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.

Now is a good time…

As more of us are becoming vaccinated and we begin to believe that the end of this very difficult time is in sight, oddly many of us are experiencing mildly-moderately distressing effects from having our lives constrained for the past year. Yesterday I read this very thoughtful article in the Atlantic:

Late-Stage Pandemic Is Messing With Your Brain

We have been doing this so long, we’re forgetting how to be normal.

One provocative thought:

“We’re trapped in our dollhouses,” said Kowert, the psychologist from Ottawa, who studies video games. “It’s just about surviving, not thriving. No one is working at their highest capacity.”

I haven’t driven more than a few miles this whole confined year. And though, as an introvert I haven’t found being just with myself and my husband unbearable, even I am chafing at the pace of return to whatever will be normal.

If you are finding this time difficult, that the forgetting that seems to come with living through this pandemic and its attendant confinement, now is a good time to consider therapy. To have a place  and time to talk about what has happened with your life this past year, about your fears, about the discoveries you have made about yourself.

I have openings. Contact me using the contact form on the Home page. I’d be delighted to hear from you.

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.

The Inward Gaze

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

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

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