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.



Persona: (Latin, “actor’s mask”) One’s social role, derived from the expectations of society and early training. A strong ego relates to the outside world through a flexible persona; identification with a specific persona (doctor, scholar, artist, etc.) inhibits psychological development. ~ Mario Jacoby The Analytic Encounter

Man is least himself when he talks in his own person. Give him a mask and he will tell the truth. ~ Oscar Wilde, quoted in The Book Of Symbols: Reflections On Archetypal Images

It started with a dream about red lipstick.

Bright red. A color I’ve never worn, except maybe during my onstage past.

When I woke up – I let my mind wander, and could almost smell my grandmothers lipstick, the blot of red lips imprinted on the tissue paper that floated down toward the wastepaper basket from the vanity.

My maternal grandmother – a farmer’s wife – put on her red lipstick, her girdle, her clip on earrings and sensible shoes before church on Sundays, or maybe in anticipation of a day trip up north to the city. By the time the car pulled off the rural route and back up the driveway home, the girdle, the earrings and the lipstick were all off – removed in the car on the trip home, if not even earlier in a powder room somewhere, stuffed in her handbag.

My paternal step-grandmother – on the other hand – wore red lipstick, and carried a long black cigarette holder in every photo and every single time I ever saw her (which was not all that often) at home with a martini playing bridge or for dinner at the Lafayette country club.

Their red lips marked them as surely as their affectionate kisses marked their grandchildrens’ cheeks: as women of a certain age and era, as women who were beyond thinking what the young thought of them – in the early 70’s the young wore heavy eyes and no lips – or no make up at all – and as old women who had no further interest in current fashion or trends.

Perhaps, in their twenties and thirties in the 1920’s and 30’s the same crimson mouth carried different connotations. Maybe at first a certain youthful, flapper-esque daring, and later a hat-wearing-lady-like respectability.

I thought of it as the fire-mouth, a severe slash of horizontal seriousness and propriety, as a war-face applied before heading into the fray. You took grandma seriously when she wore it. When the lipstick was on, she meant business, and would put up with no truck from a whining child. Red lips meant she had expectations of you.

I’ve never worn red-lipstick, because I associated it with elder maturity, the mark of the Crone, the kiss goodbye to youth and girlhood. For me, red lipstick is what white-haired old ladies, who you do not want to mess with, and who don’t give a shit about looking young anymore, wore when they meant business.

As I dozed and remembered the smell of my grandmother’s lipstick, the eye-watering pain of clip on earrings, and the click of a string of costume beads or the tap of the black cigarette holder in the ashtray and brittle looking ankles rising out of suede high heels I laughed to myself – realizing that already, twenty years younger than I ever remembered either of them being – I am already a white-haired woman, who doesn’t give a shit any more.

And who is done putting up with nonsense.

Time to bust out the red lipstick – and claim my own fire-mouth.

All transformations are invested with something at once of a profound mystery and of the shameful…. Metamorphoses must be hidden from view, and hence the need for a mask. Secrecy tends toward transfiguration: it helps what-one-is to become what-one-would-like-to-be;…. The mask is equivalent to the chrysalis. – Circlot: A Dictionary of Symbols.

As a kid, I was “taught” make up at the local community theater where I spent as much time as possible – as part of the actors craft. It made me younger when I needed to play a smaller child, could change my coloring and ethnicity when coupled with a blonde wig, and could turn me into a boy when needed. It’s first application marked the transition from rehearsal to performance. I once even raced from the theater, still covered with painted freckles, to my mother’s second wedding.

The directors who led our motley troupe – in a pick up truck and gun rack town – were older men: actors, opera singers, musicians who had modulated their big dreams to fit into an underfunded ramshackle theater in small town suburbia. After three or four years of loyalty and hard work as part of the repertory, at 14 or so I was invited to my first “grown up” cast party. The front door opened and I saw men known to me in the rehearsal hall as beige, gray, unshaven, and irritable, in all their glory: A silver turban, a sparkling purple beaded robe, an ivory kaftan with golden thread… and those rosy faces, cosmetically shaped jaw lines, flushed cheeks, dramatic eyes…

and of course, bright red lips.

The finicky and easily exasperated “old” men (probably younger than I am now) who barely tolerated a precocious child actor and regularly shushed me in the wings were suddenly alive, smiling, embracing me – offering me my first ever sip of their gin and tonic: “Just one sip! I do not want your mother to hate me!”

As beautiful as butterflies, as shimmery as peacocks.

Their painted masks introduced me to who they really were.

There are aspects of self that are only accessible and able to be revealed through a mask – as the external image and persona is manipulated to reveal aspects of our true selves that would remain hidden otherwise.

Since the mask stands between one’s self and the world it has a dual nature: It looks both in and out. A mask can disguise, cover, veil, lie, capture, release, reveal, project, protect, disown, recollect, deceive, dissociate, embody and transform. ~ The Book Of Symbols: Reflections On Archetypal Images

Winnicott speaks of the True and False self in the same space that Jung speaks of persona and for both the false socialized self is seen as healthy and necessary to some degree for social functioning – without it we would say and do things impulsively, selfishly, that could expose our vulnerable true self or harm others. Healthy false selves keep us from killing when we feel murderous, or initiating sexual contact with everyone we are attracted to.

It also protects what lies underneath: Winnicott says that the False self often brings the true self to treatment – like a protective babysitter – to make sure that the therapist is safe enough, and has created a safe enough environment to let the True self emerge.

Aggression, rejection or distortion aimed at someone’s consciously crafted persona is annoying, but the same act committed upon a True Self is utterly annihilating.

Winnicott also chillingly describes the pathology of the False self:
A False Self that has convinced itself it is the True Self.

It is common for clients to present in therapy in great distress when they have become lost in their persona – when their relationship to their external facade has become disrupted, uncomfortable or painful as internal pressures, changing life-stages, or external events require the surrender or adjustment of the face they have constructed and presented to the world.

Clients can lose their jobs, their function, or their standing in the community that they equate with their identity: How will I recognize or myself if I am no longer wearing the mask of a philanthropist, a church volunteer, a doctor, an artist, a lawyer, a psychotherapist?

Some attach to their role in the family system: as spouse, son, daughter, parent, sibling. When the family system is disrupted by death or separation, divorce, adoption or reunion – they find themselves disoriented in relationship to their own persona.

Internal prods, the insistent Unconscious eruptions of the psyche, the push of pain and the pull of hope also can put us in a dissonant relationship to our mask of choice:
“I never thought of myself as some one who would have an affair”
“I used to love my profession, but I’m so burned out I think I may have to give up teaching”
“I’ve become someone who only takes care of children – if I don’t figure out who I am other than a mother – I’m going to explode – I can’t take it anymore!”

Suddenly, the soul demands that the old persona retire itself and a new mask must be painted that creates a face that matches and protects newly emerging aspects of the self.

Age and body changes associated with adolescence, mid-life and old age should move us through our make up and wardrobe transformations as well – some of us accept such mandated role and costume changes more willingly than others, and for some they evoke profound identity disturbance as their appearance no longer fits how they think of themselves.

There are darker functions served by masks as well:

Masks are also instruments of lies, tricks, and self-deception Our culture endorses the manufacture of many “good” and “branded” personas which mask greedy, devouring and destructive behaviors. Many of us think of ourselves as exemplary citizens while we have hidden from ourselves or flat-out ignored the destructive effects of our cars, consumption habits, institutions, corporations and governments on unseen or disenfranchised others and on other species, and upon the planet itself.

Pigs wearing lipstick abound:

Our culture denies bias, racism, and heteronormativity even while it remains manifest, food labeled “healthy” masks toxic farming practices. Clean coal. Industrial growth is the face of the dark trickster that depletes planetary resources.

Disasters emerge to pressure us to shake off our collective, cultural facades and bring our false fronts into alignment with our realities: terrorist acts, war, extreme weather events, gun violence. But, too often it seems that our collective cultural and national False Selves have usurped the Truer collective spirit.

We all lie to ourselves and to each other continuously. Those who hold on to their personas lightly are willing to adjust their sense of self to accommodate new information about their effect on others. Those who cling tightly to a false self, delete and deny any information that disrupts their status and sense of public persona.

Therapist’s very often find themselves sitting with clients who are actively consciously, or unconsciously deceiving themselves. Sometimes, they choose to maintain the front at all costs, as they hang on to a persona at the expense of their souls. Re-painting the house while the pantry is empty: Staying in dead marriages for fear of the neighbors’ judgement, managing to other parents competitiveness rather than to their own children’s needs, arranging outer-appearances to look just so while mess, chaos, and destruction storm within.

A mask is a disguise which transforms the wearer, hides or heightens his personality, or identifies him with the character of the mask. Purpose: Impersonation of deified natural forces, spirits of the dead, totemic, hunted or phallic animals, respected or derided human beings for:
1) arousal of a desired emotion: bravery, self-esteem, prophetic trance
2) exorcism of baneful sprits
3) coercion of more favorable spirits.
4) Social prestige
5) Moral control and social therapy by fright or burlesque
6) Entertainment by presentation of stories, sacred or secular or by laughter producing satire

Usually more than one motive is involved.

~ Funk & Wagnalls Standard Dictionary of Folklore, Mythology, and Legend.

I still put on my make up when it is time to perform.
Not much really, it’s the ritual that I require, the transition from the comfortable introverted privacy of home to the extraverted bustle of the city and the rigors of the office.

It puts my impinging vulnerabilities away inside. It draws out my sense of strength for those who need to see me as stronger than I may be.

I stand in front of the mirror as my grandmother did, as I did for years in the dressing room before curtain.

I stand still and look squarely in my own eyes: I pull out my brushes, with long black handles. Like my grandmothers cigarette holder, like the set of brushes that waited for me in the drawer at North County Community Theater.

I put on clean smelling lotion, and some translucent powder. (interesting slip – I first wrote “power”) I apply some mascara- I need big eyes to see deeply into complex problems.

And the last thing before leaving the house: I apply my fire-mouth:
For screwing my courage to the sticking point.
For telling difficult truths.
For giving voice to intuitions from the edge of awareness.
For calling bias, contempt, racism, objectification, and abuse by their true names.
For finding words for the destructive realities that we hide from ourselves.

And for reminding the world that I have expectations, and I am well past the point of putting up with nonsense.

copyright © 2013
All rights reserved Martha Crawford

Advice: Dismissed, Unheeded and Pooh-Pooh-ed

There are things that most therapists say, wish they could say, or have given up saying, that no one ever listens to anyway.

You probably won’t listen either:
But what the hell – I’ll give it another shot:

Please get your thyroid checked, your blood sugar, make sure you aren’t anemic. Get a blood test and a physical. If you are an older man, check your testosterone levels. (I see your eyes glazing over already) Let us make sure before we spend hours and hours and you make a significant financial investment in psychotherapy that we aren’t trying to talk your glands or your pancreas into functioning more consistently.

Your symptoms don’t just live in your mind. Your mind is housed in your body. You have to treat your most pernicious anxious/depressive symptoms in your body too.

And, sure, yes, I am also talking about exercise (recent, flawed studies aside) If you’ve had your exam and your physical health permits: Get some air, some sunshine. Or get rained on. Go to a gym. Find some exercise that you find pleasurable, and do it whenever you can find time and push yourself out the door. Work up a sweat. Salsa dance. Rock climb. Or just walk. Especially when you don’t feel like it. Just around the block a few times, or to the corner and back. Spend a little time in the company of your own body – pay attention to it. We just feel and function better when we treat our bodies with self-respect.

If exercise offers no gain at all – or your energy and motivation is too too low to even consider it – then we need to intervene with your body in some other way: Medical intervention and medication may be a possibility for those who feel committed to the medical model. There are other routes as well: Acupuncture, yoga, a nutritional consult. Therapeutic massage, qi-gong, tai chi, Some believe that a ‘cleanse’ can reboot their bodies response. Some consult an herbalist. Eat aruvedically if that is your thing.


Any gesture that will get you respectfully engaged with your body’s needs again.

The futility of directiveness, I suppose, is why I allied with psychoanalytic, existential, and depth psychology models – as I’ve surrendered to the notion that there is no such thing as effective, directive advice, and that our cognition is rarely changed with out understanding our deeper fears, inheritances, habits, survival mechanisms and resistances.

But I’ll admit, sometimes I still try to slip it in, sandwiched in between moments of exploration and mirroring, amplification, and empathy.

Sometimes I am just itching to tell you what to do.

Especially when you are asking me to.

Actually, its when you ask me to that you seem to listen least of all.

I would prefer, if you are considering taking, or feel that you will benefit from psychiatric medication that it be prescribed by a board certified psychiatrist, and please please please, if you won’t or can’t use someone that I refer you to, please find someone who will collaborate, or at least return my call. Please ask them at the first consultation.

Say words like these:
“Will you feel comfortable collaborating as part of a treatment team with my psychotherapist? How do you prefer to be contacted? I would like to be sure to sign a consent for the two of you to communicate before I leave today. Are there times when you might want to know what is happening in my therapy, or would want feedback, or have questions for my therapist?”

I would prefer that you see someone who truly believes in the construct of the lowest therapeutic dose as an guiding ethical value. I would prefer that you consider it as a last resort rather than a simple quick fix. No matter what medication you may utilize for whatever emotional symptoms trouble you, please bear in mind that medication will not change anything enough in and of, or all by itself. In the very best case scenario, it is a single, potentially effective tool to apply to a multi-pronged problem. Tools can be necessary and make things easier. And tools can be dangerous and injurious.

And you will still need to talk things through, look at your choices, heed your intuition, change your life-style, confront changes that you would rather avoid.

Continuing on:

If you are single:
That is fine. Single is not pathology. Life as a single person can be an excellent and healthy choice, and far far preferable to life in a toxic destructive relationship. You are not less than because you are not in a relationship. You are not more unhappy than many many people who have partners. You may have different kinds of unhappiness then they do. Committed partnerships do not inherently make people happier. There are miserable people single, and partnered. There are joyful single folk, and joyful married folk.

No one ever listens to this at all.

If you are dating:
You can have no idea if someone is “perfect for you” after three dates, or a couple of hook ups. Truly. You, and everyone who loves you will be spared a great deal of agony if you can tolerate that fact that we human beings can be extremely attracted to someone who we don’t know at all, probably exactly because we don’t really know them at all.

Enjoy the pheromones. Try to guard your attachments until trust is earned.

And the second prescription for dating singles is like unto it:

Just because you have a somewhat icky feeling after the third week of seeing someone doesn’t in and of itself mean that you should dump them. That icky feeling may very well be a signal that this is a relationship that has the capacity for intimacy. Intimacy is scary, and dangerous. It could hurt you. But, it is what most people are seeking when they look for love. When intimacy begins to emerge – it can scare the shit out of you. Wait a few more weeks before bolting. Get more experiential data. Maybe it is a signal that something is wrong or not working between the two of you.

Or maybe its a signal that you could change each others lives.

In someways, being consistently ignored in my more advice-y moments has been relieving from the inflated illusion that I may have substantial power in my clients lives.

Its proven to me that none of of us take in anything that we do not want to, or are not ready to hear.

And none of us can take any action, or change our thinking until we are ready.

But, lets keep going shall we?

For parents of young children:
I know it is expensive, I know its a hassle. I know you are so exhausted you are done for by nine o’clock. But for god-sakes you need to get away from that baby sometimes. If you are in a couple, you need a date night. Single parents also need nights out with other grown ups: Ideally once a week but for many that is a tall order- but at least twice a month – once a month? Your child truly, ultimately doesn’t want to eat you alive, but they will if you let them.

For the chronically overworked:
You need to leave work at a reasonable time at least once a week. If it were up to me it would be more. I know there are deadlines, and this is a big ambitious city. But you need to have some sacrosanct activity – in addition to therapy – that you leave work for and show up to regularly. A book club. A painting class. Any of the activities that I already mentioned that you don’t remember because you were just yes-ing me and not really paying attention. You need to leave work sometimes. Your employer, may, in fact be happy to eat you alive, but if you let them, you will be even more miserable.

My words wash out into a wave of white-noise: just as any adult in Charlie-Brown’s universe: Wah-wah-wahwahwah-wah.

For those who complain about boredom and isolation:
Volunteer somewhere, or get connected to a community organization. We feel better when we are connected to a community of others who share similar goals and values.

A church, a temple a mosque, a political campaign, a charitable organization, and animal shelter. Habitat for Humanity, an urban garden. Its easier to feel connected to people when we are working side by side. Its easier to chat and get to see something about another’s character when you are pulling up weeds, or serving soup, or doing something meaningful together.

There is a vague and anxious guilt that accumulates when we stockpile all of our personal energy for ourselves – and don’t generate something for others. Do something that makes you feel clean and aligned with your own values and proud of yourself.

Certainly by now I have lost you.

But shall I continue to proffer and assemble my beautiful bouquet of all things ignored?

If you are “stuck”:
Keep a pen and pad by your bed and write down whatever you can remember about your dreams. I know, I know, you don’t dream, you never remember your dreams, your dreams are “just weird”, about nothing, are just little bits here and there, mostly about your job. Please. Pretty please? Just indulge me?

When you complain of feeling stuck, and spend hours and hours polling your friends and family and neighbors, and me about “what you should do” to get out of your circumstance – the problem is that you haven’t forged a sufficient, or patient relationship with your own intuition.

You don’t know what you are hungry for and you are asking other people what you want to eat for dinner. The answer will only come from the outside in that your internal hunger will recognize it or reject it.

You can eliminate the middle-men and learn to listen to yourself directly. Your dreams, your unconscious, your psyche is chewing on all of this stuff day and night. When you sleep – you produce little mind-movies about the dilemmas that are most central to you. When you have failed to solve the problem with your consciousness, why not try letting your unconscious have a crack at it? What do you have to lose?

Turn off the morning talk radio ( you only have about 30 seconds to a minute to remember your dream upon waking) set your alarm 7 minutes earlier and hit snooze. Use the 7 minute interim to think about where you just were, and write it down. Even a few key words may help. It might be boring at first. Detritus from the day – nothing exciting – but these are symbols produced by you – and if you keep paying attention – we will certainly find some content to riff on, some grist for the mill, that may lead us right where you need to go.

A drip, drip drip at a time, water built the Grand Canyon, and its part of my work to chip, chip chip away at people’s resistances to the activities of daily living that will at least make our work in the room flow more smoothly, and best put you in more contact with yourself, your core needs and a sense of well being.

But, certainly, you can feel free to ignore me about this too.
Its fine.
I’m resigned. I’m used to it.

For those who “do not know what they want:”
You will likely need some space in your life for some kind of conscious, waking contemplative activity. Learn to mediate, or write in a journal, or draw or create something. You need to spend some time listening to your inner world. Even if its boring or hard. You need to grab your fishing pole, cast the line, and wait for a nibble. Day dream. Paint. Garden. Hike. Buy some charcoals and one of those squishy erasers.

I know its embarrassing. Its not about creating a masterpiece, its about exercising your creative imaginal capacities so that your creative self is more engaged with the process of figuring out how to live a fulfilling live. Something quiet, and a little bit alone. 5 minutes! Thats all I’m asking! Fine, then just 3 minutes doodling and fantasizing and exercising your imagination?

Your imaginal world is going to give you far better advice than I can if you will just spend a couple of minutes listening. How will you be able to surprise yourself if you fill up every moment with email and texting eating and fretting, and TV and live-streaming, and errands, and work?

But I still I sit in my chair, week after week, year after year, trying to restrain myself but, of course, I crack, and indulge in re-re-re-reciting the most basic life prescriptions.

My words blow back to me like spit in the wind…

But random reinforcement is the most enticing: Every once in a while, one pushes through the icky feeling and finds the love of her life. Another, who had become hardened and frozen and cynical discovers his yearning for meaningful engagement with the world by listening to his dreams. Someone treats their thyroid and finds they have more energy for life. Two or three date nights reanimate an unhappy couples dormant sex life. A regular mediation practice slowly relieves life-long anxiety.

Just enough to keep me hooked.

I try not to. I know its dangers.
It almost never leads to anything good.

Except for when someone actually listens.

A quick note about this post: WG at Therapy Tales illustrated a silly, lovely distillation of this essay – Be sure to see the previous post for the charming result!

copyright © 2012
All rights reserved Martha Crawford

Guest Blogger – Martha Crawford, LCSW

Been sort of HEAVY around here lately, so it seemed like a good time to LIGHTEN UP.

It is a total gas, and honor to collaborate as a guest blogger with the brilliant WG at Therapy Tales!

Thanks to WG for this beautiful piece of silliness and to everyone else:



Often, after chance encounters on the subway or a restaurant- or even just in front of the building when I dash out between sessions to grab a cup of tea, I’ll hear from a startled client: “Oh, I thought you were taller!”

I usually respond: “Yes! Funny – I am actually a short person!

So many questions emerge about these shape-shifting impressions – many explored together with clients when we are back in the office. Other queries play out in private or with my professional and personal supports:

Is this merely the client’s essential need to see me as “big”? Is it their projection, idealization, transference that makes me loom large in the office?

Do I claim my limited authority appropriately? Or do I fail to take sufficient ownership of my mastery, fighting against any whiff of idealization? Or perhaps am I too puffed up, inflating myself, taking up more room than I should? Do I shrink my patients, or do they shrink themselves? Are there ways I initiate this illusion? Am bigger than I realize? Smaller than I am admitting?

Is the illusion co-created, the necessary outgrowth of the role I have assumed in their lives, the innate power-differential between therapist and patient? Or an unspoken expectation that I am unconsciously compelled to live up to?

Of course, the answer is “yes” to all of it – at once and at any given time.

Thank goodness for all the belittling, devaluing, deflating content that emerges in the therapeutic process, or a gal could get a swelled head.

But the question that emerges more and more for me at mid-life, having spent all of my adulthood immersed in the therapeutic process in some form or another: What effect does all this expanding and contracting, stretching and shrinking, inflation and deflation have on my being, on my personality, on my persona outside of the office?

Can it wear out my elastic? Will I always snap back into shape? Do I have the strength to continually experience both ends of the polarity? How does it effect my behavior with loved ones, strangers, acquaintances? How does this vocation shape, prune, contort, and wear on my identity?

Many years ago when my analyst and I prepared for him to undergo a potentially life-threatening surgery he asked me, as one of his oldest (meaning earliest not elderly) clients, if anything happened, would I speak about his work, about who he was in the room, because otherwise, no one would know.

I understood exactly.

Working in secrecy, in privacy, in confidence means that many aspects of our identities live behind the veil too. Just as clients often wonder if they are “real” people in my life, I wonder too if the attentiveness, nurturance, patience, and insight that I can channel in office are actually “real” aspects of my personality that I can claim as my own, or if they only can exist in the consultation room, in co-created transactions with clients. Would the people in my daily life who encounter my needs directly, who experience my fussy, fretful, defended, unreflective, selfish, wise-cracking, frail moments even recognize the strength and equanimity I am able to summon in short bursts when I am working in a transitional space?

A dear friend who is the son of a shrink told me about his experience of coincidental encounters with his parent’s patients out in the world: “I’d look and I’d know immediately who they were.” he said, “They were the ones who were getting the good stuff.”

For the therapist, the profession, by its very nature, acts as a chronic, seductive call to hand over all of your better nature, all your altruistic and charitable impulses, all of your golden kernels of wisdom, patience, nurturance, sensitivity and generosity, leaving your friends and loved ones with nothing but cold, inedible cobs and table scraps.

Empathy-fatigue is the cruelest occupational by-product.

It requires constant vigilance and monitoring to make sure you are giving a sufficient but not excessive amount of your emotional attention to clients, even those in desperate need, no matter how deep your affection for them. Passing through alternating states of imbalance is inevitable and unavoidable as the pendulum sings and circles past center, calibrating and compensating for the emotional output.

There are late evenings, sometimes whole days, maybe even a few weeks at a time spent tapped out, mildly irritable, impatient for gratification, comfort, restoration. When you spend all day being your best self – your worst, most needy ravenous self will inevitably emerge – most likely in your intimate personal relationships – hopefully in ways that are claimed and acknowledged and that allow for compassion and reparation for yourself and everyone around you.

“Talking like a shrink” is another common professional hazard: The use of strange, jargon-y speech combined with a concerned tilt of the head, micro-nodding, an unnaturally soothing, overly modulated almost-but-not-quite-inauthentic tone of voice, with a hint of concealed impatience, an aroma of condescension, and subtle notes of repressed rage and baby-talk.

I fight against “shrink talk” with everything I’ve got both, in the office and at large. I curse, use the crass vernacular, any practical metaphor I can grab hold of. I throw everything but the kitchen sink at it. And still now and then, while sorting through something mucky (therapy-speak translation: “processing conflicted self-states”) it slips out. Soon, hopefully, my children will be old enough to mock me mercilessly when this happens – which will be warranted and helpful.

Talking-binges: My husband and close friends bear the brunt of all the unspoken backed up self-referential nonsense, mind-minutia, random thoughts and mini-epiphanies about myself and my own needs that have emerged during the week. Luckily for them, I’m perfectly content to have them only half-listen while I talk my fool head off – spilling out all my dammed-up verbiage.

Weirdly, there are also just as many moments – commonly during times when the work has been particularly demanding after some great achievement, crushing failure, or professional milestone has occurred – when the combination of the intensity of the work and the requirements of confidentiality leave you with absolutely nothing to say at all:

“What is new you ask? Hmmm, it feels like a lot, but I guess really, nothing much…. nothing really…. just work, life… Boring I guess. How is your new job going?”

I suspect, that another one of the intermittent side-effects of being a therapist is superficially impaired listening in social relationships. After concentrating intently on others all work week, I am, at week’s end, left with a kind of social attention deficit: distractibility, diffuse attentiveness, unintentional interruptions, confusional loss of the conversational thread, unwitting changes of topic – as my brain releases its hyper-focus on all the mechanisms of communication: the unconscious slips of the tongue, telling word-choices, and unfinished sentences inherent to therapeutic conversation. My nearest and dearest offer me some time-limited forbearance – before they tease and challenge me to pull myself back together and pay balanced attention. I am grateful for both their patience and for their limit-setting.

I do know that when real needs are on the table that I can usually summon my best self, listen with deep attunement, and serve as a generous friendly resource. In times of crisis I am an effective, incisive receptive and emotionally available “go-to” friend and partner.

That being said, I have become significantly harder to befriend over the years. New relationships undergo significant vetting. Outside of the office I swerve and dodge, erect boundaries and hold even slightly imbalanced relationships at bay.

Most people seem to have at least one or two friends who are beautiful wrecks, messy charmers, or substitute younger siblings, who they enjoy taking care of, where a little more care is given than can be received. Often this imbalance is corrected for in other ways: the more vulnerable friend is loyal, funny, appreciative, enjoyable and allows the more stabilizing friend to identify (or over-identify) with an earlier phase of development, or to have some vicarious experience of a larger, more passionate, and expansive, if messier range of feelings.

I have learned, often with great sorrow, that I am not capable of sustaining that contract any longer – at least not while doing the work I do, and raising young children – even for some lovely people that I enjoy, admire, root for, and feel deeply moved by.

In my non-work relationships I am ravenous for full mutuality, equality, for a balanced exchange of giving and receiving. I invest my time in people that I can turn to, who call me out, tease me, make me laugh, distract me, indulge me and confront me. Friends and loved ones who are not impressed, know that I need exactly as much as they do, even when I am unable by professional mandate or fatigue to say why I am depleted. The relationships with people who are direct and strong-minded and out spoken, who don’t ask me to decode them, are the ones that allow me to fill my belly, laughing deeply and appreciatively at my own expense.

This is what all therapists need from their intimates to keep them from getting stuck or becoming bored, boring and brittle, swallowed whole by their own professional shadow.

That’s what keeps the snap in my elastic.

copyright © 2012
All rights reserved Martha Crawford


I am many things, I have some strengths that I can fairly claim as my own: I sing great lullabies, I am a voracious reader, an eager student. Although I probably think I am a little funnier and smarter than I actually am, I’m pretty sure I am generally amusing and informative to chat with in a social settings. I am very sensitive to color, and so my outfits match, and I’m good at decorating my living spaces in pleasing ways. I am interested in interesting people, and can curate pretty satisfying holiday parties with good food and good company.

On a professional level, I fancy that that I am, for the most-part, a good-enough therapist. Sometimes, I am even downright inspired at what I do. I have my small, brief flashes of brilliance.

And, there is a lot of stuff I really suck at.

Here is a sampling:

I wouldn’t say it is my regular practice, but it is not uncommon for me to be between 5 and 8 minutes late. Sometimes I also unintentionally start sessions early, or add additional time on the end of sessions.

(Unless you are my first patient of the day, and then it is actually uncommon for me to be on time. I give fair warning when people take these slots, and make up the time for all my latenesses at the end of sessions)

Of the all monthly statements I hand out, at least 2 or 3 of them each month are wrong – sometimes to your advantage and sometimes to mine. Sometimes they are glaringly, ridiculously wrong.

I regularly forget the dates, or mis-record when you have said that you are away on vacation, calling while you are in the middle of a massage on a beach somewhere, wondering why you missed the session.

It often takes several email attempts, with me offering alternate times, and then “oops!” taking them away again, for me to be able to reschedule appointments correctly.

I can only bear to sit down once a month to face-down my bookkeeping, and if you have a special request – such as a summary for past sessions, or reprinting a bill that has been misplaced – It can take me forever, and I may need multiple reminders.

For new cases, I often forget entirely or write down the wrong diagnosis code, or procedure code on your statement, which will annoy you only after it has first annoyed your insurance carrier, and delayed your reimbursement.

If you write me a check, and ask me to hold it until a specific date I have been known deposit it anyway causing you to bounce checks.

I think those are the highlights.

If you look at the list closely – you might quickly notice that it is all about time, money, numbers or dates.

But most clients don’t see or look for a pattern, they just feel the stinging effect that my error, my failure has on them.

They feel understandably forgotten, or angry, or disregarded, suspicious, neglected, ripped off, or exasperated. Some feel embarrassed for me, trying to find excruciatingly polite ways to show me my error with out shaming me, or revealing their disappointment or frustration.

People assume that it means that I am indifferent to their needs, that I am spacey or absent-minded, or flabbergastingly disorganized, lazy or dumb. Others forgive me instantaneously, too quickly, before they really take stock of the injury or irritation that has been inflicted.

Many expect that once they have mustered up the courage to say something to me about it, and I have heard them out, that I will never do it again.

But I will do it again,
and I make no promises that I won’t.

There are some things I simply cannot do no matter how much someone else wants or needs me to.

And there are some things I am not capable of no matter how I wish it were otherwise.

Its taken me my entire lived life to come to terms with that.
I still struggle with it now and then.

Here is what I can promise with absolute certainty: I will always, want to hear about the effect I have had on you. Even when it is hard for me. Even, and maybe especially when it makes me uncomfortable.

Better me than you. Its not rightfully your burden, its mine.

These are my limitations. I own them – I understand them. I have some appropriate compassion for myself, and even if I cannot do a damned thing to change reality, I can own the effect I have on others.

I would rather you never have to accommodate to my limits, but I have learned that I am not always able to protect others from the obstacles that I live with each day.

So, I will seek out, and actively withstand every feeling, frustration, anger, fantasy, sorrow, pity, fear, suspicion, and speculation about my “real” intention or unconscious motivation. I will reach for every association, every painful memory of past disappointments, every time someone has failed you in this way, left you waiting, made you feel forgotten, miscalculated your needs, or pressured to compensate for their failings.

I do not have any need to be protected from any of your feelings. And I absolutely do not want to leave you alone, to metabolize the effects of my incapacities.

Of course, I’ve been in the analytic community for more than 25 years as a patient, a supervisee, a student, a therapist, a supervisor, a group-member, and as a therapist to other therapists. I’ve withstood and earnestly explored every interpretation, blind guess, paranoid projection, thoughtful analysis, over/under reaction, judgement, assumption, and diagnostic formulation about these difficulties: hostility, anxiety, resistance, control issues, narcissistic indifference to others, separation difficulties, boundary diffusion, attention seeking, entitlement, self-sabotage, fear of success, an extension of my conflicts with my mathematically minded (and severely dyslexic father) affective flooding, masochism, on and on…

I am used to it. Through out my school years, everyone, including me, assumed that my difficulties with any numerical process, my complete inability to learn my multiplication, addition & subtraction tables, to remember my locker combination, to tell and estimate time and distance, to discern my left from my right, to know which way is North, to count change, operate a calculator or a cash register, to keep track of my belongings, or memorize a phone number were because I was a scatterbrain, or not paying attention or applying myself. I was clearly smart – it made no sense to me or to anyone else to assume that just I couldn’t do it.

Because I know what disruptions calculating time and money represent for others, I’ve devised some methods for coping with my disability: I use an analogue clock in the office because it is helpful to me in visualizing spatially how much time remains. Calculating time forward or backward from a digital clock was too difficult. I suspect I would function best with an hour glass.

(Actually, that is such a brilliant idea, that I just bought one for the office, just now)

I found a workable billing program which helps me prodce accurate bills about three-quarters of the time, but cannot completely protect me from myself: bad data in – bad data out.

There are times in the office, when it leaves me utterly helpless, lost, bewildered and vulnerable. I have to ask for help in figuring out a balled up account, a confusing insurance payment, a mysterious outstanding balance. I have had to accept clients protecting me (or not) when I have made billing errors, great and small, at my own expense. I’m sure that in my vulnerability I have also experienced losses and maybe even been taken advantage of, in ways that I will never, thankfully, be able to track or know about.

My cognitive limitations have forced me, over many years, to learn to be authentically, undefensively fallible, to recognize when I am beyond my capacities, to admit my need, to ask for assistance, and to accept help, while remaining intact.

I do not collapse in shame, doubt in my ultimate value or competence. I know what I have to offer. I know what I do well, what I do exceptionally well, what I do not do well, and what I cannot do at all. I have weaknesses and strengths. I am not afraid of either.

Most clients, over time, over several reworkings, begin to trust in the ways that I am solid, even if my numerical, mathematical, logistical functioning is not.

And I’ve come to understand that my inability to hide my weaknesses, and accept them, somehow gives others permission to accept their own real limitations with some self-compassion, and compassion for the people they effect.

If you, or especially if a child you know seems to have any of these difficulties in learning, calculating, mathematics, time-telling, counting change, etc. Please see or for more information on learning disability diagnosis and support

copyright © 2011
All rights reserved Martha Crawford

A Tale of Unmatched Socks and Miracle Chili

Essential Care, Handling and Training of Oneself
Part 3 of 3

A couple of years ago, a good friend of mine invited our family over for lunch. She was serving “Miracle Chili.” The miracle, she said, was that for the first time in her life, she had discovered how to cook something that she liked to eat and wanted to share with others.

I understood exactly.

I remembered a hazy afternoon in my early 20’s, laying on an unmade bed, wearing the sweatpants I’d put on the night before to save time, surrounded by piles of clothes, books strewn about, an empty fridge, and a notice of overdraft on my checking account. I dreamed of a magical day in the far distant future: a day when all of my socks would be matched and tucked neatly in a drawer. When I would know how to balance my bank account and have invented some schema for paying bills on time. I would know how to shop and plan a menu and cook something I might actually like to eat.

If I’d had more energy or imagination that day, my fantasy might have become even more complete: I might have a regular exercise routine, a physical practice that I approached with structure and commitment. I would discover some spiritual path, a meditation practice and a values-based community that would feel authentic to me, not strained, randomly chosen or forced. Some part of every day would be silent. I would learn what my body needed to be able to get to sleep at a reasonable time, stay asleep through the long night, and wake up feeling ready to face the world. I would have time to read books of my own choosing, spend enough time in nature, and explore museums to feed my hunger for beauty. I would remember to take my vitamins and get my haircut when I needed it. I would find a doctor – a general practitioner, a gynecologist, a dentist, and an acupuncturist that I trusted and would keep appointments regularly.

The process of self-care and healthy self-parenting never ends; it moves and doubles back, re-formulates as we age, change careers, and enter into new stages of life.

In my mid 20’s, I realized for the first time that I needed to begin some kind of regular exercise practice, when I first dated a guy who ran regularly.

I bought a cheap jogging trampoline – with legs that I could screw off and store under my bed. I would run/bounce, singing along to loud music with all the lights off. Obviously, I could only engage in my chosen “sport” when my roommates were out of the apartment. As a long-term exercise plan, it had some limitations.

I signed up at the public pool, swam laps at designated shifts. Frozen hair in the winter with no blow dryer outlets in the changing room ended that. I joined and quickly quit a gym- skeeved by all the indoor sweating, the damp leather seats, and the disturbing Orwellian image of people watching the Nature Channel while running on treadmills.

By my 30’s, as I began my clinical practice, it became clear to me that I needed a daily physical practice more than ever to feel well – and that my own right exercise needed to happen outside. I needed air, weather, horizon, wind, ground, and distance. I began hiking the trails outside of the city on weekends, and taking 10-12 mile urban walks during the week. I skipped subways and scheduled appointments so that I had opportunities to walk as my primary transportation. I bought an ergonomic backpack and all the weather gear I needed.

As my schedule intensified and I had less time, I bought books and looked at videos on speed walking. I did my pointy-elbowed-hip-swinging-goofy laps, 3 miles religiously around and around Washington Square Park. I grew less embarrassed, and prouder of myself, when I began to pass the slower runners.

A move to a new apartment put me near a softer running path – and I began running 2 or so miles several days a week. When we became parents, I realized that since there was no more reliable silence in my home, I needed my exercise to double up with my meditation practice. I began studying tai chi and bagua individually once a week with a martial arts master. For the past 7 years, I’ve had my own regular practice – running, meditation, and martial arts practice 4 or 5 days a week, outside, in the park near our home. And with the proper gear, neither snow nor rain nor heat will delay this courier from my appointed rounds.

Learning to cook, finding the right health care providers, establishing a meditative practice, finding a spiritual community, creating systems for housekeeping, devising my own rituals for good sleep hygiene, all involved lengthy processes of building up mastery, growing pride in myself, uncovering knowledge about what was realistic and sustainable for me, and gathering data about what actually felt good, right, interesting and pleasurable.

Don’t even think about getting it right the first time. Forget about finding and “settling” on one routine or system. Your needs will shift; your time, your energy, your location, your commute, your finances, and your priorities will change over time. And so will your bill-paying routing, your workout, your diet, your shopping list, and your bedtime.

As all things, these are fluid practices – you are unlikely to find a routine that “fits” all of your life stages, local logistics, and physical changes as you grow and mature. In Winnicottian terms: “holding” and what it takes to feel held becomes increasingly complex and changes throughout life and development. An infant is easier to hold and care for than a toddler; and providing a sufficient holding environment for a teenager is a far more complex process than mere diapering and bottle warming. Holding our adult selves well – creating a rhythm of life and activity that makes our adult needs feel contained, soothed, regarded and respected is a veritable Rubik’s Cube: needs coming into conflict with each other, switching and flipping back, working through, to find the right time and space for them all.

And then doing it over again when growth or change messes it all up.

Miracle Chili actually takes years and years to cook. Years of first learning what you are hungry for, what you like, what you digest well, what tastes good together, and what really feeds you.

And I vividly remember the day when I opened my dresser drawer and realized that somehow – after years of struggling to pay attention, many starts and stops, relearning, reworking, and regrouping – that all my socks were matched and rolled neatly in my sock drawer.

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