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

It’s the Relationship…

I sometimes dread being introduced to other psychotherapists.

“Hi! Nice to meet you – you are a therapist too?!  That’s great – I do CBT, Motivational Interviewing and Behavioral Activation – what do you do?”

Uh.

Umm.

Shrug.

“I have an office…”  I’ll vague out and drift off.

When faced with the alphabet soup of “evidenced based psychotherapies” I find myself lost and speechless.

I don’t begrudge or devalue any of those interventions for the therapists and the clients that find them useful and meaningful.

But that isn’t what I do.

None of  the methodology, measures, the cognitive distortions or neuropsychological reprogrammings would have pulled me from the quagmire I inherited – there were only a few simple things that had any chance of aligning me with my soul’s mandate and the pursuit of meaning in my life: Image, Words, Metaphor,  Relationship.

I can’t eliminate behavior, and wouldn’t even dare arbitrate which behaviors are healthy or unhealthy. I can’t fix a damned thing. And I don’t practice therapy that fixes anything, because, frankly,  I never wanted to participate in a therapy or enter into a relationship with a therapist who wanted to fix me.

I can’t make anyone’s  problems go away, including my own. And as I get older, and watch myself revisit the same conflicts and complexes in  subtler forms I wonder if “change” in the sense that most people imagine it when they speak of psychotherapy, is possible at all, and if it is even desirable.

Healing is a word that means more to me than “behavioral change”  but only if “healing” primarily means  living with ever deepening compassion for our own, and other’s wounds and vulnerabilites.  I am not a “healer”  who knows how to make wounds disappear entirely, if at all. Scars, sensitivities, vulnerabilities, residues, susceptibilities, remain, even if the bleeding stops.

And often enough life gets better and worse and better and worse  on its own – with or without psychotherapy.

So what do I do?

Its not just other therapists that want to know  – clients also want to know “what kind of therapy” I practice – and they are especially entitled to an answer, and one that is not cloaked in mystification.

And here even the language of depth therapies fail me:  I do not “do” psychoanaylsis or analytical psychology, existential or Buddhist psychotherapy  – although these models and many others feel useful and meaningful to me at times in making sense of my own experience.

So I have an office. I sit in it. People come to see me, or sometimes we go walking together.

I care when the people who come to see me are angry, murderous,  numb, disappointed, in agonizing pain, terrified, lost, stuck, bored, nauseated, lonely – even when it is very hard, very painful, or when they feel these things because of something I have done, or something I have not done or cannot do.

Sometimes when things turn brutal for someone I care about  I’ll  just hang on for dear life. I don’t give up. I don’t turn away. I am not pushed over.

I stick around. I listen and I don’t retreat, and I am not easily scared or chased off.

I try to picture in my mind’s eye the people, places, things, and images that I am hearing about or sensing. Sometimes images, feelings and pictures seem to  float up in my own mind, drawn from my own life experience,  themes from stories I have read, myths I have heard – and I put these into words to see if they are connected to the pictures and feelings that are bubbling up in the person near to me. I remain curious and committed to understanding the words and pictures and sensations that are being communicated to me as precisely as possible. I surf through the waves of my own watery unconscious and the unconscious of my therapeutic partner. I keep my filter down and my aperture open wide.  I try to stay connected in the bumpy, rocky, scary, severe, extreme places where most social relationships will not venture. Where even  familial relationships can’t, won’t or don’t go.

I lend my self out. Not my “healthy ego”  – my Self, my heart, my dreams, the pictures in my head.

There are many of us who work in this way, and who could work in no other way.

I do this because it was done for me, and this meant the world to me.

Once, many many years ago, when I worked on a unit that served severely mentally ill adults, a psychiatrist pulled me aside to offer me some encouragement. “Do you know why your clients are doing so well?” she asked. “Do you know why they are getting better? Its not because you make sure they are compliant with their medication. Its not because you set clear behavioral objectives and treatment goals. Its because you love them like you belong to them. It’s because you take them into your heart like they are your own. You give of yourself, and they feel that and it makes them stronger.  I don’t know why everyone just doesn’t do that.”

At the time I didn’t know what to make of what she said. But I didn’t then and don’t know now how to work any other way.

A few years later, at that same job, I would come to understand the need people had to work from objective and objectifying stances rather than out of their subjectivity.

On the unit we all had small safety windows in our offices – so therapists and mentally ill clients could feel both safe together talking with the doors shut. As I sat at my desk to take my lunch break, and get some paperwork done, I felt several pairs of eyes peering at the back of my neck. I looked out the window to see four or five of my clients lined up to peek in on me, one after another, while I ate.

I opened the door:

“What’s up ? Can I help you guys? I’m on a break right now okay?”

“Come on” one of the older guys said to the crew “we better go so that we don’t use her all up!

I was getting used up, although it was never because of  them. The agency and mental health system I worked in wasn’t designed to support those who worked like me. It was designed to socially control the greatest number of people for the least amount of money. Commitment, abidingness, endurance, resolve, availability, intuition and meaning were far less important than outcomes and measures, and the elimination of unwanted behavior.

Although it is true, then and now, that I must always be vigilant not to give too much, not to give more than is required, or needed. I remain careful not to ever give in a way that will make others feel indebted to me or that leaves me drained or resentful. But that is my job, my responsibility to regulate. And if, and when, I give more than I can afford, or more than others need of me, it is my job to correct and compensate for, and never ever because others have used me up.

On my long morning run just after an introduction to a perfectly nice evidence based psychotherapist who had recited his alphabet soup of what he “did”, I heard these words rising up from my beating heart:

“Its the relationship that heals it is the relationship that heals the relationship that heals. This is my fervent belief and this is where I put my professional faith”

When I got home, I googled a bit trying to locate the rhythm and the cadence of these familiar words and realized that this mantra had resurfaced, slightly paraphrased, from a book I had read only once over twenty years ago:

It’s the relationship that heals, the relationship that heals, the relationship that heals – my professional rosary.  ~ Yalom, I. (1989), Love’s Executioner, London: Penguin Books, p.91

My acupuncturist once said to me: “I don’t know how you do it. How you work the way  you do.”

I don’t always manage as well as I would like.

When my own life becomes a challenge or crisis erupts for me, or when I foolishly attempt an “objective” survey of the scope of what I have undertaken I can overwhelm myself: Caring for my elders, for my children, for clients. When I attempt to itemize the breadth and depth and range  of all the different forms of care-taking I am immersed in, when I look at my days and weeks and attempt to catalogue all the pain, fear, vulnerability and dependency that is attached to me I sometimes fear that I can be used up and that I could drown in a flood of other people’s needs.

But, when I breathe, and move through my day moment by moment – I see that I am more buoyant than I realize  and that I am tethered not only to my teachers, mentors, guides, and therapists, who stayed afloat with and for me, but that I stay afloat with, for, alongside and because of  the deep and real relationships I have forged with those who pass time my office.

Image, words, metaphor and relationship cannot use me up. They fill my heart and keep me afloat.

It’s the relationship that heals the relationship that heals the relationship that heals.

Both members of the therapeutic couple.

All of us. Always.

Back to the Garden

And he (Jung) asked himself by what mythology he was living and he found he didn’t know. And so he said “I made it the task of my life to find by what mythology I was living” How did he do it? He want back to think about what it was that most engaged him in fascinated play when he was a little boy. So that the hours would pass and pass. Now if you can find that point, you can find an initial point for your own reconstruction.
~ Joseph Campbell

I might have liked to be an astronomer, as a child I spent hours on the deck behind our house looking up at the Great Nebulae in Orion and feeling a part of the entire universe. But, unfortunately I can’t do math.

In young adulthood, being a priestess of some sort seemed my best shot at a satisfying career and I supposed the sacred rituals around the theater came close. But, as you may know, there aren’t really too many priestesses in show biz.

A ritual is an action that puts the individual not only in touch with, but in the place of, being the agent of a power that does not come out of his own intention at all. He has to submit to a power that’s greater than his own individual life form. ~ Joseph Campbell

For several years thought it might be nice to be a Unitarian or a Quaker minister: I could picture myself in my 60’s plump and happy, with spikey short white hair, extremely sensible shoes, curled up in a worn leather chair in a well stocked church library surrounded by books written by theologians, ecumenicists, philosophers, anthropologists, depth psychologists, mythologists, my days filled with study, sermon-writing, teaching, and pastoral counseling. I still occasionally fantasize about getting an M.Div one day so that my psycho-spiritual practice might one day extricate itself from the professional restrictions and expectations of the medical model.

Although I imagine all that theism might get a bit wearing.

God is a metaphor for a mystery that absolutely transcends all human categories of thought…. So half the people in the world are religious people who think that their metaphors are facts. Those are what we call theists. The other half are people who know that the metaphors are not facts, and so they call them lies. Those are the atheists. ~ Joseph Campbell

When I am fatigued or overwhelmed I think it might be nice to be a cobbler. The smell of leather, the pleasure of making something tangible, real, practical, useful, that did not require that I take my work home with me, or feel too much. Maybe I could even get some elves to make the shoes while I sleep.

There is much much harder work in the world than mine, but every once in a while, after the 100,000th “I just don’t know how you can sit and listen to people’s problems all day. I couldn’t do it!” I begin to wonder what on earth I have gotten myself into.

Every individual has his own very special problem in this late mid-life crisis about what he has been doing. How deeply has it really involved him? Has he had other outside marginal interests of any kind whatsoever? What were they? All these are very special problems. ~ Joseph Campbell

No paid vacation, no sick days, and the out of pocket cost of crappy medical insurance for a self-employed family of four are daunting enough. When my kids or a family member are ill, there is more lost income. Income which fluctuates with the economy, with the season, with the twists and turns of fate, history, chance and my own bandwidth depending of the circumstances of my own life and ability to pay deep attention. Clients just don’t come, or don’t stick when you don’t have the psychological space to take them in.

Economics is what controls us. Economics and politics are the governing powers of life today and that’s why everything is screwy. You have to get back in accord with nature; and that’s what myths are all about. ~ Joseph Campbell

Late nights and weird hours mean missing several nights a week with my kids, who can also never call to check in or to chat while I am working. As well as being out of synch with those who live and socialize on the 9 to 5 time grid. “Time off” means running errands, answering email, doing paperwork and billing, none of which can be done during client hours.

There are therapists who have partners with large corporate incomes, or some inherited wealth, who are heavily invested in real estate, or who have discovered passive income streams of some kind. They have small part time caseloads and the luxury of pursing their work, not out of logistical necessity, but merely because it is meaningful to them. There are others who charge extraordinary sums and cultivate boutique practices geared at serving clients in the upper classes.

I am none of those. I am a working, work-a-day therapist. I have made my living as a private practitioner and nothing else along side my husband, who does the same thing. We have learned to ride the roller coaster together, and support each other economically and emotionally through painful binds and financial drought. We have learned to rest when we are “light” and not allow our financial anxiety to eat up all of our chance to renew ourselves. There will be another wave of overwork to come, an influx of new cases, a sudden mass return of old clients when the weather turns cold, or it is time for New Years resolutions.

So, if the goal is merely amassing wealth, early retirement and cultivating ease, this is not the profession, at least not the way I practice. My scale slides and my fee drops as I try to make sure that no client is abandoned when they fall into financial difficulties, or excluded because of their ability to pay. I’ve made choices not to accept insurance, which too often attempted to conscript and lure me into becoming my clients “care manager” -labeling them with diagnoses, counting out their allotted sessions, and referring to a psychiatrist if they don’t “get better” before their capitation kicks in.

And when you’ve got an invisible cure for an invisible disease, you’ve got something you can sell. ~ Joseph Campbell

And often, the work hurts too. It can burn and sting and instill fear sometimes, as clients often need to explore and test out the capacity to keep them safe in your most vulnerable, weakest places and moments. Narratives of trauma, cruelty and abuse can break your heart, and eat you up, and shatter illusions about yourself, about the goodness of humanity, about the realities of life. Even the best days, the ones filled with vicarious excitement and accomplishment are about other people’s accomplishments and successes, and can leave you totally tuckered out.

Its one thing to be equitable and give everything away. Its another thing to be equitable and give away yourself. Then you can’t really help anybody can you? ~ Joseph Campbell

And the people you work with often experience you as more powerful and fully self-actualized than you are or could ever be, and often feel abandoned, or annoyed, or intruded upon when you stumble and trip or they experience your limitations.

When I was young in this field, I once asked my therapist if he ever hated his job: “Just every time I see a copy of Travel and Leisure magazine” he said. And immediately looked worried, and began to back pedal a bit – as though his honesty might make me feel rejected.

Who wants to be remembered by the notes of his students? ~ Joseph Campbell

It didn’t make me feel rejected. It was a relief. There is a shadow that attaches itself to every job, every choice, every path. And in this field, which practitioners take up primarily driven by their own wounds, whether they know it or not, the shadow can be a particularly dark and thick one.

Who wouldn’t want to escape sometimes?

The saying that a friend of mine has given me for letting me know when you are in middle age is: You’ve got to the top of ladder and found its against the wrong wall
~ Joseph Campbell

Freud had clients lay down on the couch for no other reason than he couldn’t bear to be looked at, scrutinized all day. And I sometimes wish that I could escape the watchful, fearful gaze of clients who read the smallest crease in my forehead as a sign of my impatience, or intolerance, or judgement, when it may just be that my glasses are pinching the sides of my head. Consciously arranging my face all day to reflect exactly what the client needs to see reminds me often of what intensely physical work the process of “mirroring” can be.

My days, in and out of the office, are completely and continuously centered around people. Other people. No matter how much “self-care” I invest in myself, a life of meeting clients, living in a co-op, walking crowded city streets, caring for children, for older family members, is intensely peopled.

I’ve just come out of New York, and a place like this on the Big Sur coast just wakes another whole consciousness. Its further down. And the body feels, Yes, this is my world; Ive been missing this And it seems to me its out of the body and its relationship to experiences of this kind that the mythic imagination comes. This other experience of the city is far more rational, ethical… the I-Thou relationship in the city is to people The environment in the city is geometrical and rectangular, and there are no curves; its contrived by man, the whole environment is manmade. And here you find that there is a primal being experience of which man and nature are themselves manifestations; whereas in the city you just don’t get it. ~ Joseph Campbell

Everything we do, every choice, every gesture requires the sacrifice of some alternative, potential reality. At midlife, the sacrifices we made to establish an adult identity in our culture, to create security, to live out our values, to do what we should, to start a family, to build a life and pursue a career or a vocation – return to us, as fantasy. It returns as day and night dreams, yearnings or sometimes as symptoms. Whatever is repressed always returns to us in some other form

Jung speaks of the impact of the parents unlived life upon their children, and we should also wonder about how the unlived life of the psychotherapist impacts clients and the therapy itself. How does it constrict and constrain us in the room and why? Are these choices made consciously, with an awareness of their shadow and their costs, or unconsciously, reflexively, fearfully? How do our clients teach us about what we have given up? How do we respond to the experience of envy or yearning in the countertransference? Do we heed it as a call to reach for our own unfinished business? Or do we feel diminished? How do therapists, subtly or not so subtly encourage clients to make choices that either validate their own sacrifice, or diverge from our choices so that we can watch them live out our unlived lives?

The mid-life crisis is that of unshelling a system of life and immediately moving into a new system of life. Because if this life is unshelled and you don’t have a new intention there is total disorientation. ~ Joseph Campbell

These days my escape fantasy involves a farm house at the foot of small mountain. There are green trees and fields all around. There is a small food garden growing behind the house with big wide windows, with more sky, stars, trees, crickets, birdsong and empty space, both inside and outside, than will ever be available or affordable to me in NYC.

I read stacks and stacks of books filled with pencil marks and marginalia, and write a significant part of every day. Perhaps I teach a class or two at a nearby junior college, just for the pleasure of compiling the reading lists.

I remember Alan Watts asked me one day, “Joe what kind of mediation do you do?” I said, “I underline sentences.” ~ Joseph Campbell

I see as many clients a week as I now see in a day, some in a cozy home office, some for walking eco-therapies, others long distance by video conference or e-session. All arrange to talk to me only when and as they want to. They pay whatever they can afford, whatever they think the process is worth. I don’t concern myself with accounts or collections, or how big the children’s orthodontia bill is getting.

Or maybe, in this fantasy I stop seeing clients entirely. After a lifetime of operating as a Helper, a Caretaker perhaps I have sacrificed enough to that archetype to enable that myth to release me, as I take on a new role, a new task, a new myth.

This is the big problem of retirement … the life with you have involved yourself has suddenly been moved. And so what? I’m told that the life expectancy of a blue collar worker after retirement is about five years. That means his body says, “You’ve got nothing for me to do so lets just say goodbye” ~ Joseph Campbell

There is a trail out back behind the house that leads up the mountain and I take a long, contemplative hikes several times a week. I watch for hawks and eagles, woodpeckers, and other wild-life in an entirely deer-tick free woods. Up on the hillside I have constructed a small shelter where I sit for long stretches of each day silently asking that all sentient beings be relieved of their suffering, until my thermos of green tea is cold and empty.

I work in the garden, I cook meals for my family. I wash the laundry and hang it on the line to dry near the lilac bushes, so that in the spring, the sheets smell sweet.

But when the individual is acting only for himself or his family then you have nothing but chaos. ~ Joseph Campbell

This idyllic farm is somehow near to a racially and socioeconomically diverse small city which gives me a chance to engage in community processes and cultural and charitable activities. We travel whenever we want to. Take sabbatical years to live in other countries, in other cultures. My children never bicker. They climb trees, tame wild animals, swim in a clear water creek.

Fatigue is rare, and sweet, following labors that are restorative, generative for myself and others. Each night before bed, we climb the creaky narrow wooden stairs to the widows walk and aim our telescope toward the bright and visible Milky Way searching out our proper place in the universe.

Now there is a wonderful saying in the Buddhist world: “Life is joyful participation in the sorrows of the world.” All life is sorrowful. You are not going to change that. Its all right for everyone else to be sorrowful, but what about you being sorrowful? Well, participate!” ~ Joseph Campbell

And as I dwell deeper in my soul’s fantasy, my unlived life, the life not (yet) pursued, new sorrows emerge of the clients and of the work left behind in this life. Those who would never tolerate a Skype or phone session, who would feel abandoned, who I might harm by leaving, or a least cause significant discomfort. The stories I would never see unfold.

And the people I would miss.

Fantasies of Eden, of Shangrila and the Land of Oz live in all of us, in different ways, and serve many functions. They compensate and correct our course, remind us of who we are, what we have forgotten and who we are supposed to be. Sometimes it is necessary to chase these images literally, although they will rarely be entirely captured. The processes of midlife can involve dramatic overthrow of pre-existing orders. We do out grow old shells and need to find new ones. But sacrifices can be mourned and managed consciously as well, responded to as metaphor, channeled into creative processes, or integrated into present structures through ritual and symbol.

The work can be heavy, and costly in ways that are rarely fully tallied or reckoned with.
But it is mine, for now.

The gate guardian is a symbol of your own fear and holding to your ego which is what is keeping you out of the garden. Buddha sits under the tree and his right hand says “Don’t be afraid of those guys. Come through.”~ Joseph Campbell

But sometimes, through a long day, as I nod, and listen, my brow furrowed, my ears and heart open to the pain that the person across the room is sharing with me, I imagine, that my office window, just past my peripheral vision, offers a different view.

I imagine that – instead of the floodlight and fluorescence of windows upon windows, instead of the sounds of a harsh and noisy city, instead of helicopters and barges, firetrucks and ferries – there are instead green branches, and the smell of fresh cool mountain air.

I imagine that together we could, if we choose to, pause to watch Orion, with his belt, and his sword, rising through the night, reminding us of our proper place in the universe.

All quotations from The Hero’s Journey, Joesph Campbell on his LIfe and Work, Phil Cousineau editor.

Skin Deep

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

copyright © 2013
All rights reserved Martha Crawford

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

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

Four Dreams and the East Wind

It is not at all farfetched to compare weather with human life, for few things in our universe are so identical. We are born mysteriously into the world, very much like clouds, and we disappear back into the world just as clouds disintegrate into the atmosphere from which they came. The sky is as changing as human passions, and as spiritual in its ways as our own emotions.
(~ Eric Sloane’s Book of Storms)

Surprising, uncanny things blow in with the east wind.

There are crystalline moments when the air is thick with sudden, disorienting clarity and just a whiff of dread.

Lightening bolt eurekas. Startling updrafts from the deep.

Moments when we just know: that change is mandatory and imminent, that it is time to leave the job, or the marriage, that today is our lucky day, that we are suddenly, incontrovertibly heading in a new direction.

I watch my clients struggle with such moments of bolt awakening – wondering if it wouldn’t just be easier to fall back asleep.

I’ve watched too many resist, fight, ignore, self-medicate, dodge, weave and try to serpentine out of the inner callings to face their fears or to shake up their sense of identity, or to consider something important they have long ignored.

The first dream:
A sociology class requires that I design an experiment. I would like to design one that tests for responses to warm and cold environments and decor in therapy offices. The professor hates my idea and will have none of it. He slams down a sheet with the words SAVE THE WHALES and GREENPEACE on them.
“Do this!” he says “Look at this!”
I begin yelling:
“This is not my idea, not my way! I am trying to make my idea work! I want to do what I want to do! Not what you tell me to do!”

When your psyche asserts itself, it can send you on journeys that you had no intention of ever undertaking.

We all resist in our own way, no one really wants to take on the increased responsibilities of becoming more aware of ourselves or the world around us.

Avoidance is ultimately a costly choice – symptoms emerge, hopelessness, cynicism, boredom, anxiety and depression take hold. The sense of purpose drains out of life.

Suffering is too often the only warning we will heed before correcting our course.

“The business man goes his way despite the weather, more so each day. Instead of adapting himself to the weather his goal is to ignore it… If you want to attract a crowd on a busy street corner, just stand there and look at the sky. So few of us look aloft at all that within a few minutes a crowed will have gathered, staring with you.” (~ Eric Sloane’s Book of Storms)

Many of us have lost the awareness of the ways the weather effects our mood, affect and conduct – and similarly, most modern-minded people are dismissive of their nighttime dreams as random electrical neurological processes, detritus from the day, meaningless nonsense, instigated by rich food eaten before bed, or worse, implanted by televisions left on while falling asleep.

Dreams are an essential element of the atmosphere we move through, and learning to listen to your dream life is like becoming weather wise.

The second dream: ;
I am at the same school in a class with kinder professor. He takes, what in my view, is a too strict, too extreme existentialist model – the past does not exist and has no further influence. There is only the present – and the course you set for the future of your community and the world by what actions you perform right now. I suggest that both reflection and action, both past influences and present choices must be taken into account, as well as deep responsibility for the consequences of our actions – predictable or not. He entertains my idea respectfully and as a result I am eager to listen more deeply.

Sailors, farmers and perhaps some pilots still know – not from the meteorological reports – but from the smell of the air, the feel of their bones and scars, the direction of the wind, the color of sky, the waves on the water – what to hope for, what to prepare for, what to brace for, what to fear.

Old sailors’ rhymes, weather folklore, almanacs relied on weather-mindedness, and an observational and intuitive awareness, a kind of dialogue with the world around us.

The Wooly Bear caterpillar, and the width of his central brown fuzzy band accurately forecasts how severe or mild the coming winters will be. Katydids and crickets react to the weather more quickly and accurately than thermometers.

But for the uninitiated, the chirp of the katydids, the ache in their knees, the subtle scent in the wind and the halo around the moon – if they are noticed at all – appear to be totally random, unconnected events creating no obvious narrative, no discernible through-line: merely nonsensical bits of data indicative of nothing.

Like the Wooly Bear’s coat, and chirping of the insects, dreams tell us about our own internal conditions, and how the internal winds of change will impact our energies, our mission and sense of purpose, our life tasks, our characters, and our fates.

The smallest adjustments in our inner atmosphere can create turbulence. Such windshifts always, absolutely always, involve facing some fear, the break down of some no-longer-necessary-defense, and are the cumulative result of a thousands of imperceptible shifts in thinking, behavior, experience, until some critical mass has been reached and the front beneath the previous way of life gives way.

Better sooner than later, I’ve learned.

When we are arrogant enough to assert our own agendas and ignore the weather and the rumblings on the horizon the scenario eventually goes unbearably stale, or worse, erupts or implodes without advanced preparation. Having something unsustainable forcibly torn out of our white-knuckled grip hurts far far more than proactively releasing it when it is still healthy to do so.

For the Navajo, it was the wind, that brought the Holy People, human and four-legged, from speechless existence in the underworlds to life on the earth’s surface and gave them language, thought and leadership.
(~ The Book Of Symbols – The Archive for research in archetypal symbolism)

Not that such updrafts actually lead to perpetual sunny skies and balmy weather.

Fat chance.

More often than not, they involve a rush of clarity and optimism, gathering momentum and confirmation, followed by a daunting challenge, an unforeseen enemy (usually ourselves but not always), a ridiculous amount of effort, flat out exhaustion, even some wretched, self-fulfilling complaining about feeling burdened and misunderstood. As the pressure climbs, maybe even a stormy, irritable tantrum or two.

The third dream:
I have a male roommate who has filled our apartment with piles of dusty books:
‘Where did you get these books?” I ask.
“I don’t know” he says, “I never opened them. It’s too late in the semester now I can’t bear to look.”

I build and install shelves for all the books to be treated respectfully, and to be integrated into the room. When all is done there remains a pile of unshelved science books about plants, animals and climate studies. I toss the books behind the couch.
The roommate admires the way I can “just toss stuff away like it was never there.”

I wake agitated.

Our unconscious moves through and works upon us as surely as the weather.

Of course, I am just idealistically and existentially inclined enough to believe that when my internal weather report changes it does change everything. Just as I assume that the even minor-seeming transformations in anyone, you included, can effect everyone’s reality, (mine included) as well as the collective realities of the planet and the interconnected universe itself.

The impressive thing about our dreaming lives, and the wind and weather for that matter, is that they will perform their cyclic and compensatory functions whether we actually pay attention or not. They go on of themselves, regardless of whether we think they are worthy our regard.

The dreams recounted here took place on vacation, over four consecutive nights. I recorded them, as part of my regular psychospiritual hygiene, quickly forgot them as I did not feel at all like “working,” at anything. I spent no time amplifying them or analyzing them, and didn’t look back at them until a week or so ago.

During the daylight hours in between, I went on long runs and bike rides, meditated in the woods, explored the seashore, and hiked in wildlife sanctuaries and wilderness areas. I got a strange hankering to learn more about bird watching. I felt filled with sorrow at explaining to my children that so much of the wildlife we had seen, from osprey to horseshoe crabs, to monarch butterflies to codfish, to humpback whales were endangered or threatened, I swelled to bursting with a sense of gratitude for the fresh air in my lungs and the sea breezes, and the view of the Milky Way at night. I opened up a conversation with my husband about our sense of urban disconnection from our food sources, the effects of climate change and consumption on the world around us, and a desire to make a commitment to improve our household’s relationship with nature, to accept and face the new and coming realities for good and ill, and deepen our families sense of wellness and interconnection at the same time. I got a notion in my head to investigate ecopsychologal writings, an area I had only vaguely heard of and know little about.

The fourth dream:
I am about to fail an earth sciences class that I never showed up for. I meet with a department head – a plump, pretty older woman with curly white hair. She is wearing purple. She is kind, but I don’t quite see her face. She understands immediately, with little explanation from me, what has happened and what I need. I am assuming that I will be scolded for letting this go so long – but, she even seems to understand that this is painful and anxiety provoking and seems to think it is natural to have waited and avoided it for a time. She is not urgent or worried. I am impressed by her authority, compassion, power and intelligence. She is the author of some amazing body of work in a field that I am not familiar with. I am very grateful to her, and surprised that she has more compassion for my circumstance and my anxiety than I have for myself. I had felt guilty and ashamed that I had ignored it for so long, and her kindness and understanding makes me feel how upsetting it has been to have this looming over me unaddressed. She says I can meet the requirement a different way, in my own way, it doesn’t have to be strictly through the science department, or the political science department, but I do have to meet the requirement. It is mandatory.

The wind changes sometimes.
And it changes us with it.
We can accept, or we can resist,
and most likely we will do both alternately and repeatedly.

But we will all have to meet the requirement, one way or another.

copyright © 2012
All rights reserved Martha Crawford

Follow

Get every new post delivered to your Inbox.

Join 4,304 other followers

%d bloggers like this: