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.

Looking Back

Death will not part us again, nearer to heaven than ten thousand ancestors who dream of me… ~ Rickie Lee Jones

The ancestors possess this in-between quality of the flown soul and the hovering presence ~ The Book of Symbols

Until a short time ago if you googled my name, without initials, credentials or qualifiers you would find only text and images of my most infamous and tragic relative. My name would summon a black and white photograph of a lovely blonde woman, posed formally, in a light-colored taffeta gown, with stiff bows and many strands of pearls. To me, she resembled my father, and how beautiful he might have been in drag. I never knew her, and although she lived in a perpetual vegetative state since my early adolescence – since before the internet existed – her life, her story, preempted my digital footprint until I reached the half century mark of my own life.

I often wondered what clients who googled me would make of it, when my name emerged on their screens attached to her story. Would they glean our association, guess that I was/am her namesake? Probably not. I never met her and my relation is distant enough, and further obscured by an adoption – that it is in no way obvious. It is an inconsequential, silly, tangential anecdote, a piece of Martha trivia shared sometimes at dinner parties when I’ve had a glass of wine or two.

Yet, when I realized that I had dethroned the preceding and deceased Martha Crawford in the digital archives, I found myself examining the psychological legacy I had inherited from our common ancestors and my peripheral relationship to her.

The ancestors are those who have “gone before” (from the Latin ‘antecedere’) all the life that has ever been, leaving behind the traces of kinship ~ The Book of Symbols

When clients first come to therapy, the first thing that a responsible psychotherapist does is to “take a history” enquiring about the biopyschosocial events, achievements, traumas, and milestones that compose a clients history from birth to the present:

“When did you first have these symptoms? Who are the people in your family of origin? How old were you when your brother was born? When your parents divorced? When your mother died? What was school like for you?”

Many clients resist, annoyed, wondering why I am asking about stuff from long ago that “obviously” has nothing to do with what is going on in the present.

Others are protective: “Look, I’m not interested in blaming my parents for my problems. My parents were great.”

Blame is not the point – I am scanning for patterns, for repeating themes, for unfinished business, for unexamined loyalties to the way things used to be, that have grown into present day obstacles, or, at least, are no longer useful.

Thorough clinicians often try to reach back before birth: “Do you know the story of how your parents met? What do you know about your mother’s childhood? What was your father’s relationship with his grandfather like?”

Family systemic therapies look back as many generations as possible, creating complex genograms, family trees graphed out, dotted with triangles, circles, and squares.

I remember in social work school family systems class, as we were all asked to chart out our own multi-generational family histories – the students’ gasps of surprise as patterns suddenly seemed to pop off of the page – recurring generation after generation.

I had my own realizations: My paternal great-grandfather had died when my grandfather was nine years old, my grandfather had divorced and abandoned my father when my father was nine years old, and my parents divorced, my own father seemingly incapable of fathering any longer when I turned nine years old.

Keeping mercy for thousands, forgiving iniquity and transgression and sin, and that will by no means clear the guilty; visiting the iniquity of the fathers upon the children, and upon the children’s children, unto the third and to the fourth generation. ~ Exodus 34:7 King James Version

Working at a day treatment program early in my career, I sat with the aunt of an African-American client who had severe limitations in his ability to communicate about his own history. Together we sketched out a genogram on a legal pad as I asked her about who had married whom, how many children they had. Suddenly she asked me a question, gesturing to my name plaque on my door.

“Your middle name, is that a family name?”

“Yes” I answered, “why?”

“I just wondered…” she drifted off, her brow furrowing. She tapped her pen on my page as she then wrote in the same uncommon family name, my middle name, into her family tree. Surprised, I couldn’t wrap my head around her question.

“What do you wonder?”
“Any of your ancestors live in the South?” she enquired.

My heart froze, as I realized what she was wondering. I suddenly noticed that the naming patterns in her family and in mine were shockingly similar: the client’s mother (aunt’s sister) was named Martha, and their maiden name was the same as my unusual middle name. There were uncles and brothers who had my brothers’ names, and my own aunt had the same first name as the woman sitting in front of me. As I looked over the page I saw grandparents and great grandparents with similar (or exact) and fairly uncommon first names. My mind scrambled, my heart pounded as I rapidly flipped through that branch of my family tree as I knew it:

“No. Midwestern Quakers, Iowa, Minnesota, South Dakota – many many generations… Its funny, I see not only my name, but lots of my old Quaker relatives names, here, and here, and here, in your family tree.”

“Oh, Quaker names…” she smiled warmly, obviously relieved and took my hand “I suppose that its just some sign that you are the right person to help our sweet boy.”

It was the beginning of one of the sweetest, warmest, most touching relationships I have ever known with a cherished client and his family.

Yet, this exchange about the historical, cultural realities of our lives – of who our people might have been to each other – of an abomination that my ancestors would have been legally empowered to inflict upon their greats and great-greats – served as a reminder of what had, in fact, been inflicted, of what had been survived, of the strengths and losses of previous generations and what had unfolded for this family in its wake. What could have been between us, and what was, and the attending irreconcilable divergences were as alive in our relationship as the synchronicity of our mirror-names.

Our historical context matters. It lives in our names, in our bones, in our privileges, in our genes, in our family stories, and in our strengths, scars, wounds and failures.

How would we have survived had we not been carried on the shoulders of the ancestors? How would we have found our way had we not been guided by the psychic deposits they have left us as signs….They haunt us if neglected. The bother and disturb us if we do not honor their living presence. ~ The Book of Symbols

I’ve had many clients who saw their parents behavior as mystifying, intolerable, oppressive, unjustifiable. And when we looked into their deeper historical/cultural/generational histories – of curtailed freedom, poverty, oppression, famine, war, genocide – “bad” parental behaviors suddenly became acts love from another time, another circumstance. A crying child – while a family hides from a murderous army – must have its emotional vulnerability suppressed in order for future generations to exist and survive. Parsimony appears withholding and unloving until a family history, a generation or two prior, of extreme poverty is understood and acknowledged. Cloying anxiety about a child’s diet can look merely pathological if a deep family history – of not knowing when they might next eat unconsciously conveyed forward into the present – has been overlooked.

Sometimes awareness of the personal aspects of our deeper histories fade away due to simple disinterest, disrespect for what came before, from passivity, or lack of curiosity and empathy.

And we all know what happens to those who forget history.

The unconscious compulsion to repeat can extend well beyond the scope of an individual life.

The dead may be malevolent or benevolent, feared or admired, given bribes to keep them from mischief or gifts to make them happy. ~ Funk and Wagnalls Standard Dictionary of Folklore, Mythology and Legend

And there are lost and stolen stories, the broken narratives of disrupted bloodlines: Adoption. Death. Family severance.
There are unspeakable, silent legacies: Trauma. Torture. Abuse.
There are intentionally suppressed histories: Secrets. Shame. Lies.

And certainly the stories and mysteries that surround both the Other Martha, and my grandfather, the events that bound them to each other, have been a hovering presence in my life: legacies which could not ever have been predicted, inheritances painful, joyous, and surprising. And that are also in some form, being passed on to my children for good and for ill.

According to traditional Korean beliefs, when people die, their spirits do not immediately depart; they stay with their descendants for four generations. During this period the deceased are still regarded as family members, and Koreans reaffirm the relationship between ancestors and descendants…
(http://www.visitkorea.or.kr/enu/AK/AK_EN_1_4_9.jsp)

But, I have seen too much to believe that anything is ever really lost, even when we do not have conscious access to our inheritance – our bodies speak, the ancestors whisper in our ears, live in our cells, in our genes and come to us in our dreaming.

They cannot ever be taken away from us completely, nor can we escape them.

They are with us always and everywhere,
whether we like it or not.

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

Flooded

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

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

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

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

And make no mistake: they will.

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

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

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

These are not mere disasters.

This is an initiation into a new way of life.

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

We need to face the realities we have created.

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

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

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

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

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

Monday – a day of preparation and fear:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This flood was symbolically all of this and more.

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

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

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

Tuesday – a day of shock and awakening:

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

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

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

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

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

Wednesday- a day of giving, taking and disconnection:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And perhaps others succeeded at that where I failed.

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

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

Thursday – a day of gathering and outreach

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

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

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

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

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

Friday – a day of gratitude and taking stock

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

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

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

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

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

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

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

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

A weekend of celebration and passing it on:

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

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

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

Monday and beyond….

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

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

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

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

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

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

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

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

– sometimes to the point of burnout or exhaustion.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More than they have already.

For myself and my practice:

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

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

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

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

There are people doing amazing good for each other.

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

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

There is comfort and empowerment in that.

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

or by donating to The Red Cross.

copyright © 2012
All rights reserved Martha Crawford

Touched

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He looked unbearably young and vulnerable.

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

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

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

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

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

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

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

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

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

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

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

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

Fuck.

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

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

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

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

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

That being said:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

copyright © 2012
All rights reserved Martha Crawford

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