Please don't go...
My kids have been grown up for a long time. But it feels like the sweet time of reading the same book over and over to them really ended this week with the death of Maurice Sendak. We loved Where the Wild Things Are. I read it so many times I know it all by heart. And David adored In the Night Kitchen -- "I'm in the milk and the milk's in me" he would gleefully shout when we cam to that line. Those books were loved in the way only a deeply loved story book can be, not with delicate handling but a chewed corner, some crayon scribbles, efforts to write their names when they were first trying to shape those letters. Over and over we read those books. And Outside Over There. And Really Rosie. And though I was long grown-up when those books entered my life, they connected me to my childhood and being read special stories that I wanted to hear again and again.
A few of my favorite images of the many wonderful ones I have seen this week saying goodbye to Maurice Sendak --
If you haven't seen the wonderful film of Where the Wild Things Are, do yourself a favor and get a copy and watch and remember the delight of reading and being read to. It is such a wonderful realization of this book and a great way to remember Sendak.
The Secrets We Keep
I have written before about secrets and how they play out in therapy. Yesterday I read a excerpt of a memoir that set me to thinking about another aspect of secrets. This paragraph, excerpted from A Sense of Direction: Pilgrimage for the Restless and the Hopeful by Gideon Lewis-Kraus and published in Salon, even led me to order the book:
It is nothing special that my dad had a life separate from me, or that he kept secrets; this is something all parents do — straight ones, scrupulous ones — and it’s what we grapple with, to varying degrees of success, our whole lives. What’s unusual about my relationship to my dad’s life is not that there were things about it I didn’t know because he was gay. It’s that I was able to indulge the fantasy that he kept secrets only because he was gay, that if he had been able to be openly gay he would’ve shared his entire life with me and I always would have known exactly where I stood. At a certain point other people have to understand that parents keep secrets, that parents close parts of themselves off to their children, because that is what parents do.
I have often thought about the opacity of parents. Years ago, before my children were born, I began keeping a journal because I hoped thereby to be able to leave something to my kids that would offer them a glimpse of me, as a person, as someone who was more than their mother. The irony of course is that now I am not at all certain I want them to see my journals at all, but that is a post for another day. It is difficult for children to see their parents as three dimensional people, people who had lives, desires, ambitions, disappointments, dreams before and during their time as parents. It is hard to see the person who lives inside Mom or Dad. And many, maybe most children do not want to know their parents beyond their experience of them as parents.
AIYEEEE!!!
That's what I said this week when I read "In Therapy Forever? Enough AlreadyIn Therapy Forever? Enough Already" in the NY Times last weekend. Just a little while ago I wrote about how long therapy takes -- essentially it takes as long as it takes and as long as the patient wants to work.
Along comes Jonathan Alpert, a therapist who is all about his book in which he asserts you can "change your life in 28 days", which reminds me of the diets in magazines claiming you can lose 40 pounds in a month. How many success stories do you think are walking around a year or two after trying either of those quick fixes?
If you believe a quick fix is for you, save your money and instead of buying Alpert's book just watch Bob Newhart in this video instead:
Why not a hug?
A question that comes up a lot in discussions of therapy is that of touch -- when, if at all, is it appropriate for a therapist to touch a patient? As you might imagine, this is a complex subject.
Setting aside for the moment, entirely justified concerns about issues of sexual misconduct in therapy, let's look at the common desire of patients for a hug or a pat on the back or some other reassuring gesture from the therapist. When dealing with intimate and difficult issues, it seems normal and understandable that patients would want some kind of comfort from the therapist, the person often placed in the role of re-parenting patients. But there is much more involved in such transactions than first meets the eye.
Back in the 70's and early 80's when I was much newer in practice, it was common for therapists to hug patients, an outgrowth, I suppose, of the whole encounter group movement and the idea that hugging and touching, because it felt "natural" was a good thing. But cooler heads looked more deeply at the issue and their thoughts on the issue certainly changed my mind.
How long does it take?
I am teaching a course introducing the concepts of Jungian psychology at the Senior College where I live. Senior College is a wonderful thing we have here in Maine. In 9 different centers, all associated with the University of Maine, people over the age of 50 can take and teach 6 week non-credit courses in almost any subject you can imagine. Pure teaching delight -- interested, bright students without any nonsense about teats, papers or grades!
Anyway, in this past week's class someone asked if the process of therapy could be speeded up and what do I tell people about how long it takes.
I start with new people telling them what my analyst said to me when we began -- that therapy is a journey we take together and that I am willing to stay on that journey with them and go as deep as they wish. Working in a depth oriented framework, I can't define the end point when we begin because I see an unfolding process, a journey.
Basically nothing is going to happen as a result of therapy if the person doesn't want to change. Now it is a lot more complicated than it seems. Change is inherently destabilizing and uncomfortable, even when it seems highly desired. So there is a big difference between feeling you want to change and actually doing the changing.
Adventures in typology
Even people who know nothing about Jung have most likely heard about the MBTI -- the Myers Briggs Type Indicator. The MBTI is based on Jung's typological theory. For a good brief explanation of Jung's theory, check out the entry on Typology in the Jung Lexicon. Essentially Jung’s model is concerned with the movement of energy -- inward for the Introvert and outward for the Extravert -- and the way in which one habitually or preferentially orients oneself in the world.
The MBTI is the best known but not the only measure drawing on Jung's theory. If you have not taken it, you can take an abbreviated online version here. And descriptions of the types in various places including Wikipedia.
Dr. X posted about the MBTI earlier this week. He and I have in common not only professional interests but also our type -- I am also an INFJ.
What difference does that make, you may ask? Well, I suppose in the larger scheme of things it doesn't make a whole lot of difference. But it does tell you that I am more likely to be happy in very small groups or even being alone to large gatherings. My idea of a nightmare is a cocktail party, for example, as i am actually very introverted. And it will tell you that I might not be the best person to ask for directions to a place because I rely on Intuition to a large degree and so my directions are apt to not be very precise.
Quote of the day
For today, a quote from Jung-
‘Simple things are always the most difficult. In actual life it requires the greatest art to be simple, and so acceptance of oneself is the essence of the moral problem and the acid test of one’s whole outlook on life. That I feed the beggar, that I forgive an insult, that I love my enemy…all these are undoubtedly great virtues…But what if I should discover that the least amongst them all, the poorest of all beggars, the most impudent of all offenders, yea, the very fiend himself – that these are within me, and that I myself stand in need of the alms of my own kindness, that I myself am the enemy who must be loved – what then?’ – Carl Jung
Support your local introvert
One of the Psychology Today blogs, Are Introverts Nuts? caught my eye yesterday because it reminded me of yet one more reason to find fault with the proposed DSM V -
The APA’s proposed definition of introversion is: “Withdrawal from other people, ranging from intimate relationships to the world at large; restricted affective experience and expression; limited hedonic capacity.” The definition also includes "deficit in the capacity to feel pleasure or take interest in things."
Oy, one more category of people to pathologize and probably medicate! But my day was brightened when I ran across this on Facebook-
And there is this new book too - Quiet: The Power of Introverts in a World That Can't Stop Talking. The author, Susan Cain, finds much to value about those of us who are quiet and inwardly focused. So, fellow introverts, take heart. The American Psychiatric Association does not have the last or best word!
Best on depression
My nomination for best paragraph on depression is this one by Al Galves, writing on Mad in America:
Thinking that depression is caused by chemical dynamics is like thinking a home run is caused by a bat. It is confusing a mediative variable with a causative one. Just as focusing on the bat is a mistake with homeruns, focusing on chemistry is a mistake with depression. The important variable in a home run is the batter. The important variable in depression is how the person is reacting to hard times, loss and deep concerns about his or her life. To focus on the bat is to lose sight of the most important variable, the batter. To focus on chemistry is to lose sight of the most important variable in depression, what is going on with the person who is experiencing it.
Countertransference
Countertransference is something I haven't written about much here, though it is of considerable interest to me. Lately my interest has focused on countertransference toward fat patients. Please note I am deliberately, in accord with the fat acceptance movement, using the term "fat" rather than "obese" because obese carries with it a connotation of pathology.
When a body meets a body, no formal introductions are made. What are the feelings and ideas, conscious and unconscious, that go through our minds when we are looking at another person? As therapists, we focus on words but our bodies also speak. And, in a manner of speaking, there are actually always four, if not more, bodies in the room. Each partner in the analytic dyad has both a body as material entity and a body as it expresses and symbolizes psychic life. For each person, the expressive and symbolic meaning of her own body and the body of the other changes with changes in her self-state. (Anderson, F.S.(2007). Bodies in Treatment: The Unspoken Dimension p. 237)
As a therapist I am very interested in how therapists respond to fat patients and how fatness is viewed psychotherapeutically. I have had some interesting experiences myself with therapists who made assumptions about me and the issues I wanted to work on based on my size rather than what I said. It is interesting to me that the literature is relatively silent in the last 15 years or so on this subject. I have searched long and had to find pieces written by therapists about their reactions to fat patients and written by fat therapists about patients' reactions to them -- the picking are pretty slim.
One of the books I stumbled upon is Eating Problems: A Feminist Psychoanalytic Treatment Model. I am impressed that the articles in this book do not take what I would consider a fat negative posture at all, but offer the author's thoughts and experiences with patients -- anorexic, bulimic, fat and everything in between -- in light of feminist theory and with a deep understanding of cultural forces we must all contend with. The net result is an approach that offered me some fresh insights into my own history and some very useful material I can use with my patients.
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