rebellious to God nor faithful to Him,

Chose neither side, but kept themselves apart. 

   ~ The Inferno of Dante

There are times when we find ourselves suspended.

And I find myself strung up as often as anyone.

Dante locates Limbo as the first stop on the “deep and savage road.” a  place just inside the Hell-gates of hopelessness.  But we commonly think of it as a  space between Heaven and Hell, where even the noblest souls may suffer.

Will circumstances stabilize? Or deteriorate? Is hope useful or foolish? Should we prepare for the worst? Is this the end of the world as we know it? Or the birth of a better one? Is it the  gateway to a perpetually unfolding tragedy, the horror and losses of our greatest fears? Or will we be granted our heart’s deepest desire?

Whether to invest in our dreams coming true, or resign ourselves to despair there is no way to know. Souls in Limbo are abandoned by the very ability to anticipate or prognosticate.

Those who are activated by anxiety find it a place of tortuous buzzing agitation, as their inherent optimism leads them to believe that proactivity could positively affect the outcome.

Hapless ones never alive, their bare skin galled

By wasps and flies… 

 ~ The Inferno of Dante

 The anxious-avoidant can find passive comfort in the intermission -  some even draw it out – experiencing the enforced break in the action as reprieve from pessimism and fear: at least the worst hasn’t happened… yet.

This suspense is terrible. I hope it will last. ~ Oscar Wilde

 Limbo is an inconsolable, tension-filled deprivation. A lack of. A halting, a freeze, a holding of the breath,  a nothingness sandwich with hope on one side and despair on the other.

The soul seems to me to be in this state when no comfort comes to it from heaven and it is not there itself, and when it desires none from the earth and is not there either…

~ The Life of St. Teresa of Avila, quoted in Meditations on the Tarot: A Journey into Christian Hermeticism

Few recall Cicero’s morality tale about King Dionysius and his courtier Damocles who wished aloud that he might be king himself, and was cruelly threatened into gratitude for his lowly station. Yet, everyone remembers the heavy archetypal sword, the shiny point dangling just over Damocles’ head, suspended by a single horse hair.

We hope, like Damocles, for the opportunity to be returned to the moment before the threat loomed over us, to go on as we have been going on, to be spared further suffering or any darker transformation of our fate.

In suspense, we find ourselves exquisitely alone, the tension exacerbated by isolation:

The soul is suspended between heaven and earth; it experiences complete solitude. For here it is no longer a matter of ordinary solitude where one is alone in the world, but rather of complete solitude where one is alone because one is outside of the world  – the celestial as well as the terrestrial world ~  Meditations on the Tarot: A Journey into Christian Hermeticism

 The therapist needs to be acutely aware of their own and their client’s coping style, for when they are sitting with clients who are dangling between the worlds, one’s strategy may be intolerable to the other. “Let’s-get-this-over-with” mixes with “I’ll-think-about-it-tomorrow” as effectively as oil and water. And any misattunement  merely exacerbates the sense of banishment from the realm of the everyday.

My own experience twisting in the wind reminds me it is all too easy to fall into empathic error with those who are hanging in the Unpredictable In-Between. We cherish our rhythm of life and when we encounter others whose patterns have been disrupted we can too often rush past their powerless pause: “Oh I’m sure it will all be ok!” minimizes potential and looming threats. “Oh my god that is terrible!” smothers hope. Real empathy requires tolerating the dialectic, joining the tension of the opposites: “It must be so uncomfortable to not know what to expect, and to have to wait for any answer – I’ll hope along with you that all will be well, but know I will also be here for you if it doesn’t – I know that both possibilities feel very real right now.”

And although we may not be able to guess which way this cat is going to jump, the archetypes of myth indicate that there are gains to be had, lessons to be learned, from uncomfortable, even fatal suspension.

I know that I hung on a windy tree

nine long nights,

wounded with a spear, dedicated to Odin,

myself to myself,

on that tree of which no man knows

from where its roots run.

No bread did they give me nor a drink from a horn,

downwards I peered;

I took up the runes, screaming I took them,

then I fell back from there.

(~ Stanza 138 & 139 of the Hávamál)

The tarot’s Hanged Man is a rendering of Odin, who has strung himself upside down  in order to acquire wisdom. He will die from the suspension and be reborn hanging  from the world tree, a mighty ash known as Yggdrasil.

Perhaps the wisdom that Odin gains from his ordeal, and that suspension imbues is merely this:

We are always in Limbo, whether we recognize it or not. Life itself is a feral and untamed beast. Anything can happen, and many things beyond our control will happen. Even the most ordered and controlled life unfolds in a wilderness of unpredictability. We succumb to inflation when we forget this.

The Hanged Man is the eternal Job, tried and tested from century to century…~ Meditations on the Tarot: A Journey into Christian Hermeticism

 And maybe the only cure for such puffery and complacency is to intermittently find ourselves upside down, hanging, in a state of suspense until we are humbled and reminded that living is a wild unfolding, an eternally unpredictable event.

 

 

 

 

Keep Breathing Please

To breathe is to assimilate spiritual power. (~ J.E. Circlot, A Dictionary of Symbols)

The word, in all its variants, that I heard most regularly in the early years of my own treatment, the most painful years, is also the word I repeat most often to my clients:

“Breathe.”

As in:
“Let’s take some deep breaths, please”

Or:
“Are you breathing? I’m pretty sure you’ve stopped breathing”

And more explicitly:
“You are holding your breath. When you hold your breath, you are trying to block the experience of a strong feeling – you are constricting your chest, your throat, it keeps the pain trapped, pressed down, it doesn’t let it move through.”

And sometimes this:
“Okay, listen, I can see this feeling is overwhelming, and your breathing has become very shallow and rapid, you are trying to find a way to keep breathing to stay on top of some frightened, maybe panicky feeling. I don’t want you to hyperventilate. I know you are scared, but I want you to just listen to my voice, and we are going to breath more deeply together. Put your hand on your belly, and breathe in slowly through your nose. Let just inhale slowly…. Good. Now breathe out, slowly… good. Lets just sit and breathe and then we can talk about what was coming up. But, first, I just want us to breathe together for a bit.”

I remember when the consultation room would start to spin. My head would feel very large, on top of a small, atrophied body. Although my therapist sat just a few feet from my place on his couch, he seemed a football field away. Only his reminders to breathe offered me a sense of continuity, an anchor to the present, to him, and to myself.

Other times I’d sit on the couch, certain that I was totally fine, making perfect sense, forming completely rational sentences filled with logically consistent deductions about whatever circumstance I’d been recounting. I thought his direction to take a breath was just silly, reaching for some feeling that simply wasn’t present, wishful shrink-thinking. I’d take a breath just to placate him – and then feel a sudden internal catch, a flipping sensation in my stomach, a shiver of fear. A wave of hot, shameful, dissociated emotion rose up from the depths, tears gathering behind my eyes, my throat shaking, I tried to stop myself from revealing the unbecoming repressed affect in front of his accepting gaze.

Such an intense internal combustion can occur when oxygen mixes with emotion that I sometimes worried that I might actually vomit. He wasn’t distressed by that possibility either – but simply offered to move the office wastebasket close to the couch if I thought I really needed it. I never did, thank god.

It was just pain, riding on breath’s coattails, as it rose up from below.

My own clients often release a small snort of recognition when I make the observation:
“You’ve stopped breathing again I believe… please breathe…” before their own swell of pain begins to crest.

Children, in stubborn fits threaten to hold their breath, a refusal to inhale new experience or unwanted information from the world around them, an attempt to freeze time, to arrest all change and motion, and to assert their omnipotence as Central Commander of the universe.

But, as our pediatrician once pointed out, you can’t hold your breath to death. You will simply fall unconscious and resume breathing.

Holding our breath only creates the illusion that we are in control, but the illusion is fleeting and ultimately empowers our unconscious to solve the dilemma itself whether we like it or not – without conscious assent.

Difficulty in breathing may therefore symbolize difficulty in assimilating the principles of the spirit and of the cosmos… and the rhythms of the universe
(~ J.E. Circlot, A Dictionary of Symbols)

Sometimes the pain is so intense, that all you can do breathe, as all else has become overwhelming or impossible – like a woman in labor, or a post-operative patient in a recovery bed, or the concentrated, labored breathing of the dying.

And sometimes, when extreme emotional/psychological pain makes a client yearn for “Breath’s Departure” all I can ask of them is make a promise to me that they will commit to keep breathing until the next session, or the next day, or the next scheduled check-in a few hours away.

The regularly scheduled therapy appointment lets us know when our next respite (time to breathe) will arrive. The psyche learns that we will only have to hold our breath until the next session when we can at last exhale again.

We breathe in good air, and breathe out the bad. Breathe in cool energizing oxygen, breathe out hot toxic carbon dioxide. Breathing is the ultimate, most inherently non-dualistic, bivalent act of living, our embodied light and darkness.
And the archetypal representations of breath reflect this:

Vayu, (also known as Vata, or Prana) the Hindu god of wind and breath, is “a destructive god who has an intemperate character and is often subject to violent desires which he never strives to repress.” (~ Sumanta Sanyal http://www.pantheon.org/articles/v/vayu.html Encyclopedia Mythica™)

In the Prasna Upanishad, the sage, Pippalada describes Prana variously as the primal energy of the universe, as the sun, as fire, as light that illumines all, as food, as the creator, the destroyer, the Self and as the breath. (~ The Upanishads- The breath of the eternal)

We take in anything new by inhaling, and dispose of anything no longer needed through exhaling. This is true in psychotherapeutic process too. And I watch my clients breath closely for clues about where my support is most needed and where the block resides, if resistance obstructs the processes of integration or release.

Ideally, psychotherapy allows previously unexperienced feelings, memories, instincts, intuitions, self-states to transpire (to breathe through, to become known) for the first time. It is where we say things out loud that we would, under normal circumstances, only mutter under our breath. Breath is the vehicle that we ride to conscious awareness.

We aspire to (breathe on) transformation, to new lives, to better worlds, and easier ways of being, fresher air and deeper breaths.

When we try to blow-off discomforting information about ourselves, minimizing injuries and anxieties, our dreams, our Unconscious processes, our true selves and our deepest needs, we become the destroyer, the squelcher, the smotherer of our own internal self-states.

Examining our dreams, our words, relationship patterns, assumptions, projections, and our internal responses to external events inspires (breathes into) and energizes us to press on through the stale air of stagnation. Greek pneuma means wind, soul, spirit, and breath, and represents an internalized fragment of the world soul, the generative, creative, healing principle that moves in and out of us.

Breath is the archetypal initiator of all acts of creation. In creation myths world-wide, gods breathe spirit on to the earth, into inert globs of clay, and in the therapy office the act of breathing likewise enlivens self-states that are inert, repressed or deadened.

The therapeutic process at its most elemental, is where we conspire (breathe together) to bring forth new experience of ourselves, and others into being.

copyright © 2013
All rights reserved Martha Crawford

Pain/Full

I grew up in a haunted house with a parent disabled, possessed and ultimately devoured alive by chronic physical pain. One day, Pain, an occasional intrusive visitor, burst its way in, and never ever left. Pain sat with us at the dinner table, rode with us in the car, spent sleepless night in front of the television reclining in barca-lounger, or in a home hospital bed manipulated by magic buttons. Pain spent up all of our financial resources, taught us to walk on eggshells, pressured us to forgive all outbursts and unreason, and garnered the tongue-clicking pity of the neighbors. Eventually, Pain blocked all obvious pathways to warmth, comfort and connection, as cold and dark as a cloud blocking the sun. It took up more and more and more space each passing year – until there was no room for anyone to live with it at all, until there was barely room to move or breathe.

All of us were so used to Pain and the daily incantation of its horror-litany that we grew to hate its oppressive presence. We hardened our hearts, and had no empathy or patience left for it. We were sick of its specter, and sick of its name. We surrendered to its power as it disabled us all. Pain sucked everyone dry, and left nothing behind.

Pain runs in families.

I had my first migraine at age 7. By adolescence it was typical for me to become blind-sick, with an invisible hot metal spike in my eye and throbbing skull, nauseated or vomiting before and after any high-stakes event: A big test, an audition for the school play, a nervous first date, or at the mall choosing matching his and her outfits for the high school dance.

Through young adulthood I was sick more often than not: 18-20 violent, nauseating migraines a month.

In Pain’s clutches there is no room for anything else, no comfort, no connection, no conversation. It hurts to talk, to open my eyes, to listen, to breathe. Clothes hurt, light hurts, sounds hurt, smells hurt, the throbbing of my heart beat hurts. There is nothing but Pain.

But more often than not, Pain would pack its bags and slip away before morning, like a one night stand – as if it had never been there at all. I was ready to start the day as if I had not spent the previous 24 or 48 hours nauseated, throwing up, dozing in-between waves of pain on the cool tile of the bathroom floor, the street light burning through my eyelids as it seeped in under the crack of the closed door.

I was actually getting off easy compared to what I knew Pain was capable of. I was able to have friends, to work, to fall in love and sustain a relationship, (although early in our relationship my now husband worried that I had bulimia because of my constant nocturnal nausea). I could read, play, study, live as long as I did it in between headaches.

No doctor ever asked about it. If I did mention that I thought I might have migraines, they responded that it was common and suggested that I try some product over the counter.

I assumed it was normal. It was how it always had been for me.

At 30, my first social work position, required me to have an employee physical. The agency MD noticed I had ticked the “headaches” box and conducted an earnest assessment.

“Eighteen to twenty a month!” she exclaimed. “And you’ve never had any treatment?!?”

Treatment? What are you talking about? What for?

“Most people do not spend 20 nights each month in severe pain throwing up in the dark!”

The new fangled medication she prescribed for me twenty years ago to spray up my nose made me throw up immediately. I decided on the spot that medical treatment was ridiculous if this was the best they had to offer. I deepened my mediation practice, sought out acupuncture, took Feverfew, B supplement, magnesium, yoga practice, Qi gong, Food eliminations. I reduced my migraine load to 9-12 a month.

I thought it was a miracle. I felt cured.
Better than I had ever hoped for.

The only time I saw my condition in the popular culture was in old re-runs of my favorite sitcom from childhood. “Frank, take me home, I have a sick headache!” Darren Steven’s overwhelmed mother would whine, the back of her hand pressed dramatically to her forehead after Samantha and Esmarelda had let their magic loose in her presence. Like the Bewitched script writers, I associated migraine disease with weakness, manipulation, psychosomatic illness.

So I had headaches a lot. There were hundreds pain reliever/headache commercials on TV. Other people could cope it seemed, why not me?

Early in my practice, I could get through most of my work hours. A couple of times a month, I would excuse myself from session, to be sick, and then return to the client and resume the work.

Like a cat hiding its symptoms, I’d sit in session, grateful to focus on the client’s narrative instead of the mounting pain, the excruciatingly searing light emitting from the 60 watt light bulbs, the hypersensitivity to the smell of the therapist’s perfume in the adjoining office.

A few times a month I would have to cancel out and reschedule my day all together. My therapist never did this. Never once in over a decade together had he cancelled out at the last minute due to illness. I did it regularly. For years I was ashamed to admit to my clients what had kept me out of the office. I fobbed it off on flu, tummy bugs, bad colds, “coming down with something” I worried about treatments disrupted, the precarious appearance of my emotional fortitude and reliability as I teetered on the brink of disability:

“I feel another sick-headache coming on Take me home Frank!”

The rare but most shameful moments occurred when I couldn’t/can’t make it through a session. The session begins with a manageable amount of low-grade pain, which suddenly escalates, or an intrusive visual aura partially blinds me letting me know I am mere minutes away from Pain’s explosive arrival, and I need to stop suddenly.

Pain has cut clients off mid-thought, when I realize that the line has been crossed between manageable Pain, and Pain that has possessed me:

“I am so very sorry, I need to stop. I get severe migraines, and I can’t always predict when they will strike. I’m so so sorry to leave you hanging like this – but I think the most responsible thing for me to do now is stop. I hope we can reschedule, and I won’t charge you for this session, or the next one so we can talk about what this leaves you with.”

The client looks stricken, worried, fearful that they caused my headache. They rush out gathering their things and offering well wishes over their shoulder. I cannot get their distressed faces out of my mind or shake the guilt of having abandoned them as I sit, face buried in my hands, slumped and Pain-drunk on the long, smelly, flickering-florescent subway ride home.

When it cracks and I am myself again, I send a note, letting them know I am all right and not to worry – and schedule a time to talk about what happened, what it was like to see me vulnerable, to feel abandoned, what it activates from their past, and how it changes our dynamic going forward.

It took a long time for me to figure out, on my own, that certain clients, in certain self-states, could communicate to me through a migraine – that Pain could sometimes serve as a somatic countertransference, surfacing latent content in the session.

One man, kind, charming, intelligent talented, and highly anxious left me puking into my wastepaper basket immediately after session, several weeks in a row. I monitored my food triggers- no obvious culprit. I changed his session time – to the early afternoon, to the first session of the day – still it continued. I enjoyed him, cared about him, felt touched by his struggles, and courage. Yet, somehow, unconsciously, he was making me sick. Others wondered if I should keep working with him, but had no impulse to abandon him – I was used to this. When the anxiety, illness and chaos that he was struggling to repress finally erupted into a psychotic/depressive break, my somatic countertransferential symptoms disappeared entirely and forever, and we went on to work together for many years, forming a deep and treasured therapeutic alliance.

I don’t know if I have more clients with chronic pain conditions than other therapists, if I assess for it more, or if its manifestations sit with me more intensely.

I have clients who live through, with, and in spite of pain far more severe and disabling than mine: chronic cluster headaches, spinal injury, chronic severe nerve pain, endomitriosis, permanently disabling bone injuries, fibromyalgia, rheumatoid arthritis, inflammatory diseases, autoimmune illness.

Am I therapist that is “good with” pain related issues?

There is no easy answer to how well therapists treat cases that activate our core conflicts. I suspect that I am simultaneously my best, and my worst with these cases.

I’ve seen clients, spend years, even decades like myself, ignoring, denying, hiding, carrying on, prematurely resigned, certain that their pain load, as excruciating, untreated, and disabling as it is, is immutable.

I have seen Pain annihilate people, drive them into a permanent haze of narcotic dependency and abuse, make them wish they were dead, or drive them to consider killing themselves to escape.

I’ve watched Pain eat relationships alive and suck their bones. It destroys by obliterating our ability to experience other people or even one’s own Self. At its worst, it doesn’t permit the experience of anything other than Pain itself.

I’ve also watched people move into states of conscious acceptance that Pain is permanent, and unescapable, and sometimes through that surrender, they discover how to survive and thrive.

When I sit with clients trapped in its jaws, I am terrified it will chew them up slowly, in front of me. My office transforms into the haunted house of my past. My own brushes with a near disabling pain condition rears its head. My demon-pain-fears, past and present whisper in my ears, terrorizing me.

These are the most harrowing countertransferences that I face. Yet, cognitively, I know that everyone one will and must forge their own, unique relationship with Pain.

There have been times I have chosen to disclose my circumstance, in order recuse myself from the illusion of objectivity, and allow my client to protect themselves from my own Pain-fear. A decade ago, a young client with chronic pain (who I had seen for many years for other issues) contemplated a surgical intervention that I was too tragically familiar with from my family history.

“Listen: I know that this is a very important decision and I want to support you in making whatever choice you feel you need to make for yourself. But, I have to let you know, it will be very hard over the next few months for me to separate my own experiences with this procedure from our discussion. I had a family member who had this very same procedure many times, with increasingly bad outcomes each time. I know that this is not objective data – that I am drawing on a sample of one, and it offers no statistical significance to help you figure out what you need to do. I have seen only the worst outcomes, not the best. So, that being said: I plan on doing my best to support you through this – but I need you to know that I hold biases that are specific to me – and if it ever feels like it’s getting in the way of hearing your own reason and intuition about this, please, I’ll need you call me out on it. If you see me very uncomfortable or looking fearful or worried, I just want you to be clear that it is about my history – and not about my approval or disapproval of your decision.”

The client ultimately chose to go ahead with the surgery, and we were able to stay close and connected through the pre-operative period, the surgery, the recovery and its aftermath.

And there are times that calling out my client’s Pain-blind-spots have helped me to see my own.

After years of feeling that I was functioning “well enough” with my 9 to 12 incapacitating headache days a month, my cancelled/rescheduled sessions, and my wellness practices – I heard myself confronting a chronic pain client on his resignation and encouraging him to find a reputable pain clinic that offered real treatment – not just narcotic pain medications.

“Your anger and fear that the pain will never go away entirely, are blocking you from exploring any avenue that could reduce your pain, and give you more of your life back!”

And then I thought to myself:
Ah yes, well then. Pots calling kettles, physicians healing themselves, doses of my own medicine and all that…

I googled “NYC headache specialists neurology” immediately after the session. I’d had chronic migraines since childhood. I was now over 40. I had never seen a neurologist in my life.

Two things had changed that made those 9-12 sick days or nights no longer acceptable. I began waking up ambushed by Pain in the morning. It snuck in as I slept – and it was staying longer – sometimes for days consecutively – violating all rules of migraine-hood as I knew them.

And I had become a parent.

A baby sleeping on you while you are in a Pain-stupor can be sweet and comforting. Trying to get two toddlers out of wet bathing suits, and diaper-changed under bright lighting in a noisy, crowded locker room after baby swim classes half-blind, in level 8 pain, and throwing up in garbage cans on the street while pushing a double stroller home is a nightmare.

I heard myself begging my kids to “be good” to “be quiet” because Mommy’s head hurt very badly. I heard the irritation and exhaustion in my voice 9-12 days and evenings out of the month as I scattered eggshells on the floor for them to walk on. I heard my kids ask, when they didn’t see me: “Is mommy throwing up again?” and watched them play Family: “I’ll be the mommy and lay down in a dark room!” I heard the voices and whispers that had haunted the house of my childhood. It now seemed a terrifying and real possibility that it could all happen again.

I found an excellent neurologist. With some trepidation, I went forward to try Botox – which paralyzes my scalp and back of my neck. (The standard protocol is to do the forehead and brow muscles too – which I opt out of. Being able to look worried, furrow my eyebrows and lift them happy surprise is three quarters of what is required of me professionally. )

Botox brought incredible relief -(and I have a very youthful scalp!) the number of headaches were not reduced, the severity was: no more nausea, and Pain took up much less square footage. I still had the accompanying neurological symptoms: occasional aura and visual distortions, agitation and irritability, light, sound and smell sensitivity, fatigue, dry mouth, word-loss, garbled speech.

Over time, I added preventative medication, as well as the medication needed to stop a migraine in its tracks. I still eat medicinally and mindfully, practice meditation, and martial arts based energy work, I still use natural remedies whenever possible, take supplements to support neurovascular health, and draw on the support of alternative medicines. My migraine load, for the past four years or so is down to 4-6 a month. For now. Some months I am entirely migraine free. I haven’t missed whole days of work, and only occasionally need to cancel a late night session.

My journey has been from alternative and wellness modalities, to deepening my use of allopathic support. I have had many clients who have traveled the opposite path – traditional western medicine maxed out its offerings, or proved to be harmful or useless and engaging in alternative methods of treatment and self-care and wellness has been able to carry them farther.

Three years ago, Pain reared up and threatened to consume yet another client, with no prior warning, in the form of chronic cluster headaches – which bring with them some of the most severe, acute physical pain that human beings can endure. For a full year I watched a woman I cared about being sadistically, demonically tortured by Pain at its most hateful, explosive and destructive. Neither of us knew that she would survive if or if Pain could be successfully controlled. My own fears surely led me to make many errors. There were times as I watched her collapsing, her sense of self slipping away that I flailed and clutched too tightly, acted out my agitated panic, and probably compounding her sudden violent disability with my own urgencies. I could not sit at a distance, with naive certainty that “everything would get better.” I was not able to be inherently calm or soothing. I was afraid with her.

Was that what was needed? It was frankly all that I had to give. I knew what it was to be neurologically altered, to be unable to think clearly, to post-traumatically avoid any potential trigger, to have my senses Pain-distorted and to be surrounded by Pain on all sides. I knew how cold it could be when the Pain-cloud blocked out the sun. I don’t know how she or I could have gotten through that year together if Pain hadn’t taught me how to stay with her.

It was an unfathomably brutal and traumatizing year for her before the cycle cracked – and a year that made me re-encounter all of my own worst fears on a near daily basis in and out of the office.

But even as it was happening, and certainly once her pain was finally controlled, I was extraordinarily grateful to be reminded of what my relationship to Pain was good for.

Pain becomes bearable, meaningful only when we can discover how to make it of use.

Pain can sever relatedness, but it can also blast open a portal to connection. It reminds us of our own vulnerability, our mortality, and our powerlessness as an inherent aspect of our humanity. Pain can teach us how to be tender to others, and can lay a foundation for empathy, and intimacy to flourish.

Several months ago, my son, to whom I am not biologically related, developed recognizable symptoms: His coat hood pulled over his face, his thumb inserted into his left eye-socket – he complained that the subway lights would make him throw up, and retreated to a dark room to sleep two or three afternoons a week, sometimes missing school off and on for several months.

I knew what to do. We eliminated common food triggers, found him an acupuncturist, and pediatric neurologist headache specialist to confirm the diagnosis.

“Common conditions are common” the headache specialist said when I enquired about the nature/nurture questions that live in the heart of all adoptive families. “But because you have migraines, you were able to identify it quickly and get him care. Many kids go for years and years, or through their entire lives, without ever knowing what is happening to them or that there is help available.”

Don’t I know it.

Pain’s bestows the capacity to recognize its presence and to be moved to alleviate it in others.

Pain can destroy, no doubt. I still sometimes hate its guts and it can still scare the shit out of me.

But I’ve grown to also feel grateful for its dark gifts, and surrender to its teachings, as it has guided me, and others, toward unfamiliar routes to connection, relationship and love.

Last week, I had a whopper. My son, curled up with me, and began rubbing my head.

“Right there, right Mommy?” he clucked. “That’s the worst spot, I know. Don’t worry, you don’t have to explain. I know just exactly where it hurts…”

copyright © 2013 All rights reserved Martha Crawford

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