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.

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

Flooded

Sometimes a flood destroys a world already made and the people in it; sometimes creation itself begins with the primeval water.
~ Funk & Wagnalls Standard Dictionary of Folklore, Mythology, and Legend

I am not going to over-write or over-think this one.

This is going to be way too long, and under-edited. I give myself permission to not have to be ruthless with my thoughts this week as they float up. Perhaps something valuable will drift in among the debris.

Maybe something that spills out here will help to prepare other therapists and care takers when climate change driven disasters, in one form or another, emerge in their communities.

And make no mistake: they will.

If the weather can disable this fortress of concrete and steel, no one can be assured they are exempt.

According to Oxfam International “last summer the US declared 1/2 of their counties disaster zones due to storms, floods, fires & severe drought after 12 month of record temperatures.”

Katrina already happened, and we didn’t take it in. Increasingly violent and recurrent tornados have devastated whole towns, and we continued to respond with our standard disaster/trauma responses. Drought has devastated huge swaths of farm country, brush-fires, and mudslides, and deadly heat waves don’t seem to change our tune.

These are not mere disasters.

This is an initiation into a new way of life.

These are the consequences of our consumption, our drive for convenience, our wish to accumulate, the speed that is never fast enough.

We need to face the realities we have created.

As therapists, social workers, crisis interventionists we have to take this in. This is not about helping people process an anomalous disastrous event.

This is about helping everyone, traumatized, or not, prepare for a whole new normal.

This is about practicing for storms to come, for profound challenges to an unsustainable way of life. This is about learning to let go of what does not work. This is about looking at our energy dependence, and learning new ways of living that respond to dwindling oil supplies, our fragile power grid, our hungry batteries, and addictive fuel consumption.

This is about understanding something about how easily it can all be disrupted by the wind, rain, water, and heat produced by a wounded planet trying to re-establish healthy homeostasis.

Has it only been a week? It feels like 40 days.

Monday – a day of preparation and fear:

The wind began picking up in earnest late Monday afternoon and we retreated from the park and playground into the house.

My kids channeled all their fear into fretting about Zelda and whether or not she would be all right. Zelda, a wild turkey I had seen roaming in Battery Park, the week before, had fascinated them. ( http://en.wikipedia.org/wiki/Zelda_(turkey) ) They had proudly told their classmates about Zelda, the turkey who had wandered by herself, from north of the Bronx all the way downtown. She had lived, the only one of her kind, in Battery Park for the past 10 years.

We assured them that wild birds knew special secrets to keep safe, and that we too had prepared in every reasonable way.

We told them the truth: a big storm was coming, yes, bigger than Irene. We might lose power. That the weather centers were saying that water was going to flood areas near the rivers and ocean and in neighborhoods nearby, but that our house was high on a hill and no one thought the water would come this high. We explained that many friends had evacuated, and were all in safe places, waiting. We assured them that if we were told to leave by weather scientists – that we too would leave right away – and would do everything we could to keep them safe always.

Most importantly, we treated this storm as part of unfolding new realities. We said that this storm would be good practice and teach us important things about how to take care of ourselves and others through future storms, and that we should use it learn everything we could.

On high ground – we watched the waters rising, engulfing the neighborhood two hundred yards away and driving out neighbors immediately adjacent to us. Red Hook, a few miles away where clients and friends both live and work, was submerged, flooded out before the sun even set.

As the night wore on, and the wind’s howls became more ferocious – I began to check in with clients who still had power, some trapped and unable to evacuate in flood zone A, some who lived on the Jersey shore. Colleagues friends, and clients were on disaster calls, working continuously through the storm, and beyond, in the city hospitals. Others who were first responders I was able to catch glimpses of in news clips and know they were okay, at least at the time of the report.

For a few people who didn’t have access to TV or radio, I conveyed by text, the wind and weather reports as I heard them.

Our home was safe enough. We never lost power, and were able to follow the reports of cars floating down Wall Street near our office, of the East Village- our previous home and home to many friends -waist high in flood water.

As the night wore on and the wind intensified, and the power outages began we retreated to the safest room in our house, and followed the storm as best we could, through our phones – on twitter, facebook, and the NYC office of emergency management.

Bellevue, where my husband had worked and I had volunteered through 9/11, where we both had many professional and personal connections – had lost power and the hospitals were evacuating. Beyond unthinkable, trying to imagine negotiating those labyrinthine hallways in the pitch black, surrounded by panicking and disoriented patients.

Every harrowing report implicated someone we knew, someone we had treated, someone we cared about, someone we loved.

The wind began to die down around 10:30 pm. The flood waters began to recede around 11:30 and most communities were starting to drain by midnight.

We have lived, and worked in this city a long long time. Between the two of us, we have lived in many neighborhoods, worked in many different communities, and been professionally invested in hundreds and hundreds of people from all over the city and its surrounds.

On my own roster of open cases – I have clients who live in every severely effected area: The Rockaways, Breezy Point, Astoria, Hoboken, Jersey City, the Jersey Shore, Long Island, Red Hook, DUMBO, Coney Island, the East Village, and of course, all of Manhattan below 28th Street.

I, my children my immediate family members were safe and fine, but I had empathic connections to someone in every devastated community. I knew personally, professionally (which are not so separate in times like these) people and their stories of their families, their friends, their neighbors, their associates – I could envision and imagine a woman I never met but had heard tell of with a severely disabled child in a destroyed area of Queens, someone else’s elderly stubborn parents refusing to leave the Jersey shore, the exhausted communities of cops and FDNY and their families weathering the storm without them. I could see in my visual and imaginal memory folks I know and know of living high in towering urban housing projects, cold with no lights, in the dark.

Floods archetypally and collectively represent the washing away of one epoch, and the birth of another: Noah, and before him Gilgamesh, with their big boats, matching doves with tree branches and their same rainbow promises that the Lord of the Universe would abide by a new contract now that the old one had been washed away.

Personally, in an individual dream, floods are symbolic of great waves of unprocessed emotional experience – that floods out our capacity for thinking, for analysis, for strategy.

This flood was symbolically all of this and more.

This was real, happening to real people, in my real extended, personal, and professional community, to human beings and families that I was really connected to, had intimate knowledge of, and attachments to.

There was no opportunity to derealize, to pretend it was happening to random “others” somewhere else. This was happening to my chosen family, my closest friends, my neighborhoods, my clients, my communities, my city.

When you work close and warm using your own Self, in the heat of transference, intersubjectivity and alchemy, cold distancing isn’t an option, even when it might be useful in helping you to keep your bearings, or protect you from getting washed away.

Tuesday – a day of shock and awakening:

In the morning, after little sleep and a little breakfast, we went out to explore what had been lost. We stopped counting downed trees when we lost count on our square block. We went down to the river which, although still swollen, had retreated back to its banks. We traced the waterline by the shattered windows and ruined store fronts that we passed.

My husband and I hiked across the Brooklyn Bridge in the lingering rain to see if our office had taken in water. Our superintendent had spent the night, turning off the electricals to prevent shorting and fires. He estimated only a foot or so in the basement, although we had been in zone A, and Wall Street, one block away, had been completely flooded.

I reached out to several people on my caseload who I knew had been in significant danger, and sent a mass “bcc” email to all letting them know that the office was out of commission and I would be scheduling walking/talking sessions for clients in Brooklyn, and phone sessions for clients that needed to talk on Thursday and Friday.

Responses came trickling in – many who thought they were “fine” with or without power, or “not effected at all” on high ground. And as many stories of crisis, trauma and loss: photos of clients homes destroyed, tales of watching rising waters out of windows, cold and blacked out apartments, people evacuated unable to return to their homes, people trapped in their homes by water, by downed trees, by cold, dark stairwells.

People rescued and assisted by kind neighbors and strangers.
I fell in instantaneous love with every Samaritan who selflessly assisted a client in need.

Wednesday- a day of giving, taking and disconnection:

After a fear-free nights sleep, we woke up activated:

Wednesday was Halloween, and I could not stomach the thought of talking my kids door to door, in fancy costume, begging for candy – when there were people unhoused and unfed and unclothed in our own communities a few miles away.

We went through closets and gathered all of our extra blankets, coats, wool socks, sweater, canned goods, bottled water, hurricane candles, extra batteries, flashlights.
On line I found Redhook.recovers.org run by OWS, and was directed to a church that was gathering supplies and taking deliveries to Red Hook and the Rockaways.

I contacted all the people in our co-op and our neighborhood, sent notices out on email and facebook, asking for donations of batteries and flashlights, blankets, coats and sweaters.

I asked people to drop off supplies in our vestibule, and said that we would be glad to transport any supplies all week.

One family, among our closest friends, responded immediately, ran up to their apartment and brought down their canned goods.

All others stared at us blankly. “I don’t think we don’t have any extra batteries… ” one lied vaguely. Some were more direct: “I am going to keep my own bottled water.” Some offered useless items instead: ” Hmm – I might have some summer clothes…”

No thanks – they need food, warm clothes and coats because its cold outside and their homes are gone, also batteries and flashlights and water.

People looked at me as if I was doing something unbecoming, annoying, impolite.

I tried hard not to judge their response and also not to turn it in against myself. I knew from other disasters and from 9/11, that this was my typical activated response to the devastation around us.

My professional practice as a social worker and a therapist is to imagine something about the core needs of others and cultivate the most supportive, effective response. Its what I do all day – why should others react in the same way that I do?

I’m certain many that rejected my outreach found, and will find in the long weeks ahead their own ways to respond over time – with goods, services, time, money.

Everyone is allowed their own response to shock, me included.

Maybe they didn’t have the opportunity for this to feel real to them, maybe they had no experiences of or relationships to people in the communities that were directly impacted, maybe this didn’t feel personal to them, yet, this time.

Maybe we can’t respond to anything easily or effectively if we haven’t forged a personal connection somehow.

We stopped by our local mini-mart and they donated a full cart of canned goods for us to transport, bless them.

The kids worked hard through the day sorting, bagging and boxing supplies along side of us. They gave generously, appropriately, and I was touched by their maturity, industry, and autonomy. Proud to bursting.

But, at the end of the day, and for the rest of the week, our vestibule would remain empty. Not a single donated can or a battery or an old coat.

And this thought too: I must also consider, and with thoroughness, that my rush to offer up goods and services may not have been particularly helpful at all. Perhaps my boxes of canned goods and rice and beans and coats in all sizes and blankets are sitting somewhere, in a cold basement or the back of a van, or an evacuated shelter – burdensome and unused.

Perhaps I simply created the illusion of being useful, because I needed to be of use.

There are times when the most useful thing is to sit still, and stay out of the way.

And perhaps others succeeded at that where I failed.

By nights end I need to check in with my husband: “Do I seem crazy or off-putting or too agitated when I am asking for donations? Because I feel like people are staring at me like I have three heads? Is anxious impatient energy pouring off of me? Was I inappropriate or demanding?”

“No” he said, “you were asking normally – I think you just have to ask a lot of people and thats how it goes – between our friends, our things, and the mini mart we gave them a lot of stuff, and I’m glad we responded the way we did. You are just always the canary in a coal mine – and remember what happens to them!”

Thursday – a day of gathering and outreach

On Thursday we began hearing from chosen family – our children’s god mothers and god fathers – whose homes were without power. It was growing colder. The darkened parts of the city were feeling edgier, less safe each night. Walking uptown to harvest power was creating irritable crowds at the power outage borders – as hundreds searched for places to charge their phones, buy hot foot and drink, and more batteries before heading back into their darkened homes.

They came to stay until power and heat were restored – which comforted us as much as them. It felt healing, soothing, strengthening to have our tribe gathered.

We were anxious about our clients well-being. Without an office available, I scheduled any client that wanted or needed to talk on Thursday. I had walking/talking sessions for clients who lived in Brooklyn, I had sessions behind the locked gates of our community garden, I had phone sessions in my room while one of the godmother’s turned our daughter’s room into her temporary office. For the first time ever: a half-phone/half-text session emerged as a treatment modality when the cellular system refused to allow our phones to stay connected.

It was both comforting and exhausting to try to cobble together jerry-rigged pseudo-structure out of the chaos, and brought into sharp focus how much injury the city, its inhabitants – and its infrastructure- had sustained.

When a twitter friend forward me the information that Zelda the turkey had survived, with a photo of fat, happy turkey on top of a dumpster – everyone in the household cheered as though Noah’s dove had just returned bearing an olive branch.

Friday – a day of gratitude and taking stock

The house remained warm, kid- and friend-full, and I spent the day feeling enormously grateful for the reading on ecotherapy and ecopsychology and climate science I had been led to explore over the past several months.

I felt prepared by the reading I’d done, startled by the timing of the events, heartbroken for others, for but not surprised, or stunned.

Even more grateful that I listened to my own inner leading and had organized a study group of smart and thoughtful clinicians that will soon be gathering together to look at the way that our disconnection from a wider awareness, and our denial of the consequences of our collective behavior effects our community’s and our culture’s mental health.

I need more than ever to find words, in the company of a like minded group, to speak to clients about our collective denials, our estrangement from realities, our defenses against science, our minimization of disturbing realities.

It was a day for me to starting waking up to our own disturbing realities and secondary losses as well: two self-employed private practitioners, with our office out of commission, it was becoming clear that we would feel a significant blow to our businesses and household finances.

Many clients have sustained unfathomable losses, and will need pro bono and reduced fee support. Some may move, as many did after 9/11. Others will lose their jobs, some have lost businesses, many have also lost, and will lose several weeks of income themselves. Paying for therapy becomes a low priority or an impossibility.

I have made a policy of never abandoning a client because of financial crisis, I reduce or suspend fees, perhaps reduce sessions if large balances are still accruing, or schedule on an “as needed” basis, until the crisis is negotiated.

I hope I can afford to maintain that policy going forward while also caring for my family.

A weekend of celebration and passing it on:

Saturday with our extended chosen family gathered we had a full day of joyous celebration, and permitted ourselves to forget all that was happening around us.

Because a fantastic force of nature, far more generative and creative and consequential than Sandy, arrived on this planet 8 years ago when our daughter was born, and that deserved to be celebrated no holds barred.

Sunday we returned to reality, and used our car and our gasoline to shuttle donated supplies to Red Hook, the Rockaways and Breezy Point.

Monday and beyond….

This week, we have returned tentatively to work, in a building intact, with power but with no phone, wifi, or heat. The night time view from my window is eerie: One window looks out on buildings filled with light and flickering TV screens. The other window faces a chasm of darkness, pitch black, unlit, unoccupied buildings

Clients seem to fall into four different categories of response
(I have seen similar responses before, including my own, in the days and weeks after 9/11):

1) Those who are totally and directly affected, and know it, but who are very busy coping, and not feeling much yet. They are in the throes of loss of home, loss of businesses, loss of community, loss of neighborhood, loss of place and root. They are wandering through their days, displaced, unmoored. At particular risk are those who have survived trauma and disaster before:

Standard disaster/post-trauma/crisis intervention training is extremely helpful here – and there has been a great deal written about that elsewhere. But it is probably not complete or sufficient in and of itself, as climate-driven disasters are likely to continue to unfold, in some form or another. This is about all of us coming to terms with a new way of life.

2) Those who were not in the direct path, but feel disturbed, disorganized, anxious about what is to come – or guilty and hesitant to permit themselves to “feel bad” when they are so “lucky” – or who sense that everything has changed although they have “no right to complain” because “nothing bad really happened” to them:

For these clients it is important to validate that it is healthy, and normal and appropriate to feel distress when your community is profoundly wounded. Some worry that their non-personal distress is a sign of personal weakness or low grade hysteria rather an expectable experience of empathic connection to those around them.

“I felt a great disturbance in the force, as if millions of voices had cried out in terror….” Obi Won says when a distant planet in a nearby galaxy explodes. The quote is resonant and memorable collectively – as if we too can imagine sensing such massive, collective, disturbances with Ben’s sensitivity. How much more powerfully do we feel such disturbances when the millions crying out are those we encounter every day, when we have been seated side by side with them on the broken commuter trains and subways?

3) Those who were not affected, or were secondarily affected, who are involved in advocacy, who are working to assist others and those actively grieving the injuries to their community and environment:

– sometimes to the point of burnout or exhaustion.

These clients first and foremost need their perceptions validated and their grief supported. This is particularly difficult for therapists struggling with their own estrangement and denial. These may, or may not need help discerning their own limitations, their need for self-care, and managing survivor’s guilt.

Too often, these responses are pathologized as mere activations of events or injuries from childhood, when they are a healthy, appropriate and related response to real events in the present.

4) Those who were not directly externally affected, and who are not internally affected by the disaster either:

Some might report that they had a relaxing time away from work, might describe the city slow down as a “vacation”, some might even describe having a good time partying and see the event as having little or nothing to to with them.

Some may have cursory awareness of the losses around them, but are not moved, distressed or upset for anyone else, or for the community – beyond being glad that they themselves were not in harms way.

Others among the unaffected, living just miles away, may have paid no attention whatsoever to the disaster around them, have not read a paper and ignored, or avoided coverage of the event, and do not even know what has happened all around them.

To be sure, some of these have marshaled panicked defenses: flung themselves into manic hedonistic binges, strapped on their narcissistic armor or thrown up walls of primitive denial to manage their own fear.

And many who imagine they are truly “fine” have suffered from (or will suffer from) other, displaced symptoms, stemming from the lack of sufficient relatedness to others to their communities and the planet. These are often clients who feel anxious, estranged from meaning in their lives, friendships and in their work, who have significant difficulties forging and sustaining empathic and reciprocal relationships.

These are clients who often don’t seem to know what other people are “for”, what their own central purposes and values are, and sometimes seem at a loss as to what it is they want from therapy itself.

How disassociated have our lives and our culture become that we can imagine that it is normal to be unaffected by devastation in our community a mile or two away, or by a feverish planet creating recurring superstorms?

Denial prevents us from preparedness, prevention, and harm reduction with regard to climate change- exacerbating the toll in disasters like these.

Why didn’t people leave evacuation zones?
Why did people stay with their children in harms way?
Why do we want to rebuild in flood-zones when the water levels are rising?
Why have we not listened to the obvious, clear scientific consensus and mounting evidence?
Why do we ignore every warning?

Just like addicts and their cohorts living in collective denial – clinging to short term comforts while accruing disaterous long-term consequences: our culture, communities, and individuals need to begin to face painful, grief-filled realities in order to reduce harm to ourselves and the living world.

Addressing, confronting, and working through treacherous resistance is the therapists purview.

This IS our job. We do this everyday. We know how to work through and around unhealthy defenses.

We need to offer up our skill set to help our culture and our clients respond to reality or our clients will continue to suffer.

More than they have already.

For myself and my practice:

I want to support my clients’ and the planet’s attempt to heal from the injuries our inflated consumption and denial has inflicted.

I want to mourn with my whole community when we are brought low and humbled with profound losses of life, of our way of living, of property, home, rootedness and place.

I want to appreciate the dark and painful relief that comes when we are reminded that we are not so powerful and we restored to our proper place and size on a planet that lived and thrived for thousands of epochs before humans and will spin and live richly far past us.

I want to cultivate gratitude for and strengthen the resilience and health in others, in my community, and the world around me.

There are people doing amazing good for each other.

There is one kooky, wild turkey happily roaming free in the middle of a concrete jungle.

There are birds, bearing olive branches, all around us.

There is comfort and empowerment in that.

Please help Hurricane Sandy victims in NYC by donating to New York Cares http://www.newyorkcares.org

or by donating to The Red Cross.

copyright © 2012
All rights reserved Martha Crawford

The Bear Will Eat You

This one is just for me.

No great idea, no over-arching theme revealed. No burst of poetic inspiration.

No gift from me here.

This is the dark-side of the moon – the cost of the work – the damage it does to those of us who practice.

Damage is not all that it does, but make no mistake: damage is done.

There are seasons that cycle through your practice:
Cycles of joy, pride and celebration.
Cycles of sorrow, pain and loss.

And there is darker more disorienting stuff than that.

Cycles of hate, paranoia, terror, nausea, horror, and cruelty that set your world on edge and claw at your sense of reality.

Sometimes all the birds are flying in the wrong direction.

Days and weeks when you hear things that you can never un-hear. Impossible and unjust traps of fate as destructive as the one that Oedipus encountered. As intolerable as the torture of Job.

Rashomon days.

When the stories you hear overwhelm and contradict, and undermine your ability to believe easily in anything simple, or reliable, or good.

When your head swims with the horror of how cruel and destructive we can be to one another, and nothing makes sense at all.

Certainly this was true of the months and months of crisis work in NYC after 9/11.
Each day, a round of fresh horror.

But, even without mass tragedies – be warned that when you approach this field there will be weeks when you will sit in one Kobayashi Maru after another – un-winnable scenarios, from which there is no escape.

There are days, where the darkness you bear witness compounds thicker and heavier with each narrative that spills forth in your office.

Days when the road to hope becomes so steep, it rises up ninety degrees into a sheer, impassable wall blocking your path. No way to move forward. No place to run.

Tragedies so entrapping that they can tear clean through the fabric of living.

I will tell you one such story – disguised beyond recognition – but exactly as impossible and intolerable as one I encountered my first year in the field – many many years ago.

The client had her first psychotic break at age twelve, following a violent rape by a stranger. She has spent a life time in and out of hospital, day treatment programs, residential treatment facilities. In her early 20’s she had a child, which she knew she could not raise, who her sisters and mother raise and care for on her behalf. The woman remains close and connected to her child and family. Shortly after her daughter turns twelve the family stops returning the woman’s calls and refuse to let her come to the house, causing her great distress. Eventually, many many months later a sister calls to tell me that the twelve year old daughter has survived a violent rape by a stranger who broke into their apartment and was arrested. She was hospitalized medically to recover from her injuries for over a month. She seems to have also had a psychotic break as a result, is hearing voices, pre-occupied with internal stimuli, and has now been admitted to the same adolescent psychiatric unit that her mother was after her assault and decompensation. They could not bring themselves to tell the child’s mother, and asked that I do it, as they are hoping that a visit from her may help her daughter.

On the street, in the news papers, at the coffee shop – we find ways to distance ourselves from stories like these: My neighborhood isn’t like that, we don’t have mental illness in the family, such things could never happen to me.

Just like those of us who have never had cancer can hang onto our magical thinking that cancer will never happen to us either.

But that kind of distancing is an abandonment in a therapists office.

And remember: tragedy, like mercy, rains down evenly on the just and the unjust.

Sometimes, not all the time, but sometimes, a (fictionalized) day or a week can look like this:

10:00am – A woman’s child has disappeared. The police search.

11:00am – A husband mourns his wife’s recent suicide and cares for their child who found her body.

Your capacity for hope, for faith, for belief in humanity, shaken into crumbs and dust.
You may be dangling by your fingertips but you know that you are needed.

12:00pm – A fresh, out of the blue stage four cancer diagnosis.

1:00pm – Lunch and email. No good news. An email from your son’s teacher concerned about his talking in class. An urgent and contentious co-op meeting called that evening to discuss a potential high-stakes lawsuit.

Reeling, unable to process it all. Lost, bewildered.

None of these are new cases. All of these people you have been working with for years and years on other things – finding more job satisfaction, improving their marriages, resolving their conflicted relationship with their parents.

All are blind-sided.
You are half-way through your day.

2:00pm – A man with chronic debilitating physical pain losing hope.

3:00pm – A survivor of long ago child sexual abuse abuse forcibly subpoenaed to testify as more recent victims seek to prosecute the perpetrator.

You stop looking at your schedule. You don’t want to know what is going to come next. You close your eyes between sessions and hope that the next person is the actor who may have just landed a long sought after role, or someone who has just met the love of their life.

4:00pm – A woman, recently moved in with a man she has trusted for many years has been hit by him.

5:00 – A man finds out that his romantic partner of 20 years has emptied their mutual bank account, has had a secret life, and left him with nothing.

6:00 – Dinner. You can’t think straight.
You have no advice to offer, you know no way out but through it all.
You are afraid to even check your email, your voice messages, your text messages.

There is nothing you can do in the face of such broken-ness but to break as well.

It is the only sane response. The only place to connect. To be broken together.

If you care for these people, and you do, deeply, you must let it break you too.

You struggle with your personal responsibility. Should you have seen it coming? Is that what that dream they had was about? How could you, should you have protected them from this? Could you have stopped something, diverted something, prepared everyone for the shock?

Darkness wins sometimes. Or can at least, successfully dominate for a long season.

And by this point in my career, I am exhausted by the naiveté of those who insist that everything is meaningful and simple, that our choices cause our fates, that Love is always stronger than hate.

I am just as exhausted by my own naive wish that life be always sensible, causality clear and obvious, and controllable. How, after all these years, after all I have seen, can I still be stunned by senslessness? How can I still be loyal to a split off archetype of how things “should” be? How do I manage to still feel violated, and disrupted by the darkness in the world?

Some bears are too big to eat.

Some stories, especially when told by those you have invested in and cared for and nurtured, leave scars on your brain, and break your heart in too many different ways at once.

Later, maybe, they can be wrestled with. Meaning can be forcibly extracted, or shoved down the throat of senselessness. We cannot choose what happens to us, or to others. But many learn how to make tragedy meaningful in the aftermath.

But only in the aftermath.

For now, you can’t look away.
The job is to look. To hear.
To sometimes let love break you.

7:00- a man whose beloved but unstable twin brother has relapsed again and committed a violent offense while high.

8:00 – A woman whose partner has delivered a still born child

9:00 Home. To curl briefly in the bed with your sleeping child and smell their breath and hair before watching some stupid, mindless anesthesizing TV with a glass of wine.

And you feel guilty/thankful, that this time, for this round, it isn’t you.

And you know it has been before. And it will be again.

You remember how much it meant – when it was you – to tell the story to someone who wouldn’t look away.

You fall asleep, and dream compensatory, consoling dreams.

In the morning, you spend time with your family, work-out, feed yourself a healthy breakfast. Put on your lipstick, and head back in.

And hope today you will eat the bear.

copyright © 2012
All rights reserved Martha Crawford

Stretched

Often, after chance encounters on the subway or a restaurant- or even just in front of the building when I dash out between sessions to grab a cup of tea, I’ll hear from a startled client: “Oh, I thought you were taller!”

I usually respond: “Yes! Funny – I am actually a short person!

So many questions emerge about these shape-shifting impressions – many explored together with clients when we are back in the office. Other queries play out in private or with my professional and personal supports:

Is this merely the client’s essential need to see me as “big”? Is it their projection, idealization, transference that makes me loom large in the office?

Do I claim my limited authority appropriately? Or do I fail to take sufficient ownership of my mastery, fighting against any whiff of idealization? Or perhaps am I too puffed up, inflating myself, taking up more room than I should? Do I shrink my patients, or do they shrink themselves? Are there ways I initiate this illusion? Am bigger than I realize? Smaller than I am admitting?

Is the illusion co-created, the necessary outgrowth of the role I have assumed in their lives, the innate power-differential between therapist and patient? Or an unspoken expectation that I am unconsciously compelled to live up to?

Of course, the answer is “yes” to all of it – at once and at any given time.

Thank goodness for all the belittling, devaluing, deflating content that emerges in the therapeutic process, or a gal could get a swelled head.

But the question that emerges more and more for me at mid-life, having spent all of my adulthood immersed in the therapeutic process in some form or another: What effect does all this expanding and contracting, stretching and shrinking, inflation and deflation have on my being, on my personality, on my persona outside of the office?

Can it wear out my elastic? Will I always snap back into shape? Do I have the strength to continually experience both ends of the polarity? How does it effect my behavior with loved ones, strangers, acquaintances? How does this vocation shape, prune, contort, and wear on my identity?

Many years ago when my analyst and I prepared for him to undergo a potentially life-threatening surgery he asked me, as one of his oldest (meaning earliest not elderly) clients, if anything happened, would I speak about his work, about who he was in the room, because otherwise, no one would know.

I understood exactly.

Working in secrecy, in privacy, in confidence means that many aspects of our identities live behind the veil too. Just as clients often wonder if they are “real” people in my life, I wonder too if the attentiveness, nurturance, patience, and insight that I can channel in office are actually “real” aspects of my personality that I can claim as my own, or if they only can exist in the consultation room, in co-created transactions with clients. Would the people in my daily life who encounter my needs directly, who experience my fussy, fretful, defended, unreflective, selfish, wise-cracking, frail moments even recognize the strength and equanimity I am able to summon in short bursts when I am working in a transitional space?

A dear friend who is the son of a shrink told me about his experience of coincidental encounters with his parent’s patients out in the world: “I’d look and I’d know immediately who they were.” he said, “They were the ones who were getting the good stuff.”

For the therapist, the profession, by its very nature, acts as a chronic, seductive call to hand over all of your better nature, all your altruistic and charitable impulses, all of your golden kernels of wisdom, patience, nurturance, sensitivity and generosity, leaving your friends and loved ones with nothing but cold, inedible cobs and table scraps.

Empathy-fatigue is the cruelest occupational by-product.

It requires constant vigilance and monitoring to make sure you are giving a sufficient but not excessive amount of your emotional attention to clients, even those in desperate need, no matter how deep your affection for them. Passing through alternating states of imbalance is inevitable and unavoidable as the pendulum sings and circles past center, calibrating and compensating for the emotional output.

There are late evenings, sometimes whole days, maybe even a few weeks at a time spent tapped out, mildly irritable, impatient for gratification, comfort, restoration. When you spend all day being your best self – your worst, most needy ravenous self will inevitably emerge – most likely in your intimate personal relationships – hopefully in ways that are claimed and acknowledged and that allow for compassion and reparation for yourself and everyone around you.

“Talking like a shrink” is another common professional hazard: The use of strange, jargon-y speech combined with a concerned tilt of the head, micro-nodding, an unnaturally soothing, overly modulated almost-but-not-quite-inauthentic tone of voice, with a hint of concealed impatience, an aroma of condescension, and subtle notes of repressed rage and baby-talk.

I fight against “shrink talk” with everything I’ve got both, in the office and at large. I curse, use the crass vernacular, any practical metaphor I can grab hold of. I throw everything but the kitchen sink at it. And still now and then, while sorting through something mucky (therapy-speak translation: “processing conflicted self-states”) it slips out. Soon, hopefully, my children will be old enough to mock me mercilessly when this happens – which will be warranted and helpful.

Talking-binges: My husband and close friends bear the brunt of all the unspoken backed up self-referential nonsense, mind-minutia, random thoughts and mini-epiphanies about myself and my own needs that have emerged during the week. Luckily for them, I’m perfectly content to have them only half-listen while I talk my fool head off – spilling out all my dammed-up verbiage.

Weirdly, there are also just as many moments – commonly during times when the work has been particularly demanding after some great achievement, crushing failure, or professional milestone has occurred – when the combination of the intensity of the work and the requirements of confidentiality leave you with absolutely nothing to say at all:

“What is new you ask? Hmmm, it feels like a lot, but I guess really, nothing much…. nothing really…. just work, life… Boring I guess. How is your new job going?”

I suspect, that another one of the intermittent side-effects of being a therapist is superficially impaired listening in social relationships. After concentrating intently on others all work week, I am, at week’s end, left with a kind of social attention deficit: distractibility, diffuse attentiveness, unintentional interruptions, confusional loss of the conversational thread, unwitting changes of topic – as my brain releases its hyper-focus on all the mechanisms of communication: the unconscious slips of the tongue, telling word-choices, and unfinished sentences inherent to therapeutic conversation. My nearest and dearest offer me some time-limited forbearance – before they tease and challenge me to pull myself back together and pay balanced attention. I am grateful for both their patience and for their limit-setting.

I do know that when real needs are on the table that I can usually summon my best self, listen with deep attunement, and serve as a generous friendly resource. In times of crisis I am an effective, incisive receptive and emotionally available “go-to” friend and partner.

That being said, I have become significantly harder to befriend over the years. New relationships undergo significant vetting. Outside of the office I swerve and dodge, erect boundaries and hold even slightly imbalanced relationships at bay.

Most people seem to have at least one or two friends who are beautiful wrecks, messy charmers, or substitute younger siblings, who they enjoy taking care of, where a little more care is given than can be received. Often this imbalance is corrected for in other ways: the more vulnerable friend is loyal, funny, appreciative, enjoyable and allows the more stabilizing friend to identify (or over-identify) with an earlier phase of development, or to have some vicarious experience of a larger, more passionate, and expansive, if messier range of feelings.

I have learned, often with great sorrow, that I am not capable of sustaining that contract any longer – at least not while doing the work I do, and raising young children – even for some lovely people that I enjoy, admire, root for, and feel deeply moved by.

In my non-work relationships I am ravenous for full mutuality, equality, for a balanced exchange of giving and receiving. I invest my time in people that I can turn to, who call me out, tease me, make me laugh, distract me, indulge me and confront me. Friends and loved ones who are not impressed, know that I need exactly as much as they do, even when I am unable by professional mandate or fatigue to say why I am depleted. The relationships with people who are direct and strong-minded and out spoken, who don’t ask me to decode them, are the ones that allow me to fill my belly, laughing deeply and appreciatively at my own expense.

This is what all therapists need from their intimates to keep them from getting stuck or becoming bored, boring and brittle, swallowed whole by their own professional shadow.

That’s what keeps the snap in my elastic.

copyright © 2012
All rights reserved Martha Crawford

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