The Change

A hand fan sits at the side table by my office chair.

I have become a lady with a hand fan.

And when a client tells me something that makes me laugh, or makes me anxious, or activates my over-protective anger on their behalf, or touches on some topic that leads toward a shame of my own – or sometimes for absolutely no reason at all – I feel a sudden flush, like a little lightening strike – that sends tentacles up and down my arms and up to my throat, past my ears up to my scalp and think:

Uh oh. Here it comes:

And then a sweat starts to break out on the back of my neck, and under my chin, and at my hairline, and across my nose and down my arms and its getting hotter and hotter and I know that is no where near peaking and passing yet. The client (it doesn’t matter man, woman or queer, young or old, four hundredth session or an initial consultation) is still talking and I try not to interrupt but all this heat is rising with an adrenal surge – if I don’t do something I’m going to have to run from the room and tear off all my clothes and plunge my head into a basin of ice water – so I go ahead and reach for the hand fan. “Keep talking” I say, “I’m listening” and I am, “Don’t mind me” as I start fanning myself frantically as the damp just begins to cause my glasses to slide down my nose. My hair frizzes. I push my glasses up and they slide back down. I flap flap flap flap and fan and fan myself until it passes, and the tingle has subsided, and the cool comes back in a relieving wave like when you open the door of a too hot sauna after the doorknob spun uselessly in your hand a second or two and you weren’t at all sure you’d be able to get out.

They look at me confused, or annoyed by this new and intrusive behavior: “Hot flash” I say. “Just a fact of life. I’m listening. Go on.”

A reminder to the client, and myself, that everything changes.

My gray hair is no longer premature. My glasses, even in their pleasing frames, are progressive lenses. Without technological advances they would have been trifocals. My paternal grandmother’s genetics announce themselves with the arrival of glaucoma and high ocular pressure that is nowadays easily managed with daily eye drops. I now suddenly have bad feet – neuromas, plantar plate and facia injuries. Mostly  just genetic signs of age. Like my maternal grandmother I now wear orthopedic shoes. Thankfully I have cuter options to choose from than the heavy black lace ups she had to wear. I don’t get to run outside anymore. Too hard on the infrastructure. I’ve shifted to an elliptical in my suburban basement.

Wrinkles I don’t care much about even if I don’t love the little sag I see coming in under my chin, and I work hard to be kind toward my changing body shape. My weight has stayed consistent – not skinny, not fat – always hovering around plump – but I notice age is redistributing things. Belly, bottom expanding – the parts of myself I was most ashamed of in youth and battled to suck in and minimize – now assert themselves and demand acceptance. I try to embrace the challenge – and the metaphor –  and integrate the suppressed parts of myself with compassion, and reach for new forms of healthy pride. I shop at stores that accommodate the tastes, desires and bodies of women of my age. And I am free at last from the curse of fashion magazine covers that compelled me to compare myself with those impossible airbrushed images, always falling short of my unconscious, internalized wish to identify with them. Now it is simply all too absurd and therefore nullifies their spells

I am not old, but I am older. And my “young” clients – who I met in their teens or early twenties when I was in my mid-thirties – who I watched grow up, are no longer young. In their late thirties and forties, I helped initiate them into adulthood and I will eventually initiate them into later middle age.

So I’d better pay attention because I don’t recall anyone initiating me. Or maybe in the arrogance of youth, I rejected the models of older women around me. Even though I admired their wisdom, I was afraid of their aging bodies:  their sensible shoes, their cute little attempts at working out, and their colorful dresses with “flattering” waistlines. Their little nothing-to-worry about skin cancer surgeries. Their forgetfulness and their brain-farts searching for common words. Their white roots showing in between colorings. Their chin hairs. Their chunky jewelry. Maybe I did dismiss those women’s bodies and their relationship to them, and the ways they had to learn to re-adorn themselves – by thinking of them as “old women” and their rituals as nothing for me to have to worry about for a long time.

And laughably they were likely all my age or younger than I am now

But I will have to initiate my tribe of clients into this space. So I have to listen to my body, and not battle with it, and do this with dignity and humor and face reality and find meaning and pleasure in it.

And celebrate the things that I have escaped from: street harassment, heels, henna and sunburned tummies. And revel in the things I have earned: long contemplative walks. The freedom that comes with being too exhausted to engage in any bullshit at all.

And take heed when I am with older and elderly clients, and clients entering therapy at this age, my age, who I see more of than ever before. Which makes sense: Why would you choose a therapist who hasn’t even begun their descent? Who hasn’t reached what we optimistically call midlife or who can have only abstract empathy as you are facing the decline?  So I listen to them closely. I watch them reach for unfinished business, and allow themselves to engage in wishes long forestalled. I watch them morn the foreclosure of lives they hoped to live but will clearly not now or ever come to pass. I listen to them contend with the loss of the generation in front of them and the arrogance of the generation behind them. I hear their anxiety about their financial futures, their fear of becoming obsolete in the work place, the challenge of retrenchment, of down sizing, of moving into smaller spaces, one level, without too many stairs. I hear them battle with an unending string of doctors appointments – too many specialists and a list of medications that keeps growing.

I hear of retirements and second chances at passions set aside. Of demeaning part time jobs. Of motorcycles impulsively purchased. Of unexpected divorces and break ups in long long term relationships. Of “practical” careers abandoned. Of gardening. And what its like to find themselves to be the old guy or old lady at the gym, or studying French, or learning to paint, or preparing to climb a mountain because they have always wanted to. Of libidos lost, and prostate problems and erectile dysfunction and painful intercourse. And wild, unexpected affairs with partners twenty years younger. And loneliness. And anger that the light is too brief and our time too short and how quickly it all flies by, in the blink of an eye. Of aches and pains and joint replacements. Of stroke and heart attack and cancer and dementia.

Of the audacity and the tender support and impatience of adult children. The excruciating pain of encountering one’s own failed parenting. The surrendering of freedoms, and privacy and driver’s licenses. Of grief – first of lost mentors, parents and elders, and then large die-offs of peers: a small wave gone in the mid-50’s, another cluster disappears in their 70’s. Of phones filled with phone numbers of the dead. Of the deliciousness of grandchildren. Of the anxieties that come with fixed, dwindling, or disappearing incomes. Of fear of mortality. And worse, the fear of infirmity coupled with lack of compassionate care.

Of the wacky, cackling joy of being an old coot who is less afraid then they have ever been because there is little to lose and everything to gain. Of  knowing how to grieve and having all hubris modulated by the inherent vulnerability of staying alive for sixty, or seventy or eighty years. Of the relief, the deep deep relief of not having to psychologically strive any longer to be things that you are not, or never really chose to begin with.

And of the memoirs they will write.

Their stories initiate me. I watch them lose their way and find their stride and settle back into power spots which sustain them for awhile until everything shifts again.

I store the stories of my elders in my life and my practice as guideposts – to learn from their mistakes, to orient myself, and to offer as a template to those behind me who will be joining the circle of elders eventually.

If they are lucky.

It all changes and keeps changing. Our work in psychotherapy changes dramatically as we age. It is no longer about constructing an identity, staking a claim, separating from family of origin, or the lure of great accomplishments.

The problem of the adult is very different. He has put this part of the road behind him, with or without difficulty. He has cut loose from his parents, long since dead perhaps… has possibly come to realize that what originally meant advancement and satisfaction has become a boring mistake, part of the illusion of youth… Here there are no fathers and mothers; all the illusions he projected onto the world and upon things gradually come home to him, jaded and way-worn. The energy streaming back from these manifold relationships falls into the unconscious and activates all the things he had neglected to develop.

~ C. G. Jung, Two Essays on Analytical Psychology, paragraph 90

The energy comes streaming back. All that was set aside asserts itself. It surges up from underneath the ego structures that we spent the first half of our adulthood constructing. It breaks out like a sweat, like a flash. We can thrash and panic or we can, flap flap flap, grab hold of our hand fans and cool the hell down – allowing it to move through, knowing that this is the task at hand.

There are great losses ahead as well as great opportunities to reclaim aspects of our identities long forsaken. Trials and treasures.  Blossoms and sunsets.

Me change! Me alter!

Then I will , when on the Everlasting Hill

A Smaller Purple grows –

At sunset, or a lesser glow

Flickers upon Cordillera –

At Day’s superior close.

~ Emily Dickenson




Address

In psychotherapy no subject is off limits.

We need to be reminded of that sometimes.

Some clients (and some therapists) have been taught medical models of psychotherapeutic care that suggest therapy clients should be focusing on “personal problems” and not “politics.” That talking about their place in the larger world is psychotherapeutic “resistance.”

Well, sometimes it is but sometimes over-focusing on individual problems is the resistance.

I’ve had clients who have talked about nothing other than the latest headline in the Daily News, for years. And clients who are so insulated or overwhelmed that they make no reference whatsoever to 3,000 people dying a mile from their home on September 11th, or a hurricane that floods and incapacitates the very city they live in.

Some are too porous, unable to insulate themselves, buffeted by every news flash, every Op Ed. Some have lost, or never had, the ability to discern between what is their business, their next necessary step, their ultimate work in the world and what lies beyond them, what is a fruitless or even destructive diversion.

Others live as if the larger community has no impact upon them, as if they have no civic or collective responsibilities of any kind.

We all live, embedded, in a particular personal, relational, familial, local, national, international community.

REBECCA: I never told you about that letter Jane Crofut got from her
minister when she was sick. He wrote Jane a letter and on the envelope the address was like this: It said: Jane Crofut; The Crofut Farm; Grover’s Corners; Sutton County; New Hampshire; United States of America.

GEORGE: What’s funny about that?


REBECCA: But listen, it’s not finished: the United States of America; Continent of North America; Western Hemisphere; the Earth; the Solar System; the Universe; the Mind of God–that’s what it said on the envelope.           

~ Thorton Wilder, Our Town, Act 1

We are fragile pack animals living in a particular time, in a particular place, at a particular point – embedded most certainly in the March of History and maybe also in the Mind of God.

Our personal patterns of denial, anxiety, despair, action and paralysis can affect the course of history as surely as historical forces shape and build, contort, lift up, oppress or destroy our lives

My grandmother-in-law told us a story over and over (retold here with my husband’s permission) about how she had learned of the concentration camps from a refugee who had escaped the camps by some miracle, to whom she had offered a meal as he fled, passing through her small town in Hungary.  Her assimilated Jewish husband and family didn’t believe her when she told them about what was coming their way. “You are being hysterical. It would never happen here. The Archbishop dines in our home!”

She wanted to flee. No one would listen. She was a canary in a coalmine, smelling the lethal gas long before the others who were focused on the problems and pleasures of everyday living. She could feel the vibration of the giant, pounding, destructive footsteps of a world historical event as it lurched toward her, soon to load her onto a cattle car annihilating her husband, her siblings, her nieces and nephews.

Her primal fear mounted, hysterical or valid, she couldn’t be certain, culminating in a choice between horrors: Two cyanide pills placed on the table. One for herself, one for her thirteen year old daughter.

“When they come they will put us in a terrible place, we will starve, we will be tortured. They may separate us. We will suffer. We will almost surely be killed. Or, we can take these pills now, together, and die peacefully. What do you choose?”

Our lives shape all of history and history shapes our whole lives.

But in each moment, all any of us can do is to assess, for ourselves: Are my fears founded? Are they over-reactive? Is this a cloying worry or a healthy fear? All any of us can do is to question ourselves: Am I too impervious? Am I in denial? Am I ignoring the signs and signals? Will I be on the wrong side of history? Or is this background noise that has nothing to do with me, that would be pointless to get caught up in?

Her daughter chose life. And they stayed together and survived the horrors of two deadly concentration camps – but the horror never left them. It shaped them forever, and their family and my family.

So: Sometimes I will explicitly ask clients how historical/political events are impacting them. I am certainly asking these questions now, at this point in time, in this particular moment in history.

Clients whose identities are marginalized or oppressed don’t assume I am safe to talk to unless I actively invite the content in. Other clients may simply not know that it’s considered legitimate for them to examine their place, their responses and responsibilities inside these events. Some need to be gently nudged awake or even shaken. Some need to be soothed. Some have constructed denial bubbles to insulate themselves but I can feel the anxiety churning underneath. A few know exactly how they are effected, monitoring their tendency to flood or to shut down or both – and actively work to stay calibrated and grounded. The activists I see are exhausted, absorbing so much vicarious and community based trauma they need extra permission to pace themselves. Some struggle so intensely with the pulls of their own internal conflicts – that there is scant energy left to take note of world events swirling around them.

The place where your identity makes contact with your community, your nation, and the historical moment is you too, and is absolutely as legitimate to discuss in psychotherapy as an argument with your partner or conflicts from childhood.

We can suppose we are insulated. But we aren’t really. It’s an illusion. We live in community. Our communities affect us like the water we drink, the air we breathe.

Almost everyone is feeling of powerless, worried, afraid of the deep polarizations taking place all around. Many are in active conflict, debate, estrangement with family and friends. Some feel that they are asphyxiating in avoidant silence. Some have drawn battle lines. Almost everyone expresses feeling simultaneously activated, and concerned that any action they may take will be impotent or destructive to themselves or others.

This tension of this particular place in time and history is a real psychological force that needs to be tended to and observed. We don’t know whether the tension will dissipate or constellate, and we don’t know how our choices will affect the outcome or how the outcomes will affect us.

Psychotherapy, at its best must make space for all of this too.

But listen, it’s not finished: the United States of America; Continent of North America; Western Hemisphere; the Earth; the Solar System; the Universe; the Mind of God.

 

In Public

(Note from Martha: “A.”, who meets me in my office for psychotherapy wrote a thoughtful and honest essay about having a psychotherapist who also writes and blogs about the processes of psychotherapy. I invited A. to share the piece here as part of a conversation about the challenges, annoyances and benefits of encountering your psychotherapist’s writing online. Some of this we have discussed together previously in the office, some of this was in the essay previously shared with me, and some of this we are processing together, as we write, for the first time.)

 

A: One of the first things that I asked you, when I became a client, was this: how did you experience having a blog reader materialize in your office? What was it like to have someone who had read your words, corresponded a bit by email, now sitting across from you in the flesh?

MC: It was strange. And touching. It meant that you already felt some connection, some basic alliance to a deeply personal part of me – it made me feel vetted and chosen for the work we would undertake together. Since you arrived (you started reading my blog very early, well before I closed the comments down), people have come to see me who are aware of the blog, or who have found the blog in pre-Googling me and decided that they mind or don’t mind or like or don’t care about the blog. But as far as I know, you were the first, and now one of very few people, who had an internal relationship to me as a writer, and who then took the risk to find out who I was, externally, as a therapist.

And it wasn’t just any piece that you contacted me after, it was a piece that was deeply personal to me, and that wrote about my own woundedness and healing and “re-membering” – and it meant a great deal to me for that to be so explicitly meaningful to someone that they would make an appointment with me.

A: What if I had just stayed a blog reader? What if you hadn’t emailed me back?

MC: I try to email everyone back – although I don’t often have space any more. I think that I remember that there was a significant wait between the time that you contacted me, and the time that we were able to begin working together. What if you hadn’t decided to wait? What if you felt rejected by that and never contacted me again?

We would have both missed out on so much.

A: Yes, I waited quite some time before summoning the courage to ask for an appointment. Via email, of course. That email went through many draft forms, and sat for a few months, before I finally hit ‘Send.’

I remember being taken aback by your size. You are quite petite and I guess I expected someone with such a big voice to be bigger. Not big, just bigger than you are.

MC: I don’t sound like a short little fast-talking person when I write? I wonder what I sound like?

A: I also had to reconcile the voice I imagined you having, with your real voice (of course, now that you’ve taken up podcasting, readers can know exactly what you sound like and no longer need to imagine your voice). I had my own idea of how your words sounded to my internal ear, and while I don’t have the words to describe that voice, the sound I imagined was different coming from your mouth to my ear. Like the way the character you imagine in a book doesn’t exactly match the actor cast in the movie. It takes some getting used to.

MC: It must have been very strange to have to encounter what you had projected on to me, and what limitations and imperfections that are inevitably edited out of my writing “voice.” You had to encounter my humanity and mourn some idealizations that had built up while you only encountered me in the ether.

A: Yes, that’s true. I think this is where I get annoyed with the people who only know you as the idealized therapist from your blog. In your writing, you can make everything look right, even if it’s not in real life.

So my relationship to your blog is complicated.

MC: So is mine.

A: On the one hand, it’s how I found you. On the other, it brings up a whole host of anxieties: are you writing about me? Why aren’t you writing about me? Why didn’t you tell me you were going to write that? Did you think of telling me about that post ahead of time?

MC: Have you ever felt unsafe or unprotected there, by me? Or are you talking more about the disconcerting experience of hearing how the work, and sometimes even specifically our work together, sits with me, and turns into a lesson for me over time?

A: No, I have never felt unsafe or unprotected. I think it’s more of feeling invisible.

Is it strange to have a therapist who blogs?

MC: I bet the answer is yes – although of course psychotherapists have been writing about their work and their cases for generations in books and theory, in psychoanalytic journals, in case presentations. But I suppose, that the intended audience in those circumstances is other psychotherapists – but they certainly aren’t the only potential audiences. Clients can purchase journals and search the archives and download abstracts of publications by their psychotherapists. I think that I decided that those publications were “hidden” behind largely illusory boundaries and pretend firewalls. And that if my writing could be available for purchase in a journal, it could be available and accessible for free online.

I’ve heard my psychotherapist present a case before – although thankfully it wasn’t MY case. But I suspect that if I did encounter something he had written about us, or me, or about what our relationship engendered in him, that I would be largely (but not entirely) comforted by it. And that comforted or not, it would be meaningful and incorporated into our relationship in meaningful ways.

A: Should I even read your blog, or not?

MC: Of course I will tell you that you are welcome to. I wouldn’t post it if I wasn’t able and willing to talk about whatever it may stir up or activate. But for yourself I suppose the answer to that question is what do you look to the blog for? What are you seeking there? What do you learn that isn’t revealed to you in session, or couldn’t be if you asked? Do you hurt yourself with it? Or comfort yourself? Does it soothe you? Or overstimulate you?

A: Initially, I look for signs of me. I have this ritual anytime you publish a new blog post. I don’t click on the link immediately. I wait, and when I’m ready to take it in, I quickly scan the entire essay, looking for any hints of me. Only once I know if I’m in the post, or not, can I give it a proper read. Sometimes I’m relieved to see that I’m there, sometimes I’m annoyed to find hints of myself; sometimes I’m relieved to see that I’m not there, sometimes I’m annoyed that I’m nowhere to be found. It’s complicated.

Sometimes I read just to understand what’s going in with you, to figure out what topics or ideas are being stirred up in your head, that wouldn’t come out in a session otherwise. Sometimes the blog is very comforting, present and past posts alike. Sometimes current posts are very over-stimulating and I can’t read it at all. It largely depends on the topic, and where I’m at in my own internal experience, and where we are at in our relationship together.

MC: That makes sense. I’m glad that you have found a ritual to create a frame around how you read it.

A: When we first started working together I feared I would never be interesting enough to feature in a post. Later I cringed to see anything that felt remotely familiar.

 MC: Cringed in what way? Pain? Fear? Or was it the uncertainty if it referred to you or us at all? Have you ever read anything that made you worried about my allegiance to you?

Heinz Kohut talks about the need that we have to be reflected back to ourselves in relationships, in ways that are simultaneously accurate and admiring. That many of us have grown up in a hall of fun house mirrors that have taught us ugly distortions about who we really are. It sounds like when you read something about a fictionalized or conglomerate client (i.e.: “Some do this, and some do that”) you might worry that you are the client being discussed, or that it activates a fear of being distorted? Or, when you have felt certain that I am processing something about our relationship have you felt unfairly represented?

A: I am all too familiar with that fun house of mirrors. I just cringed to see me, or us, or our work together, there in writing, on the internet, for everyone to see. It often feels like looking at parts of my soul from outside of my own body. And yes, I often feel disoriented and not sure if I am seeing myself or something else, all together, entirely different.

MC: It sounds like when I try to sift what I hear and what I learn as a psychotherapist down to its universalizing core – and it strikes you there – that it feels simultaneously relieving, exposing, erasing (feeling invisible). I do try to really boil the themes and ideas down to the marrow – I never write about anything that I don’t recognize as being located in the depths of my own soul, as a client, as a therapist too.

One of the most popular blog posts I ever wrote, I wrote thinking of you, almost as a prayer for you, and I don’t know if you saw yourself in it at all.

A: Not at the time. I wish you had told me this when you posted it. It would have meant a lot to hear that from you, at that time. I treasure it now, it is a wonderful gift, and it means a lot to me that your words resonated with so many of your readers.

MC: I think that it didn’t occur to me to tell you about the post, because I was trying to tell you, explicitly and directly exactly these thoughts in each session – and it seemed hard for you to take it in.

A: Well exactly, so maybe this was another attempt to get through to me? But this is what I mean when I say that you do such a good job of writing about the every-person that it seems everyone sees themselves in your writing and stories. So sometimes it makes it hard for me to find myself among the collective, among the shared consciousness and unconsciousness and archetypes and histories.

My favorite line in that whole post is this: “Sometimes when things turn brutal for someone I care about I’ll just hang on for dear life.” It is comforting to know that you will hang on, and won’t just drop your end of the rope.

But also, I am very conscious of “using you all up.” Of demanding too much, or taking too much, that you have nothing left to give. That is always a fear of mine. Even if you do your best to regulate on your end, I still worry that I am too much.

MC: I never experience you that way, I didn’t experience my clients in day treatment program that way either – I just needed to eat my lunch with the door closed, to feed myself, so I could come back to them.

A: Then there’s the reality that it’s your blog, and your side of the story. Sometimes it seems your readers hang on your every word, oblivious to the parts that have been edited out.

MC: I try to edit out parts to protect my clients – and report, as accurately as I can, my own ugly and unflattering failures – but I have noticed that weird phenomena – that when you try to write honestly about things you really truly feel failed at, strangers idealize you as being “brave” or “authentic” when sometimes I am neither – I am really just writing about failing.

A: I know. I don’t think all of your readers realize that you can actually fail. Some see you as this “amazing” and “perfect” therapist (you may have closed down your comments, but other bloggers will re-blog a post, and those comments are still wide open).

MC: I’ve never ever read that or followed those links. It never occurred to me.

A: I know you laugh at my references to your “fan club,” but you have one. And I think it even surprised me, to witness first-hand the extent at which you could fail. And that’s without ever idealizing you as the perfect therapist. I thought you might be a good fit for me, and I knew from your blog that I should be prepared for mistakes and mis-attunements.

MC: You and I hit a very hard impasse, while you were really just rounding the bend of your first year in therapy with me – and, in my mind – it occurred at the intersection of a few normative misunderstandings, miscommunications as well as some major misfortunes. As a member of the “sandwich generation” caring for my elders and my children, my mother became suddenly seriously ill – and I was under extraordinary strain: logistically, financially, emotionally. I was just generally as exhausted and depleted as I have ever been in my life, and I was not always able to protect my caseload, or you, from what was happening to and around me.

A: Sometimes it makes me feel trusted that I know more of the story than you share in your blog. Sometimes it makes me feel angry that you’ve left a critical piece of information out and I wish you hadn’t disabled the comments so that I could write in and set the record straight.

MC: Can you tell me when? This is your chance! Set the record straight! If you ever have felt distorted I will always want that clarified. Or are you referring to things about myself that I cannot see or understand easily without checks and balances of others in place? Even when it stings, I’m glad, ultimately, to learn about my own shadow from you.

A: You wrote a series of posts on conflict in the therapeutic relationship, at the exact time that we were embattled in a conflict of our own. It was the only time you told me in advance of a post that you were working on. You told me that the post was not about me. I didn’t believe you then, or now. Maybe it wasn’t entirely about me, but I was definitely in there. How could I not be?

MC: I still don’t experience that piece as being about you or about us. I wrote that piece trying to process what I was left with after a newish client walked out on me, quite enraged, after just a few sessions. It felt like a violent refusal to enter into conflict – and I was left with all this stuff that I really wanted to say and nowhere to put it. It was during this “sandwiched” time – and I was late or missing sessions in order to shuttle my mother to chemotherapy appointments and frankly I was pissing people off left and right. My kids were enraged with me because of my unavailability, my mother needed to handle more alone than she was capable of, I disrupted or disappointed or upset my entire caseload. I didn’t think of that piece as being about you, because we were actively staying connected in our conflict as hard as it was – I wrote it aimed toward all the clients I’ve ever known who could or would not stay when conflict emerged, and what I wished could have happened instead.

But I can never be sure what will emerge as an unconscious influence in something I’ve written. Of course you were present in that piece, as were all the people I was in conflict with at that time, all the people I was disappointing. But I wasn’t consciously focusing on our impasse as I wrote it. I recognized later that it could be read as applicable to us, which is why I wanted to give you a heads up – because I knew that you actually read the blog.

A: I too would have bolted if conflict erupted when I was still a “newish” client. I nearly bolted more than a year into our work together. What really upset me was that it felt that no one seemed to realize that there were actual clients behind these posts. That there was someone in sheer and writhing pain. I just wanted to scream “there’s a real person over here, in agony, curled up in a ball… could you all stop waxing and waning philosophical for a moment and pay attention to the actual person, over there in the corner.”

MC: I’ve been in that position in the past, curled in that ball. I knew you were in pain during that time. I didn’t forget your pain. And I know, with regard to that particular conflict, it is sometimes still present.

A: Yes, there can be a good side of anger, but I just felt that my side, the angry, dark, hurting side, was left out. I felt hurt, and like no one cared, because “hey, isn’t this anger stuff in therapy great!” No, it’s not, not when you are in the thick of it.

MC: It is terrifying and horrible when it is activated and we are lost in the thick of it, as you say. It is learning to survive it and find ways to regain and create intimacy that is the “great” part – but that is only great with some hindsight. In real time it is terrifying.

A: Sometimes it makes me feel annoyed that your readers get the benefit of our work for free, that they get a nice-and-tidy summary of one of our sessions, without having to put in anything. We did the work, I paid the fee, and your readers reap the benefits!

MC: You mean when our conversation teaches me something in real time right in front of you (as in that link)? And then I write out the pieces that came together so that I can remember it, and then I share it? I bet what makes you angry is that YOU taught ME that lesson through our relationship, and that I then made it my own, and shared it with others. But I HOPE that works in the other direction too sometimes? I hope that we always teach each other and can hang onto what we learn together, and make something of it.

A: I don’t mind you sharing our work with a broader audience. Like many who blog about therapy, and the kinds of issues that brings one to therapy in the first place, I’m delighted and touched if my own experiences and our own therapeutic alliance and processes can be of use to anyone else out there. If what we work through together in session can have a life and meaning outside the closed doors, and help alleviate the pain and suffering of another, then I’m thrilled.

I guess it just becomes hard when our work done together becomes your work. It’s not that I’m mad that you shared it, it’s that I wish for an acknowledgement from you before it gets shared out to the world. “The work we did today in session was really important and meaningful and I want to blog about that. Would that be okay with you, even if I can’t mention you, directly or indirectly, because I need to protect your confidentiality?”

MC: It’s difficult because I don’t always know what you will hear yourself in, or where you have entered into a piece without my awareness. I work very hard to disguise everything, and really think of people in the aggregate when I write. I don’t always know where you are. And even in the piece that you experienced as a very direct summary of our session together – as I wrote it I was thinking about all the ways that love is soft, and hard, and beautiful and violent. And again, when I was finished I could see how it overlapped with our discussion and other clinical and personal interactions that I’d had. And my own therapy and therapist too. I will make this commitment: when I know that I am consciously writing about us, I will be sure to tell you and ask. And I can I ask you to tell me anytime you see our relationship enter into my writing unconsciously? It is a very soupy thing. Our lives and our unconscious selves, and our “souls” without being too dramatic, become tangled up together – we become part of each other in ways that I image we don’t always recognize.

A: I know that piece wasn’t just about me, but about other relationships that you were working through. If you are wrestling with a certain issue, it is not surprising that you start to see it everywhere. And then we all work together, disconnected but collectively through you, to make sense of it all (again, making it hard to find one’s self in your writing).

It just felt uncanny – the timing of when you posted, the words and phrases that sounded verbatim to what we had talked about. I have no doubt that you worked out something for yourself when we were together. But I was a part of that.

Sometimes I think I get angry because you beat me to it. You figured it all out and wrote it down and posted it up to your blog before I even had a chance to sort through my own reactions and experiences. You’ve got a blog post written and I haven’t even made it down the elevator. And that, no doubt, adds to the confusion: what is mine, what is yours, what is ours together? How did I feel about that session? What came out? What didn’t?

MC: “What is mine, what is yours, what is ours together?” These might be the core questions of all intimacies.

A: I don’t have an audience with whom I share what I learn in therapy. I try to use it to make me a better mother and a better person, in general. But I don’t actively share any of what I learn with anyone. I indirectly share what I learn with my children. If nothing else, I strive to end the cycle of passing on generational wounds, for their own sakes. I don’t want them to have to re-learn things as an adult that they should have learned the first time around as kids.

I do want your readers to know that your openness and transparency online is magnified in session. You answer direct questions, you readily share your history and experience when it is applicable, you exhibit real human emotions whether it be joyful outbursts or tears of sadness. I feel I know you, the real you and not just some therapist persona, and that makes it easier to trust you.

MC: I think this is one of the kindest things that anyone has ever said to me.

A: You are human after-all, and not the super-human therapist on your blog.

MC: I keep telling people that, but the more you explain it to people, the less they believe you. Jung says that it is absolutely thankless to argue with the projections of others. And I am really grateful for all the humanity you have brought to our work together, and all of the ways you have encountered, and survived, and been patient, and kind, and held me accountable, and forgiven me for my own humanity.

A: That’s really irritating. How am I meant to top that? I guess it is YOUR blog, and by rights you should have the last word. But I’m not going to let you, not this time.

MC: Ha! Go for it. Bring it home!

A: In the end, I am more grateful for your place in social media than I am annoyed by it. I’ve (mostly) figured out where I live in the blog, where I am referenced, which posts are mine and which ones are inspired by me. Most of all it’s a way to connect, non-intrusively and from afar, as I count down the time to our next session. And at the end, connection is at the heart of a good therapeutic alliance.

On Leaving Gladstone’s Library

Note:  This seemed more like a post about writing than a post about psychotherapy, (although those identities are increasingly tangled up for me) so I posted it at Subtext Consultations. Here are the first few paragraphs and a link to read the rest: 

**********************************

How do I write about writing without talking about what I am writing about?

I don’t mean to be cryptic, I don’t mean to build suspense or be tantalizing – because the final product, if there ever is one, will a long way off.

So don’t hold your breath.

So there isn’t any point in my being coy – but I do need to find ways to skirt around the subject of my writing in order to talk about the process, and to acknowledge the incredible gift that has been given to me in the form of a two week stay at an extraordinary residential library in Hawarden, Wales: The Gladstone Library.

To read further please click here.

Listen in:

So: as I sit at Gladstone Library  on a writing retreat –  wrestling with writing a larger piece (referred to by some as “a book” ) and enjoying two weeks of reading, writing, walking and contemplation in Wales –  another thing has happened that readers and friends of the blog might want to know about:

As an excuse to schedule regular chats together: 12920497_559299710898889_471395175850904443_nJason Evan Mihalko Psy.D. ( The Irreverent Psychologist/ @jaypsyd ) and I have started a (probably)  bi-monthly podcast: All That Fits in 45 where we will be psychobabbling about all the things psychotherapetic  that we can fit in a forty-five minute hour.  You can hear our initial and introductory  episode  on iTunes or on Sound Cloud

I’ve learned several important things so far:

  1. I talk WAY too fast and will consume less caffeine before the second podcast.
  2.  My terrible potty mouth that has earned us an “explicit” rating (which is unlikely to change) 
  3. Jason is as thoughtful and available and hilarious as he is on social media, and great fun to talk to.

We will be recording our next podcast tomorrow on boundaries and psychotherapy to release at a later date.

If you would like to hear our meandering explorations of the psychotherapeutic life – you are warmly invited to listen in and to post us questions or topic suggestions for future conversations on Facebook or at Twitter (@AllThatFitsIn45 )

(And deep thank you to Cranky Muse Projects for their amazing artwork on our behalf!)12809693_556335131195347_7678051234958925582_n

 

 

Multitudes 

In everyday conversation we have come to use the word “ambivalence” to mean “indifference”:

“Where do you want to go to dinner tonight?”

“I dunno. I’m ambivalent, you decide.”

But when psychotherapists use that word that isn’t what they are suggesting at all. They mean they suspect or sense that you are chock full of strong and conflicting feelings.

And how fortunate we would be if it were a simple conflict between only two states of mind. Often it is a cacophony of internal voices, needs, impulses, prohibitions, and logical assertions all arguing, interrupting and all talking over each other so that we have no idea what to do:

“I just can’t make up my mind” (into one mind)…

To read more please follow this link to Psyched Magazine

Trembling

 

  1. The world does not know that we must all come to an end here; — but those who know it, their quarrels cease at once. ~ The Dhammapada

Every minute of 2015 someone who loved and needed me was dying,

And my experience, for every minute of 2015, was one of consistent, contained, unrelenting terror. I felt joy, gratitude, hope, sorrow and anger as well – but coursing under it all, was a river of pure fear, visceral horror – a kind of adrenal fuel that drove me into extraordinary feats of care taking, as I crawled along the edge of a knife.

And when they left this earth, my very first experience was relief- a relief that continues to expand – even through the early waves of sorrow – a relief that grows and solidifies underneath me as I integrate my losses and the intensity and duration of the waves of grief modulate, and as I return to life changed and grateful for all that they left behind with me.

And in its absence, I have become intensely curious about the specific nature of this terror, its origin, form and function:

Okay, so I was scared shitless. What was it for?

What, if any, good did it do?

  1. As a fletcher makes straight his arrow, a wise man makes straight his trembling and unsteady thought, which is difficult to guard. Difficult to hold back. . ~ The Dhammapada

I am not afraid of loss, or living with loss, or my own pending sorrows. I have lost many loved ones in my life and know how to take them into me, and keep them with me and draw strength from my evolving internal connections.

But I was and have always been terrified,  horrified by the presence and the threat of suffering in those I love, and in others.

And when death came, it meant that suffering, or the threat of suffering, or both, were over, and I was unburdened of my most primal fear.

All of this is fairly straight forward, nothing earth shattering or bone shaking here.

Just basic empathy: We would of course, as empathic people, feel distressed by the suffering of others.

But my primal fear irritated me like a severe allergy, it whispered in my ears all day long and it told me this:

“You must do whatever you can, every single thing you can, to control, eliminate, prevent, head off, or reduce their suffering. Any suffering they experience is your responsibility to respond to with all of the resources at your disposal. You must be available 24 hours, ready in a flash, to take action to do anything, everything, you can to prevent it.”

  1. “May both the layman and he who has left the world think that this is done by me; may they be subject to me in everything which is to be done or is not to be done,” this is the mind of the fool, and his desire and pride increase. . ~ The Dhammapada

I’m sure my red-alert-readiness, my foolishness,  actually bugs the shit out of others  in the moments when they are working hard, and maybe even succeeding at withstanding their own emotional and physical suffering.

And of course, I have to consider how this reactive allergy to the discomfort of others led me to this profession, how I am called every single day, to sit in the presence of sufferings that are not mine.  I have chosen a life that requires  that I sort through- thirty some  hours a week for  twenty plus  years – what sufferings I can help alleviate and what suffering is not mine, is beyond me, is unsoothable.

And to tolerate my own impotence in the face of it.

  1. Him I call indeed a Brahmana who, even here, knows the end of his suffering, has put down his burden, and is unshackled. . ~ The Dhammapada

As a psychotherapist I am so often powerless –  pressed into circumstances where any action I consider or any power I claim only serves to disempower the client I hope to serve. The more powerless I am the more I must acknowledge that the person sitting opposite me on the couch is the only one with the power to make sense of their own anguish.

Sometimes even actions as still as listening, bearing witness or sitting near are worthless in the face of suffering.

Then, I am afraid.

Sometimes fear is all I have to offer.

Because I’ve become curious, I have  asked clients who experienced severe suffering in my presence how my fear impacted them.

“It let me knew that you really cared.”

“I could see that you really got what I was going through and understood how horrible it was.”

“It meant a lot to me, it showed me that you loved me.”

Hearing this offered its own relief, but still, I wonder what I might have offered if I had been less afraid.

Fear can create an inflation, an adrenal hubris,  which can seduce me into assuming responsibility for distresses and discomforts that I can never soothe or assuage. 

And although I have built up the capacity to contain my behavior, the fear rings like a malfunctioning alarm that cannot be turned off once it detects suffering in the air. 

  1. Him I call indeed a Brahmana who has traversed this miry road, the impassable world and its vanity, who has gone through, and reached the other shore, is thoughtful, guileless, free from doubts, free from attachment and content. . ~ The Dhammapada

 

What if I could accept other people’s suffering as inevitable and unavoidable, as their own property without being afraid? Could I be more present, more connected?

Could I have been more effective if I weren’t so afraid?

Can I “hold” fear differently?

If this fear is a kind of empathy in itself – and I suspect it is – if I am holding and absorbing fears that others cannot hold alone,  is there a way for me to withstand them differently or better?  

Is it a human necessity for the alarm bell to be activated ? 

Is it possible or desirable to remain committed to ameliorating what suffering we can and still stay peaceful in the presence of intractable suffering?

Is it even “right” by my own values to “stay peaceful” or detached in the presence of intractable suffering?

Is that healthy detachment? Or indifference? Self-preserving? Or self-centric?

Or just cold?

  1. Him I call indeed a Brahmana who has left what gives pleasure, what gives pain, who is cold and free from all germs of renewed life, the hero who has conquered all the worlds. . ~ The Dhammapada

 These are questions that, consciously or unconsciously, psychotherapists and care providers wrestle with every single day. Psychotherapists need to build defenses and force-fields,  finding  ways to detach,  to self preserve and allow others to claim ownership of their intractable sufferings.

And let’s be frank: I suck at detachment.

 I wonder if it is possible not to defend, or distance – but to remain authentically attached, compassionate and peaceful when others suffer near us.

Isn’t the capacity to maintain some internal peace intrinsic to our ideas of mature compassion? 

Can we allow ourselves to be empathically affected by the intractable suffering of others and not tremble in its presence?

I tremble.

I just wonder if it’s mandatory.

It might be.

If it isn’t mandatory it might still be unavoidable. I am no Buddha, and no one I know thinks I’m on the road to Nirvana.  

Yet, I also wonder what life might look like, what consolations I might have to offer if I could accept my right and limited place in the world, to love with all my heart, to do all I can and should do, to be able to recognize clearly and preceisely when I should do no more, and then to calmly instill confidence in others that I believe they have the power and capacity to contend with, withstand or come to terms with their own suffering. 

And then, at that point, allow myself to rest, still and present, peaceful and unafraid.

May all sentient beings have happiness and its causes,
May all sentient beings be free of suffering and its causes,
May all sentient beings never be separated from bliss without suffering,
May all sentient beings be in equanimity, free of bias, attachment and anger.

 

(The Dhammapada translated by F. Max Muller)

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