One of those days…

I had all kinds of ideas for what I wanted to write about today – more about therapy or maybe some thoughts I have about a workshop I am developing or maybe the way the flowers in the garden are hurling their beauty out for us to see before frost comes in a matter of weeks to make everything brown and gray again. But I can’t wrap my mind round those things today.

I am sad about RBG’s death.

Heartbroken about all the people who have died in this horrible pandemic — in my mind’s eye, I see them as tiny lights blinking out, one by one by one.

I am tired of the confinement of the pandemic, of the anxiety it arouses, knowing this invisible virus could bring the end to my life.

I missing able to touch people and be touched — and deeply grateful for the enduring and endearing presence of my husband. 

I feel the anxiety so many of us feel about the upcoming election. I eagerly await the arrival of my ballot so I can vote.

So what do I do on a day like this? 

Well, it is chilly here this morning, so we gave in and turned on the heat for the first time this season. It feels good.

I have loads of yarn. Knitting socks feels satisfying, the magic of a single thread, unbroken from toe to top, delights me. And everyone can always use socks.

My Kindle is full of books. Today I choose to read one in paper.Good books and good yarn and a mug of tea go a long way to soothing.

What do you do to soothe yourself, to care for yourself in these anxious times?

Misfit Produce, Lady Ragnell, Mr. Rogers and Me, Pt. 2

Better late than never — a look at the story of Sir Gawain and Lady Ragnell and what it has to do with us today.

Our story is from medieval England. It is often titled ‘Sir Gawain and The Lady Ragnell. Lady Ragnell also known as the loathsome Lady Ragnell, bargained with King Arthur. A spell had been placed over him. Unless he could correctly answer the riddle “What do women desire above all else?”, he would die. She agreed to tell him the answer to the riddle. In exchange, she desired to be married to the King’s nephew, Sir Gawain. He was known as the most handsome, skilled and compassionate knight at the Round Table, whereas Lady Ragnell was a very ugly hag. Sir Gawain willingly chose to marry the Hag Ragnell, so that his King’s life would be spared. He did not know that a spell cast over Ragnell, had turned her into a loathsome Hag for half of each day, but left her as a lovely princess for the other half. 

On their first night, after brief hesitation, Gawain decides to treat his new bride as he would if she were desirable, and go to bed with her as a dutiful husband is expected to do. However, when he looks up, he is astonished to see not an ugly hag, but the most beautiful woman he has ever seen standing before him. Ragnell explains she had been under a spell to look like a hag until a good knight married her; now her looks will be restored, but only half the day. She gives him a choice-would he rather have her beautiful at night, when they are together, or during the day, when they are with others? 

He wisely gave her the right to choose, having learned that above all else, women desire the right to have sovereignty over their choices.  In giving the Hag Ragnell the right to decide when she would be beautiful, the spell was lifted, and she was beautiful all day long.

It is in fairytales that when a spell is broken, the entrapped woman becomes a beauty. Most of us have heard those stories for decades. We may think we don’t accept them as literal because we cannot see how they are present in our modern lives. The entire diet and weight loss industry and cosmetic surgery depend on our belief that we will be better loved, have more opportunity, live happily ever after if/when we lose weight, make our breasts larger or smaller, reshape our nose. Even among many therapists the assumption is that the best outcome is for s fat patient to lose weight — more about this on another day. 

We recoil from the language but fatness is also seen as reason to blame the fat person who ate his or her way into ‘freakishness’. Even using the word ‘fat” makes people uncomfortable, thus betraying the assumption that fat is bad. But many, perhaps most fat women and girls feel themselves cursed, bewitched like Lady Ragnell and condemned to life as a hag unless or until a modern day Gawain comes along and is willing to be with, to love her as she is. Because giving Ragnell the authority to choose for herself what she preferred was in fact being willing to be with her as she was. 

How many of us have head of husbands complaining that his wife “had let herself go”, meaning she had gained weight and gotten older, and implying that he wanted her less? Or know women who are constantly trying to lose that 10 or 25 or more pounds that stands between them and beauty?

In my own life, in my first marriage from the time we got married until the time of the divorce, he kept telling me he would really love me when I weighed 120 pounds. It went on for 24 years. I was angry that he kept telling me throughout the marriage that he would really love me when I weighed 120 pounds. And he was angry that I never attained that goal.  In the end the spell was broken, but I did not transform into a slender woman. I divorce him and a few years later met and married my own Gawain, a man who was and is willing to love me as I am.

Polly Young Eisendrath’s book, Women and Desire: Beyond Wanting to be Wanted . Wanting to be wanted, fearful of not finding the partner who will want us, believing ourselves that fat is unloveable, is the curse many woman live under. Therapy and doing the work of coming to value ourselves and the right to be loved for who we are is the way out.

Misfit Produce, Lady Ragnell, Mr. Rogers and Me, Part 1

Today I am beginning a several post series looking at bodies, especially fat bodies, and psychotherapy.

You might very well ask what this image — used by the company, Misfit Market which describes itself “Misfits Market delivers ugly, but otherwise perfectly edible fruits and vegetables”. I have frequently seen this image online for several months now. It struck me that even fruits and vegetables are expected to conform to some standard of beauty in order to be acceptable, even though appearance has little or nothing to do with their actual nutritional value. And that sounds so very familiar.

Take a look at this from John Berger’s book, Ways of Seeing:

“A woman must continually watch herself.  She is almost continually accompanied by her own image of herself.  Whilst she is walking across a room or whilst she is weeping at the death of her father, she can scarcely avoid envisaging herself walking or weeping. From earliest childhood she has been taught and persuaded to survey herself continually. And so she comes to consider the surveyor and the surveyed within her as the two constituent yet always distinct elements of her identity as a woman. She has to survey everything she is and everything she does because how she appears to men, is of crucial importance for what is normally thought of as the success of her life. Her own sense of being in herself is supplanted by a sense of being appreciated as herself by another….  

One might simplify this by saying: men act and women appear. Men look at women. Women watch themselves being looked at. This determines not only most relations between men and women but also the relation of women to themselves. The surveyor of woman in herself is male: the surveyed female. Thus she turns herself into an object — and most particularly an object of vision: a sight.”

When we women don’t rise to the standard of beauty expected of us, we become as misfit people, not marketable nor desirable. And we must survey ourselves constantly to assure ourselves that we acceptable. And when we don’t measure up, when we fall outside that conventional range of attractiveness, then like the misfit produce, in a way we become freaks.

Irvin Yalom is much loved by many therapists. Yet in his book, Love’s Executioner, he too reveals an all too common view of fat women as akin to misfit produce.

“I have always been repelled by fat women. I find them disgusting: their absurd sidewise waddle, their absence of body contour‚ breasts, laps, buttocks, shoulders, jawlines, cheekbones, everything, everything I like to see in a woman, obscured in an avalanche of flesh. And I hate their clothes‚ the shapeless, baggy dresses or, worse, the stiff elephantine blue jeans with the barrel thighs. How dare they impose that body on the rest of us?”

To his credit, Yalom acknowledges that this is an instance of countertransference, and that is good. But in the many comments that refer to this essay, I have not seen anyone be critical of the attitude he expresses nor what effect it had on his patient. Because though he did not voice his feelings, they were there in the room and no doubt she felt them, especially as they aligned with what she and any of us who do not fall within the range deemed attractive experience every day.

What is this issue with the body about? Let’s look at the body as shadow.

Jung, in Collected Works,Vol. 18: The Symbolic Life wrote:

We do not like to look at the shadow-side of ourselves; therefore there are many people in civilized society who have lost their shadow altogether, have lost the third dimension, and with it they have usually lost the body. The body is a most doubtful friend because it produces things we do not like: there are too many things about the personification of this shadow of the ego. Sometimes it forms the skeleton in the cupboard, and everybody naturally wants to get rid of such a thing.”

Jung sees body as shadow, avoided because it inevitably brings into the room those aspects of life we most wish to avoid — death, aging, desire, greed, excess. Certainly the female body, and especially the fat female body carries this shadow and inevitably activates in both patient and therapist all of the anxieties attendant upon these shut off aspects of life.

One more look at this trap of attractiveness from a Jungian analyst, Polly Young-Eisendrath:

From the Pandora story we can see that identifying with this “power”[of beauty] is a double bind – you’re damned if you do and damned if you don’t. If you identify with the image of female beauty, you put yourself into the Pandora box: beautiful but empty. Increasingly as a woman ages, she finds that identification with a beautiful appearance is a losing game. She will lose the game through aging when she no longer looks like Pandora, a “maiden” – youthful, slender, lovely. To identify with a beautiful appearance and to pursue that power leads to depreciation of her other strengths and ultimately to depression about falling short of standards. To disidentify with the power of appearance (and “let herself go”) usually leads to feeling like an outsider, feelings of low self-confidence, and fears of failing to find a heterosexual partner or to be the object of a certain kind of male regard.”

Damned if we do and damned if we don’t, where do we go from here? That’s for the next in this series, where we will look at the story of Sir Gawain and Lady Ragnell. Look for it on Wednesday.

On My Shelves

 The NY Times Book Review has a regular feature called By the Book, a Q&A with an author. I have published a book, though the NY Times has yet to discover me and I do read a lot, so here is my take on their questions: 

What book is on your night stand now?

Truthfully I no longer keep books on my nightstand as I no longer read in bed. And as you can see, my bookshelves are anything but tidy. Still next to me and on my Kindle I have a pile of books waiting to be read or in varying stages of being read:

Sarah Perry The Essex Serpent

Matt Haig How to Stop Time

James Lee Burke A Private CathedralAbigail Saguy What’s Wrong With Fat

Michael Eigen Rage

Francis Weller The Wild Edge of Sorrow

Michel Pastoureau Blue: The History of a Color

What was the last truly great book you read?

I come back again and again to Barbara Stevens Sullivan’s The Mystery of Analytical Work: Weavings From Jung and Bion. There is so depth to this book. I wish I had people I could read and discuss it with.

Or When Women Were Birds by Terry Tempest Williams. I love this book and have given it or recommended it to many women.

What is your favorite literary genre? Any guilty pleasures?

I love memoir. I am endlessly interested in the stories people tell and write about their lives. 

I also love mysteries and thrillers. They are my popcorn reading.

Have you read any good books on philosophy lately?

No.

What were your favorite books as a child? Did you have a favorite character or hero?

I had a book about a man who sold balloons in the park. I don’t know the name but I can still see the illustrations. I also loved the book of fairy tales that my grandmother had and would read to me.

I had a book that had been my father’s when he was growing up — Cop: A Police Dog.I liked it more because it had been my dad’s than that I liked the book itself.

I read Nancy Drew and Cherry Ames. I used to go to the library and come home with armloads of books — everything from poetry to novels. I started reading biographies when I was around 10. The libraries on the Army posts where I lived didn’t limit what I could check out or how many books I could have at a time. So I read everything that looked like it might be interesting.

What books had the greatest influence on you when you were a student?

Man and His Symbols was published when I was in college and it made me a Jungian before I really even understood it.

What was the last book that made you cry?

What comes to mind first is When Breath Becomes Air by Paul Kalanithi

And there were passages in Naming the Gods by Gary Astrachan that moved me deeply.

The last book that made you laugh?

I must be brain dead this morning because none comes to mind right now.

The last book that made you furious?

Too Much and Never Enough by Mary Trump. Everything about him makes me furious.

What’s the best love story you’ve ever read?

Like Water for Chocolate. 

Are there any psychotherapists that you think are also particularly good writers? What are your favorite books on psychotherapy?

There are indeed wonderful writers among psychotherapists. Barbara Stevens Sullivan is a favorite of mine. Michael Eigen. Christine Downing. Naomi Lowinski.

And if you could meet a character from literature, who would it be?

A friend of mine, Janice MacDonald, writes mysteries, terrific mysteries set in Edmonton, Alberta where she lives. And as it happens I am a character in one of her books, Hang Down Your Head. So I know one!

Who are your favorite writers of all time? 

Margaret Atwood, Marge Piercy, Jung, Freud

What are you planning to read next?

I have a Kindle app full of books to read. I just started How to Stop Time by Matt Haig.

Sleeping Beauty’s Mother

I am reposting this piece today because I have seen here and there renewed efforts to focus on children’s weight and controlling it. I think often  about Sleeping Beauty’s mother. Most of us are like Sleeping Beauty’s mother, eager to do whatever we can to spare our children difficulties.

 

You see that beautiful little girl in that photo? She was 5 years old there. I was delighted beyond measure when she was born. I always wanted a daughter, in part I’m sure to redeem my experience with my mother. To me she was and is the most wonderful daughter ever — smart, funny, and beautiful — everything I could hope for. 

But like Sleeping Beauty’s mother, we always fail in one way or another. Remember how it happened that the curse came to be in that fairy tale family? When the long desired child, a daughter, was born to the king and queen, they planned a great celebration. According to which version you read, they invited 7 or 12 fairies to the great feast. And whichever version, that is where the problem begins because one fairy is left out and she appears just as each fairy offers her gift to the child. She is angry at being neglected and acts out her anger by giving a curse, namely that on her 16th birthday, the girl would prick her finger on a spindle and die. The last fairy cannot undo the curse but she can mitigate it so that instead of dying, she and all the kingdom would fall into deep sleep for 100 years until a prince would come and kiss her awake. 

All The Spindles

Remember all the efforts Sleeping Beauty’s parents made to keep her from the curse placed on her at birth, that she would prick her finger on a spindle?They searched high and low determined to find and eliminate all the spindles and thus stave off the curse.

Well, knowing my body and how like the Fuller women I am, I was afraid that my daughter faced the curse of having to battle her weight all of her life. And I was determined to do anything and everything I could to protect her from it.  

Our concern here is not with interpreting the fairy tale; that has been done by many. Our concern is with the mother and all the efforts she made to keep her daughter from ever encountering a spindle and thus staving off the curse.  Such a frantic wish to protect her child.

Fate 

But the Moirae* could not be escaped no matter how vigilant she was or how hard she tried. When she was 16, the princess happened upon a woman who was spinning and asked what she was doing. She asked for the spindle and as soon as she took it into her hand, she pricked her finger — and well, you know the rest.

The mother failed in her effort. And even more, the curse happened at least in part because of the lack of a place setting for the dinner or enough goody bags, depending on the version. A careless error of omission that opened the way for this curse to come to pass.

 

I have been thinking about this a lot lately. How often we fail to be able to protect our children from whatever curse it is we fear. No matter how hard we try, there will always be one spindle. And perhaps the seeds of the whole problem lie in our frantic desire to keep our children from pain such that in the process, we fail to teach them things they really need to know. I was as much enthrall to the desirability of slenderness as anyone and so in a way my efforts led to exactly what I least desired.

I read and I talked with everyone I could think of who might be able to help me. I breastfed her for all of her first year, because it seemed breastfed babies were less likely to become fat. I held off introducing solids until she was almost 7 months old, because it was thought that early introduction of cereal predisposed to obesity. I made all of her baby food so that I knew there was no hidden sugar or modified starch. I was vigilant about what I and my husband ate, so that we were modeling healthy eating. I struggled to overcome my shame about my body so that I wouldn’t communicate that to her — I worked my ass off to get comfortable talking about my body, answering questions about it, getting comfortable in my skin.  

And it seemed to work. Until she was around 11 she was slender and I thought maybe we had escaped the curse. No matter how vigilant I was or how hard I tried, I hadn’t reckoned with genetics and puberty. She began to gain weight. She started menstruating when she was not quite 12 and it seems that it signaled the pricking of her finger on that spindle I had tried so desperately to get rid of. She became plump, with the same rounded body I have. Initially I was in despair because I had done absolutely everything right, everything that was supposed to stave off the curse. We didn’t overeat, eat junk food or any of the other “bad” things. We walked and did things together. She walked to school every day and played field hockey. None of it kept her slender.  

My heart broke for her as she struggled with it all. We talked about bodies, about doing everything possible to be healthy, that people come in all sizes. Her doctor and I determined that it was important for her to focus on being active and healthy, not dieting because she was at risk of developing an eating disorder, like several other girls in her class had.  

It was like walking through a field of land mines every day. I wanted someone, anyone to wave a wand and let her have the body she wanted. I felt guilty, that somehow I was responsible for her weight, for having passed along this terribly difficult problem to her. I worked  with renewed vigor on my own body issues. But none of it could change things. And I had to forgive her for not having escaped and myself for not having been able to save her.  

She is 43 now. She is not thin, but she has settled into an adult weight less than mine. She is active and healthy. She has been able to keep her weight fairly stable by concentrating on being healthy. She is largely free of the self-loathing I was still struggling with when I was her age. 

I read here and there and everywhere that if we get children to eat healthily, avoid junk food, and exercise, we can prevent obesity, and I think of my beautiful daughter. If they only knew how hard it is to eliminate all the spindles in the kingdom. 

* In Greek mythology, the Moirai are the Fates

A bit more on therapy

“Exchanging words is the essence of psychotherapy.” Nor Hall

I met with someone new the other day. When I meet with a new patient, I always have a slight anxiety before starting with this new person — anxiety and also anticipation Will we “click”? What new doors will open through this person and our work — because this process changes both of us, though not to the same degree. So there is that tingle of the new and unknown as I answer the door or the Zoom window as we do today. And then, once in my office, whether in person or on the screen via Zoom, Skype or FaceTime, we sit down and I ask, as I always do, “What brings you here today?” and we begin.

It is a curious process, therapy is. I have no visible tools. No questionnaires. No workbooks. No pills or potions. I do have a magic wand, though it is only for effect and rarely brought out. I bring with me 40+ years of sitting and listening in the same way plus my own life experience and analysis and a lot of reading. The journey is never the same with any two people. Which is why I never get tired of it, never weary of starting again with “What brings you here today”.

When psychotherapy works, it is not magic. For me, the experience of seeing therapy work though is like a miracle. I go about my business, and I know how to attend to my work. I observe. I listen. I take in. I accept the person as he or she chooses to present in my office, with as little or as much as they disclose. I attempt to the best of my ability to bracket my own issues and unfinished business, my own insecurities, trusting myself to the moment and the occasion of our meeting.

Then, I describe what I am observing and experiencing in the presence of this unique person who has come for help. It is to me a signal of transcendence that that simple process can change things.

Freud wrote,

“Nothing takes place between them except that they talk to each other. The analyst makes use of no instruments— not even for examining the patient—nor does he prescribe any medicines. If it is at all possible, he even leaves the patient in his environment and in his usual mode of life during the treatment…The analyst agrees upon a fixed regular hour with the patient, gets him to talk, listens to him, talks to him in his turn and gets him to listen… It is as though he were thinking: ‘Nothing more than that?… ‘So it is a kind of magic,’ he comments: ‘you talk,and blow away his ailments.’ Quite true. It would be magic if it worked rather quicker. An essential attribute of a magician is speed—one might say suddenness—of success. But analytic treatments take months and even years: magic that is so slow loses its miraculous character.”

~~~~~~~~~~~~

Therapy While Fat

One of the major issues I look at in The Fat Lady Sings is the issue of anti-fat bias in the psychotherapy consulting room. I write:

In a room with a slender therapist and a fat patient, it is the patient who has a weight problem. That therapist, bene tting from thin privilege may well assume that the way she eats, what she eats and how she exercises are what make her different from her patient, what make her thin and her patient fat. She may believe that because she carefully monitors what she eats and faith- fully exercises, that she has control over her body, control that the fat woman could have if only she tried harder and did as she does. There is nothing in the media or even the professional literature to contradict her assumptions.

 There is actually very little in the way of guidelines for therapists in how to work with fat patients or even how to make their offices welcoming. I have been able to locate three sets of guidelines for therapists when dealing with patients with size issues — one published in the American Psychological Association’s Monitor, one by NAAFA, and the last by Marion Woodman. So let’s look at the first two.

Guidelines for Psychologists

First, from the APA Monitor, a brief set of guidelines for therapists interested in being “size friendly” — it’s a short piece and seems to have been little noticed, though it was published in January 2004.

 Here are the guidelines:

* Don’t make assumptions about overweight clients, such as about whether they have an eating disorder or are working toward acceptance of their weight.

* Display size-friendly artwork or magazines in your office or lounge.

* Have seating in your office that can accommodate larger people. An example is armless chairs.

* Raise your colleagues’ and students’ awareness by addressing these issues in formal and informal ways, such as during clinical supervision or in workshops. 

 * Ask larger clients about eating behaviors in the same way you would ask a thin or average-sized person. 

* Through self-questioning and introspection, become aware of your own level of prejudice toward overweight people.

* Educate yourself on issues that affect overweight people, such as the genetic influences of size and the effects of dieting on physical and mental health.

* Understand that an overweight person’s problems are not always a result of their weight and that therapy does not bring thinness. Be aware that resolving life issues also does not necessarily result in weight loss.

I am willing to bet that very very few therapists are even aware that these guidelines exist, much less follow them. They are for the most part good guidelines, though whether questions about eating behavior are easily contaminated by bias. The therapist should ask herself, “Am I assuming this person eats differently from the way I do?” In my practice I do not habitually ask these questions unless they arise from my patient’s material.

NAAFA Guidelines

Next, NAAFA Guidelines  Here is their list of common assumptions for you to consider:

GUIDELINES FOR THERAPISTS WHO TREAT FAT CLIENTS

There are several assumptions, based on myth and prejudice rather than fact, which many members of our culture–including psychotherapists–believe to be true about fat people. These assumptions affect how therapists view and work with fat people in their practices. It is imperative that therapists recognize and clear out misinformation and bias in order to be most supportive and effective with their clients. We recommend that psychotherapists practice weight neutrality – i.e., make no assumptions based on a person’s weight, and not tie goals of treatment to weight outcomes.

ASSUMPTION #1: You can determine what people are doing about eating and exercise, just by looking at them. 

People naturally come in all sizes and shapes. Many fat people eat no more than thin people. some fat people are extremely active; some thin people are extremely inactive. Therapists must get to know each individual and his or her unique life.

ASSUMPTION #2: emotional issues cause “excess weight,” and once the issues are resolved, the person will lose weight. 

Humans come in a range of weights, just as they come in a range of heights. There is no evidence that emotional problems are more often the cause of higher weight. The idea that one has to explain why someone is at a higher weight is as nonsensical as trying to explain why someone is tall. There are fat people with emotional problems just as there are thin people with emotional problems, and the problems do not necessarily have anything to do with weight.

ASSUMPTION #2A: Large body size indicates sexual abuse, or a defense against sexuality. 

Some people who have been sexually abused may be fat; however, we cannot draw any conclusions about a person’s psyche based on body size. Many fat people are comfortable with their sexuality and are sexually active.

(I am not certain where the notion came from but around 15-20 years ago, the same folks who were promoting MPD were also promoting the idea that some 90% of fat women had been sexually abused. I never saw any research to support this figure but it was widely held for some time — C.F.)

ASSUMPTION #2b: fat people must be binge eaters. 

A small minority of fat people meet the criteria for Binge eating Disorder (BeD), as do a minority of thin people. There are also fat people who are malnourished, restricting, purging, and below their “healthy” weight. People with eating disorders deserve effective treatment and are often able to recover; however, their weight may or may not change in that process. An arbitrarily chosen weight should not be a goal of treatment, since weight is not under direct control. The focus should be on a sustainable, high quality of life, and on helping the person to accept the resulting body size.

ASSUMPTION #3: If a person is distressed and fat, weight loss is the solution. 

Being the target of weight prejudice can be cause for profound distress; however, the solution to prejudice is to address the prejudice, not the stigmatized characteristic. What would we do for a thin person in similar distress? The quality of support the person is able to give herself, and the quality of support available to her in the world, are key areas of focus. We do not have interventions that lead to lasting weight change, but we do have interventions that free people to be kinder to themselves and mobilize their energy to make their lives better.

ASSUMPTION #4: fat children must have been abused or neglected. 

Their problems can be fixed by restrictive dieting and rigorous exercise. fat children and their parents have been increasingly ostracized in a culture that equates a thin body size with personal value and appropriate parenting. children often gain extra weight before a growth spurt. enforcing weight- loss dieting and competitive exercise can lead to rebellion against both, as well as disordered eating. children need to be supported in using hunger and satiety cues to make decisions about eating, and in valuing their bodies and the variety of bodies in the world. 

ASSUMPTION #5: I am not biased against fat people. 

Research consistently shows that most people, including most healthcare professionals and even those who work closely with fat people, hold negative beliefs about fat people. Please investigate your own associations with weight and bodies of different sizes, including your own body, as essential preparation for working with fat people. (2) Therapists should be able to let go of any agenda to eliminate fatness, and see the beauty in fat bodies and the strengths of fat people living under oppression.

What is your experience?

If you are in therapy or have been in therapy, how does/did your therapist stack up against these guidelines? Are there others you think should be included?

Note about the image above: This is a sculpture given to me by a friend when I was writing my book. I do not know who the artist is.

Good News!

Photo of Paul

Back in 2008 when Jung at Heart was still pretty new, HBO began running a series about a psychotherapist and his patients. The show was called In Treatment. I loved it from the start and I set upon myself the task of blogging every episode, no small feat given that in the first season, there was a new episode every weeknight. I thought then and still believe that it is the best dramatic representation of therapy done to date. If you want to read what I wrote, just click on the In Treatment link at the top of the page — season by season, al the posts are there.

Friday I ran across this announcement — Big news! HBO plans to reboot the series. You can bet I will be watching and writing about each episode. In the meantime if you have questions or comments about the series or what I wrote about it, please post in the comments here.

On Not Being Able To Paint

That’s my art desk. It is suitably smeared with paint and certainly looks like I spend a lot of time there. But…

My brother is a painter. He paints trompe l’oile – which means fool the eye. Here is one of his paintings. 

 

Painting by Ken Fuller

Not my style but he is good at it. Somehow that he is an artist and was also my mother’s favorite led me to avoid art, focusing instead on intellectual pursuits. Still something in me kept wanting to paint and draw. My brother once said that anyone could draw, which was not encouraging to me at all. I took the art classes in school that were required but once finished with them I turned away from painting or any kind of art for many years. I think the last thing I made was a paper mache dog that I meant to be a dachshund but looked sort of like a weird brown worm with legs and ears.

Maybe a class would help

I lived in Portland, Maine for a long time. Portland is the home to a well regarded degree- granting art college. In the early 90’s I decided to take a drawing course through their continuing studies program. I hoped to find a class for people who did not think of themselves as artists, a class that would support and encourage people like me who wanted to draw but were intimidated by the doing of it. I did not find that — the people in the course saw themselves as artists and then there was the critique of every assignment. I dropped out.

A couple of years later my good friend and I found two wild wonderful women artists who were offering classes for people just like us. And it was just what I needed. Supportive, encouraging, full of laughter — a place where my very timid artist self could creep out and start to experiment, to express myself in paint.

Along the way I discovered that I love art supplies. I loved accumulating tubes of watercolors and oil paints. Lots of them. Brushes. Paper. Canvases. I was a very well supplied pretty unproductive artist. After a while the class died out. I painted a little more. I used them in my analysis. But away from the class, just on my own I struggled to paint anything. And then I stopped. And then I gave away all my supplies.

Fast forward to the last few years when I discovered the wonderful world of online art courses. I began again to accumulate art supplies. My lust for paints and brushes and the like was reawakened. I even did a few of the projects. But I still felt inhibited. And besides I was finishing my book. I watched every video. I liked the idea of mixed media. Images of potential projects would come to me but they never came to life on paper, mostly because I hated that I couldn’t bring into being what my mind’s eye saw.

Painting and Analysis Intersect

In addition to being a therapist, I was also in Jungian analysis for a long time — we ended just over 3 months ago. It was where I could struggle with my demons and learn more about myself. You might think that therapists make good therapy patients but really, not so much.

One of the features of Jungian analysis is opening to express feelings, experiences creatively — in art or poetry or writing or dance — a transformative process. As I said above, drawing and painting I kind of consigned to my brother. He was good at; I believed I was not. But writing — now that is a different story, I write easily and without fear, unlike what happens when I attempt to express myself in pigments on paper. Whatever I painted, I then looked at with a critical eye, a judging eye rather than seeing it for what it was, an effort to express something.

My analyst kept urging me to paint. And I would — for a while and then I would stop again. It was an ongoing struggle for me. I understood that the very fact that writing came so easily to me made painting important for my growth, not as an artist but of my self.

Recently I remembered a book I read at least 30 years ago — and truth be told, did not really understand when I read it. It is a bit of a classic published in 1950, written by Marion Milner, herself an analyst. I dug out the book, On Not Being Able to Paint. And began to read it. There in the foreword was this:

It is fascinating for the reader to follow the author’s attempts to rid herself of the obstacles which prevent her painting, and to compare this fight for freedom of artistic expression with the battle for free association and the uncovering of the unconscious mind which make up the core of an analyst’s therapeutic work. The amateur painter, who first puts pencil or brush to paper, seems to be in much the same mood as the patient during his initial period on the analytic couch. Both ventures, the analytic as well as the creative one, seem to demand similar external and internal conditions. There is the same need for ‘circumstances in which it is safe to be absent-minded’ (i.e. for conscious logic and reason to be absent from one’s mind). There is the same unwillingness to transgress beyond the reassuring limits of the secondary process and ‘to accept chaos as a temporary stage’. There is the same fear of the ‘plunge into no-differentiation’ and the disbelief in the ‘spontaneous ordering forces’ which emerge, once the plunge is taken. There is, above all, the same terror of the unknown. Evidently, it demands as much courage from the beginning painter to look at objects in the external world and see them without clear and compact outlines, as it demands courage from the beginning analysand to look at his own inner world and suspend secondary elaboration. There are even the same faults committed. The painter interferes with the process of creation when, in the author’s words, he cannot bear the ‘uncertainty about what is emerging long enough, as if one had to turn the scribble into some recognisable whole when, in fact, the thought or mood seeking expression had not yet reached that stage’. Nothing can resemble more closely than this the attitude of haste and anxiety on the analyst’s or patient’s part which leads to premature interpretation, closes the road to the unconscious and puts a temporary stop to the spontaneous upsurge of the id-material. On the other hand, when anxieties and the resistances resulting from them are overcome, and the ‘surrender of the planning conscious intention has been achieved’, both – painter and analysand – are rewarded by ‘a surprise, both in form and content’.

I sat down this morning and looked at a blank piece of watercolor paper. Nothing came for what felt like a long time. And then I began to make marks on the paper. No image in mind of what I wanted it to be. I just let the brush make marks until  I felt done.

As my analyst did, I often suggest to my patients that they paint or make collages or write or dance or work with clay. Most often they, like I, balk, resist, say they don’t know how or what they create isn’t any good. For some of us the road to being able to express ourselves is long and often hard, but it is worth the journey.

Maybe you can paint something today? Or write something? Or go inside a dream and explore it? Try it.

Fee — another piece of the frame

It’s almost the beginning of a new month with bills to be paid so let’s consider money and therapy.

Therapists that I know generally do not like to talk about money and fees. Most of us came to this work out of a desire to help others. And we often become uncomfortable with the business aspects of being in practice. The training programs I am familiar with make no mention of the business aspects of practice. So most of us went into, and many continue, practice with too little knowledge of and attention to nuts and bolts issues like fees.

I don’t recall ever considering how much money I could or would make as a therapist. In fact I had no idea when I began. That wasn’t a factor in my decision. Certainly that insurance did not cover therapy when I began practice meant that fees were lower and expectations about income more modest.

I recall something the analyst Donald Meltzer said at a workshop I attended years ago. When he was asked about third party payment for analysis, he first said that we must remember that he who pays the piper picks the tune. And though he and his colleagues were at first envious of analysts elsewhere in Europe where analysis was covered by insurance, gradually he came round to seeing that they were not better off as they had to contend with the intrusions of authorities who could change the terms under which analysis was covered without warning. Then he said that anyone entering this field planning to drive a luxury car and make a lot of money should reconsider becoming a depth psychotherapist because this work demands sacrifice on the part of both patient and analyst and that often means adjusting the fee. 

Setting fees is not a science. Fees and the business aspects of private practice are not taught in graduate school. There is not very much written about fees either. So we have to have a sense of what other therapists in our area and with our training charge, what we are comfortable charging, and how to handle those who cannot afford full fee. As someone who works long term with patients,  I do negotiate fees to accommodate need. I went through a process of determining for myself how much is enough, what I am comfortable charging patients. 

Yes, greed plays a role

Greed is an issue here; greed in the sense that no matter how noble some of our motives for being a therapist are, it remains the case that it is how we earn a living. And if we don’t get paid, we don’t eat. Therapists who rely on the compassion of strangers to provide for them are most likely going to have to find a job to pay the bills. I know of only one writer who has been willing to talk about the issue of greed in psychotherapy — Barbara Stevens Sullivan has a chapter on it in her book, Psychotherapy Grounded in the Feminine Principle. Any time I have attempted to raise the issue among clinicians, I have been met with ferocious resistance and complete disavowal of even the slightest whiff of greed as part of what we do in charging for our time.

I learned from Sullivan about the place of greed in the Tibetan Wheel of Life; greed is one of the three root delusions at the center. For therapists, denial of the importance of money and being paid can be a potent source of problems. Being unconscious about the importance of money in one’s life places a person at risk of being in the grip of unconscious greed. Openly acknowledging the importance of being paid and the desire to have enough money to live well creates the opportunity to consciously think through the issues.   Once I became comfortable with the fact that indeed I do not do my work out of the pure goodness of my heart and that I do enjoy being paid for what I do, the whole issue of dealing with fees became much easier.

Like many, I had felt almost guilty charging for my time. And as a consequence, for a long time, I set my fees too low and I was lax in collecting and in dealing with issues with patients about money. In fact, in my own discomfort with the whole subject, I was modeling for them that money was a somewhat taboo topic and I was unconsciously encouraging them to be as reluctant about paying me as I was to acknowledge that I wanted to be paid. My plumber seemed to have no problems letting me know what he charged for the work he did and that he expected to be paid on time. Nor did my dentist or my attorney. So step one was acknowledging that earning a living is what I am about, as much and often more than any of the noble aspects of working with people. This is a tough thing for a lot of therapists. How can I be “good” and openly embrace my desire for money?

Then comes the problem of what is enough? If a new patient tells me she cannot afford my full fee, we work together to find what she can afford. The fee settled on needs to be enough without either being too little or too much.