When we go into the woods

Into the woods

Starting therapy is a lot like going into the woods in fairy tales. We go together into territory that is both like and very different from ordinary daily life. But sometimes people are casually dismissive of therapy,  that it is just good listening and if friends could learn good listening skills, then therapy wouldn’t be necessary. Certainly listening empathically can and does provide catharsis and catharsis is an element of therapy. But it is only an element, not the whole thing.

When I enter a session with a patient I endeavor to do so without memory or desire — which is to say that any day as I meet with my  patient, I put away thoughts about this blog, about my husband’s latest project, about other patients, and about our last session with each other  and I prepare to meet her in the moment and without an agenda. I wait for her to begin and allow her to set the agenda for our time together. I follow the thread of her concerns and as I do so, bits and pieces of the other times we have met come to mind. I hear more of her themes and as we go along I am relating them to themes I have heard from others and what I know about such themes. I am aware of issues in her life that have led to her personality being structured as it is — this is a clinical piece where I touch into my database of experience with people who have similar histories and who have had the constellation of issues in their lives that she has has and what I know from more theoretical material as well.  I challenge a bit here, ask a question there, offer a suggestion, share a personal experience. I watch as we do our dance of of speaking and listening and I see when an interpretive arrow hits the mark and when it misses.

I am patient with hearing the same story told many times over the course of our work together and I listen for the subtle ways it changes as we explore the nooks and crannies of her life, how she begins to see herself in her life a bit differently and sees others a bit differently as well. The story in its basic outline remains the same but it changes as well in nuance and color and emphasis.

I bring to my work over 40 years of training and experience, many years of my own personal therapy, 10 or more years of supervision by masters in the field, and 70+ years of my life experience. I do not ask nor in any way expect my patients to reciprocate with me and listen to me and my issues. I have no agenda for what they should do. No subject is off-limits, including the full range of feelings they have about me.

What I do is well beyond empathic listening, though that is part of what I do. And while I agree that anyone benefits from being able to talk about feelings with an empathic listener, I do not think that listening alone is sufficient for dealing with a wide range of the things people bring into therapy. For some, it is about a corrective emotional experience, for others a chance to look at their lives with a person who is not entangled in that life and can be neutral, for still others it is where deep psychic wounds can be opened  so that they may heal. It is also a place where we can pay attention to dreams and symbols and archetypes and fantasies and discern the pattern of meaning in a life.

It is hard work. It is sacred work, I believe. 

Better to be bad than weak

Some years ago I read Harry Guntrip’s Schizoid Phenomena, Object Relations, and the Self. I often think of something he wrote in that book, that many of us would rather be bad than weak. Now that seems paradoxical at first but think about it — it is often more satisfying to believe that we, in our “badness” ,create the behavior in others that bothers us, because that way, if we become good, then they will change too.

If my mother treated me badly because I was bad; if my lover is abusive because I am not good then all I have to do is change, become good and then I will have the mother I wanted, the lover who will cherish me.

But if I have no control over my mother’s behavior or my lover’s abuse, then I have to live with knowing that I cannot change them, that I have to deal with who they are as they are.

To accept that I cannot determine the behavior of others means I must be more aware of my own choices and what drives them. I have to surrender my illusions about my power to control others.

Slow Magic

“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 this new person arrives — 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. And then, once in my office, whether in person or on the screen via 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 bring with me 40+ years of sitting and listening in the same way plus my own life experience 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 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.”

Mistakes

“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 40 years and I still make mistakes — different ones, but mistakes nonetheless. 

 When things go awry because of something I say or do, 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. And these days with the ubiquity of mobile phones, the chances that a message I might leave will be heard by someone other than the intended recipient is pretty small.

Sometimes with the best intentions, like Humpty Dumpty, all the king’s horses and all the king’s men cannot put the therapy back again.

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. 

Personal Myth

“I suspected that myth had a meaning which I was sure to miss if I lived outside it in the haze of my own speculations. I was driven to ask myself in all seriousness: “What is the myth you are living?” I found no answer to this question, and had to admit that I was not living with a myth, or even in a myth, but rather in an uncertain cloud of theoretical possibilities which I was beginning to regard with increasing distrust. I did not know that I was living a myth, and even if I had known it, I would not have known what sort of myth was ordering my life without my knowledge. So, in the most natural way, I took it upon myself to get to know “my” myth, and I regarded this as the task of tasks…”  C.G. Jung

 

I return to this subject over and over again, in my personal life and with the people I work with. Your personal myth is the story you have for making sense and meaning of the world. It is the story you are living. Keep in mind that myth is our story about our experiences as a human. It is not something that is false or unreal. Discovering and exploring  the myth you have been living opens the door for editing and changing the story. And in changing the story, you change your life.

Your personal myth might develop from myths you have read and heard — stories of Greek or Roman gods. Or it could be that you find your myth in fairy tales.  Or try writing your own fairy tale — begin with Once upon a time…

Years ago when I was early in my own analysis, I began to write a fairy tale. It was a new experience for me, though I had long kept a journal. I sat down one evening and began to write , starting of course with “Once upon a time in a far away land…”.  I didn’t have a preconceived idea about the story or where it would. I simply let it write itself and when the words stopped coming, I stopped. It was nowhere near finished after that first bit of writing and I didn’t pick it up again until the urge to write more came to me. The process continued like this — write until I had no more to write, stop and out it away, start again whenever the urge stuck again — for seven years. I was tickled by the length of time it took to complete the fairy tale because somehow 7 years felt like it belonged to the realm of such stories. In the years since then I have revisited the fairy tale, made minor revisions, reflected on it. Just this past week I have been with it again, this time contemplating a major revision. 

Here are some ways to get started writing your own myth:

1. Take the lyrics to a song you like — change them  and add lyrics that tell the story of your life’s journey. For example, consider the song “I Would Do Anything For Love” — could that be your story? How would you change the song?

2. Think of a favorite children’s story and put yourself into that story.

As your write, consider what is the story your are writing? How does it end? Is there a spell cast over you? How do you break it? And what do you feel as you write?

Are You Ready for a Journey?

“I thought I found an answer when I was older, meditation, yoga, channeling. A way of making use of a talent, a gift. And now it’s back worse than ever. No, not worse than ever, but it feels like that because I’ve been OK so long. It’s like unfinished business has come back to haunt me.” 

 “The gate that opens and closes can’t close.”

“Two years ago I began medication and it helped, not completely, but relief. Then the sleeplessness started and my doctor suggested I speak with you.” 

 “Are you ready for a therapy journey?” 

              Michael Eigen, Under the Totem: In Search of a Path.

 

So writes Eigen of his beginning work with a patient he calls Rose.

Are you ready for a therapy journey? I want to remember this question, hold it in mind for the next time I begin with someone new. Describing therapy as a journey isn’t unique to Eigen, but I don’t think we say it out loud all that often and not at the beginning.

People come to therapy looking for answers, for solutions to problems in their lives. In an era of “evidence based” medicine, they expect there to be some formula, some evidence based set of things they can do to make themselves feel better. They want assignments, suggestions, techniques — mindfulness, journal writing, drawing all of which are useful tools but do not carry magic. 

It is hard not to respond to this desire for a solution, a fix. Hard not to make suggestions, not to offer something to soothe the longing expressed for relief, for a partner, for happiness. We become therapists at least in part out of a desire to help.

But that kind of therapy is not what Eigen means when he asks his question. The therapy journey is a journey inward, with no predefined end point and often goes into unexpected territory. And on this journey, the therapist is more likely to ask questions than provide answers.

Are you ready for a therapy journey?

It’s the Relationship

Two Chairs

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 psycho-therapeutic 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 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 with that. 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

Therapeutic Space

In my search for how others have thought about the issue of therapeutic space, I encountered some of the writing of Yi-Fu Tuan, a geographer. Tuan wrote a very interesting little book, Space and Place: The Perspective of Experience in which he muses about how people think about space and place, home and neighborhood. One of his thoughts is that space is what we encounter when are are someplace new and unfamiliar and it becomes place as we learn its features and landmarks. This leads me to contemplate the fact that every time a new patient comes to see me, not only is the patient in a space which is not yet place, but so am I, because, though the physical features of the room are the same from patient to patient, the addition of a new person changes the space. As we begin the process of coming to know each other, we are each creating place, place which contains the other.

And I am pondering who the therapy space is for — the patient or the therapist? Or both? 

Psychotherapy in Darkness

I think often of this powerful quote from Jung on therapy:

“The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help (the client) acquire steadfastness and patience in the face of suffering. ” -C.G. Jung

How very different this view of therapy is from what most people seek. Jung understood that suffering is a part of life, that it has meaning and that to live fully is to know that suffering will be a factor in one’s life throughout life. If I look back on my own life, I know that I have learned most from those times which were difficult and often painful, not because I wanted to but because of the choices and consequences i faced at those times. The good times, the times of great happiness are wonderful and I have celebrated and cherished them and look forward to more. But it has been in those dark times when I have had to face myself and look deeply into my life and my actions that I have grown most.

Reflecting on consolations and desolations, joys and sorrows, is a part of many spiritual practices. Matthew Fox wrote in modern terms in Original Blessings about the Via Negativa, the path that takes us into darkness. So much of post-Enlightenment culture has been about the flight from darkness that many of us have lost sight of the meaning and value of darkness. New life begins in the dark. Seeds germinate in the dark.

Therapy which acknowledges and even embraces the dark times, suffering as well as joy, opens the door to that new life and creativity that can come from them.

Millennials and Online Psychotherapy

labyrinth solid white bkgrd

A Tweet about this article caught my eye before the holidays: Millennials and the false allure of online psychotherapy. Just the term “online psychotherapy” can mean anything from Skype or FaceTime sessions to email. Not all therapists are comfortable with or accepting of therapy except when done face to face in the consulting room. So I am used to seeing articles here and there decrying therapy which occurs via telephone or Skype. And that is what I expected to read about in this article. To a degree, that is indeed what I found.

After describing factors that seem to make millennials “the most stressed out group in the country”, there is this brief bit:

With Talkspace, for just $25 per week, clients can purchase “Unlimited Messaging Therapy” that allows them to text with a therapist whenever emotional problems arise. The Web site for the app states, “just like texting with a close friend, you can now message your therapist every day, for an entire week, writing as many times as you want.” Initial sessions for In Your Corner cost as little as $25 dollars for “instant expert support when you need it.” That might include online therapy, written coaching plans and stress-reduction techniques from a meditation instructor.

I had only recently heard of these quick response options from my son, who is just starting out in private practice and considering what he might offer. When he asked my opinion, I asked him if he really wanted to work with anyone on that kind of uncommitted catch as catch can sort of basis, because in my mind, it is not therapy but more like a stop at a first aid station for a band-aid now and again. He tried to make a case for it, thinking maybe some people would want to convert over to more regular scheduled therapy. I told him that when therapy starts with such a haphazard frame and very little commitment, it doesn’t seem likely to change because in accepting it, the therapist is colluding with the patient in his or her belief that a quick fix, an encouraging word as needed is sufficient to actually deal with ongoing issues and problems. 

Years ago I had a copy of the fairy tale “East of the Sun, West of the Moon”. And there was a line in it that seems to fit the therapeutic process — the road is long and hard but when you get to the end, you will find great reward. Therapy isn’t about becoming happy or soothed but is about traveling the road inward and becoming more conscious about oneself and life experience so that a greater freedom of choice becomes a available. It isn’t a pacifier there for instant gratification. No matter how much any of us might like to have something like that.

It is ultimately, no matter the orientation of the therapist, the relationship, which can only develop over time, that heals, that fosters change. And that can’t come in texts or quick emails. And yes, it can occur over time talking with a therapist over Skype or the telephone.

Now to spend some time reflecting on how our children came to expect that “instant expert support when you need it” is the way to go.