What is the myth?

What is the myth?

It is often the case that at midlife and beyond  life calls us to look again at who we are, what we have done, what we believe in. This is prime time for discovering what is the story we have been living; as Jung put it — 

I asked myself, “What is the the myth you are living?” and found that I did not know. So…I took it upon myself to get to know “my” myth, an I regarded this as the task of tasks…I simply had to know what unconscious or preconscious myth was forming me.”

Human beings are narrative makers. We remember ourselves and our lives in stories — stories we tell our friends, family, strangers, ourselves. When a new patient comes to me, I say “tell me about yourself” and await the story of this person’s life and how it has brought her to me. And if we work together for some time, that story will change so that the story she tells at the end will be recognizable as hers but different in some ways from the tale told at the beginning.

“The universe is made of stories – not atoms” —   Muriel Rukeyser

So, we swim in a sea of stories — our own and those of the ones around us. And we shape our lives around the story we tell ourself is ours, the story that we live. Think of a person you no doubt know whose life could be summed up in the song title, “I would do anything for love” — can you begin to see the story he or she is living? And how might that person be able to change the course of the story, write a new chapter if only she knew it was what she is living?

“The story I am writing exists, written in absolutely perfect fashion, some place, in the air. All I must do is find it….” Jules Renard 

Exploring personal myth is one way to discover the story. 

In the last 20 years or so, a number of books have been written on the subject of personal myth. Of the lot of them, 2 stand out for me as better than the rest:

James Pennebaker: Writing to Heal — Pennebaker, a social psychologist, has done considerable work examining the healing potential of writing. 

Sam Keen & Anne Valley Fox: Your Mythic Journey —  this book encourages the reader, through writing and reflection using question drawn from the work of Joseph Campbell, to uncover our story and explore its meaning.

I am never entirely happy with self-help books. In order to appeal to a large audience, in my view, they lose bite in favor of what is palatable and likely to engage masses of readers, rather the same way that the food from Taco Bell is suggestive of Mexican food but lacks the complexity and range of real Mexican food. So think of these books as a way to do personal myth, lite. Digging into one’s life, looking at Shadow as well as Persona, takes time. Plus all of us are at best reluctant to look into the corners and under the rocks where our darker or less acceptable aspects lurk. That said, these books offer a palatable way to begin to look at personal myth and may whet appetite for looking deeper.

In the Third Act

A rose blooms in winter

Almost 12 years ago I taught a course I called Conversations in the Third Act at the local branch of the University of Maine’s life-long learning center. If life is a drama in three acts, then all of us over 50 are in the third act and dealing with a whole new set of issues, questions, and challenges.

In the secret hour of life’s midday the parabola is reversed, death is born. The second half of life does not signify ascent, unfolding, increase, exuberance, but death, since the end is its goal. The negation of life’s fulfillment is synonymous with the refusal to accept its ending. Both mean not wanting to live, and not wanting to live is identical with not wanting to die. Waxing and Waning make one curve. ~ C.G. Jung

Coming to terms with the loss of youth and the dawning realization that life is finite is intrinsic to later life. Much has been written about the passage into midlife and we have no doubt all heard of the Mid-Life Crisis. One person may experience the fear of losing control and the sense of self that once worked. Another may feel the fear of further losing areas of self-expression. Frequently, there is the existential fear of mortality and diminishing time, the realization that half of life is gone. And for those of us in our 60s and 70s and beyond, an even deeper recognition of the finiteness of our lives.

It is common  to experience anger or depression in response to lost time and opportunity for more authentic experience. Depression and underlying regret may reflect an emerging sense of emptiness and the superficial relationship to life of the “adapted self.”

These are calls to attend to life issues which have been neglected. As Jung said,

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.

In drama the first act is used to establish the dramatic situation and introduce the main characters. At the end of the first act, an inciting incident complicates the story and moves the screenplay into the second act. — This is childhood through young adulthood, when we set the stage for our lives, choose our work and relationships.

The second act, commonly described as “rising action”, typically depicts the protagonist attempting to solve the problems caused by the inciting incident. The Climax, which ends the second act, is the scene or sequence in which the main tension and dramatic questions of the story are brought to their most intense point. —  This is the time from 35 or so to the 50s even 60, what has classically been known as midlife. At the end of this act, there is a dawning awareness of the end, even though it does not seem imminent.

Finally, the third act features the resolution of the story and its subplots. It is the third act that I have become most interested in, the time I myself now inhabit, This is the time in which life’s loose ends, unresolved plotlines, that is the denouement of life.

I know that I am younger at 72 than my mother was. Already at my age, she was old and seemed to have moved into just waiting for the end. Women become invisible around age 40 when we are seen as faded flowers, no longer attracting the eye of young men. That fading is even greater as we enter this last act of life. We are scarcely seen in movies or on television, in magazines or popular culture. In the last election, Hillary Clinton, younger than Bernie Sanders or Donald Trump or Joe Biden, was sometimes subject to open speculation about whether her age made her a bad choice for President. Men can be elder statesmen in the 70s; women of that age, no matter their accomplishments, are expected to disappear.

But this is a time of great possibilities as well. Look at me — I published my first book just 2 years ago . If you have HBO, watch Grace and Frankie — women in their 70s who are filled with ideas for new things to do, new businesses to launch while their husbands believe they must surrender to age and retire. 

There is work to be done in this act. It is our last opportunity to make revisions to this story we living, the last chance to reconcile holes in the plot and to move the story forward to its inevitable end.

No Going Back

No, no, there is no going back.

Less and less you are

that possibility you were.

More and more you have become

those lives and deaths

that have belonged to you.

You have become a sort of grave

containing much that was

and is no more in time, beloved

then, now, and always.

And so you have become a sort of tree

standing over the grave.

Now more than ever you can be

generous toward each day

that comes, young, to disappear

forever, and yet remain

unaging in the mind.

Every day you have less reason

not to give yourself away.

 ~ Wendell Berry ~

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

Perfection or Completion?

Every day of 2008 I took a photograph first thing every morning out my dining room window.  I didn’t know why and I didn’t know if I had the discipline to follow through every day for a year – after all I started Bonnie Craig’s 21 day shape-up program at least 5 times and never got past day 8 (and never did the whole thing).  But something in me knew it was an important undertaking for me and so, day by day, every day, I took my picture.

I made myself be content with the pictures as they came out, altering them only to saturate the color a bit to compensate for the compression of the jpeg format. I was frustrated sometimes by what I didn’t know about – how to better capture the light and by the inevitable smudge on the window on the days I couldn’t open it to take the picture. 

As I reflect on the project this from Jung comes to mind:

“If a woman strives for perfection she forgets the complementary role of completeness, which, though imperfect by itself, forms the necessary counterpart to perfection. For, just as completeness is always imperfect, so perfection is always incomplete, and therefore a final state which is hopelessly sterile…the imperfectum carries within it the seeds of its own improvement. Perfectionism always ends in a blind alley, while completeness by itself lacks selective values.” (C.G.Jung, CW 11, para. 620)

I had to be content with my imperfections as a photographer, with the errors that inevitably crept in and in the process, as completing the project became my goal, I became better at what I was doing. Good lessons in it.

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.

Week 2: Issues

Photo of Paul

On the HBO forums there has been considerable discussion of the note-taking issue. And we saw this week that after seeing April, Paul sat down to write some notes. Which we know from what he said to Mia when they met to discuss the lawsuit taking session notes is not his usual practice. So why now?

The answer is simple — anxiety. 

The whole issue of session notes is related more to risk management and insurance company requirements than it is to good care and the best interests of the patient. In fact. until fairly recently, it was up to the therapist what kind of notes if any notes would be taken. And, depending on licensing requirements and whether or not one accepts third party payment, it is still up to the therapist on this issue. Some therapists document via a short notation the occurrence of a session combined with  billing records. Others take notes during the session. There is nothing in these approaches or any other that correlates to skill or outcome.

In a paper presented to the APA, Martin Williams explains how what starts as a way to manage risk morphs into standard of care — and sometimes into mandated requirement:

“Why wouldn’t you want to take notes about your session? …

Some psychologists—many more, I think, back a few decades ago and fewer today—do not think of what we do as medical, or as a treatment, or as something for which written documentation is appropriate. We see our work as forming relationships with patients, relationships that are unlike that of doctor-patient, but more like teacher-student, consultant, clergy-parishioner, or simply peers. Some of us believe that medicalizing that relationship by writing notes about how “the patient is progressing” or even about what happened during the session creates a barrier between the two people who are engaged in a personal journey together. Along those same lines, some of us eschew diagnosis and treatment plans.

It doesn’t really matter whether you agree with this Humanistic approach to psychotherapy. It serves as a good example of how risk management evolves to become the standard of care. Somewhere along the line, psychologists thought it would be a good idea to document what you did in therapy as a way of protecting yourself from certain claims, especially claims that you failed to do something. If someone claims you failed to ask your patient if he or she was still feeling suicidal, and your notes show that you did ask that question, bingo, you’re protected. If the patient later suicided, but after the session you wrote a note documenting the reasons that you believed the patient was not suicidal, and those reasons make sense to a later adjudicator, you have a degree of protection that you wouldn’t have had you just reconstructed that session from memory—subject to the skeptic’s view that your memory had been conveniently altered and rearranged to diminish your liability.

So it makes sense that those of us who want more protection would minimize their risk by taking notes, taking notes to document that we did all those things that someone later might claim we failed to do—a fine risk management idea. Fast forward to 2002 and we find that record keeping is no longer about risk management. It has become the standard of care…

One no longer keeps records to protect oneself. Now, one keeps records because not doing so is considered unethical in and of itself. Risk management evolves to become the standard of care.”

Ultimately each therapist has to decide where he or she stands on this issue. If one does not accept third party payment, it is a little easier because there are not then concerns about insurers demanding to inspect files, which they have the right to do for covered patients. The therapist must weigh duty to protect the patient’s interests and confidentiality vs. risk management. Consider also that patient files can be subpoenaed in other legal actions such as divorce cases and the confidentiality issue can be quite significant.

So Paul, now anxious about the lawsuit filed by Alex’s father, is taking notes after seeing April, not because it makes him a better therapist but because of his fears. It isn’t clear whether he is also taking notes on other patients. 

This is a difficult issue. Before therapy was routinely covered or expected to be covered by insurance, risk management and these kinds of records requirements were rare for therapists. And given the low incidence of lawsuits against therapists, the fear generated by risk management folks is disproportionate. Years ago in response to someone asking how he felt about insurance coverage for analysis, a well-known Jungian analyst said that we must remember that he who pays the piper picks the tune. We do well to bear this in mind as third parties become more a part of what we do.

“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 C W, vol. 4, para. 442