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.
(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.
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.
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: Jason 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:
- I talk WAY too fast and will consume less caffeine before the second podcast.
- My terrible potty mouth that has earned us an “explicit” rating (which is unlikely to change)
- 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!)
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.
- 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?
- 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.”
- “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.
- 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.
- 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?
- 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 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)
I might, sometimes, be a good enough psychotherapist – although there are certainly those for whom I have not been good enough.
But I am most certainly a terrible business woman. I dread doing my professional accounts each month, my financial books are shaggy and unkempt.
And an interesting unconscious habit, a persistent black out, a fiscal “tick” has stuck with me from the moment I hung out my shingle: I spend hours making up bills – and I forget to hand them to my clients to collect my fee.
I have even (and this has happened repeatedly) written up a statement in the last five minutes of a session, for the client sitting in front of me, said “Goodbye! See you next week!” walked them to the door and listened to the elevator doors closing behind them – and looked down to find a monthly statement: the CPT code and session dates, any previous balance (from the month before when I also forgot to give them their bill) the total due and my license number – still in my hand.
I’m a shrink, right? I am trained to think about such things – so of course I do, and I have – for the past twenty years – and I still haven’t cracked it.
I’ve tried all kinds of behavioral interventions and mnemonics – set alarms, and organized visual reminders – nope.
I’ve set up rituals, which I adhere to, of reviewing the bookkeeping tasks for the day – uh-uh. Nothing penetrates the blank-out.
I’ve even held the remaining bills for the day in my lap, and forgotten to distribute them.
I mean, I get them distributed eventually. Some by hand, some electronically –but in fits and starts and herky-jerky – and in the end I feel very valued and valuable to my clients – and I am grateful that I usually get paid, and paid well enough to care for my family. But this odd billing disorder isn’t born of complacency. There have been many years where I was scraping by, or short on rent – and still found myself with a stack of undistributed bills sitting on my office end table at the end of the day.
I own my worth. I can set my fees at a rate that reflects my value and training and expertise. Sure, there are lots of therapists in NYC who have a higher average fee than I end up with as my sliding scale and flexibility with clients in crisis, and pro-bono cases drag my averages down. But that is not unconscious. That is my choice, those are my values, and that is what helps me to curate a healthy and diverse generalist caseload.
I’m not inhibited about talking about money, and I like getting paid. I can talk openly, and even enter into conflict about my fees – I make sure to manage fees in a way that protects my clinical relationships from resentment or overextension. My fees are high enough to require a significant, if proportional, commitment from my clients, and to meet my own needs for reimbursement for what I have offered up.
And so I dig deeper than that:
I sit in a room of my very own, and the world comes to me.
Seekers, from every walk of life, from every profession, from many different cultures, come to my door.
They bring with them, each of them, hundreds and hundreds of stories to tell. Thousands upon thousands of myths and dreams, narratives, of hopes and heartbreak are laid at my feet. The more still I sit, the more stories are offered to me.
Like gifts. Like precious offerings.
These stories, priceless and sacred, are left behind with me, a pile of totems, charms and talismans to protect and instruct me as I move through my own story.
Like a safe deposit box I am filled with other people’s treasures.
If I am very very lucky, and I have held still enough and said the magic words, whatever they may be, often enough (I am very very good finder of magic words) I may be allowed to become a part of these stories, and to help create their meaning and influence their outcome in some small way, and hopefully for the better (but you never know for sure with magic words, what forces you will unleash).
There are boring bits. Long periods of exposition or sometimes endless description of the landscape – but I’ve learned to rest during those patches because soon enough – the tale will pick back up and we will be facing demons and dragons and rescuing royalty and sitting on the edge of our seats and escaping by the skin of our teeth.
And each session there is a new and amazing hero, in a new story, and I am their trusty side kick, or their genie in a bottle, the village fool, the scape-goat, the ugly step-sister the crone in the hut at the edge of the forest, or the princess they have yearned for, or the Queen on her throne or the wickedest witch of all.
And the protagonists move through their tasks so heroically, with such courage and fortitude, I am continuously stunned and surprised by each new trick, each riddle solved, and every feat of strength.
And the story is so engrossing, so compelling, and it offers me so much even as I play my delimited part within it, that I am swept up and satisfied and filled. And like all big stories, big myths and dreams, I have been transformed myself by the tale.
And I think what happens – is that I just forget.
I forget, and sometimes it just makes no sense to me,
that I am actually supposed to be paid at this point in the adventure, as I wait, dangling in suspense for next week’s installment.
I can’t write authentically about anything other than early bereavement right now. Except maybe compound bereavement, complex bereavement, working as a therapist while you are actively bereaved. After your toes have been curled around the edge of the abyss watching several loved ones slowly slowly fall into it every single day for a year or two.
How you think, but you have thought before, that it has stopped – that the dying has paused – and that maybe the universe will offer you a decade or two to catch your breath before you again lose someone who is part of your psychological and logistical infrastructure – but what if it doesn’t pause (last time it didn’t) and what if it keeps going – and swallows someone else up you love, or you?
What if lightening strikes repeatedly in the same spot? What if freak events, school shootings, car accidents, house fires, drug overdoses, aneurisms or just more cancer cancer cancer keep coming?
About the feeling of falling down a rabbit hole, the floor pulled out from under you, and having no idea when or if you will hit solid ground again.
About the terror of looking forward – because it means encountering the days, years, minutes ahead without someone who you might have assumed would travel through time with you but is gone, and not just gone for right now, but gone always. Never to be seen or heard again
I can only in this moment write about how it is also hazardous to look back – because if you calculate all that you have negotiated and all the heartbreak of the death and dying cluster you hope you have passed through (but who really knows for sure) you will feel a fatigue so great, so crushing, so heavy that you know your body actually demands three solid months of sleep to recover – but there are children to care for and bills to pay, and the unflinching and unceasing demands of life to keep up with.
And the past has other dangers – sometimes called memories – which can comfort and soothe and strengthen you but can also turn against you into a brutal accounting of what exactly has been taken from you, and what is no longer with you in the present moment.
About the strange alienation when you hear normal people talking about everyday things – and who, understandably try to engage you in conversation about everyday things, while you are actually still living in the crack between the worlds where every second is both sacred and terrible and as far from everyday as humanly imaginable – but you somehow – strangely- without understanding how – are still able to chat and smile and nod and act “as if” you are a part of this earth – when you haven’t really come back yet, and aren’t sure who you will be when you do return.
And the times when you do feel normal – uncannily normal – like nothing happened, nothing changed – when you go about your business, and again, kind and well meaning people treat you as if you are still altered (you aren’t are you?) but you feel regular and you just want to cash in on that for the time being but everyone’s concern disrupts the illusion and you remember you have just had a human being that you cherished amputated from your life.
The self-compassion that you have to cultivate in order not to push or shame yourself, when you feel nothing, or you feel totally fucked up, or you feel fine, or you feel the worst, searing burning pain, or you feel terrified, or you feel lost, or you feel a little manic-y in your love of life, your appreciation for what is good or kind or just or beautiful, or your slightly panicked need to say every positive grateful thing you feel to the people around you over and over again in case you don’t get to say it later, or in case the moment arrives where you will never get a chance to say it at all.
How you search for places to put your thinking – or behaviors to engage in – that comfort you for a second and how you hope that thought or that photo, or that song, or that peaceful spot doesn’t dry up on you and lose its ability to function as a balm for all your sorrows.
Gathering your thoughts before sleep, trying to court dreams which make this make sense, or which offer consolation.
And how, you go to work, and you want to go to work, to tend to and care for others who mean the world to you – and stand shoulder to shoulder beside other people who are contending with challenges and suffering, loss, illness, bereavements, alienations of their very own – and your power to take those in, take those on, and mirror it all back can make your own wound useful – but can also exhaust you and expose you to profound re-injury – the most painful kind of re-wounding when you work from your vulnerability and it is rejected or attacked.
And can you really withstand that right now?
Usually, yes, absolutely. The connection and the potential of intimacy makes it all worth it, and probably there is an internal mandate to keep doing it because what else can you do? What other way of working in the world will cook this stew into something digestible?
But sometimes momentarily no. Not at all. It is not withstandable and why did I ever take on this fucked up job of absorbing other people’s aggression and confusion and wishes for me to be perfected when I am not I am not, I have never been and I am certainly not now, not at all. Who did I think I was? I suck at this, it is the worst and is there anyway to get out of this at this point?
Suddenly remembering that even your breakability is valuable because it connects you to the brokenness of others
Finding seconds of relief and stacking them upon each other.
Remembering you are grateful for the love that you are now grieving and for the love and kindness, and the attempts at kindness that are all around
Remembering what those you have lost would want for you.
Trying to see yourself as they saw you.
Arguing with them in your head. Giving them back the fucked up bits that they might not have accepted when they were alive.
Learning to speak to yourself in their healthy voice.
Recalling that everything you are contending with that feels unnatural is natural.
That grief is part of the natural order of things, and allowing it to function in your life as a natural force.
And remembering that it is all expectable. Necessary. Unavoidable.
That all this is just grief itself.
Nothing less. Nothing more.
(For an accompanying discussion on the processes of bereavement and how you can support those in early bereavement please read this. )
Update: The Astraea Ellie Conant Fund closed on June 30th after six months of fundraising and after an amazing glorious float in her honor rode down the middle of the NYC Pride Parade. At the time of its closing just over $18,000 had been raised in her memory to support LGBTQ youth in Korea.
I know many people who read this blog made contributions and I thank you for your kindness, and support and for helping to change the world in Ellie’s memory.
Recently I wrote a post entitled “Death Ed.” for a dear friend, a chosen sister who was facing a terminal illness.
She died early New Year’s Day, peacefully, in the arms of her amazing partner. We received the call as we were eating ttok mandoo guk, the traditional Korean New Year soup that she had taught us to make.
It is nearly impossible to describe Ellie to those who have not met her. It is also nearly impossible to explain to those who do not know us how it is that we became a family. Her own words are more effective than any of my own.
She helped to raise my children. She helped me care for my sick and dying mother.
She fed my Korean children the food her Korean mother fed her as a child and taught them to cook it for themselves.
She was there on our worst and best days as a family.
She understood my children in places that I will never comprehend, but will always respect.
She made me laugh my ass off even in the darkest times. She stepped up for me, and permitted me to do the same for her.
She changed people’s lives who met her one time, for ten minutes and never ever forgot her.
It has always been easier for both of us to give help and harder for us both to receive it. But somehow we learned to ask and accept and receive help from each other.
And because Ellie was such a supportive soul, and so encouraging about this blog:
I will take what we learned together and ask my What a Shrink Thinks community to help us make sure that this loss generates care and consolation for others:
Before her death, Ellie spent time thinking about her legacy, the causes and the people on this planet that she most wanted to support – projects that would serve as extension of her core values and passions. She decided that her memory would be most honored by caring for LGBTQ youth in Korea. With the help of Astraea Lesbian Foundation for Justice we are able to direct donations made in her memory toward a shelter in Korea for LGBTQ youth, as well as other projects.
Please help her extraordinary and nurturing spirit continue to work for change, compassion and liberation in this world.
Please share this post and follow this link to the Astraea donations page, and be sure to indicate that your donation is in memory of Ellie Conant.
Donations will be accepted through June, 2016–both the month of Ellie’s birth and the annual Pride celebration she loved so much. How fitting that we support her in spreading Pride into the world.
To my beloved adoption community:
So many people have reached out to us to ask how they can support our children through the loss of their dear dear Imo.
This is how:
Our bonds as a family were forged & solidified there, it is an annual community/family reunion for us and we hope you will all help us to keep Ellie’s generous spirit present at the conference so the kids can see that she is not forgotten.
She left us with so much , and I hope that we can extend that abundance to others.
With a full and grateful heart,
“I will say to God ‘Don’t just condemn me – tell me why you are doing it.”
The Book of Job, 10:2
Everyone writes about the Book of Job at some point – and maybe, every one who ever writes is really just writing about the Book of Job.
A lot of people really hate this story.
Not me. I find it relieving. It tells the truth straight up, no bullshit.
The world is not fair or just. God is not merely moral. Life is feral. Fate is fickle.
If we are concerned about being “good” it better be for our own sakes, so that we can feel clean and proud of ourselves with few regrets when the shit hits the fan – because the shit will hit the fan someday, and often more than once, sometimes so repetitively that you cannot bear it. Because Life won’t be good to us just because we are so very busy trying to be good.
Being “good” protects you from nothing. Evil can win. And karma isn’t always the bitch you hope it will be.
So if you haven’t read it (just in case there is anyone who hasn’t read it) here is what happens: God bets Satan that his most faithful follower, Job, will remain faithful no matter how he is tortured. Satan takes that bet: destroys his crops and herds, kills all of his servants and children. Seven sons and three daughters in one fell swoop.
Job is traumatized beyond all imagining, but retains his faith in a just and powerful monotheistic God. So Satan asks to up the stakes: Illness? Physical suffering will surely break his faith: Sure, God says, just don’t kill him: Job is covered in boils from head to foot.
At first it seems like he is holding it together:
“Shall we receive only pleasant things from the hand of God and never anything unpleasant?”
But when Job finally speaks to his three closest friends – we learn that he is traumatized to the point of suicidal despair. He has lost everything that was ever comforting or meaningful to him. And he is grieving the destruction of a cherished fantasy that there is order and justice in the universe. It is dawning on him that whatever he thought God was, he is not an omnipotent parental God who rewards goodness and punishes evil.
And over the course of the next few chapters he will also learn how much his friends suck.
They all, one after another insist that God is both omnipotent and just. And therefore, Job is responsible for his own agony, a sinner who must repent.
None of them will stay with Job for a moment as he ponders these excruciating questions: What if God isn’t just? What if I didn’t do anything wrong, or certainly do anything wrong enough to warrant THIS – then what? What if God isn’t what or who I thought? What if I projected my own sense of morality onto an entity that is something else entirely? Does my blameless suffering, and the blameless suffering of others prove that I am more moral than a God who would torture me on a whim? How do I stay attached to Life, to a sense of meaning or purpose or beauty or awe if I live in a Universe that would allow dark forces to destroy everything I have ever held dear? If Evil is permitted to dwell in comfort and decent men are permitted to suffer – If I chose to continue to believe, what is it that I believe in?
And the God of Life comes to Job as a Whirlwind. And speaks of wild animals and the Big Bang, and the wind, and rain – of the firmament and lightening. And of instinct and intuition. The Sacred Whirlwind speaks of lions, of ravens, of mountain goats and wild donkeys and oxen. The Divine Hurricane roars about ostriches: who abandon their eggs without a thought, completely devoid of maternal impulse but who can run faster than the fastest horse. The Holy Tornado of Life goes on and on, about hippopotami and crocodiles (the crocodile actually gets seven or eight full paragraphs of speechifying). The most primal, powerful, lizard – a being designed purely to devour and survive – a creature that we would never dream of considering on moral terms, except in our most anthropomorphizing moments: “Oh that poor baby zebra! That terrible monster just ate him right up!”
A crocodile, a hippo, an ostrich or a hurricane are neither right or wrong, moral or immoral. They are. They just are. Beauty and horror swirl and twist together in the Awesome Cyclone.
Job and his shitty friends have it all wrong.
Once I asked my martial arts master about the role of aggression in all of the animals forms we studied: The Monkey, The Tiger, The Dragon, The Sparrow, The Snake.
“They will all kill, you ” he said “but it is not their intention to kill.”
These are the forces that the God of Job identifies with.
Life is feral. God is not in the business of justice. The Sacred is a wilder and more primal, more ancient force than Job or his cronies knew.
It is not our fault. It is not the Whirlwind’s intention.
The Whirlwind may strip us of all the things we have ever believed or loved. It may tear our lives apart. And it will be completely natural for it to do so.
The Cosmos is neither wicked, nor just. It is not fair or unfair. Life is not reasonable or unreasonable.
To ask “Why?” is simply a wrong question, and mistakenly assumes a reasonable, moral explanation.
And there is a worse question, one that will lead us to wish we were never born and to yearn for the grave. A question that compounds trauma and impotence with rage and shame:
The most destructive question we can ask, with our fists raised to the heavens:
A question as senseless as asking Why matter? Why anti-matter? Why ostrich-eggs? Why crocodiles? Why hurricanes?
When we expect that the Holy Tempest is supposed to operate within the parameters of human morality, when we imagine that we deserve justice from the Hands of Fate – we have set ourselves above nature. We imagine that we should be able to command The Storm of Life to unfurl itself neatly even though there is nothing tidy about a storm. It assumes that the balance of Nature is morally ordered.
To ask “Why me?” in a wild amoral universe – is a dead end proposition: The only possible answers – explored all through out Job – lead to the depths of despair: 1) Trauma and clusters of cumulative trauma are the fault of the individual due to sin, foolishness, or error. Or 2) The Universe, God, Fate, the Powers-That-Be are intentionally, purposively sadistic or criminally neglectful.
Fairbairn says that in this circumstance most of us will turn trauma in on ourselves – that we would prefer to eat the sin and take the blame than to live to in a universe steered by the Devil’s whims.
The only psychologically tolerable answer to “Why me ?” is this:
There is no answer. The laws of probability mean that some people will experience cumulative traumas and losses and some will not. In terms of moral explanation it is an inherently unanswerable question and any answer you attempt to extract can lead you toward suicidal despair.
The Book of Job suggests that you need to ask different questions entirely:
Questions like these:
Can you look squarely at the cruelty and beauty of life – at the awesome power of a Wild God, of a Universe which is not centered in anyway around you or your comfort or your goodness and still choose Life? Can you summon the energy to find meaning in living when everything is taken from you? Can you still love a God that might strip you of your very identity? Can you feel awe for a primal force, for a Sow who will bear and suckle her piglets but who might also eat them? Can you withstand the horrors of living and stay committed to the miraculous precarious balance of the world? Can you cherish your own brokenness and suffering and the brokenness of others? Can you lose people you love, or many people you love, can you be profoundly harmed, and still continue to love?
Can you withstand the fact that living is in no way a secure proposition and be filled with awe at its power and fragility, even as it destroys you? Can you embrace this feral universe – with all its destructiveness and creativity – as surely as the God of Job loves the potent, dangerous, glorious, primal crocodile?
We may be sacrificed like Job’s children, as the gods gamble with our fate. We may shatter like ostrich-eggs. We may also acknowledge that the fragility and destructiveness of all of nature lives in our own wild hearts. That, within us, lives the terrible crocodile and the frightened zebra that feeds him.