Address

In psychotherapy no subject is off limits.

We need to be reminded of that sometimes.

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

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

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

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

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

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

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

GEORGE: What’s funny about that?


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

~ Thorton Wilder, Our Town, Act 1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Nothing More

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.

 

 

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(For an accompanying discussion on the processes of bereavement and how you can support those in early bereavement please read this. )

 

 

 

 

 

 

 

In Conflict

Anger (v) c.1200, “to irritate, annoy, provoke,” from Old Norse angra “to grieve, vex, distress; to be vexed at, take offense with,” from Proto-Germanic *angus (cf. Old English enge “narrow, painful,” Middle Dutch enghe, Gothic aggwus “narrow”), from PIE root *angh- “tight, painfully constricted, painful” (cf. Sanskrit amhu- “narrow,” amhah “anguish;” Armenian anjuk “narrow;” Lithuanian ankstas “narrow;” Greek ankhein “to squeeze,” ankhone “a strangling;” Latin angere “to throttle, torment;” Old Irish cum-ang “straitness, want”). In Middle English, also of physical pain. Meaning “excite to wrath, make angry” is from late 14c.  ~  ( http://www.etymonline.com)

So someone is always angry at me about something. At least one person a day, often more than that.

Often enough with good, fair reason and because of something I have done or not done, said or not said. I am running late. I push when I should have held back, or held back when more was needed from me.  I can make my own errors, stumble about, bang into a painful bruise. Sometimes I am clumsy, slow, frustratingly thick-headed. Or lost in my own projections, operating on an erroneous assumption, or stuck in my own subjectivity.

Sometimes people are angry because they have been sold a bill of goods, hopefully not by me, although I am probably also a participant, that psychotherapy can offer them a cure, some relief, when the truth is less certain. Sometimes it can and sometimes it can’t.

People get angry that I don’t have the magical powers to take their pain, their confusion, their ambivalence, to heal the wound away.

Some become angry that I don’t just know. Right away, instantly, what is needed and how to provide it. Sometimes people become angry because they have told me what they want from me, and they believe that I am withholding, refusing to cough it up.

Some want to control, extract, command that I fill their need to their exact specifications and are enraged at the dereliction of my professional duties when that need remains thwarted, unfulfilled, exposed, empty when I can’t. Or won’t.

Some become smaller, exceedingly polite, self-diminshing in order to metabolize the anger that a mis-attuned moment has activated. And then I have to drag  it out of them:

“I wonder if something I said made you feel angry?”

“No. I am not angry….”

“Well, something shifted in our conversation and it seems like maybe I said something that hurt? Maybe anger is a strong word for you? How about annoyed?”

“Well, okay. Yes. Maybe I was a little annoyed”

Some become angry because I can see the pathway in, I have gazed at a vulnerable and naked space in them – and they want to cast me out and drive me away. Some are secretly terrified that I will go and their anger helps them organize a pre-emptive strike. Sometimes anger helps people self-regulate, manage their dependency, separate.

Sometimes the anger that emerges in session, or is directed toward me is obviously displaced, patently unfair. A lashing out. And still, somehow, it is almost always understandable to me when I can hold, or uncover the subjective context that it is embedded in.

Usually I am a participant. I bear at least some responsibility. At the very least I lit the fuse, even if I didn’t build the bomb.

Sometimes the client is angry or disappointed that I have my own wound. And they have found the very spot where my needs, my history, my trauma, my vulnerability lives and they want something from me in the exact pocket of my psyche where I have nothing to give at all.

Some attack or express contempt for my core values, my stance, my beliefs, my sense of what is right. Some reject the models of psychotherapy I have embraced, the patch of ground I stand my professional identity upon.

And of course, I get angry too.

I breathe and do my best to stay cool. I contemplate the tightness in my chest: What am I responding to? Where do I feel strangled, offended, tormented, grieved, distressed? What needs to be opened up between us in order to be released from this constriction? Where has our relationship grown too narrow?

If I am caught off-guard, or feel too reactive, too agitated, I  may ask to table the discussion until I can think with a cooler head. But the arrival of anger must never be ignored or forgotten. It is a sacred signal and attention must be paid. We must return to it, examine it, discover its gifts and lessons once our nervous system and our heart-rates have settled.

Anger and aggression have important, constructive functions too: to establish boundaries, to protect privacy and autonomy, to fight for justice, to correct imbalances, to guard vulnerability, to take risks, to hunt for prey, to compete for resources, nurturance and provisions, to challenge and surpass ourselves.

And sometimes to forcibly remove obstacles to intimacy and wholeness.

In relationships, anger points our attention toward the tight, narrow, constricted, strangled, tormented, wanting aspects of ourselves and others so we can broaden and console our hearts, release our fears, open wide our souls.

As frightened as we are of it, anger is a sacred energy – and a central one in the psychotherapeutic process.

I don’t ever intentionally provoke a client’s anger, but I am not fearful of it.  I don’t avoid conflict, because I know the gifts that it can bestow.

I try to inform every new client that comes into my office that anger has a place in our work:

“There will be times when I  disappoint, disturb or upset you. I won’t have done it on purpose, although it might feel like I have. Sometimes you may not notice it while you are in session – as most of us are taught to be agreeable and polite and avoid talking about such things – but it may strike you after you leave – on the subway ride home or even the next day. You may notice something sticking in your head, something I said or didn’t say that struck you the wrong way, that feels off, or annoying, or wrong. You may think to yourself  ‘Why the hell would she say or do that?’  If you notice any feelings or thoughts like that it will be extremely valuable and important, if you can, to bring that back in to our next session, or even to jot down a quick note so it doesn’t get lost in the weeks events- so that we can remember to talk about it. It may be hard and uncomfortable, but its really valuable  – and its an essential part of how therapy works.

It helps me to understand you as precisely as possible, to be a better therapist for you. You may point out things that I haven’t recognized or considered- or that I had a different perception of. Sometimes you may be distressed by some real limitation or blindspot I have, or even some core value that I hold that you disagree with. That is okay too. I can’t promise that I can always change or stop it whatever has been upsetting, but I can promise that I will always do my best to examine my part of any divergence that  comes between us and I will absolutely care about how it makes you feel. And if we can talk about it frankly, it may give us a chance to find a new way through, a new solution, a new space.”

It seems that whenever I have neglected to invite anger to enter into the process as a welcome guest, conflict barges in unannounced and unexpectedly, harming the therapeutic relationship – sometimes irreparably. Anger and conflict are experienced then, as definitive proof that something is wrong in the therapy, rather than as a vital component, a therapeutic mechanism of healing and connection.

Or, the relationship proceeds walking only the most avoidant and  domesticated paths, making the woods and the wilds of our innate aggressive impulses appear more terrifying, a place too dangerous to ever venture.

Conflict is part of the therapeutic process, not a failure of it. And part of this job is to initiate people into the generative, creative, and intimate uses of anger, and to learn how to move through the angry states in our psyche and our relationships in order to live, to love courageously, fearlessly, and honestly.

And Jacob was left alone; and there wrestled a man with him until the breaking of the day.

And when he saw that he prevailed not against him, he touched the hollow of his thigh; and the hollow of Jacob’s thigh was out of joint, as he wrestled with him.

And he said, Let me go, for the day breaketh. And he said, I will not let thee go, except thou bless me. ~ (Standard King James Version Genesis Chapter 32: 24-26)

Even when seems to have knocked us out of joint, conflict can bring blessings. Owning our anger explicitly, consciously, and constructively makes us more whole, and less afraid of ourselves.

And other times my job is just to survive it, withstand it, not be destroyed by it, and not let my love or my empathy be destroyed by it. To continue to have compassion for the distress that is present in front of me, to take all the responsibility I can for my part, and to understand that the rest is not about me at all.

If I can. I can’t always.

And sometimes even that is not enough.

It does neither of us any good for me to merely withstand abusive energies. Limits must be set. There are things I can’t accommodate. Angers I cannot absorb. It is my responsibility in those moments to set limits, protecting us both. I cannot let a client who needs me, harm me or compromise my integrity or we are both lost.

Anger is at once an energy which destroys and derails, and one which creates, strengthens, and fuses and purifies, through its refiners fire and alchemical heat.

Part of my job, as I see it, is to initiate clients into the constructive, transformative, generative uses and processes of anger.

Any one can get angry- that is easy- or give or spend money; but to do this to the right person, to the right extent, at the right time, with the right motive, and in the right way, that is not for every one, nor is it easy ~ (Aristotle, Nicomachean Ethics, Book II, 1109a.27)

If we can manage to wrestle through conflict squarely and bravely together – operating in good faith – or setting limits when anger has temporarily washed good faith away – certainly it is not difficult to see how to carry those processes out into the world, into other relationships.

The word wrestle, derives from “wrest” from the Old Norse, meaning “to bend” and the healing forms of anger make way, when we have listened to each other deeply, for us to release our tormented tightness and constriction, and discover how to bend toward each other.

What is external occurs internally as well, so our well negotiated conflict also becomes model, a mirror to help us sort through purely internal arguments between conflicted self-states.

It is exactly as if a dialogue were taking place between two human beings with equal rights, each of whom gives the other credit for a valid argument, and considers it worthwhile to modify the conflicting standpoints by means of thorough comparison and discussion or else to distinguish them clearly from one another.  ~ C. G. Jung, The Transcendent Function.

How else will we change each other? How else will be transformed?

If we avoid what we fear in ourselves, and in each other – what will be possibly be able to learn about ourselves?

The shuttling to and fro of arguments and affects represents the transcendent function of opposites. The confrontation of the two positions generates a tension charged with energy and creates a living third thing… A movement out of the suspension between opposites, a living birth that leads to a new level of being, a new situation. ~ C. G. Jung, The Transcendent Function.

But first we must embrace the wrestling match.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hard Times


Let us pause in life’s pleasures and count its many tears,
While we all sup sorrow with the poor;
There’s a song that will linger forever in our ears;
Oh hard times come again no more.
Tis the song, the sigh of the weary,
Hard Times, hard times, come again no more
~ Hard Times lyrics by Stephen Foster

I didn’t mean to write this, or intend to write anything – it is probably unwise to publish it, but I suppose I will anyway. Frankly I’ve been thinking I should take a break from writing altogether for a bit.

I’m just not so filled with easy inspiration, or reassuring confidence, or heart warming feel-goodisms.

My husband and I are in midlife and are, like many of our peers, sandwiched in between caring for our elders and our children. All of whom, for the time being are in significant and legitimate need of our support through some more and less challenging medical realities. Testing, appointments, evaluations, treatments, follow up, referrals. We are in the thick of it and it looks like we may be for a while.

A summer which felt like it was ripe with openings, fortune, potential and new growth crashed into a shocking and frightening fall which will unavoidably open up to a tiring cold winter.

It happens sometimes. We’ve faced such things before, and will again. I’ve seen and supported clients and friends and neighbors as they’ve passed through similar hard times.

Just as all human beings do.

But psychotherapists are supposed to be invulnerable, no? Fully actualized? Enlightened? Able to absorb anything that comes their way?

And who would want to see (or read) a psychotherapist in the midst of hard times?

Better to source out some therapist who is perky and happy! Who feels in control of life! Who can make you feel better!

Yet, sometimes life gets heavy. Sometimes there is work to be done. Sometimes we are pulled in many directions. Sometimes our choices are narrowed down by circumstances beyond our control. Sometimes a great deal is required of us. Sometimes, despite our plans and intentions, our possibilities restrict themselves to a very few or none at all. Sometimes our external freedoms become constricted. Sometimes the wolf is at the door.

So, for me, this isn’t a silly, playful, easy season filled with boundless, bouncy energy.

I am sometimes weary. I am sometimes overwhelmed. Sometimes I want to run. Sometimes I am incredibly proud of myself and my ability to keep moving, to get done all that I need to, and stay connected to myself and others. Sometimes I want to spend a day in bed with the covers over my head. Sometimes I am swelling with appreciation for the tender comforts around me, the honesty and intimacy and contact that the relationships in my life, personal and professional, offer me whether they know it or not.

Sometimes this season has offered me glimpses of deeper truths, timeless ones, that transcend and soothe through the rough and jumble of the road I am on for the moment.

I am all right. I’m okay just as I am. Where I am feels healthy and appropriate. To be too cheery right now would be denial of reality, a self-deception, and would pull me further away from the phase of life and the external challenges I am passing through for the foreseeable future. But certainly not forever.

Many days you have lingered around my cabin door;
Oh hard times come again no more. ~ Stephen Foster

Happiness doesn’t last forever, but nor does sorrow, and neither does trouble. All states have gifts to offer, lessons to teach, blessings to bestow.

Things get heavy sometimes. Its just a fact.

Sorrow has its season.

Even for psychotherapists.

Energy retreats, retracts, and peace can be found in small, still moments, in quiet spaces deeply internal. Fake smiles, chit chat, false reassurances would make me less present, banish me, send me away, exhaust and deplete me more and make me abandon myself, thinning out my resources to connect to others.

“How are you?” Some clients routinely ask – usually I respond, honestly, “Fine! How are you?” Now my response is more subdued, but still honest. “I’m okay. And you?” or “I’m hanging in. What is happening in your world?”

Though her voice would be merry, ’tis sighing all the day,
Oh hard times come again no more. ~ Stephen Foster

To do this work I need to be in contact with myself, and I need to stay in contact with myself, and remain loyal to my own energies, even when it is not comfortable.

Through my professionally arranged face, through my slower, quieter responses, through the circles under my eyes, (which can betray me – no matter how much “concealer” I apply) some still feel the shift in my energies. Some, especially those who come for time limited short term work, to focus on a single issue, or who use therapy as a problem solving space, take it as their cue that it is time to finish up, assuming that if I am offering less, that it is a signal that our work is complete.

Some clients know part of the story, as medical appointments for family members have caused me to cancel, reschedule and rearrange appointments more than I have ever before. Some know the whole story because they dream of it, or read me so closely, and so hard that it frightens them more not to be told what is happening.

Some don’t know anything, or know a little, but need me to protect them from thinking too much about me – as it is hard enough for them to stay loyal to their own experience.

Some become angry with me, without knowing why, because they sense, unconsciously, in their pre-verbal places that part of my psyche is working on my own challenges and conflicts. For those who had depressed or preoccupied early caretakers it is especially threatening, as they are sure that if they sense any dip in my energies that I will become unable, unavailable, to sustain my caring, loving attention.

There are those who are immersed in much harder trials, more consuming, more traumatizing, more violent conflicts, more emergent circumstances and more acute crisis than mine and it snaps my perspective into place, as I move my own experience further down the triage list – and immerse myself in the need that is in front of me with the skills I have accumulated over many years.

Some, who perhaps I have enabled by being more active than was necessary when my tank was full to overflowing, are being given more space to take up the reflective, interpretive work as their own, as I hold back to listen more, perhaps offering less direction or guidance than I might in a more buoyant time.

And there are many moments through my workday which lift and inspire me: A client falling in healthy reciprocated love. Another who feels ready to marry. The birth of babies through hard pregnancies, the courageousness of a client trusting me enough to share the ways that they do not yet trust me. The bravery and integrity of another in the face of danger. A piece of creative work shared, beautiful and transforming. The incredibly powerful, awe-inspiring imagery of dreams. Undeniable growth, accomplishment, achievement, mutual admiration, appreciation. Closeness in all forms, shapes and sizes.

While we seek mirth and beauty and music light and gay,
There are frail forms fainting at the door;
Though their voices are silent, their pleading looks will say
Oh hard times come again no more. ~ Stephen Foster

And then there are actual gifts that come with hard patches.

When the ability to engage in the Extraneous is eliminated, the Essential reveals itself more quickly and incontrovertibly.

Priorities become crystal clear. And when you trust your exhaustion, you know that it will steer you away from the superfluous, unnecessary.

And when you feel alive and engaged you know you are in the presence of something vital and healing for all involved.

I can feel when I am barking up the wrong tree almost instantly. I can tell when it is better to wait something out, rather than bang my head against the wall. I can spot any opportunity for relieving contact with the healing processes of Life as they move continuously between and around us all.

I have more compassion for myself: if I have a harder time organizing, scheduling, getting my bills done, or it takes me a beat or two longer to understand what is playing out in the room, I know that I am doing my best. I accept and take responsibility for my errors without being tempted to punish myself for them. I am doing what I can do. I can model self-compassionate behavior, a way of being that is less concerned, for now, with pushing past limitations than accepting them.

I may now have less energy for heroic maneuvers, for flashy interpretations. I will not be leaping over tall buildings in a single bound or pulling a rabbit out of a hat in the season ahead – I am currently unable to be seduced by inflation or grandiosity, it is just too tiring – and life is simply too humbling at present. I cannot over-extend, bite off more than I can chew, or take on anything that could prove to be too much later.

I am in exquisite and direct contact with my own needs, and the fact that I am finite.

I treasure and value the impact and the necessity of stillness like never before.

And I understand “self-care” less as a discreet activity or a scheduled event and more as an on-going way of being, moment by moment, in the presence of people who need me – as I negotiate the balance between their needs and my own and attempt to honor them both.

We will all pass through such times. And we can receive something from them as well. And if I can do nothing other than try, and fail, and try again to model an experience of being simultaneously intact and overwhelmed, of staying in caring and compassionate relationship to myself, my family and my clients, perhaps, through hard times that is more than enough.

Never to ask for easier circumstances, but for greater strength, and to accept gladly, (when they come) rest and ease along the road. ~ Pierre Ceresole

It’s the Relationship…

I sometimes dread being introduced to other psychotherapists.

“Hi! Nice to meet you – you are a therapist too?!  That’s great – I do CBT, Motivational Interviewing and Behavioral Activation – what do you do?”

Uh.

Umm.

Shrug.

“I have an office…”  I’ll vague out and drift off.

When faced with the alphabet soup of “evidenced based psychotherapies” I find myself lost and speechless.

I don’t begrudge or devalue any of those interventions for the therapists and the clients that find them useful and meaningful.

But that isn’t what I do.

None of  the methodology, measures, the cognitive distortions or neuropsychological reprogrammings would have pulled me from the quagmire I inherited – there were only a few simple things that had any chance of aligning me with my soul’s mandate and the pursuit of meaning in my life: Image, Words, Metaphor,  Relationship.

I can’t eliminate behavior, and wouldn’t even dare arbitrate which behaviors are healthy or unhealthy. I can’t fix a damned thing. And I don’t practice therapy that fixes anything, because, frankly,  I never wanted to participate in a therapy or enter into a relationship with a therapist who wanted to fix me.

I can’t make anyone’s  problems go away, including my own. And as I get older, and watch myself revisit the same conflicts and complexes in  subtler forms I wonder if “change” in the sense that most people imagine it when they speak of psychotherapy, is possible at all, and if it is even desirable.

Healing is a word that means more to me than “behavioral change”  but only if “healing” primarily means  living with ever deepening compassion for our own, and other’s wounds and vulnerabilites.  I am not a “healer”  who knows how to make wounds disappear entirely, if at all. Scars, sensitivities, vulnerabilities, residues, susceptibilities, remain, even if the bleeding stops.

And often enough life gets better and worse and better and worse  on its own – with or without psychotherapy.

So what do I do?

Its not just other therapists that want to know  – clients also want to know “what kind of therapy” I practice – and they are especially entitled to an answer, and one that is not cloaked in mystification.

And here even the language of depth therapies fail me:  I do not “do” psychoanaylsis or analytical psychology, existential or Buddhist psychotherapy  – although these models and many others feel useful and meaningful to me at times in making sense of my own experience.

So I have an office. I sit in it. People come to see me, or sometimes we go walking together.

I care when the people who come to see me are angry, murderous,  numb, disappointed, in agonizing pain, terrified, lost, stuck, bored, nauseated, lonely – even when it is very hard, very painful, or when they feel these things because of something I have done, or something I have not done or cannot do.

Sometimes when things turn brutal for someone I care about  I’ll  just hang on for dear life. I don’t give up. I don’t turn away. I am not pushed over.

I stick around. I listen and I don’t retreat, and I am not easily scared or chased off.

I try to picture in my mind’s eye the people, places, things, and images that I am hearing about or sensing. Sometimes images, feelings and pictures seem to  float up in my own mind, drawn from my own life experience,  themes from stories I have read, myths I have heard – and I put these into words to see if they are connected to the pictures and feelings that are bubbling up in the person near to me. I remain curious and committed to understanding the words and pictures and sensations that are being communicated to me as precisely as possible. I surf through the waves of my own watery unconscious and the unconscious of my therapeutic partner. I keep my filter down and my aperture open wide.  I try to stay connected in the bumpy, rocky, scary, severe, extreme places where most social relationships will not venture. Where even  familial relationships can’t, won’t or don’t go.

I lend my self out. Not my “healthy ego”  – my Self, my heart, my dreams, the pictures in my head.

There are many of us who work in this way, and who could work in no other way.

I do this because it was done for me, and this meant the world to me.

Once, many many years ago, when I worked on a unit that served severely mentally ill adults, a psychiatrist pulled me aside to offer me some encouragement. “Do you know why your clients are doing so well?” she asked. “Do you know why they are getting better? Its not because you make sure they are compliant with their medication. Its not because you set clear behavioral objectives and treatment goals. Its because you love them like you belong to them. It’s because you take them into your heart like they are your own. You give of yourself, and they feel that and it makes them stronger.  I don’t know why everyone just doesn’t do that.”

At the time I didn’t know what to make of what she said. But I didn’t then and don’t know now how to work any other way.

A few years later, at that same job, I would come to understand the need people had to work from objective and objectifying stances rather than out of their subjectivity.

On the unit we all had small safety windows in our offices – so therapists and mentally ill clients could feel both safe together talking with the doors shut. As I sat at my desk to take my lunch break, and get some paperwork done, I felt several pairs of eyes peering at the back of my neck. I looked out the window to see four or five of my clients lined up to peek in on me, one after another, while I ate.

I opened the door:

“What’s up ? Can I help you guys? I’m on a break right now okay?”

“Come on” one of the older guys said to the crew “we better go so that we don’t use her all up!

I was getting used up, although it was never because of  them. The agency and mental health system I worked in wasn’t designed to support those who worked like me. It was designed to socially control the greatest number of people for the least amount of money. Commitment, abidingness, endurance, resolve, availability, intuition and meaning were far less important than outcomes and measures, and the elimination of unwanted behavior.

Although it is true, then and now, that I must always be vigilant not to give too much, not to give more than is required, or needed. I remain careful not to ever give in a way that will make others feel indebted to me or that leaves me drained or resentful. But that is my job, my responsibility to regulate. And if, and when, I give more than I can afford, or more than others need of me, it is my job to correct and compensate for, and never ever because others have used me up.

On my long morning run just after an introduction to a perfectly nice evidence based psychotherapist who had recited his alphabet soup of what he “did”, I heard these words rising up from my beating heart:

“Its the relationship that heals it is the relationship that heals the relationship that heals. This is my fervent belief and this is where I put my professional faith”

When I got home, I googled a bit trying to locate the rhythm and the cadence of these familiar words and realized that this mantra had resurfaced, slightly paraphrased, from a book I had read only once over twenty years ago:

It’s the relationship that heals, the relationship that heals, the relationship that heals – my professional rosary.  ~ Yalom, I. (1989), Love’s Executioner, London: Penguin Books, p.91

My acupuncturist once said to me: “I don’t know how you do it. How you work the way  you do.”

I don’t always manage as well as I would like.

When my own life becomes a challenge or crisis erupts for me, or when I foolishly attempt an “objective” survey of the scope of what I have undertaken I can overwhelm myself: Caring for my elders, for my children, for clients. When I attempt to itemize the breadth and depth and range  of all the different forms of care-taking I am immersed in, when I look at my days and weeks and attempt to catalogue all the pain, fear, vulnerability and dependency that is attached to me I sometimes fear that I can be used up and that I could drown in a flood of other people’s needs.

But, when I breathe, and move through my day moment by moment – I see that I am more buoyant than I realize  and that I am tethered not only to my teachers, mentors, guides, and therapists, who stayed afloat with and for me, but that I stay afloat with, for, alongside and because of  the deep and real relationships I have forged with those who pass through my office.

Image, words, metaphor and relationship cannot use me up. They fill my heart and keep me afloat.

It’s the relationship that heals the relationship that heals the relationship that heals.

Both members of the therapeutic couple.

All of us. Always.

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