Jung At Heart Archive April 2010

Quadrant

A bit of shameless self-promotion -- 

On Monday the latest issue of Quadrant arrived. While it is always interesting to read, this issue is especially interesting to me, because an article I wrote! My first publication so I am just a tad excited.


As the twig is bent ...

"Psychoanalysis cannot be considered a method of education if by education we mean the topiary art of clipping a tree into a beautiful artificial shape. But those who have a higher conception of education will prize most the method of cultivating a tree so that it fulfils to perfection its own natural conditions of growth."Jung CW, vol. 4, para. 442

People come to therapy expecting cure or healing from their problems. I don't think of therapy as healing in the usual sense. To heal means to make whole or healthy, to recover or restore and comes from the root kailo meaning whole or uninjured. In order to think of what I do as healing, I would need to see the people I work with, and indeed myself, as broken, ill and I don't, not in the sense of illness. Barbara Stevens Sullivan has a wonderful way of putting this:

"In some sense, a person is her wounds. A sapling, planted beside a supportive stake that the gardener neglects to remove, will grow around the stake. The stake's presence will injure the growing tree; the tree will adapt by distorting its "natural" shape to accommodate the stake. But the mature tree will be the shape it has taken; it cannot be "cured" of the injury, the injury is an intrinsic aspect of its nature." (The Mystery of Analytical Work, p. 175)

I do believe that all humans are wounded, varying in degree and type of wound, but we are all wounded. My first professor in abnormal psychology put it this way -- from the moment of conception we are bombarded by influences of all kinds, both noxious and helpful and as adults we are who we are at least in part due to the effects of these influences. Some of us will be more scarred than others, but none of us will be unmarked by the experiences of our lives. So wounded per se is the normal state, not a state of ill-health. 

Now, the extent to which our wounds make our lives complicated and/or difficult is where therapy enters in. Problems in living are what bring most people that I have seen into therapy -- the desire to experience life in a different way is the motivator. There is no procedure or pill or technique I can apply that will close the wound. Whether or not healing is the appropriate description for becoming conscious of something that is an integral part of us, an unerasable part of our history, is something I balk at a bit. I can become more conscious of the ways I have internalized people and issues in my life. Becoming more conscious of them increases the array of possible responses I have available to me, so I can choose differently and thus find myself not in the old familiar ruts but in very different relationship to myself and those around me. That is what I believe therapy does for people and indeed is what I have experienced in my own therapy. I cannot be what I might have been had I not had the mother I had or the experiences in life I have had -- I am indelibly marked by them. But I can be freer in how I live my life and perceive my possibilities through the process of examining my thoughts, behaviors, history, dreams, reactions. That is what talk therapy as I know and do it is about.

Someone who knew me when I was 25 and knows me now would not notice too very many things different about me except that I am heavier, my hair is grey and I am wearing glasses rather than contacts -- all external manifestations of age and the life I have lived. Someone who knew me very well then and now might notice that I am calmer, less prone to sarcasm, more contemplative, warmer, maybe more confident. They would recognize my delight in words and willingness to express opinions, that I have a dry sense of humor. That I am a bit shy and reserved, keep a pretty tight zone of privacy around myself. But on the whole, I would likely seem more relaxed.

The changes I have experienced in my life as the result of a long and successful analysis are interior, and though they shape what others see, are most likely unknown to others. Those inner changes were hard won. The forces against them from my early life were fierce and did not go down without a ferocious fight. Through those hours of talk with my analyst, I began to be able to see the destructive bits and then to be able to not act on them, to let them go by, like bubbles rising in champagne. I still have moments of feeling like I used to feel, but I see it, I feel it when it happens and I now have the freedom to make choices that do not feed those moments and so they do not grow into hours or days as once they did.

I see therapy  as opening the door to new possibilities. I cannot undo my history, make myself as if my childhood or any part of my life had been ideal, but I can become more conscious of the ways that history and my interpretations of it have operated in my life and in that way allow me to choose from a wider array of possible behaviors as I go forward. I think we are all wounded to greater and lesser degrees. But healing, in the sense that we usually think of it, seems to me to not be operative in the dealing with these wounds. 


Mistakes

I am slowly reading a new book by Barbara Stevens Sullivan, savoring it as I read. Among many bits that I have underlined is this one, which I have been thinking about a great deal lately:

"People do not grow in sterile containers with perfect analysts; they grow in messy human relationships with analysts who try their best to do right by their patients  but whose best must frequently consist of reparative efforts vis-á-vis the difficulties they have created."

How do we recover from the mistakes that we make? We recover by recognizing that of course we make mistakes because we are human and it is how we learn. I have been in this work for 35 years and I still make mistakes -- different ones, but mistakes nonetheless. 

We must start with accepting the patient's feeling of having been hurt or otherwise affected by our error. Which means at least initially not trying to get the patient to understand or accept an explanation of our good intentions. Doing that -- trying to explain -- is  really for the therapist, an attempt to soothe ourselves and to see ourself again in a positive light. 

 Initially I need to be able to simply accept that I made a mistake, be willing to own that mistake. Optimally the relationship is solid enough that my mistake does not end it and we have the opportunity to work through it, to look at what happened and why and how it came to be experienced painfully. 

Sometimes the therapist's mistake breaks the relationship. What do we do then? Well, we have to sit with it, reflect on what happened to see what we can learn from it. Maybe got some supervision to see if looking at the situation with another pair of eyes illuminates it for us. We learn what we can from it and let the patient go. Pursuing trying to get her to hear the explanation starts to be its own problem.  

A wise supervisor once told me that we fail our patients in exactly the way they need to be failed and the trick is to be able to work through that. And he was right. Years ago I had a new patient come to me after having fired two previous therapists -- one who fell asleep in a session with him and another he found unsympathetic. So I knew I started on thin ice, that he was looking for me to fail him also. One day he called and left me a message that he had to reschedule. I called back and left a message saying only my name and a time he could reach me. He got furious and said I had violated confidentiality by leaving the message so his roommate could hear. Now I knew I had left no indicator of who I was or why I was calling, but it didn't matter because *for him* I failed. No amount of reasoning mattered. So we failed to work it through. I did learn to check with new patients about whether or not it was all right to leave a message if I had to get in touch by phone. 

But what about the instance when the therapist really likes the patient and believes that he can help him? 

It is hard to let go but what I want for a patient may not be what is best for her in her eyes -- and those are the eyes that count. If she came back, I would be able to feel good, vindicated in some way -- and sometimes patients do come back-- but at the time, I have to live with the blow to my pride and my sense of my professional self. It is in these humbling experiences where we learn most. 

Liking a patient is important but in a way, we have to hold that in a different place from where we hold such things ordinarily. Because therapy requires of us a measure of sacrifice, of willingness to hold our needs and desires in abeyance, knowing we must meet them outside of our professional relationships. When we embark upon this work, we sacrifice being able to follow up on attractions in the same way we can when we meet people outside of our professional roles. It is hard sometimes. I have had more than one patient in the last 35 years that I would have loved to become good friends with. But I was in their lives in a different way, a way which unfolded into a different kind of intimacy and exchange.  


Change

“Your vision will become clear when you look into your heart.  Who looks outside, dreams…Who looks inside, awakens…”   –C.G. Jung

Someone recently asked me how much does a person have to want to change in order to change at all?

Basically nothing is going to happen as a result of therapy if the person doesn't want to change. And 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.

I read somewhere that a famous guru when asked how to stop smoking said, "That's easy. Don't smoke the next cigarette." All the work of therapy lies in that space between the question and the action. 

The pattern of beliefs and feelings we have about ourselves, built up over a lifetime often with roots in our earliest relationships and never really challenged by us create the prison we live in. We don't realize is that this prison has only three walls and no bars keeping us in. We don't realize this because we stand in the corner looking at the walls in front of us and believe that there is no way out. Therapy is, at least in part, the process of turning around and discovering that we can walk out of our prison. That process is not easy and it can take a very long time, but stripped to bare essentials, that is what we do in therapy.

So you decide one day to go to a therapist to see what she can do to help you. In therapy, no matter how much you may believe you are controlling your responses and behavior, over time your habitual ways of thinking and acting about yourself and your world show up. These are the stories you tell yourself about yourself; they make up your prison. As the therapist questions your habitual responses and views and challenges your ideas about yourself and the world, ever so gradually, you start to change -- daring to be more open, to question what you have believed, to try new ways of behaving. It is slow and subtle. The therapist has to be both patient, caring and willing to challenge you, the patient, even make you uncomfortable or upset. And be able to not take personally the feelings you have toward her or him. Gradually the story you tell yourself about yourself changes, not in kind but in degrees. The things that used to be self-defining recede a bit to allow other self-perceptions and beliefs to come to the fore. The more deeply ingrained the patterns, the longer it takes to change them.  

The therapist doesn't DO anything. We listen, we offer observations in the form of interpretations, we may confront but we have no magic to make change happen. It is entirely possible to spend months or even years in therapy without changing at all. The hard work of making the change -- or, to return to our famous guru's recommendation, not smoking the next cigarette -- is up to the patient. 

So why see a therapist? Because it is very difficult to see yourself clearly. Just as a camera cannot photograph itself except in reflection, the kinds of changes that are the heart of therapy need someone to serve as a mirror, as someone who can see and hear you without having an agenda about or for you, someone who can be caring and brutal. I can't think of anyone I know who has done that without help, including myself.

Therapy isn't about being happy, it's about honestly knowing who you are, and then picking a suitable life.  Every day you must consciously choose who you are.  Choose. 

I have lived on the lip

of insanity, wanting to know reasons,

knocking on a door. It opens.

I've been knocking from the inside!

~ rumi ~


Got questions about therapy? Leave a comment or email me using the form on the right, and I will do my best to answer. Please keep questions general rather than about your therapy or therapist.

The Inward Gaze

A writer is someone who spends years patiently trying to discover the second being inside him, and the world that makes him who he is. When I speak of writing, the image that comes first to my mind is not a novel, a poem, or a literary tradition; it is the person who shuts himself up in a room, sits down at a table, and, alone, turns inward. Amid his shadows, he builds a new world with words....To write is to transform that inward gaze into words, to study the worlds into which we pass when we retire into ourselves, and to do so with patience, obstinacy, and joy. Orfan Pamuk -- nobel lecture, 2006 

I ran across this lovely quote about writing some time ago. While I write -- here, in my journal, and in fits and starts on various articles I hope someday to publish, I struggle to think of myself as a writer. A few years ago, an editor friend of mine told me that the difference between a writer and a person who writes is that the writer works on what she writes, revising and editing and struggling to find the right words to say what she sees or feels. A person who writes -- well, that person just writes. For the longest time, I rarely wrote more than one draft of anything and the thought of revising came only when someone else told me I needed to do so. But I took those words of my friend seriously and began to think of what I write as worthy of more attention and energy from me. Of course, now I must learn when to stop and allow what I have to just be as it is, even though it is not exactly what I hoped. Baby steps.

Anyway, recently when I read that quote again, I thought of writing and my own journey as a writer, but I thought also of the process in analysis and therapy. Because it seems to me that he describes that process also. In analysis, the gaze also goes inward and the effort is to transform the images and feelings and memories into words, into words eventually transform experience and by opening new possibilities, make change. And we do this work with "patience, obstinacy, and joy" -- though the joy sometimes comes late to the experience.

What if?


One of the search terms I have set for Google News is "psychotherapy". It's interesting to me that I almost never see any articles about the battle that is being fought over the very existence of psychotherapy.

A friend of mine  recently interviewed for psychiatry positions and at most of the ones she visited, she was greeted with a proud declaration that they are all medical model and she was told of a wide array of support services for her and very little about what, if any, psychotherapeutic services are offered.

On the level of community mental health, this is the direction that things are going. Such centers depend on health insurance reimbursements and health insurance companies are less and less interested in paying for therapy, even when it is as effective as medication and more effective in combination with medication than is medication alone. So it is very cost effective to pay the high salary -- relative to what other mental health professionals earn -- for psychiatrists and have them see many patients a day in medication clinics. Far more cost effective than paying other professionals to see 6-8 patients a day in psychotherapy.

Psychotherapy is losing its place in community mental health. Because it does not fit well within the medical model. But even more than that, it is because psychotherapy has long been riven with turf battles of its own -- which theory is correct? who should be licensed? different training standards for each of the several disciplines involved. So instead of a single field, psychotherapy, we have the field Balkanized into social work, family systems, clinical psychology, counseling, nursing, psychoanalysis, cognitive behavioral therapy and on and on. There is no single voice, no single umbrella organization speaking up for psychotherapy.

I wonder what would happen if someone presented at a conference suggesting that psychotherapy should not be in the medical model at all? That maybe psychotherapy belongs in a wholly different category, somewhere in the neighborhood of education, spiritual development, and personal growth? What if we stopped trying to prove scientifically that the relationship in therapy is healing? What if we gave credence to self-report by patients that therapy had helped them? What if we stopped considering problems in living, which is what most people coming for therapy are struggling with, as illnesses? What if we considered treatment of major depression and other problems responsive to psychotropic medications as belonging to one field and psychotherapy to another one altogether? What if?

© Cheryl Fuller, 2007. All  rights reserved.