This is What Happened

Someone asked me to write this. Sort of.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I guess the answer is yes.

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.

Suspended

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

These words with heartfelt grief that seized on me

Knowing how many worthy souls endured 

Suspension in that Limbo

 ~ The Inferno of Dante, Robert Pinky translator

 

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

 

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

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

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

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

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

But it wasn’t.

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

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

This is the sorrowful state of souls unsure….

Who, neither rebellious to God nor faithful to Him,

Chose neither side, but kept themselves apart. 

   ~ The Inferno of Dante

There are times when we find ourselves suspended.

And I find myself strung up as often as anyone.

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

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

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

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

Hapless ones never alive, their bare skin galled

By wasps and flies… 

 ~ The Inferno of Dante

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

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

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

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

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

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

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

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

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

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

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

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

I know that I hung on a windy tree

nine long nights,

wounded with a spear, dedicated to Odin,

myself to myself,

on that tree of which no man knows

from where its roots run.

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

downwards I peered;

I took up the runes, screaming I took them,

then I fell back from there.

(~ Stanza 138 & 139 of the Hávamál)

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

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

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

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

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

 

 

 

 

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.

The Seed

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

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

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

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

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

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

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

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

Except for one:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

copyright © 2013
All rights reserved Martha Crawford

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

Strange Dreams

You know those nights, when you’re sleeping, and it’s totally dark, and absolutely silent, and you don’t dream, and there’s only blackness, and this is the reason, it’s because on those nights you’ve gone away. On those nights, you’re in someone else’s dream, you’re busy in someone else’s dream.

Some things are just pictures, they’re scenes before your eyes.
Don’t look now, I’m right behind you.

~ Laurie Anderson, Someone Else’s Dream, lyrics

The first time it happened was early in my career, too early for me to know or understand the phenomenon well – and certainly too early to trust it.

I was working in milieu therapy, a day treatment unit, where several hundred “severely and persistently” mentally ill adults came each day to receive their medication and case management, group therapy, art therapy and rehabilitation.

I dreamed that I was wearing a police officer’s uniform, and one of my clients was begging me to spank him, while he masturbated.

I was startled by the dream, it felt different in tone and quality from my “usual dreams” whatever that meant.

I explored it in my own therapy extensively – looking at the countertransferential sadistic and aggressive impulses that emerge when working with clients who have difficulty containing their own aggression. I considered the power and class differentials between me and my stigmatized, disempowered clients, and tried to examine my privilege and the authority, authoritarian, and social control functions that I was expected to serve on the treatment unit. I explored my personal, familial and historical associations to the specific client, to police officers, to spanking, and to domination and submission.

I explored my own sexual fantasy life – but, the sexualized aspects of the dream somehow felt off: a dream could have shed light on power/authority issues without sexualizing it.

But, the sexual nature of the dream just didn’t feel like my kind of kink.

The next week, the dreamed of client came in for an awake, daytime session and confessed that he had been embarrassed to tell me that he had been having masturbatory fantasies about me for sometime. He imagined me, dressed up as a police woman spanking him.

I felt enormous relief. The strange bits of the dream weren’t mine. The dream was about my role on the unit, and also about the ways I had been subtly, unconsciously pulled by this specific client to “police” and monitor his compliance and program attendance in ways that were stimulating to him, perhaps over-stimulating to him, and which made perfect sense with the clients history of sexual and physical abuse.

That was when I began to understand, many years, before I began to study Jung, that my own dreams about clients were not merely about my individual psyche.

I told my therapist excitedly about my new realization and he responded:

“Be careful.”

Be careful of what, I wondered? It seemed to me that I was in greater “danger” or getting pulled more deeply into some destructive authoritarian enactment, scolding or punishing, or chastising a client who could feel too stimulated by it if I hadn’t had the dream.

The dream had clearly protected me, and the client. Surfaced a dynamic, an unconscious currency, an exchange that was already present, but unspoken, unacknowledged.

The dream itself wasn’t the danger.

“If a dream shows me what sort of mistake I am making, it gives me an opportunity to correct my attitude, which is always an advantage”
~ C. G. Jung, Dreams

I left a long message on my therapist’s answering machine after that session, certainly too long, trying to shake off the undermining caution, and the traditional psychoanalytic models of dream theory that we had both been indoctrinated into

The various psychoanalytic branches which grow off of Freud’s ego psychological tree view dreams as subjective and individualized experiences, as a portal to unconscious conflicts which are about the clients personal history – and the conflicts from the past which have been transferred onto the therapist or other loved ones. And an analyst’s dreams could only reveal something about the analyst’s individual, private psyche, and transferences. If an analyst were to dream about a client, it would speak to their countertransference, the aspects of their own historical conflicts, or perhaps a dangerous over-identification, activated and constellated in the treatment.

I don’t know about your dreams. But mine are sort of hackneyed. Same thing, night after night. Just…repetitive. And the color is really bad – And the themes are just – infantile. And you always get what you want – And that’s just not the way life is…
~ Laurie Anderson Talk Normal, lyrics

There was another, more minor dispute about dreams a year or so later. Another one of “those” dreams – this time a strange dream I had about my therapist:

I was in his home, sitting on the treatment couch. His wife, as I imagined her, was nearby. A daughter, a son, and five month old baby boy. I sat and played with the baby boy while others went about their business around me, not interacting with me. The dream itself had little emotion attached to it, I was neither happy, nor distressed, perhaps a little bored, but enjoying the baby enough. Yet, in the dream, and afterward, I wondered why I was there, and worried that I was intruding on the scene.

Again, of course, I explored the dream extensively: as a transferential wish to have siblings, to be a part of his family, to be parented by him. To be trusted and invaluable member of his inner circle. I considered whether or not this tiny baby was an extension of my self, perhaps my inner child, that I wanted to be responsible for, as I was seated, held by the sofa now in the middle of his living room.

Four months later, he informed me that he would be taking a leave for a few weeks. Shorter notice than his usual vacation at an odd time.

“Are you about to have a baby? Is this a parental leave?” I asked.

Yes, he admitted, a boy.

I expressed my happiness and congratulations. But, I had a question:

“Do you remember that dream I had a while back? About you having a new baby boy?”

Yes, he said.

“Was your wife, by any chance, 5 months pregnant at the time?”

Yes.

“Did you think about that then? Did my dream seem strange or uncanny to you? Because I remember saying that it felt like a weird dream for me to have – and I worked very hard to try to understand how it might have been about me! But, now I see, it was also about you – or about us both!

Yes. He had thought of that.

“Well it would be very helpful to me if the next time that happens that you just let me know so we can sort it out. Maybe in a previous session I was sensing that you were internally preparing for the birth of your son, I’ve known you through other parental leaves, and I – or maybe both of us – felt that I was intruding on that scene. And you sort of left me trying to take responsibility for the whole unconscious scenario by myself.”

Fair enough, he promised.

Enlightening an interpretation on the subjective level…may be entirely worthless when a vitally important relationship is the content and cause of the conflict. Here the dream content must be related to the real object. ~ C.G. Jung, Dreams

Many many years later, following a weekend which involved a very emotional and excruciatingly painful crisis involving my family of origin, a client of mine reported this excerpted dream (with permission) which she had herself after the previous Thursday session:

“You were motioning me to wait – but this guy started to upset you.  I thought you’d tell him to stop going through your papers (they were certificates, I think, of your degrees or licenses or something). Instead, your emotions quickly escalated and you started yelling / pleading with him to stop – and you screamed ‘what are you doing! you’re ruining my life’ He was completely in control of upsetting you.

You sat down across from me, legs curled in and started crying out of control.  I couldn’t help but to cry as well – seeing you in so much pain. You were destroyed.  I think I tried to hug you but you were a broken, small, mangled version of yourself.

There was a pause in the dream. I’m telling you about the dream that I just had (above)- and how upsetting it was for me because it was so strange but midway through, it’s abundantly clear that you’re not listening.  You’re going through your papers.

I stopped talking mid-sentence and waited. You looked up at me and I asked you if you’re listening – if you’re with me.  but you weren’t. So I got up to leave, undramatically. but really very upset. And I said “I can’t do this.” you just watched and didn’t stop me.  I left without looking back.”

Her “strange” double dream not only anticipated my unexpressed concern with a crisis that was about to erupt, the distress I had been in – it showed me the ways in which I could re-injure the client, abandon her and damage our alliance if I chose to hide behind my professional papers, degrees and certificates.

We began by exploring her associations and history, her relationship with her wounded parent, and her personal subjective assumptions about the dream – I started slowly, as, frankly, I did not want to expose the details of a personal conflict that felt still vulnerable and I did not want to burden the client or require that she take care of a “small broken” version of myself. Neither did I want to abandon her behind a professional stance that exempted me from my responsibility for my own unconscious processes as they influenced the treatment relationship.

As we were about to move on, just as the subject was changing, I summoned my courage:

“So, listen, there may also be another component in the dream. You’ve been going through a very intense time, and I know that you have been really needing me lately, and whenever we feel we need someone, we watch them very closely. I am wondering if this dream may also be about me in someway… After our session on Thursday, I had a family emergency/crisis which flared up, and I think, I did, over the weekend feel quite small and broken and I did cry a great deal like in your dream. I wonder if you were reading the signs in me, maybe in the same way you learned to at home, to anticipate an upcoming crisis. And then, the second part of the dream expresses your fear that I could deny your astute perceptions of me, and just pretend that nothing ever happened. Kids learn to read their parents like the weather, and maybe you were reading me, and feeling my own storm coming on, and then expecting that I would just act like you hadn’t felt anything real about me.”

“Yes”, she said, breathing more deeply.
“I must have felt something coming on. I always had to do that at home, and my family would act like I was crazy.”

More deep, relieving breaths.

“Are you ok?” she asked.

“Yep.” I answered, “I take good care of myself.”

“It must be left to the analyst to decide how far he, himself, is the patient’s real problem” ~C.G. Jung, Dreams

In some therapeutic relationships, dreams become the transitional play-space where the patient and the therapists’ unconscious processes communicate and play with each other, telling us both about the aspects of the therapeutic relationship that we have consciously missed.

I’ve learned to trust my dream life, and my clients dream lives as they sense and sort through the unconscious processes that exist as a dynamic in relationship to others, to the systems we live in, to the culture and communities we embed ourselves in.

“That is to say, I take dreams as diagnostically valuable facts”
~ C.G. Jung, Dreams

I once dreamed about a client who was unable to tolerate weekly therapy and had terminated abruptly:

I walk down the streets of the city through various familiar neighborhoods and the client pops up randomly, here and there, as if they are making brief, cameo appearances -walking on the sidewalk next to me, coming out of a store, standing at the cross walk as I pass – in a movie that is about something else.

I realized upon waking that I needed to let the client come in as needed, pop up, pop-in, and not try to force them to into my story-board of weekly standing appointments.

Certainly there are many dreams that emerge entirely from our personal unconscious, our unprocessed conflicts alone, calling attention to our history of past traumas, losses and misattunements.

But in the past fifteen years of recording my own dreams, my dreams of clients, and my client’s dreams, it has become obvious to me that dreams serve many other functions as well.

Last night I had that dream again. I dreamed I had to take a test In a Dairy Queen on another planet. And then I looked around And there was this woman… She was writing it all down. And she was laughing. She was laughing her head off. And I said: Hey! Give me that pen! ~ Laurie Anderson Talk Normal, lyrics

I’ve come to think of dreaming as a natural, sensory and relational phenomenon, a means of digesting and incorporating our unconscious perceptions: dreams solve problems, anticipate transitions, highlight things we have overlooked, prepare us for dangers, help us communicate to each other, tell us what issues our psyche is working on in the background, reveal what lives and moves out of our awareness, point out imbalances in our relationships and environments, and extrapolate/project future outcomes from the current trends in the patterns we are embedded in personally, relationally, systemically, and globally.

All of nature talks to me. If I could just figure out what it was trying to tell me. Listen!
~ Laurie Anderson, Sharkey`s Day, lyrics

Many clients in the weeks before 9/11 reported dreams of the like that I have not experienced since. I had been enrolled in a Depth Psychology class studying Jung at an institute in the city, and everyone in the class was asked to keep a dream journal for ourselves, and for all our clients’ dreams. The week before the attack on the World Trade Center, we read aloud from our journals: Strangely, there were many dreams within dreams: of kamikaze jets flying down the streets of the city, of giant tornadoes coming “from the east” which destroyed tall buildings killing hundreds of people, dreams of four giant bombs dropped from the sky but the fourth one doesn’t explode. And those were just my clients. Other classmates’ journals contained surprisingly similar themes and images: lost pilots, building explosions and collapses, one classmate’s client dreamed of turning over the Tower card from the tarot deck.

We wondered together what violent shift was present in the environment that could be reflected in the community’s dreams.

Perhaps any random sample of dreams reported at any given time would contain similar imagery.

I don’t deny the statistical realities of probability or chance.

But I haven’t been privy to a similar thematic thread since.

And I would damn sure brace myself if I was.

Some say our empire is passing as all empires do. And others haven’t a clue what time it is or where it goes or even where the clock is.
And oh, the majesty of dreams, an unstoppable train, different colored woodlands. Freedom of speech and sex with strangers
~ Laurie Anderson, Another Day in America, lyrics

I’ve had dreams, for example, where one highly/overly intuitive client critiques my treatment of another client with a highly/overly developed thinking function: the dream itself offering me excellent insight and supervision into both of the clients undeveloped bits and the functions that I am called upon to strengthen in each of them.

Sometimes I share dreams that have been helpful to me in a case with the client.

Sometimes I don’t.

And another interesting “strange dream” phenomena, which I have experienced many times – A client and I dream a similar sounding dream, the day or two before session, from different vantage points: A dream of a terrible storm in a steep valley, me looking from the ridge of the hill, the client looking at the clouds coming over the high tree-line. A dream with the client swimming against the current, tiring in the water looking up at a woman in a small boat, and me, in a small canoe trying to figure out how to pull a drowing client safely on board.

The dual dream content itself is usually fairly obvious, and takes little work to interpret, but the synchronistic phenomena itself has come to represent to me a kind of alchemical consolidation of the therapeutic relationship itself.

Our unconscious lives have found themselves in the same place, in the same time, working on the same problems, from different perspectives.

I don’t claim that this is science.

Nor do I believe it to be magic.

I remain agnostic as to the ultimate causes or explanations for such synchronistic and unconscious experiences.

But, to the degree that the function of dreaming remains mysterious, and unknown, perhaps we can only approach such mysteries with faith.

And to learn how our dream lives, whatever their origin or function, can serve to deepen our connections to each other and the world around us.

There was this man…And there was this road…
And if only I could remember these dreams…
I know they’re trying to tell me…something.

Ooooeee. Strange dreams.
Strange dreams

~ Laurie Anderson, Sharkey`s Day, lyrics

copyright © 2013
All rights reserved Martha Crawford

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