Smoke and Mirrors

 

I am silver and exact. I have no preconceptions.

What ever you see I swallow immediately

Just as it is, unmisted by love or dislike.

I am not cruel, only truthful—

The eye of a little god, four-cornered….

~  Sylvia Plath, Mirror

 

We all know the story of Narcissus, and the dangers of falling too deeply in self-love, mesmerized by our own reflection.

And we all know that fairy tales warn us of the black arts of deceptive mirrors which seduce us into the belief that we are indeed the “fairest of them all”

Psychoanalytic theory has wrestled with the idea of the reflected self – and the hunger we all have to see ourselves accurately and completely. The need to gaze at ourselves is simultaneously labeled as narcissistic disease, and the same mirroring gaze is the cure itself.

Self-involvement, self-regard, self-love, self-awareness, self-negation, self-esteem, selfishness and self-reflection. Our fascination with mirrors speaks to our archetypal hunger to see ourselves in both a flattering and an accurate light, our fear of what we may find, the tricks and dangers that lurk through the looking-glass and the wish to know realities that require the aid of the reflecting glass.

For without such reflections we cannot begin to know ourselves at all.

 

Relationship as Mirror

I  your glass Will modestly discover to yourself

That of yourself which you yet know not of.

Shakespeare ~  Julius Cesar

The first literal and metaphorical mirror we encounter is  “the gleam in the mother’s eye” – a glimpse of our infant-selves, feeding, reflected in the dark pupil of a care provider. For those lucky enough to first see themselves in an eye-mirror that is smiling, admiring, bonded, and loving our most primordial sense of Self will be surrounded in adoration and security. For those with depressed, absent, distracted or indifferent care takers the first glimpse of ourselves may be anxious, disrupted, hopeless or fragmentary.

And some cannot find themselves there at all.

Mothering and mirroring are archetypal functions entangled and intertwined  long before psychoanalysis conflated them:

In Christian art the mirror came to represent the eternal purity of the Virgin Mary. As the medieval writer Jacobus de Voragine wrote:

As the sun permeates glass without violating it, so Mary became a mother without losing her virginity She is called a mirror because of her representation of things, for as all things are reflected from a mirror, so in the blessed Virgin, as in the mirror of God, ought all to see their impurities and spots, and purify them and correct them…”  ~ The Fitzwilliam Museum 

Over time early caretakers wield their parental power with “an increasing selectivity of responses.” As the mother’s face-mirror shifts from admiring to disappointing, approving to disapproving, flattering to shaming it prunes our sense of our own strengths and weaknesses, and helps us to assemble a socialized self – a mask, a false-self, a personae to introduce ourselves to the world.

The first experience of a disapproving mirror casts us from the garden, initiates us into the processes of repression and introduces us to sin and shame.

The most destructive energies within us must first be met with some approval for their self-preserving, evolutionary function in order for us to integrate them into our own self-image, and learn to modulate them and use them effectively.

The consequence of the parental self-objects inability to be the joyful mirror to a child’s healthy assertiveness may be a lifetime of abrasiveness, bitterness and sadism that cannot be discharged- and it is only by means of therapeutic reactivation of the original need for the self-objects responses that the actual lessening of rage and a return to healthy assertiveness can be achieved.  ~ Heinz Kohut, The Restoration of Self.

In Kohut’s model, the psychotherapist creates an opportunity for a corrective experience  by assuming transferred responsibility for these mirroring needs – as a self-object that helps to repair and integrate distorted or unmirrored aspects of the Self. The therapist offers an accepting, admiring gaze, one that allows the client to shed the distorting self-representations left over from being raised surrounded by fun house mirrors.

For Kohut, the need for healthy self-mirroring objects, accurate enough, even through its imperfections, is life long. Psychotherapies that span a life-time are not seen as failed – but as necessary compensations for our ongoing need to see and accept ourselves as we are over time.

No one looks in a mirror just once. We feel the need in to check in on ourselves, to peer and peek, take in and groom our reflections, sometimes several times a day, every day as we grow, mature and decline over for the course of our lives. We wonder if we could know ourselves over time, if we could have a sense of how life passes through us at all without our mirrors.
 
In me she has drowned a young girl, and in me an old woman

Rises toward her day after day, like a terrible fish. ~  Sylvia Plath, Mirror

Mirrors & Shadows

In myth, scripture, fairy tale and legend, the mirror as archetype serves far more uncanny functions, functions more dangerous, ambivalent, sacred and transcendent than merely regulating our self-esteem.

Mirrors reveal to us what cannot be shown to anyone else, what we do not know, and perhaps don’t want to know about ourselves at all.

Whoever looks into the mirror of the water will see first of all his own face. Whoever goes to himself risks a confrontation with himself. The mirror does not flatter, it faithfully shows whatever looks into it; namely, the face we never show to the world because we cover it with the persona, the mask of the actor. But the mirror lies behind the mask and shows the true face. ~ CG Jung “Archetypes of the Collective Unconscious”

Our truest face, our whole Self includes a shadow that is terrifying to us, as almost every scary movie will attest to. What is more frightening than staring in a mirror, alone, in an empty house, at night with nothing to encounter except yourself in the quiet dark? What horror will be revealed? What chilling doppleganger lurks underneath our daytime persona?

We are horrified and titillated by seeing our denied, demonic shadow selves reflected.

There are destructive creatures lurking in our personal unconscious that can only be vanquished, by taking indirect aim through their reflection, as Perseus defeated Medusa. Complexes that are so potent, that if we attempt to face them too squarely, too directly we could be turned to stone.

There are monsters and entities which are only recognized by empty mirrors which reveal their soul-lessness.  Our undead selves, the haunting self-apsects not alive but not dead either,  vampiric states that drain us when we are unaware, our eyes closed to what has emerged to feed when we were not awake to ourselves.

In Psychology and Alchemy, C.G. Jung details a dream in which a mirror appears as “an indispensable instrument of navigation” referring “to the intellect which is able to think, and is constantly persuading us to identify with its insights (reflections).”

Metabolizing shadow content is one of the functions of psychotherapy too, as well as safely and incrementally,  breaking down the repressions, fear, and judgement which caused those self-states to find themselves banished to the mirror-lands to begin with.

Here the focus of psychotherapeutic work is less on the psychotherapist as corrective mirror,  but more as a warm and accepting guide, who’s job is to usher us into active relationship with our own Unconscious.

Mirrors can also show us glimpses of worlds far beyond our personal unconscious.

 

Mirrors, Soul and Spirit

For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known.

~ 1 Corinthians, 13:12 King James Bible

 

Mirrors are windows into alternate universes, to magic realms, to the upside down places, and can transport us to the dream-lands and spirit worlds. They are the looking-glass we can fall through, and the portal which both dark and benevolent spirits pass through to contact us.

Faust on his journey with Mephistopheles first falls in love with face of Divine love – Heavenly beauty, the Anima, manifest as the face of Helen of Troy when her image emerges in a magic mirror. It is this contact with his own soul and the redeeming spirit which, in the end,  will ultimately save him.

And from her living body, lying there

Comes there indeed all heaven my soul to bless?

~ Faust, Goethe

Mirror phenomenon are also representative of the intuitive function: To look in a mirror lit only by candle light reveals the spirits of those who have died. Or practice mirror gazing, catopromancy,  as Pythagoras did, and divine your fate  as it emerges in the glass. Reflection under the moonlight  opens the mind’s eye to  the images, intuitions, and guidance of larger psyche:  the instincts and perceptions unconsciously repressed or consciously dismissed in the light of day.

Without the silvered glass we may never retrieve unknown, forgotten or lost pieces of our own soul.

 

Soul Loss

It was a maxim both in ancient India and in ancient Greece not to look at ones reflection in the water and …the Greeks regarded it as an omen of death if a man dreamed of seeing himself so reflected. They feared that the water-spirits would drag the persons reflection or soul under water, leaving him soulless to perish. This was probably the origin of the classical story of the beautiful Narcissus, who languished and died through seeing his reflection in the water ~  Paula Elkisch, The Psychological Significance of  the Mirror

Like photographs, when isolated cultures without mirrors were introduced to them for the first time, it was often  assumed that the reflection was their actual  soul, having left the body.

We cover mirrors following a death so the soul does not become lost within them and a broken mirror is an image of a shattered soul in pieces, and it will take  seven years before its wholeness is restored.

If the mirror is “‘a thing that has been made the screen for mans projections” (Elkish)  then through the processes of projection we lose some part of our soul.

So, what then are psychotherapists as personified blank-screens and mirroring-objects gathering up client’s projections and transferences – but soul-stealers and head-shrinkers, holding our client’s souls hostage for a weekly ransom?  As psychotherapists we must always acknowledge the darker aspects of our powers and the archetypes that are present in the therapeutic transaction. As clients, the mirror as archetype reminds us that we must remain always cognizant of the  dangers of becoming trapped, lost, hypnotized by images of our own projected soul.

It seems that the fear of loss of self (or soul) together with the attempt at retrieving the lost makes the mirror so fascinating ~  Paula Elkisch, The Psychological Significance of  the Mirror

 

Mirrors, Tricks and Miracles

The universe is at root a magical illusion and a fabulous game ~ Alan Watts

Of course stage magicians also rely on mirrors to create pleasurable tricks and amusements.   It is a deception that we participate in happily, willingly, suspending our disbelief to delight in the hidden mirrors ability to make things appear or disappear, or to make something or someone dense, burdensome and heavy transform into something as light as a feather. As we watch the volunteer from the audience levitate, mirrors obscuring the mechanisms of suspension, our own burdens feel lighter too.

Mirrored tricks and illusions can have profoundly healing effects: Mirror-boxes are used to effectively treat phantom limb pain following amputation. The intact limb is placed in front of the mirror box, which masks the missing limb. The patient watches the mirror while they stretch, unfurl, scratch, or massage the intact limb, relieving the discomfort of the missing limb. The mind is not fooled into the literal belief that their missing limb has been restored, but the brain is fooled and the illusion soothes and relieves.

And perhaps psychotherapy is at its very best, a similar curative illusion, a healing trick, a soothing substitution – rather than a literally corrective experience for losses incurred in the past. A trick which both participants must remember is both an illusion and a cure.

Or maybe it is something else:

 

Now I am a lake. A woman bends over me,

Searching my reaches for what she really is.

Then she turns to those liars, the candles or the moon.

I see her back, and reflect it faithfully.

She rewards me with tears and an agitation of hands.

I am important to her. She comes and goes….

~ Sylvia Plath, Mirror

An image presented itself to me in a hypnogogic state recently – as I drifted in between sleep and waking:

I sat in my office chair, my face hidden from view, my head behind a mirror inside a box  much like a medicine cabinet. I sat across from an unknown Other, who I could see only dimly, but who saw their soul reflected when they faced me. They were transfixed, filled with yearning, with deep hunger for more contact, to forge a deep and lasting relationship with the face in front of them. I was not fooled. I knew that I was not what they sought. But it was nearly impossible to impress the truth upon them: What they thought they could only access through  “me” was merely a reflection of their Self:  “wholeness, totality, the union of opposites, the central generative point where God and man meet… the fountain of our being which is most simply described as God” ~  Edward Edinger – Ego and Archetype

“Mirror”: from the Vulgar Latin, “mirare” to look at,” variant of Latin mirari “to wonder at, marvel, be astonished”  – also the historical source of “Miracle” and “Miraculous”

What you seek is already within you. This reality is subjective, not the outer, objective reality.  ~ Ram Dass, Polishing the Mirror quoted in Parabola vol, 39, issue 1

 

It is your own lush self

you hunger for 

 ~ Lucille Clifton, Eves Version

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In Conflict

Anger (v) c.1200, “to irritate, annoy, provoke,” from Old Norse angra “to grieve, vex, distress; to be vexed at, take offense with,” from Proto-Germanic *angus (cf. Old English enge “narrow, painful,” Middle Dutch enghe, Gothic aggwus “narrow”), from PIE root *angh- “tight, painfully constricted, painful” (cf. Sanskrit amhu- “narrow,” amhah “anguish;” Armenian anjuk “narrow;” Lithuanian ankstas “narrow;” Greek ankhein “to squeeze,” ankhone “a strangling;” Latin angere “to throttle, torment;” Old Irish cum-ang “straitness, want”). In Middle English, also of physical pain. Meaning “excite to wrath, make angry” is from late 14c.  ~  ( http://www.etymonline.com)

So someone is always angry at me about something. At least one person a day, often more than that.

Often enough with good, fair reason and because of something I have done or not done, said or not said. I am running late. I push when I should have held back, or held back when more was needed from me.  I can make my own errors, stumble about, bang into a painful bruise. Sometimes I am clumsy, slow, frustratingly thick-headed. Or lost in my own projections, operating on an erroneous assumption, or stuck in my own subjectivity.

Sometimes people are angry because they have been sold a bill of goods, hopefully not by me, although I am probably also a participant, that psychotherapy can offer them a cure, some relief, when the truth is less certain. Sometimes it can and sometimes it can’t.

People get angry that I don’t have the magical powers to take their pain, their confusion, their ambivalence, to heal the wound away.

Some become angry that I don’t just know. Right away, instantly, what is needed and how to provide it. Sometimes people become angry because they have told me what they want from me, and they believe that I am withholding, refusing to cough it up.

Some want to control, extract, command that I fill their need to their exact specifications and are enraged at the dereliction of my professional duties when that need remains thwarted, unfulfilled, exposed, empty when I can’t. Or won’t.

Some become smaller, exceedingly polite, self-diminshing in order to metabolize the anger that a mis-attuned moment has activated. And then I have to drag  it out of them:

“I wonder if something I said made you feel angry?”

“No. I am not angry….”

“Well, something shifted in our conversation and it seems like maybe I said something that hurt? Maybe anger is a strong word for you? How about annoyed?”

“Well, okay. Yes. Maybe I was a little annoyed”

Some become angry because I can see the pathway in, I have gazed at a vulnerable and naked space in them – and they want to cast me out and drive me away. Some are secretly terrified that I will go and their anger helps them organize a pre-emptive strike. Sometimes anger helps people self-regulate, manage their dependency, separate.

Sometimes the anger that emerges in session, or is directed toward me is obviously displaced, patently unfair. A lashing out. And still, somehow, it is almost always understandable to me when I can hold, or uncover the subjective context that it is embedded in.

Usually I am a participant. I bear at least some responsibility. At the very least I lit the fuse, even if I didn’t build the bomb.

Sometimes the client is angry or disappointed that I have my own wound. And they have found the very spot where my needs, my history, my trauma, my vulnerability lives and they want something from me in the exact pocket of my psyche where I have nothing to give at all.

Some attack or express contempt for my core values, my stance, my beliefs, my sense of what is right. Some reject the models of psychotherapy I have embraced, the patch of ground I stand my professional identity upon.

And of course, I get angry too.

I breathe and do my best to stay cool. I contemplate the tightness in my chest: What am I responding to? Where do I feel strangled, offended, tormented, grieved, distressed? What needs to be opened up between us in order to be released from this constriction? Where has our relationship grown too narrow?

If I am caught off-guard, or feel too reactive, too agitated, I  may ask to table the discussion until I can think with a cooler head. But the arrival of anger must never be ignored or forgotten. It is a sacred signal and attention must be paid. We must return to it, examine it, discover its gifts and lessons once our nervous system and our heart-rates have settled.

Anger and aggression have important, constructive functions too: to establish boundaries, to protect privacy and autonomy, to fight for justice, to correct imbalances, to guard vulnerability, to take risks, to hunt for prey, to compete for resources, nurturance and provisions, to challenge and surpass ourselves.

And sometimes to forcibly remove obstacles to intimacy and wholeness.

In relationships, anger points our attention toward the tight, narrow, constricted, strangled, tormented, wanting aspects of ourselves and others so we can broaden and console our hearts, release our fears, open wide our souls.

As frightened as we are of it, anger is a sacred energy – and a central one in the psychotherapeutic process.

I don’t ever intentionally provoke a client’s anger, but I am not fearful of it.  I don’t avoid conflict, because I know the gifts that it can bestow.

I try to inform every new client that comes into my office that anger has a place in our work:

“There will be times when I  disappoint, disturb or upset you. I won’t have done it on purpose, although it might feel like I have. Sometimes you may not notice it while you are in session – as most of us are taught to be agreeable and polite and avoid talking about such things – but it may strike you after you leave – on the subway ride home or even the next day. You may notice something sticking in your head, something I said or didn’t say that struck you the wrong way, that feels off, or annoying, or wrong. You may think to yourself  ‘Why the hell would she say or do that?’  If you notice any feelings or thoughts like that it will be extremely valuable and important, if you can, to bring that back in to our next session, or even to jot down a quick note so it doesn’t get lost in the weeks events- so that we can remember to talk about it. It may be hard and uncomfortable, but its really valuable  – and its an essential part of how therapy works.

It helps me to understand you as precisely as possible, to be a better therapist for you. You may point out things that I haven’t recognized or considered- or that I had a different perception of. Sometimes you may be distressed by some real limitation or blindspot I have, or even some core value that I hold that you disagree with. That is okay too. I can’t promise that I can always change or stop it whatever has been upsetting, but I can promise that I will always do my best to examine my part of any divergence that  comes between us and I will absolutely care about how it makes you feel. And if we can talk about it frankly, it may give us a chance to find a new way through, a new solution, a new space.”

It seems that whenever I have neglected to invite anger to enter into the process as a welcome guest, conflict barges in unannounced and unexpectedly, harming the therapeutic relationship – sometimes irreparably. Anger and conflict are experienced then, as definitive proof that something is wrong in the therapy, rather than as a vital component, a therapeutic mechanism of healing and connection.

Or, the relationship proceeds walking only the most avoidant and  domesticated paths, making the woods and the wilds of our innate aggressive impulses appear more terrifying, a place too dangerous to ever venture.

Conflict is part of the therapeutic process, not a failure of it. And part of this job is to initiate people into the generative, creative, and intimate uses of anger, and to learn how to move through the angry states in our psyche and our relationships in order to live, to love courageously, fearlessly, and honestly.

And Jacob was left alone; and there wrestled a man with him until the breaking of the day.

And when he saw that he prevailed not against him, he touched the hollow of his thigh; and the hollow of Jacob’s thigh was out of joint, as he wrestled with him.

And he said, Let me go, for the day breaketh. And he said, I will not let thee go, except thou bless me. ~ (Standard King James Version Genesis Chapter 32: 24-26)

Even when seems to have knocked us out of joint, conflict can bring blessings. Owning our anger explicitly, consciously, and constructively makes us more whole, and less afraid of ourselves.

And other times my job is just to survive it, withstand it, not be destroyed by it, and not let my love or my empathy be destroyed by it. To continue to have compassion for the distress that is present in front of me, to take all the responsibility I can for my part, and to understand that the rest is not about me at all.

If I can. I can’t always.

And sometimes even that is not enough.

It does neither of us any good for me to merely withstand abusive energies. Limits must be set. There are things I can’t accommodate. Angers I cannot absorb. It is my responsibility in those moments to set limits, protecting us both. I cannot let a client who needs me, harm me or compromise my integrity or we are both lost.

Anger is at once an energy which destroys and derails, and one which creates, strengthens, and fuses and purifies, through its refiners fire and alchemical heat.

Part of my job, as I see it, is to initiate clients into the constructive, transformative, generative uses and processes of anger.

Any one can get angry- that is easy- or give or spend money; but to do this to the right person, to the right extent, at the right time, with the right motive, and in the right way, that is not for every one, nor is it easy ~ (Aristotle, Nicomachean Ethics, Book II, 1109a.27)

If we can manage to wrestle through conflict squarely and bravely together – operating in good faith – or setting limits when anger has temporarily washed good faith away – certainly it is not difficult to see how to carry those processes out into the world, into other relationships.

The word wrestle, derives from “wrest” from the Old Norse, meaning “to bend” and the healing forms of anger make way, when we have listened to each other deeply, for us to release our tormented tightness and constriction, and discover how to bend toward each other.

What is external occurs internally as well, so our well negotiated conflict also becomes model, a mirror to help us sort through purely internal arguments between conflicted self-states.

It is exactly as if a dialogue were taking place between two human beings with equal rights, each of whom gives the other credit for a valid argument, and considers it worthwhile to modify the conflicting standpoints by means of thorough comparison and discussion or else to distinguish them clearly from one another.  ~ C. G. Jung, The Transcendent Function.

How else will we change each other? How else will be transformed?

If we avoid what we fear in ourselves, and in each other – what will be possibly be able to learn about ourselves?

The shuttling to and fro of arguments and affects represents the transcendent function of opposites. The confrontation of the two positions generates a tension charged with energy and creates a living third thing… A movement out of the suspension between opposites, a living birth that leads to a new level of being, a new situation. ~ C. G. Jung, The Transcendent Function.

But first we must embrace the wrestling match.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

The Seed

To see things in the seed, that is genius – Lao Tzu

At the initial consultation with any new case, I search for the seeds. The small, encapsulated point of contact that is filled with all the potential for whatever might be able to grown between us, as well as the seeds of destruction: the previous patterns and pre-existing conditions that will challenge any healthy connection and may even block our growth together entirely.

And there is something else I am scanning for as well. Something more mystical maybe – something that a good evidence-based skeptic would scoff at; a sense of the soul-seed of the person sitting across from me.

There are intuitive indicators internal and external: a client who reports a dream that led them to me, a certain kind of swelling identification, a little empathic heartbreak, the wish to soothe and console or a restrained impulse toward all-out rescue. A sensation that makes my heart feel bigger than it was before we were introduced, a rising courage to withstand something I had been afraid of seconds earlier, for the sake of a just-met person whose name I am not quite sure how to spell yet.

This Soul of mine within the heart is smaller than a grain of rice, or a barley-corn, or a mustard-seed, or a grain of millet, or the kernel of a grain of millet. This Soul of mine is greater than the earth, greater than the atmosphere, greater than the sky, greater than these worlds. (The Upanishads, Chandogya 3.14.2-3)

I look for some intuitive confirmation that we may be right for each other and that I can provide the necessary conditions for their truest destiny, the best, deepest, highest, hardiest Self to emerge. I am trying to assess if I have the resources to support them in withstanding and thriving even if the elements are less than ideal, if the therapeutic connection I can provide will prove to be fertile soil.

But even if I spy these tiny potentialities, there is no predicting with any degree of certainty what direction they will grow, or if they will take root at all. What we hope for together may not manifest. Who you think someone will become may bear no resemblance to who they turn out to be. Nothing is as consistent over time as we would hope.

Farmers know this in their bones, there are few certainties.

Except for one:

The Mother and the Mustard Seed
A woman whose child had died asked Buddha to resurrect her babe. Buddha promised that he would do so when she returned to him with a mustard seed from a home that had not been touched by death. She traveled from village to village seeking a home where no one had died. She returned to Buddha without the seed, realizing that death and suffering were inescapable, and vowed to spend the rest of her days seeking to console the suffering of others.

Personas, false selves, and even what were seemingly core identities can, terrifyingly, die on the vine in an instant. As external conditions are always changing, our route to survival and growth can cause us to diverge from any anticipated trajectory. We are epigenetic creatures: we are no fixed thing. There is a step-wise process through which the inner germ of our identities, triggered by external and environmental influences, can lead us to act in ways that we could never have planned for. And which could never be discerned from gazing at the dormant seed, or the picture on the front of the seed packet.

Too many people I thought I had known throughly – both in and out of the office – have suddenly blossomed or gone to seed, flourished or died out, transforming into someone, or some alternate way of being that I could never have anticipated and which surprises me utterly. Sometimes it is a heartbreak as they become something I can no longer recognize, relate to or understand at all. Sometimes the harvest is more abundant than I could ever have hoped for.

And certainly, there are times that whatever I envisioned at the outset – for good or for ill – was just dead wrong. Even the gods don’t hazard such predictions.

Behold, a sower went forth to sow; And when he sowed, some seeds fell by the way side, and the fowls came and devoured them up: Some fell upon stony places, where they had not much earth: and forthwith they sprung up, because they had no deepness of earth: And when the sun was up, they were scorched; and because they had no root, they withered away. And some fell among thorns; and the thorns sprung up, and choked them: But other fell into good ground, and brought forth fruit, some an hundredfold, some sixtyfold, some thirtyfold. Who hath ears to hear, let him hear. ~ Matthew 13 King James Bible

The surprise unfolds in both directions. Cases I thought I was foolish to take on become deeply gratifying. Connections easily established fall to pieces. Perhaps the most surprising is when my initial impressions bear whatever fruit I thought they might.

Survival, and certainly the processes associated with thriving are inherently creative, and therefore surprising acts.

The “Seed of Life” is a sacred geometric pattern, consisting of seven circles in sixfold symmetry – an interlocking pattern of spheres and seeds – which forms a basic component of the Platonic solid known as the Flower of Life. ( http://www.geometrycode.com/free/seed-of-life-pattern-construction-using-compass/ ) In Kabbalistic thought it represents the six days of creation and the seventh day of rest.

The creative processes of adaptation and Life itself, which seems to unfold in a straightforward, sequential uninspiring manner, can startle and amaze us with their symmetry when viewed all at once or with hindsight.

The pattern repeats, until we become aware, and sometimes continues, even then, without our choosing. Organic growth rarely shows us where it is heading in advance. We never know for sure if the seeds we have sown will feed us or leave us hungry. It is, too often, only revealed after the fact.

Some seeds never sprout above ground at all, but do their work entirely deep below the soil, in the Underworld.

In Greek myth, when Persephone is kidnapped by Hades she retains every chance of being rescued by Demeter, her mother, assisted by Helios the sun – who locates the missing maiden – and Zeus who demands her return to resolve the global famine triggered by Demeter’s grief-tantrum. Until Hades offers Persephone a quick snack: six pomegranate seeds. Unbeknownst to her, swallowing those six small seeds -certain they were harmless refreshment, something she thought she knew and recognized, and yearned for as familiar nourishment – sentenced her to live as the bride of Hades, Queen of the Underworld, separated from her devoted Earth-Mother and all that she loves above ground for six months out of every year, half of the rest of her eternal life.

Attaching too certainly to our expectations of others, banking on potential outcomes can take us on dark and harrowing journeys.

When we fall in love, we are attaching to the archetypal Seed in the romantic Other. In the early months of connection, we fall for their potential, who they hope to be, what they might grow into, and who they wish they were – rather than who they actually are. Only time can reveal that.

And we can be proved wrong. Or perhaps we were exactly right, but that seed exists only as one potential among many. We can fall in love with something the beloved does not even know exists inside themselves. Certainly the mustard seed has no knowledge that it can grow into the tallest and most useful of plants.

Sometimes we can believe so much in the unrecognized potential of another that we can help them to manifest it, but only if it is what they yearn to grow into.

Other times, we find ourselves more committed to a Seed in our loved ones than they are. Anyone can choose to arrest or prune their growth, change direction, or yank a potential Self out at the roots. When this happens, attaching too tightly to our favorite Seed or the as yet unmanifest Best Self in our lovers, friends, children, parents, clients – can deplete all of our resources and yield nothing.

In ego-psychological terms this Seed can be thought of as the ego-ideal. In the Venn-diagram of Freud’s tripartite structure – the Ego-ideal lives in the seed shaped overlap, ( a vesica piscis) between the Ego (our conscious sense of self) and Superego (our internalized moral injunctions) It is the seat of our conscious dreams, ambitions and aspirations of who we believe we could and should be.

Then said he, Unto what is the kingdom of God like? and whereunto shall I resemble it? It is like a grain of mustard seed, which a man took, and cast into his garden; and it grew, and waxed a great tree; and the fowls of the air lodged in the branches of it. ~ King James Bible, Luke 13:18-19

It is our ideal and idealize-able self, the Self that we need never feel guilty or ashamed of. The favorite Self that we wholly morally approve of, the Fulfilled Self, the Be-All-You-Can-Be Self. The Self many of us spend our lifetimes pursuing at a distance, our Actual Self lagging far behind.

Lovers, parents, (and therapists for that matter) need to see this in us, nurture it, admire and believe in it, but not too intensely. If they attach too exclusively this Seed, we will feel abandoned in our daily deficits and vulnerabilities. We will not feel loved for who we are, but only for the potential gratification our Seed-self can offer. We want our shitty, stupid, annoying, pain-in-the-ass bits – to be acknowledged – for that is where our deepest needs lie.

Loving relationships of all kinds wither when they are nurtured in the wrong way, loved too much for incomplete reasons. Too excited for the imagined harvest, there is no quicker way to kill a seedling than by overwatering. You cannot pry open a bud to see the flower or eat the fruit that lies within the pit.

The inherent mystery of the Seed – and perhaps of the therapeutic process itself – is this: It is a small piece of the whole which also contains the whole within it while at the same time it is also nothing definite at all, unmanifest, pre-existent, uncertain.

It is the starting point,
or not,
of a future completely unknowable.

copyright © 2013
All rights reserved Martha Crawford

The Myth of the Good Client

So you want to be the best, most gratifying client ever? You want to insure that your therapist adores you, always looks forward to your sessions, gets as much out of working with you as you get from them? Thinks of you as polite, funny, intelligent, astute, self-reflective?

All that probably makes you totally anxious, ties you in knots, and blocks your ability to teach your therapist what it is you actually need from them. And what you don’t.

But it won’t make you a good or a bad client.

There are in fact clients that I’ve thought of as “bad clients” – and I’m certain that if you are concerned at all about “being good” that you are probably not one of them.

“Bad” therapy clients are those have presented in therapy with completely ulterior manipulative non-therapeutic motives (See Deliver Us: Thoughts on Evil in Psychotherapy http://wp.me/p1AOzF-74) who want nothing to do with engaging in a therapeutic relationship. They come because they think it will help them win a legal case, to create false “pain and suffering” for a spurious lawsuit, to establish trumped up psychological disability to subsidize leave from work while they look for a better paying job, to inflate their insurance claims following an accident, to do some seat time to placate the demands of some other person who has “forced” them into treatment – to prove to their employer or their partner that they don’t have a substance abuse problem (when they do), to try to coerce me into helping them rationalize abusive or destructive behavior toward others, to prove to themselves that therapy and therapists are all full of shit and therefore they won’t have to take responsibility for the pain they inflict on others or on themselves.

Those cases usually come to an impasse in a few sessions and they leave quickly as it becomes obvious that I will not provide whatever it is they are seeking from me.

But, not every “good” client shows up because they want to.

When I was in agency based practice, I worked with many legally mandated clients – clients whose probation or alternative to incarceration requirements (or parents or school principals – practically all kids and teens are “informally mandated” clients) required that they remain in some form of treatment. The first step was to assess the client’s capacity to engage in the process on their own, for their own purposes and to “undermine the mandate”:

“I know that to avoid trouble that you are required to be in treatment, but you are not required to be in individual psychotherapy with me – and there are many kinds of appropriate treatment I could suggest to your P.O. or to the courts (or your parents). I have a good communication with them and it won’t put you in harm’s way at all if I say that you would benefit more from an anger management group, or a recovery support group or some other kind of help. You’ve shown up at this appointment to meet your requirements, and part of my job today is to see if this is the right kind of support for you or figure out what might work better. Also, I am not mandated by anyone to provide services to you or anyone that I think will be ineffective, destructive, or waste my time or yours. So can you think of anything that you would like to talk about in therapy with me, or work on for yourself, to make your own life feel better? In other words: Is there is any part of you that might actually want to be here?”

Many stayed because they wanted to and to fulfill their mandate simultaneously, and we went on to do constructive, deep pride-inducing work together -and some were referred to other kinds of services.

Perhaps the rest of us are just mandated to seek therapy by Life Itself.

Ultimately what is a “good” case and what is a “bad” case has nothing to do with you, and everything to do with the hope and fears, world view, strengths and limitations, and unconscious processes and projections of the therapist.

A “bad” case is lazy language for a case that activates the therapist’s sense of inadequacy.

I have no specialized training in eating disorders for example, and although I did a brief tour of duty in drug rehab and recovery for a few years – and have a working knowledge of the most basic treatment methods for both issues, I know that I do not have the skills necessary to support anyone but those in the very earliest stages of either of these conditions, those with the very best prognosis, or already well along in their recovery.

Sometimes clients don’t view themselves as having an eating disorder, or substance abuse problem – and present to therapy trying to address their depression and anxiety without treating the addictive or compulsive disease. Answers to assessment questions are minimized, or denied along with the painful core issue. No matter how much I may like someone, no matter how much I may wish to attach, support or help them, I will experience these as ill-fitting cases for me, cases where I will not be of use, where my hands are tied, my skill set the wrong one, or the modalities I offer are inappropriate to apply to the issues at hand. I will end up – in service of best practice and the clients well-being – referring the case on, (sometimes sadly and unfortunately experienced by such client as “sending them away” no matter how I try to articulate my limitations)

But these are not in any way bad clients, they are merely clients for whom I would be an expressly bad, or at best a not-good-enough therapist.

I have also been the wrong therapist for clients who may think that they want analytically informed therapy, but who in actuality want a great deal of concrete advice, or for me to dictate the number of sessions, focus exclusively on symptom reduction (rather than also searching for deeper understanding, more meaning in life, and greater acceptance of themselves) assign homework sheets, want me to provide concrete answers and prescriptions to “so what should I do now?” or expect that I will be the one to somehow “fix the problem.”

There are plenty of respectable therapists and coaches who work in a variety of cognitive, behavioral, and solution focused models, many of whom I admire, as well as groups and programs which will also offer more highly structured services. I begrudge no client (or therapist) their path or their process – it simply isn’t mine.

I’m going to ask you about your night-time dreams and try to engage you in exploring the symbolic content within and around you. I’ll ask about your past, your future, your relationships other people animals, the Earth as a whole, and to me. I’ll try to understand if your work and sexual life are satisfying and meaningful to you.

And if that isn’t what you want from therapy, I am sure to annoy the hell out of you. And you will blanketly reject what I do have to offer, which won’t be that much fun for me either.

(Although I do love being honestly and authentically disagreed with when my course need to be corrected. If you really want to be a “good” client, you’ll find some way, however polite and subtle to let me know when I’ve missed the mark, and hold out for being understood as precisely as possible)

There is another kind of client, that senior clinicians often call a “good training case” which is short hand for a client that would be a bad fit for their practice, but would benefit from a therapist who is building their practice, perhaps with a smaller case-load, where the client will have to share the therapist’s attentions and energies with fewer “therapeutic siblings”. There may be more space in the schedule for extra sessions, and more room to go the extra-mile for clients who may need more support, email or phone contacts than a therapist with a full and established practice can offer.

Therapists sometimes also need to balance their caseloads for their own well-being as their needs shift and change. Too many clients of one type, or with similar needs, or with one kind of presenting problem can leave a therapist burned out, overwhelmed, or as disconnected as a flight attendant offering instructions on how to buckle a seat belt. Too many challenging cases can fatigue a therapist, rather than keep them on their toes: too many easy-going clients can let a therapist phone it in as they lay back in their recliner.

Winnicott used to only allow one or two clients at a time to move through regression to stages of intense dependency as he would become too overwhelmed otherwise – and would either need to hold their dependency at bay until he was emotionally available, or refer the case to another analyst.

Therapists also balance their caseloads out by modality – (couples, individuals, groups, supervision etc) by diagnosis, by areas of speciality, and by fee. Early in my practice, I was firmly instructed by supervisors who cared about me, that I was not allowed to take on any more sliding scale clients – no matter how connected I felt or interesting the case until I had cared for my own basic financial needs. I now pass the same instructions on to overextended supervisees.

And by the way: A “good client” can look an awful lot like a “bad client” before trust, and an alliance is earned:

I remember presenting a case at my first clinical conference about a client I cared deeply about. During the question and answer someone asked if I had felt connected to him right from the start: In fact, when the case was assigned to me at the clinic where I was working at the time, I’d had an immediate and intense aversion to his written case history, for no obvious reason. After our first meeting I’d entertained the fantasy of handing his folder to my supervisor and refusing the case outright because I was confident I could not connect to him.

Yet, quickly, I developed warm affection for him, the work had been rich and rewarding and my understanding of symbolic content archetypal forces cracked wide open. The very client I’d imagined ducking out on became a profound honor to serve.

I realized then, that quite often my first response to a client that I was about to connect to deeply, who was going to require a new level of intimacy from me, who was going to change me, move me, press me into new terrain, was likely to be a semi-conscious sense of dread.

(In total honesty – I felt a similar fear, trembling and sickness unto death the week before I moved to NYC, on my first date with my now husband, and of course again in the hours before we married. I was filled with terror on a Biblical scale the evening before becoming an adoptive mother to both of my children, and immediately preceding every single good, disorienting, transformative blessing that has ever befallen me)

Even now, still, with many years of this awareness, the unconscious resistance to being changed asserts its self, as many cherished therapeutic partnerships tease me about how I didn’t return their initial calls right away, or lost their initial emails, or sent them back to the preceding therapist for further closure, or how I just sounded “weird” on the phone, or somehow unwittingly made them run some minor obstacle course to get to the first appointment.

When my son was in kindergarten he once said (after several readings of Pickles the Fire Cat – which I highly recommend for the under 6-year-old set) in words that might make my favorite non-dualistic theoretical and spiritual mentors proud:

“You are not a Good Mommy.
And you are not a Bad Mommy.
You are a Mixed-Up Mommy and that’s the Very Best kind.”

And you, in all likelihood are not a Good client or a Bad client.

But, the Very Best Mixed-Up kind.

And nothing is better for a Good-Enough therapist than that.

copyright © 2012
All rights reserved Martha Crawford

Touched

Michael (a highly fictionalized/conglomerate but all too real client) was scared as hell and little more than a month away from aging out of the group home he had lived in. At the close of the session he was trembling. I had seen him twice a week for the very first three years of my private practice (many many years ago now) and I had fielded at least as many hours of emergency and crisis phone calls. Hired as an independent contractor by the group home agency, I had watched him, week after week, grow from a gangly coltish boy, into a young self-identified gay man, as tough as he was pretty.

He had no one.
His parents, both severely mentally ill, profoundly sadistic, and long gone. He had lived in an undisputed, unfathomable house of horrors, tortured and feral, until he was removed at age 7. He had then been bounced, through a series of group homes – staffed by indifferent, and often explicitly abusive workers.

He reported being harassed by homophobic staff and peers, called a “girl” a “she-male” and much much worse because of his carriage, style and orientation. He had decided to remain at his current placement as it was “better than all the others.” A month or so earlier several staff members in the group home had been pulled out of their offices by police and taken away in handcuffs.

I had decided that I would remain available, and give Michael the opportunity to continue in treatment with me, and told him of my decision. He knew that the agency would no longer pay for my services after his birthday, and protested that it wouldn’t be fair to me. For my part, I had watched him grow up in my office, and I couldn’t let him disappear into an abyss. He had been through too much. We set a fee of $1 a session.

I wanted to spare him even more loss. And I was inflated and foolish enough to think that I could. Michael knew better, knew that what was to come would be too much.

The truth is I was terrified for him, terrified of the horrors he had absorbed and of the wounds he would carry forever. Terrified that the tortures he had survived, the abruptly cold bureaucratic transition ahead, in combination with the genetic predisposition he had inherited, would result in a terrible psychotic break, one that I could not contain in my office, even if I saw him five days a week. There was no sign, no observable evidence of it yet, but I felt it coming like a storm beyond the horizon.

I wanted to stop it from happening. I wanted to stand between him and what I feared was inevitable. I wanted to hold him together. For both our sakes.

I had just left the mental health system. I knew what lay ahead if the worst happened: I knew what kinds of counselors and rehab techs and psychiatrists, and day programs, and residence workers, and group leaders, and intensive care managers could become his treatment providers. Some caring and gifted, and as many, or even more: hard, shaming and incompetent. I knew the institutionalized food he would be fed, the sedating medications that he would be compelled to take in order to be seen as “compliant” and worthy of treating. I knew the groups he would sleep through, and the hospitals that would re-traumatize him, restrain him and discharge him long before he was stabilized. I knew how committed I had been to offering clients the opportunity to heal in a system that merely wanted to manage behavior and how impossible it was.
I knew how horrible it had been to watch people I cared about succumb simultaneously to their illness and a broken system.

You will see that the analyst is holding the patient, and this often takes the form of conveying in words at the appropriate moment something that shows that the analyst knows and understands the deepest anxiety that is being experienced… There are times when you carry around your child who has earache. Soothing words are no use… but eventually, it will be understanding and empathy that are necessary.
~ D. W. Winnicott in the Maturational Processes and the Facilitating Environment

There is a question I have been very commonly asked, in varying forms, by other peoples’ clients and by younger clinicians, since first I began publishing my writing on line:

When is it okay to hug a client?
My therapist held me and rocked me, is that okay?
What kind of physical contact is all right in my therapists office?
My therapist takes my hand and it makes me feel better but my friends say it is dangerous. How can that be if I asked her if she would?
Can I hug my therapist?

These questions can only be answered with many many more questions:

What is the need? What is the impulse? What is the intention? What might the outcome be? What is the nature of the alliance? What are the expectations? Why is this emerging at this point in the relationship? What are the forces, conscious, and unconscious that make physical contact in a talking therapy seem necessary, natural, or like a good idea? What does contact communicate? What might the short term consequences be and what are the long term implications? What kind of touch? What is the message being expressed and what is the message that might be received? How are these the same or different?

Will the experience, memory, and interpretation of physical contact be consistent over time? Who is initiating contact? How might the inherent power differentials between therapist and client skew their interpretations and experiences of physical contact? What is the history, examined or unexamined in either party, of infantile or early childhood deprivation? Of sexual abuse? Of severely disrupted attachment? Of sexual acting out?

Is touch in and of itself being seen as solution, a mechanism of cure, an intervention? Why, if the therapist has only been trained in one of the many variations of the talking therapy, would the therapist want, need, think that this form of touch was within their purview of expertise?

Why can’t the wish for physical contact be translated into words? What words might touch suppress, avoid, or circumvent?

As Michael blew his nose, and wiped his tears to leave the session he said:
“Thank you for not leaving me” he said. “I wish I could hug you, but its probably against the rules?”

He looked unbearably young and vulnerable.

I hugged him and he held on tight. I felt life a life guard dragging a drowning boy to shore.

Margaret Little in her lovely therapeutic memoir, Psychotic Anxieties and Containment, (which doesn’t sound lovely at all but it is) speaks about her own treatment, and need for dependent regression to infancy and merger with Winnicott:

“Here I feel it is appropriate to speak of the two things about which there has been misunderstanding – holding and regression to dependence. D.W. used the word holding both metaphorically and literally. Metaphorically he was holding the situation, giving support, keeping contact on every level with what was going on, in and around the patient and in the relationship to him.

Literally, through many long hours, he held my two hands clasped between his, almost like an umbilical cord, while I lay, often hidden beneath the blanket, silent, inert, withdrawn, in panic, rage, or tears, asleep and sometimes dreaming” – Margaret I. Little

Our bodies have needs, and there are wounds that need to be processed in and of themselves with preverbal, experiential, tactile, somatic interventiions. Touch is sometimes felt to be necessary by and on behalf of those who have suffered profound disruptions in their earliest experiences of sorting their insides from their outsides, whose capacity to attach has been disrupted, who have never been safely held.

But that does’t mean it is safe or healthy for any therapist to hold any client.

In the weeks ahead, the break I feared erupted, more violently than I could have imagined. Michael was wild, entrapped in thick and convoluted paranoid fantasies, he had several physical altercations on the street, with others in his group home, with strangers. He continued coming to session, regressed, disorganized.

Michael next began leaving voice messages on my machine in a voice not his own. The last one I listened to, cold hard and threatening, filled with chilling contempt, caused the blood to drain from my face, my hands to shake, and a cold sweat to break out on my forehead. A voice which Michael must have heard whispered his own ear through out childhood said this:

“Don’t you feel stupid? Don’t you feel foolish for caring about me now? You will regret ever having known me. I hate you more than you can ever know. I’ll make you pay.”

When I called the group home – he had not yet transferred out – the worker said:

“Oh yeah, she’s been walking around here for weeks screaming about you, saying she’s gonna kill you. Talking about all the different ways she’s gonna do it. She’s gonna get a gun, get a knife….” All of which were easily accessible to Michael.

Yeah, thanks a lot for letting me know and coordinating care – oh and, remember all that “duty to warn” stuff? Well done. A pleasure working with you and your organization.

Fuck.

If murder threatens, you call in the police to help not only yourself, but also the client. In all these emergencies you recognize the clients cry of despair because of the loss of hope of help.

~ D. W. Winnicot in The Maturational Processes and the Facilitating Environment

I called the brand new group home supervisor and told them to have Michael taken to the ER and assessed.

Winnicott was in his primary professional identity, a pediatrician. “Psyche and soma for him were not separable… He kept a stethoscope, sphygmomanometer, and clinical thermometer handy and used them” (Little, Psychotic Anxieties and Containment)

My training is in the verbal therapies: I know many acupuncturists, massage therapists, cranial sacral therapists, that act as defacto counselors and do very deep healing and emotional work. I also know osteopaths and somatic psychologists who are trained and sought out for their expertise in therapeutic touch. I have great respect for their work and I regularly refer clients who need tactile intervention to such care providers – as well as trainers, martial arts masters , and yoga instructors – following the clients leanings and preferences – so that the somatic intervention can be delegated to a specialist and we can hold the case, and the client’s whole Self, together as a team.

That being said:

When I worked with young children, I never once rejected child’s hug, nor would I, but neither would I impose one.

I have willingly and appreciatively, accepted hugs from clients that were clearly spontaneous expressions of gratitude, appreciation, or connection.

I have covered clients in regressed states with the blanket in my office, and sat on my ottoman near to them.

I have been known, on occasion, to hug a receptive client good bye after a long stretch of deep work, or to re-greet the same client with a hug hello after a lengthy absence.

I have escorted terrified, suicidal or decompensated clients to the psychiatric emergency room holding their hand, or with my arm around their shoulder.

I have encountered clients in medical crisis in and outside of the office and held or touched them to assist them in getting to medical treatment, or to keep them calm until help arrived.

I have occasionally put an arm around clients, with their permission or at their request, when they have been in very significant crisis or after a sudden or shocking death, or following a life-threatening event.

And sometimes contact has emerged as a spontaneous expression of joy after a miraculous surprise. One or two clients over the course of the past two decades may even be able to report that I danced a little jig, and engaged with them in a sort of silly mutual square-dance-like ring-around-a-rosey while squealing with glee like kids at the circus.

I recall my own analyst hugging me as I left the office for the last time on the eve of motherhood, as I left to meet and hold the baby boy who would become my son.

We are human and share the need to grieve and celebrate physically together sometimes.

But all these instances are the very rare exceptions that sustain the rule, and were extensions of well-established and mutual trust in the relationship, Moreover, contact was not offered as a treatment, a solution, or as an intervention in itself. Nor did contact stifle or divert us from talking about the feelings, positive or negative, about our relationship, what the physical gesture meant, or the events and context around us.

In my office, we work together to speak of physical impulses, and assign language to the states that move through our minds and bodies. I have expressed verbally to clients that I have an image in my mind of rocking them, hugging them, or some other impulse associated with early holding functions. I recently verbalized an absurd impulse to cross the room and give a client a good tickle – All seemed to have as deep, if not a deeper holding effect than actual contact.

If physical contact ever feels like it needs to be kept secret, if it is ever sexualized or seductive, if the client feels uncomfortable or has mixed or shifting feelings about it, even if they value or initiated the contact – then it was impinging, a boundary violation, a very significant error, and perhaps a sanctionable act on the therapists part.

I never saw Michael again. The hospital that admitted or discharged him never contacted me, or asked about his treatment or my understanding of his history or his future needs. The mental health residence that took him in, the day treatment program that assumed responsibility for his care never asked about our three years of work together.

Michael did call me himself. I would hear from him about once a year. Sometimes twice a year, for six or seven years after our work together, before the calls stopped.

He always profusely apologized for what had happened between us. And I had a several chances to express my own sorrows about my inability to keep us both safe in a way that would have allowed us to sustain our work together. He complained that he had grown unrecognizably fat from the medications he was taking, and that I wouldn’t know him if I saw him on the street. Sometimes he would call, off medication, confused, agitated, disengaged from whatever program he had been “non-compliant” at, and ask if I could be his therapist again.

Once, I got a phone call from his intensive case manager letting me know he had violated the terms of his outpatient commitment, asking if I knew his whereabouts.

The last time I heard his voice, he left this message:

“Don’t hate me. I hope you don’t hate me. You must hate me, you have a right to hate me, but please, please don’t hate me for what I done.”

When I listen to the case, as told to me by my own, younger self, with a supervisory ear, I want to unburden that clinician, to assure her that both she and Michael were caught in an impossible situation, that there was no real holding for therapist or client, that Michael’s break was and deterioration was inevitable, unpreventable in this era, with the resources available, with the current system, and that the wish to hold him together physically, emotionally, psychologically was human, loving and understandable.

But at my core, I still hear Michael’s voice:

“I wish I could hug you, but its probably against the rules?”

What if I had asked: What rules Michael? Perhaps they were his own internal, unspoken rules and parameters – a mandate that his primitive dependence not be activated in any setting that could not truly contain him. If I hadn’t hugged him could we have maintained an alliance through the break? Did I activate primal needs impossible for either of us to contain? Did I make a terrible scenario that much worse? Could I have mitigated or advocated for him within the system? Could I have softened the blow?

If I knew then, what I know now, could I have helped him to hold on?
Could I have held both of us better?

Occasionally holding must take a physical form, but I think this is only because there is a delay in the analysts understanding which he can use for verbalizing what is afoot.

~ D.W. Winnicott in the Maturational Processes and the Facilitating Environment

copyright © 2012
All rights reserved Martha Crawford

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