I sometimes dread being introduced to other psychotherapists.
“Hi! Nice to meet you – you are a therapist too?! That’s great – I do CBT, Motivational Interviewing and Behavioral Activation – what do you do?”
“I have an office…” I’ll vague out and drift off.
When faced with the alphabet soup of “evidenced based psychotherapies” I find myself lost and speechless.
I don’t begrudge or devalue any of those interventions for the therapists and the clients that find them useful and meaningful.
But that isn’t what I do.
None of the methodology, measures, the cognitive distortions or neuropsychological reprogrammings would have pulled me from the quagmire I inherited – there were only a few simple things that had any chance of aligning me with my soul’s mandate and the pursuit of meaning in my life: Image, Words, Metaphor, Relationship.
I can’t eliminate behavior, and wouldn’t even dare arbitrate which behaviors are healthy or unhealthy. I can’t fix a damned thing. And I don’t practice therapy that fixes anything, because, frankly, I never wanted to participate in a therapy or enter into a relationship with a therapist who wanted to fix me.
I can’t make anyone’s problems go away, including my own. And as I get older, and watch myself revisit the same conflicts and complexes in subtler forms I wonder if “change” in the sense that most people imagine it when they speak of psychotherapy, is possible at all, and if it is even desirable.
Healing is a word that means more to me than “behavioral change” but only if “healing” primarily means living with ever deepening compassion for our own, and other’s wounds and vulnerabilites. I am not a “healer” who knows how to make wounds disappear entirely, if at all. Scars, sensitivities, vulnerabilities, residues, susceptibilities, remain, even if the bleeding stops.
And often enough life gets better and worse and better and worse on its own – with or without psychotherapy.
So what do I do?
Its not just other therapists that want to know – clients also want to know “what kind of therapy” I practice – and they are especially entitled to an answer, and one that is not cloaked in mystification.
And here even the language of depth therapies fail me: I do not “do” psychoanaylsis or analytical psychology, existential or Buddhist psychotherapy – although these models and many others feel useful and meaningful to me at times in making sense of my own experience.
So I have an office. I sit in it. People come to see me, or sometimes we go walking together.
I care when the people who come to see me are angry, murderous, numb, disappointed, in agonizing pain, terrified, lost, stuck, bored, nauseated, lonely – even when it is very hard, very painful, or when they feel these things because of something I have done, or something I have not done or cannot do.
Sometimes when things turn brutal for someone I care about I’ll just hang on for dear life. I don’t give up. I don’t turn away. I am not pushed over.
I stick around. I listen and I don’t retreat, and I am not easily scared or chased off.
I try to picture in my mind’s eye the people, places, things, and images that I am hearing about or sensing. Sometimes images, feelings and pictures seem to float up in my own mind, drawn from my own life experience, themes from stories I have read, myths I have heard – and I put these into words to see if they are connected to the pictures and feelings that are bubbling up in the person near to me. I remain curious and committed to understanding the words and pictures and sensations that are being communicated to me as precisely as possible. I surf through the waves of my own watery unconscious and the unconscious of my therapeutic partner. I keep my filter down and my aperture open wide. I try to stay connected in the bumpy, rocky, scary, severe, extreme places where most social relationships will not venture. Where even familial relationships can’t, won’t or don’t go.
I lend my self out. Not my “healthy ego” – my Self, my heart, my dreams, the pictures in my head.
There are many of us who work in this way, and who could work in no other way.
I do this because it was done for me, and this meant the world to me.
Once, many many years ago, when I worked on a unit that served severely mentally ill adults, a psychiatrist pulled me aside to offer me some encouragement. “Do you know why your clients are doing so well?” she asked. “Do you know why they are getting better? Its not because you make sure they are compliant with their medication. Its not because you set clear behavioral objectives and treatment goals. Its because you love them like you belong to them. It’s because you take them into your heart like they are your own. You give of yourself, and they feel that and it makes them stronger. I don’t know why everyone just doesn’t do that.”
At the time I didn’t know what to make of what she said. But I didn’t then and don’t know now how to work any other way.
A few years later, at that same job, I would come to understand the need people had to work from objective and objectifying stances rather than out of their subjectivity.
On the unit we all had small safety windows in our offices – so therapists and mentally ill clients could feel both safe together talking with the doors shut. As I sat at my desk to take my lunch break, and get some paperwork done, I felt several pairs of eyes peering at the back of my neck. I looked out the window to see four or five of my clients lined up to peek in on me, one after another, while I ate.
I opened the door:
“What’s up ? Can I help you guys? I’m on a break right now okay?”
“Come on” one of the older guys said to the crew “we better go so that we don’t use her all up!”
I was getting used up, although it was never because of them. The agency and mental health system I worked in wasn’t designed to support those who worked like me. It was designed to socially control the greatest number of people for the least amount of money. Commitment, abidingness, endurance, resolve, availability, intuition and meaning were far less important than outcomes and measures, and the elimination of unwanted behavior.
Although it is true, then and now, that I must always be vigilant not to give too much, not to give more than is required, or needed. I remain careful not to ever give in a way that will make others feel indebted to me or that leaves me drained or resentful. But that is my job, my responsibility to regulate. And if, and when, I give more than I can afford, or more than others need of me, it is my job to correct and compensate for, and never ever because others have used me up.
On my long morning run just after an introduction to a perfectly nice evidence based psychotherapist who had recited his alphabet soup of what he “did”, I heard these words rising up from my beating heart:
“Its the relationship that heals it is the relationship that heals the relationship that heals. This is my fervent belief and this is where I put my professional faith”
When I got home, I googled a bit trying to locate the rhythm and the cadence of these familiar words and realized that this mantra had resurfaced, slightly paraphrased, from a book I had read only once over twenty years ago:
It’s the relationship that heals, the relationship that heals, the relationship that heals – my professional rosary. ~ Yalom, I. (1989), Love’s Executioner, London: Penguin Books, p.91
My acupuncturist once said to me: “I don’t know how you do it. How you work the way you do.”
I don’t always manage as well as I would like.
When my own life becomes a challenge or crisis erupts for me, or when I foolishly attempt an “objective” survey of the scope of what I have undertaken I can overwhelm myself: Caring for my elders, for my children, for clients. When I attempt to itemize the breadth and depth and range of all the different forms of care-taking I am immersed in, when I look at my days and weeks and attempt to catalogue all the pain, fear, vulnerability and dependency that is attached to me I sometimes fear that I can be used up and that I could drown in a flood of other people’s needs.
But, when I breathe, and move through my day moment by moment – I see that I am more buoyant than I realize and that I am tethered not only to my teachers, mentors, guides, and therapists, who stayed afloat with and for me, but that I stay afloat with, for, alongside and because of the deep and real relationships I have forged with those who pass through my office.
Image, words, metaphor and relationship cannot use me up. They fill my heart and keep me afloat.
It’s the relationship that heals the relationship that heals the relationship that heals.
Both members of the therapeutic couple.
All of us. Always.