Conversations in the Third Act

“We cannot live the afternoon of life according to the programme of life’s morning, for what was great in the morning will be little at evening, and what in the morning was true will at evening have become a lie.” ~  C.G. Jung

Today I am beginning a series of posts about living in the third act of life. For those of us in our sixth or seventh or eighth decade of life, we have the opportunity to create the Third Act of our lives. We are in a period of life in which we are free from social expectations and reduced family obligations, with the freedom and the need to find new meaning and purpose. We are living longer than ever before in better health and our choices are expansive as we shift our view from building a career in our Second Act to creating the Third Act of our life story. 

The goal of all life, the end point, death is what lies in front of us all. And in this act, it looms larger than it has before and is much more a part of consciousness. To be fully alive is to know that death lies ahead.

Between here and death, there is a lot of territory. Work to be done to deal with things left undone, to reconcile ourselves to our past, to seriously consider the story we have been living with an eye especially toward any changes we want to make in the remaining years.

‘The first half of life is but preparation for the second …’ (Jung)

1. Are you who you expected to be at this point in your life?

Healing?

bent branch
bent branch

“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. I don’t have any tools in my toolkit that can create change in anyone. I don’t even really have a tool kit. what I do is listen and witness and sit with the people who choose to come to work with me, to tell their stories, share their suffering, explore their dreams. 

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.

I cannot ever be who 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. My life has been shaped by the containers in which I have grown. In the container of my own analysis, I have become 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 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 that allows 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. So is therapy healing? If by that we mean it makes the wounds go away, I’d have to say no. But if we mean does it make life better, does it help us become freer, more alive, open to creativity? Definitely yes.

It’s the relationship

Many, maybe most people believe that therapists “do” something which makes patients feel better because it is hard to believe that it is the relationship between the therapist and the patient which is the healing factor.

If I go to the dentist because I have pain in my mouth and the dentist doesn’t help, I likely will seek help elsewhere, and that seems reasonable. But I look to the dentist to *do* something to make me feel better. The dentist does not usually, at least in acute situations, require of me that I do more than be cooperative and hold my mouth open. But psychotherapy is a different thing altogether. Therapists do not perform procedures upon patients in order to relieve their suffering. We might sometimes wish we could and certainly patients wish we would, but it just isn’t that way.

In any depth psychotherapy, the therapist does not tell the patient how to solve problems. The focus of treatment is exploration of the patient’s psyche and habitual thought patterns. The goal of treatment is increased understanding of the sources of inner conflicts and emotional problems. This understanding is what we call insight. Now insight without action is pretty useless. But the therapist doesn’t say to do this or that but instead might ask how this new understanding might be put into action in the patient’s life.

In order to accomplish this work of therapy, the patient and therapist must have a good working relationship, or therapeutic alliance. The patient needs to feel that the therapist is on her side, so to speak, allied with her in her desire to have a better, happier life. And in turn, the therapist needs from the patient a willingness to do the work of therapy, to put feelings into words, to talk about what she is thinking and feeling. And that includes being willing to talk about feelings of anger, disappointment or frustration about the therapy or therapist.

“For psychotherapy to be effective a close rapport is needed, so close that the doctor cannot shut his eyes to the heights and depths of human suffering. The rapport consists, after all, in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. Unless both doctor and patient become a problem to each other, no solution is found.”  C.G. Jung

Most often when I hear people saying that therapy isn’t helping, I am also hearing an expectation that the therapist will tell the person what to do in order to feel better. And  to a very limited degree, we can do some of that — like take a walk or write in a journal or try painting or some other creative outlet when having difficulty between sessions. But on the big things — like whether or not to stay in a marriage or change careers or leave home or any of many many other important life decisions, we cannot tell a patient what to do. We, as human beings ourselves, have enough trouble finding our way through the complexities of our own lives and not only cannot, but really should not presume to be in a position to make decisions for others in their lives. No matter how much the patient may want it. But talking about wanting that, being angry that the therapist won’t do it — that is the stuff of therapy. Because it is the relationship with the therapist that facilitates change.

Ultimately we behave with the therapist the way we do with most important people in our lives, with the same kinds of assumptions about the therapist and about ourselves. And we do so unquestioningly. 

It is also true that it is difficult for the therapist to respond to feelings and issues that the patient does not talk about. All rumors to the contrary, we are not mind readers! This underlies the basic therapeutic dictum that the patient should say whatever comes to mind.

Now of course, this is difficult for most of us, conditioned as we are by social norms, by rules we have learned from our parents. Remember Thumper in Bambi:”If you can’t say something nice, don’t say anything at all”? Most of us operate on some version of that in our relationships and avoid saying things to another person that we think might make them uncomfortable or angry with us. But therapy is a place where Thumper’s Rule needs to be suspended. So, if you don’t tell the therapist you don’t feel cared about, there isn’t much the therapist can do to help you explore those feelings. Similarly if you are angry with the therapist, have sexual feelings toward him or her, or any of the myriad of other feelings and thoughts about the therapist you might have. It all belongs in therapy. Putting those feelings into words is a key  part of what therapy is about, after all, because that opens the doorway to understanding where they come from and how to deal with them in ways that are helpful rather than destructive in life.

You Don’t Always Get What You Want

A couple of years ago I read The Last Asylum, by Barbara Thomas. It’s one of those books that has stayed with me and leads me to think more deeply about the things she writes about — madness, analysis, healing. 

Thomas came to analysis wanting her analyst to take care of her, much as she wanted and got friends to take care of her. She wanted him to give her answers, to tell her what to do to feel better. It took a number of years for her to come to the place of accepting that he could not and would not tell her what to do or give her answers or take care of her. What he could do was help her to find her own answers but in order to do that she had to surrender.

This brings to mind a day when my daughter was 4 and had an epic tantrum. The kind of tantrum where I sat on the floor holding her, careful to keep my head out of the way of her flailing and hurling of her own head and let her be in that state, let her cry and yell and flail and just lovingly hold her so that she did not hurt herself or me. Finally she stopped yelling and the storm subsided into tears and then calm. I let go of her and she turned and said ”Mommy, why did I do that?” Just as Thomas railed at her analyst until she finally let go, my little girl had to do the same. Though of course there were many times in her childhood that she got angry with me or her father or brother, many times she felt us thwarting her desires, she found words to express those feelings and there were no more epic tantrums. In a way this is what Thomas describes. She had to go through that long struggle to get her way, to get what she wanted in order to get what she actually needed. She had to reach the point of surrender in order for her to get that.

And isn’t that what happens to many if not most people in analysis or in any other intense intimate relationship? Does there not come a time when to get what we need, we must surrender our insistence on what we want? Because we must learn the difference between want and need. Or as the Rolling Stones put it, “No, you can’t always get what you want But if you try sometime, you just might find You get what you need”. Thomas did not get what she wanted. My daughter didn’t get what she wanted. In my own analysis, I didn’t get what I wanted. But in surrendering that, low and behold, we got what we needed. The same is true in therapy. In order to get what we want, we need to surrender to the process and if we stick with it, we will get what we need.

Words that shaped me

I have always been a reader and books have played an important role in shaping me as a person and as a psychotherapist. So in no particular order of importance, here are ten books that have stayed with me and in both subtle and not so subtle ways helped to shape my thinking about what I do.

1. Freud’s Introductory Lectures on Psychoanalysis — the basic text for my second course in psychology in college, taken when I was a sophomore. Whether it was the ideas of Freud or the genius of the professor, Irwin Kremen, this book and course grabbed me and really got my interest in psychotherapy and in the workings of the mind going.

2. Man and His Symbols — Carl Jung. I discovered this book while browsing in the Gothic Bookshop at Duke sometime when I was a junior in college. I was fascinated by the ideas, though I didn’t understand a lot of them. 

3. I Never Promised You a Rose Garden — also read while I was in college. I count myself lucky to have encountered these books n my college years when psychoanalysis and depth psychology was still the dominant mode.  This novel set me to browsing the shelves of the library reading all kinds of books about psychotherapy and psychoanalysis.

4. August — I still recommend this novel by Judith Rossner to friends. The novel focuses on the relationship between a psychoanalyst, Dr. Lulu Shinefield, and a young troubled woman, Dawn Henley, from the beginning of their therapy together through to its termination. And because it gives us perspective from both sides of the couch, I think it is really unusual.

5. The Words to Say It– Claudia Cardinal. Around 20 years ago, a patient gave me this book. It is a fictionalized report of the author’s seven years in psychoanalysis and gives a sense of that process. 

6. The Treatment – Daniel Menaker’s novel about Jake Singer and his analysis with Dr. Morales, a wild and passionate analyst. Though Dr. Morales behaves as likely no analyst would, his passion and willingness to engage Jake in the way he does captures the excitement that I find at the heart of this work. 

7. Schizoid Phenomena, Object-Relations, and the Self – Harry Guntrip. Through the 70’s and 80’s I read widely in psychoanalysis, object relations, Jungian psychology. I would look at the bibliography of any book I liked and find as many of those books that sounded interesting to me and read them. This gave me an intensive education that I couldn’t have gotten any other way. This book, with its awkward title, was one I I’ve gone back to a couple of times. 

8. Psychotic Anxieties and Containment: A Personal Record of an Analysis With Winnicott –  Margaret Little. This little book, just 129 pages, was terrific for giving me a deep sense of what it is to be a wounded healer. Not many analysts or therapists write about their own wounds and madness. Margaret Little gives a tremendous gift in this account of hers.

9. Women Who Run With The Wolves – Clarissa Pinkola Estes. I go back to this book again and again, drawn by different fairytales and her analysis of them. To my mind, this is one of  the best books  based on Jungian principles and most accessible to the general public.

10. Of Two Minds: An Anthroplogist Looks at American Psychiatry – T. M. Luhrman. An interesting look at the split in psychiatry between those who lean to brain and those to mind.

Of course in the process of writing this list, another dozen or so books sprang to mind. I’ll save them for another day.

Slow

Summer is the time for slowness. I have been reading a lot but not writing much, though I expect to remedy that in the next little while. Meanwhile, here is a lovely quote about therapy from Freud:

 “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.”

Leo Shows His Past

This noble beast is Leo. He is three years old and has been with us since he was about nine weeks old when we adopted him and brought him home. That first day he strode boldly out of the carrier and made it clear that he intended to rule the house. They told us at the shelter that orange cats tends to be dominant and it certainly looked like Leo fit that bill. He quickly made friends with our two other cats, Roscoe the old guy and Ollie who is about the same age as Leo.

We didn’t know a whole lot about Leo’s origins. We knew he had been found on the street in Rockport when he was about six weeks old, a tiny thing, too small really to be alone like that.  He was in the shelter just long enough to become healthy and be ready to be adopted. 

After a while, though Leo was from the beginning an affectionate and friendly kitten, we noticed that he never stayed at the food dish to eat but rather would fill his mouth with dry food and then go elsewhere in the house where he would drop the food and eat it, or at least most of it. So we were always finding little piles of dry food in the places he liked to be. And when one of us would sneeze or cough loudly, Leo would startle and run away. Then we moved a couple of months ago.

All of our cats are indoor-only cats, so the move was the first change of place for Leo since he joined our family. Now it became evident how much Leo really hates change. We brought the cats to the new house after all the furniture and boxes had been brought in. One by one the cats emerged from their carriers and began to explore the house. Except for Leo. Who found a hiding place. And we hardly saw him for almost two weeks. We would catch glimpses of him as he raced to the kitchen to grab some food, but otherwise he stayed hidden away in a closet or behind boxes, clearly not thrilled with being in this new place. 

Finally after two weeks he began to spend time outside of his hideaway. He would race into the bathroom any time I was there and purr and rub against me. And he began again to perch on my lap, between my legs so he could watch tv — he loves television. And he returned to sleeping next to my feet at night and walking on my husband during the night when he thought he should be fed. He seemed to have returned to his old self.

Then we changed the kind of litter in the litter boxes. And on that very same day there was a huge and very loud thunderstorm — and Leo disappeared into hiding again, this time for about three days. It is now a bit more than two weeks since that trauma and he has again emerged and seems even more his open self than before.

We know that trauma leaves its mark on developing brains of humans. I can’t help but believe that is what we see in these behaviors of Leo’s — the way he takes his food away from the dish, his response to changes in his environment — are how the trauma of his early weeks marked him. Though he has been safe and warm and loved for all but a very few weeks of his life, those weeks remain with him.

In Treatment, Season 4, Weeks 5 & 6

 

 

I watched the last 4 episodes of this season last week. I had really looked forward to this show. I wanted to like it and be as interested as I was in the first 3 seasons. It hasn’t turned out that way. I have not even felt moved to write about the episodes in the way I did originally. So today I will offer my impressions of the season as a whole and talk about what bothered me about it.

I have said before that I very much like the actors. They do heroic work with what they have been given. But the whole thing lacks the verisimilitude that marked the first 3 seasons. It’s not the acting but the scripts, I think. In Treatment in its original form was notable for being the best representation of psychotherapy in a drama that we have seen. Compare it with Couples Therapy on Showtime and of course, the differences are glaring. Couples Therapy is a documentary series with a real therapist so does not operate in the confines of drama. In a way, comparing the two series is unfair. In Treatment took risks and experimented with format in ways that made it more compelling than it would have been as a normal drama. And it might even be that it paved the way for CouplesTherapy by demonstrating there is an audience for such a series. All of that is to the good. So what didn’t I like this season?

As I have said before the “patients” this season all feel to me like types and not so much like real people. The dialogue too often felt academic and a bit stilted. The stories just don’t ring true for the characters. I WANTED to care for the patients and the therapist, but I couldn’t muster the empathy. The dialogue just lacks believability. I found myself rolling my eyes at the screen and expressing my annoyance out loud, which I guess shows I was engaged at least at the negative level.

No therapist is perfect. Jungians speak of the “wounded healer” — that we are drawn in part to our work because of our own wounds. We deal with those wounds in our personal therapy and analysis so as not to act them out with patients but to have our experiences serve as a source of deep understanding. Brooke like most if not all of us is wounded. That doesn’t bother me. But she, through the course of the season, is an actively drinking alcoholic and is not in treatment herself, not actively, which means she is impaired. The problems this creates actually to my mind dominate just about everything she does. While we learn that Paul is her supervisor, they do not talk regularly and she does dodge him. In this way, she echoes Paul’s dual relationship with Gina. Brooke’s friend/sponsor, Rita, cannot provide all of what Brooke needs. Just as Paul did not get a firm handle on what he needed and wanted until he enters therapy himself with Adele, so Brooke is not getting what she needs though in the closing scene of the season she does call Rita and say she is ready to stop drinking. And that is great but only part of what she needs to do.

One of if not the best episode of the season came in week 5 when Brooke was to meet with Paul. Paul cancels at the last minute which leads to the device of Brooke, the therapist, meeting with Brooke, the patient—a little gimmicky but overall it works. We learn the most about her in this episode as she confronts herself. For me, it pulled together a bunch of things. In a sense, the three patients can, as in a dream, be seen as aspects of Brooke herself. Eladio and Laila both suffer, as indeed Brooke does, from mothers who cannot give what they need. Brooke’s mother was an alcoholic and just didn’t see her really. Like Colin, Brooke contorted herself in an effort to get her mother to like and want her. 

Mother — mother absence, mother problems — is the dominant theme of the entire season. Brooke, who is motherless, gave up her only child at birth and those became absent to her own son. 

Eladio wants Brooke to be his mother, the mother his own could be. He wants unconditional love, which Brooke cannot give him. She can see and feel his transference but every time the emotions become strong and he evokes a big feeling from her, she bolts — literally leaving the room, referring him to a psychiatrist, then to another therapist. She is correct when she tells him she is failing him, but it is not at all clear that she can see it is her own unresolved mother complex and her drinking which underlie her failure.

With Colin, there is a massive boundary violation which she tacitly accepts. He shows up at her house unannounced and proceeds to act as if they should have a session. And, she does not make him leave. The next week, when he returns, they spar and he then attempts to engage her sexually. She doesn’t acceded to his desire but she does not make him leave either. To me, that was mind-boggling. There is no way to remain neutral and objective once that boundary has been crossed. That she agreed to continue to see him is a problem. This is a situation in which I believe the better course of action is to refer him elsewhere and end work with him. Brooke seemed unable to see how deep manipulative Colin is, imagining somehow that she could penetrate his thick defenses. He would momentarily look like she had found her mark but it never lasts. Colin isn’t motivated to do the work of therapy, was only there because the court ordered it. What this case did was provide a platform for some heavy handed talk about  privilege and race that entirely missed the real issues with Colin.

More than once Brooke launched into mini-lectures about theory and technique or ethics. She does this with Eladio, Colin and Laila. With Laila, instead of saying she, Brooke, is concerned that Laila might be having suicidal thoughts, she says the law requires her to ask. That feels clumsy to me and a bit impersonal. When Colin tries to engage her sexually she talks with him about erotic transference!

These things are problems with the writing. As I said before, the actors, especially Uzo Aduba as Brooke, are superb.

Reboots often fail to live up to the original. This is no exception.

So, what did you think?

InTreatment, Season 4, Week 4

Week 4 — what to say? Brooke is deeper into her relapse, pursuing unconsciousness with a vengeance. It is painful to watch. Everyone that we see her with tries to connect with her and every time at the critical juncture, she flees either literally or figuratively.

Eladio confronts Brooke — “What am I to you?”. He feels her double messages, tells her she runs hot and cold. He wants her to be with him as he is with Jeremy, his charge, whom he loves and loves enough to be honest with. 

Colin, who like the good narcissist that he is, is at turns charming and maddening. He invents stories to tell her and when caught in the lie, makes another story. She does not really respond to the one naked thing he says which is “I want you to like me.” Underneath we know he feels that he can only get people to care by doing his charm offensive, that if he is real, he will be rejected. He succeeds in making Brooke angry and she tells him she had promised herself no more narcissists because they don’t change, shooting her own arrow into Colin. She would need to hold her therapeutic stance, to let him feel, and to work to get deeper inside his need, his desire to have her like him. One wonders how she might respond differently were she sober and not mired in her own lies and emptiness.

We see how really wounded Laila is this week. Brooke is better with her but seems not to get until the end of the session that Laila is likely suicidal. 

And then Adam, who isn’t especially appealing but who tries to connect in some way with Brooke. At the beginning of the week he offers to have a child with her if that would help. And he accurately identifies that her son, gone from her since birth, is more of an idea than a reality, hence his suggestion that they could have a child together.

Brooke has another bender and this time it is the last straw for Rita who tells her she can’t stay, that when Brooke is ready to stop drinking, she can call her. Brooke complains to Adam about Rita and sadly, he colludes with Brooke’s claim to victimhood. He again tries to connect with her. They have sex but she seems hardly there—to be fair, she was drunk so unable to be present. Then as they finish, she passes out, becoming literally unconscious finally.

Watching Brooke this week was depressing. And made me angry. I wanted to shout at her and at the writer’s who have created this mess. Many years ago, I and some friends attending a family therapy workshop volunteered to role play a family for the workshop leader to “work” with. The family we fell into being was rather like the characters in this season — types, exaggerated, unrelenting. We became caricatures of family. 

I don’t know where things can go with the rest of the season. A suddenly seeing of the light on any of their parts would feel phony. Yet sliding down even further a bleak prospect. 

I noticed today that HBO has released all of the remaining episodes.I plan to watch them this weekend and next week post about what I see and reflections on this season and tissues it raises. For now, color me less than pleased.