In Conflict

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

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

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

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

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

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

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

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

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

“No. I am not angry….”

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

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

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

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

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

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

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

And of course, I get angry too.

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

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

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

And sometimes to forcibly remove obstacles to intimacy and wholeness.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

If I can. I can’t always.

And sometimes even that is not enough.

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

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

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

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

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

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

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

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

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

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

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

But first we must embrace the wrestling match.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hard Times


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

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

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

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

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

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

Just as all human beings do.

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

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

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

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

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

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

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

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

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

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

Things get heavy sometimes. Its just a fact.

Sorrow has its season.

Even for psychotherapists.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s the Relationship…

I sometimes dread being introduced to other psychotherapists.

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

Uh.

Umm.

Shrug.

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

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

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

But that isn’t what I do.

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

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

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

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

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

So what do I do?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I opened the door:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Both members of the therapeutic couple.

All of us. Always.

Back to the Garden

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Who wouldn’t want to escape sometimes?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And the people I would miss.

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

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

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

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

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

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

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

Keep Breathing Please

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

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

“Breathe.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

copyright © 2013
All rights reserved Martha Crawford

Pain/Full

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

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

Pain runs in families.

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

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

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

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

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

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

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

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

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

Treatment? What are you talking about? What for?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And I had become a parent.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Don’t I know it.

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

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

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

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

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

copyright © 2013 All rights reserved Martha Crawford

Keeping Secrets

Kalli was the secret-keeper of Maldinga. Every day the people of Maldinga straggled through the woods to the clearing where Kalli’s cottage stood. They came one by one, never in two or threes. And one by one, they told Kalli their secrets.
~ Kate Coombs, The Secret Keeper.

Almost two years ago, when I began to talk to friends, colleagues about writing on-line – I could see it made people uncomfortable.

“How are you going to do that?”

“What if your clients read it?”

“I wouldn’t want my therapist to have a blog.”

At the time, the questions and comments struck me as strange: therapists publish their narratives all the time, in books and journals easily purchased or subscribed to on line. They give presentations in public settings, to other psychotherapists, and to the interested public, often filled with extensive case information and histories, whose names, occupations, sometimes genders and personal details are obscured to protect their client’s confidentiality.

Early one morning Sheld the baker came to the cottage. He gave Kalli a basket of fresh rolls and a copper coin. Then he whispered, “I sell loaves weighing less than full measure.” Kalli nodded and caught his words in her hand. After Sheld went away with a sigh, Kalli opened her hand again. The secret was now a small gray rock, like a stale bread crumb. Kalli went inside and tucked it into one of the hundreds of tiny drawers that lined the walls of her cottage. ~ Kate Coombs, The Secret Keeper.

“But aren’t you supposed to stay anonymous?”

“Why don’t you write under a pseudonym?”

Anonymous? With a secret identity?

You mean like Batman?

Clients have seen me in public spaces in hundreds of different ways: putting out my garbage in my sweat-pants and slippers, sweating with my hair in a headband on my morning run, bickering with a sassy kid at school drop-off, dining with my husband on “date night,” in line buying tickets to see a stupid romantic comedy that I am half ashamed see at all, in my bathing suit on the beaches of Cape Cod, in public restrooms in department stores, looking like a foolish middle-aged woman practicing martial arts in the park, picking up my prescriptions at the pharmacy, and at rallies for causes they disagree or agree with.

Such public encounters reveal things about me clients may not like or feel comfortable with. It has never crossed my mind to try to be anonymous, to disguise myself, or cauterize my own needs or interests outside of the office, or in any public setting.

Anonymous
1: of unknown authorship or origin
2: not named or identified
3: lacking individuality, distinction, or recognizability
~ Merriam Webster

I don’t move through the community in drab camouflage, and I made no vow to live an unidentifiable life.

I am not a traditional Freudian, and have never, at any point in my career, aspired to be a “blank slate.” I don’t think it’s even possible.

Although I try not to intrude my own agenda into my clients’ experience, or make them tend to my needs in anyway, the notion that it is possible to “keep myself out of the room” seems to me a mystifying illusion.

Therapists are always “in the room” whether they admit it or not.

I am not required by my profession to live in anonymity – I am mandated to maintain confidentiality.

When confidential information is used for purposes of professional education, research, or publication, the primary responsibility of the clinical social worker is the protection of the client(s) from possible harm, embarrassment, or exploitation. When extensive material is used for any of these purposes the clinical social worker makes every effort to obtain the informed consent of the client(s) for such use, and will not proceed if the client(s) denies this consent. Whether or not a consent is obtained, every effort will be made to protect the true identity of the client. Any such presentation will be limited to the amount necessary for the professional purpose, and will be shared only with other responsible individuals. ~ New York State Society for Clinical Social Work Code of Ethics

I don’t publish identifying information about any client, or any extensive material about any single case history or study. I have tried to fictionalize cases, and blur out identifying specifics entirely. I have created studies of clients in aggregate, noted typical clusters and trends among the clients I have seen over the years, made note of cultural trends, and tried to use my imagination to put me in the midst of cases that I have never met or heard of. I try to speak about the universalizing aspects of the therapeutic experience, my own therapy, my own experience of the work.

I strive to meet my ethical requirements, hyper-vigilant in adherence to the spirit and letter of my ethical mandate. I would never publish anything that would put my clients in harm’s way – that could ever put them at risk to be recognized. And I believe I have done that, at least, successfully.

But is that enough?

Strangely, two years into writing I am revisiting these questions anew, after a synchronicitous cluster of internal and external events, among them several enquiries and comments from other therapists that have made me wonder again why I write. I have been repeatedly asked, and am asking myself about the effects this kind of writing has had on my practice itself and on the clients in my care.

The truth is I just don’t know.

There were so many secrets.
A small boy didn’t like his new baby sitter.
The grocer’s wife had hidden ten gold pieces under a tree root.
A plain girl loved a handsome boy and dared not tell him.
The miller’s son had stolen a coat.
The tailor had left his widowed mother alone and come to Maldinga to seek his fortune.
The mayor’s daughter was sneaking about, keeping company with a young rascal.
~ Kate Coombs, The Secret Keeper.

Publishing my words in public requires clients to trust me even more with their wounds and sorrows and shames.

Most clients have made no mention of it, and I assume have never read my writing, or feel no need to discuss it with me. (If you are one of these, reading this now, and have not brought it up, I hope you will consider this an invitation to address together anything, positive or negative, painful or pleasant, that reading this may activate)

I have told a few clients about it directly, so that they do not feel ambushed or frightened or betrayed by finding out about it in some other manner.

The vast majority of those who have found it or been told of it have expressed positive feelings about it, feel that reading serves as a transitional object between sessions, or gives them access to ideas that may not have entered our therapy directly otherwise.

But that doesn’t mean that it will continue to feel that way. There may, one day, be an essay that agitates, annoys, or distresses. Or words read previously that are experienced differently at a later time, in a different self-state.

I let every client who enters my office know that over the course of treatment I expect to make errors. And although I will always try to protect them from any severe clinical harm, or negligent malpractice I will undoubtedly fail and stagger, causing them pain and discomfort at some point. I may mis-respond, misunderstand, or miss my own blind-spots. I may even re-injure pre-existing wound.

I am sometimes disappointing to both clients, and to myself.

And although I’ve accepted that as inevitable to the mechanisms of the therapeutic process and my own fallibility: it still causes me deep sorrow when it happens, no matter how or where: in or out of the office, on the street, or online.

And as I’ve written about elsewhere ( http://wp.me/p1AOzF-k ) I’ve also learned that powerful therapeutic opportunities for repair, for forgiveness, for re-working, and for corrective experience can lay dormant, almost invisible, curled up within these painful failures.

There is no doubt that publishing my experiences as a therapist, in any format, coupled with my capacity for error and mis-attunement can cause discomfort, and could even potentially disrupt valued therapeutic relationships.

Some have discovered it on their own, and yearn to see themselves in my writing, and feel sorrow that they have not found themselves there. Others, have encountered aspects of my identity, that they do not like, and would rather not know.

Some feel overstimulated, overwhelmed, ashamed at having googled me at all, and try to keep it to themselves – sometimes their dreams have let me know. Still others see themselves in the universalized or imagined scenarios I write about, and hope/fear I am speaking of them specifically.

There are times when we are called to meet deeper obligations that require more from us, beyond the professional guidelines.

Obligations to clients, as well as obligations to ourselves:

I have, and will, make errors in this public space, just as I do in the office.
Even as I scrape off every bit of identifying data, avoid any extensive case discussion, and do my best to disguise all the content, writing about my work carries the capacity to hurt, but hopefully never harm, people and relationships I care deeply about.

I can fail to disguise a reference sufficiently to serve a clients comfort level, or “make up” a scenario too close to one that I have consciously forgotten but remain unconsciously preoccupied with. I can overlook a single word that might sting and intended to edit from an earlier draft. I can leave a client out of a discussion they would want to be included in, or include a reference, no matter how disguised, that activates a sense of exposure.

I can misread how I will be read, or mis-read.

And, as always, our best intentions can diverge from their real outcomes.

One day, in Kate Coombs lovely children’s story, the Secret Keeper turns cold and tired from keeping so many secrets, and stops answering the knocks on the door from the burdened villagers. With their encouragement and participation, she discovers a way to transform the heavy, hard secrets, into meadowlarks, butterflies and rose petals. These re-formed, transfigured, secrets are released publicly, before the gathered village, deepening the both Secret Keepers connection to the village at large, the villagers understanding of each other.

I don’t write or publish to market, practice-build, to make money, or for professional reputation: and although I don’t write for my clients, I always write with them in mind. I believe they are absolutely entitled to read anything I have written, if they so choose, and hold me accountable for it.

I publish what I write because I believe in what I do, and believe that being transparent is necessary to empower clients as full and equal participants in a process that is too often cloaked in disempowering mystification.

I write because I am full to bursting. I have spent so many years hearing stories that have whitened my hair, broken my heart, vicariously and directly traumatized me, inspired and consoled me. Stories such as these can fill your drawers, accumulating until they turn cold and heavy.

I write to ethically make use of what I have experienced and absorbed, and learned vicariously from others – and if I did not, I suspect I could sink into a vast ocean, a sea of other peoples’ pain and trauma, triumph and intimacy, joy and loss.

I write to let other practitioners and younger clinicians know what life in this field feels like, to share some of what I have learned, and to transform some of what I have held as single secrets, as individual stories, into something that can be released to the larger community to help us all understand each other better, and the culture and era we are embedded in.

I write to wrest meaning from it all.

I will stumble and I will mis-step, and I will do all that I can to make reparation.

But writing itself has become an integral, essential part of my practice.

I write to continue working, so that I can keep on keeping secrets.

copyright © 2013
All rights reserved Martha Crawford

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