Can You Always Trust Your Therapist?

512px-Credibility_Trust_Provenace_data.svg

Any seasoned therapist knows a fair number of other counselors, some casually, some quite well. We refer patients to a few of these people and steer clear of making referrals to others. The reason for the latter is pretty simple: doubts about their skills. That raises a second question: should their patients have the same uncertainties?

Going to the doctor in the days before there were lots of different types of medical professionals was a no-brainer. The doc was the expert. The medical model required the patient to submit to the physician’s ministrations. You were passive, he was active, and everything was supposed to work without much thought on your part.

No more.

To begin, there are many different types of counselors: clinical psychologists, psychiatrists (some of whom only prescribe medication), psychiatric social workers, marital and family therapists, licensed clinical professional counselors, and other titles. The first two are doctoral level practitioners, the rest most often hold masters degrees. The type and extent of training varies.

Then there are an enormous number of therapeutic approaches. Here, for example, you will find descriptions of 30 different kinds and this list does not include all the specialities within each type: http://www.counselling-directory.org.uk/counselling.html

The plethora of therapy modes creates a dilemma for the patient. At bottom, the issue is trust:

  • Is the doc expert at the precise model of treatment best suited to my condition?
  • Is the type of therapy he might recommend for me empirically validated? Empirical validation refers to a large body of well-controlled research demonstrating that therapy approach X for diagnosis Y produces better results than either no treatment or a placebo.

If you multiply the number of diagnoses by the number of approaches to treatment, you come up with a number so large as to confuse many patients. Indeed, we can say with certainty that there is no therapist who is expert in each approach for every type of diagnosis. Mental health professionals must therefore narrow their focus to a limited number of diagnoses and a small selection of approaches to those diagnoses.

Most practitioners possess training and experience in one or more forms of healing Depressive and Anxiety Disorders. They may not be prepared, however, to take on all subtypes under these headings. Thus, for example, a person who accepts patients with Anxiety Disorders might not be prepared to work with all 10 of the coded diagnoses listed below the broad descriptor “Anxiety Disorders:”

ANXIETY DISORDERS:

  • 309.21 Separation Anxiety Disorder
  • 312.23 Selective Mutism
  • 300.29 Specific Phobia
  • 300.23 Social Anxiety Disorder
  • 300.01 Panic Disorder
  • 300.22 Agoraphobia
  • 300.02 Generalized Anxiety Disorder
  • 293.84 Anxiety Disorder Due to Another Medical Condition
  • 300.09 Other Specified Anxiety Disorder
  • 300.00 Unspecified Anxiety Disorder

Why an Empirically Validated Treatment is Important? An Example:

Given all the issues mentioned, consulting a therapist who can diagnose and recommend the treatment most likely to help is crucial.

Here is an example of how this might best work in practice. The recommended and empirically validated treatments for Obsessive Compulsive Disorder (OCD) include Exposure and Response Prevention (ERP) or medication, with a 70% effectiveness rate overall. Our hypothetical patient is hamstrung whenever leaving his home, his office, his car, etc. He checks over and over whether he has locked everything for fear of an irrational catastrophe. This causes him to waste an hour or more a day. Our friend is late for appointments, work, and social events, angering many people and placing his job and family relationships in jeopardy.

If one were to treat this gentleman with ERP, the therapist and patient would together rank those situations that are the least anxiety provoking to the ones most upsetting. The client would then be exposed to a fear-inducing event at the low end of the list, having agreed not to engage in his usual compulsive checking despite his turmoil. The patient’s fight against the urge to check is the portion of treatment called response prevention. The expected outcome is a diminution in his fear and checking as he repeats these exposures without confirming the security of the lock. The patient gradually faces the more unsettling items on the hierarchy until the troubling behavior is eliminated.

Traditional talk therapy, designed to uncover the underlying “reasons” for such compulsivity, is ineffective in treating OCD. At this point in the history of this condition, if a therapist chooses to provide a treatment not meeting the standard for “best practices,” he risks not only his patient’s well-being, a waste of his money, and a squandering of his time, but a malpractice suit.

What Increases the Risk of a Therapist Not Choosing an Empirically Validated Treatment (Assuming It Exists)?

At least three possible reasons:

  • He is unaware of the research pointing to the recommended approach.
  • He doesn’t “believe” in the validated mode of therapy.
  • He doesn’t possess the training to deliver it properly.

As noted above, therapists are not schooled in every method of doing their job. They perform in a competitive field, especially in large urban areas, and are under downward pressure from insurance companies regarding their fees. There is the possibility of unconscious self-persuasion of the knowledge and skill to treat a wider range of conditions than close scrutiny would justify, thus enlarging the potential pool of patients who might consult them. All health practitioners are required to spend more time documenting their work than previous generations of peers. Therapy clients also often desire evening or weekend appointments, creating an incentive for the doc to be available for sessions during “leisure” hours. Any of these factors can unintentionally limit the time needed to keep up with the latest research and receive the necessary training.

Depending on the practitioner’s location and discipline, there are requirements for continuing education. Licensed psychologists in Illinois must take at least 24 hours of continuing education every two years to maintain their practice. At least three hours cover professional ethics. No other directives point him toward a particular area of knowledge. In other words, these requirements are not guaranteed to remedy any shortfall in competence to treat OCD or any other particular disorder.

What You Can Do:

Where does this leave you, the present or future patient?

Counselors almost all mean well, but we all should recognize “the road to hell is paved with good intentions.” It is in your power to do the following:

  • As early as possible, understand what the initials after your therapist’s name mean, e.g. M.D., Ph.D., L.C.S.W., etc. This is not meant to disparage any particular group, all of whom include excellent practitioners. Rather, knowing this gives you the most basic information about the counselor’s background.
  • Learn about the kind of training he received subsequent to his degree and what he specializes in, both in terms of diagnosis and approach to treatment.
  • Ask him why he is suggesting a particular approach and find out what other approaches exist, and, especially whether they have been empirically validated. It should be noted empirically validated therapies do not exist for every diagnosis.
  • Be sure to confirm, as much as possible, whatever you are told by doing your own research.

Once again, I’m not assuming any wrong doing by your counselor. However, remember, you are dealing with another human being, no matter how kind or intelligent.

As an old Russian proverb tell us, “trust but verify.”

 

On the Need for Reassurance: What Do You Do After Therapy?


256px-'The_Thinker'_by_Auguste_Rodin,_14.75_inches,_North_Carolina_Museum_of_Art

When we go to the doctor our expectation is to receive a cure: something to finish off the illness. We might expect a similar result from a therapist. He will apply the magic ointment to make our hurt go away. Typically, however, we are not offered a fix with a lifetime guarantee, but guidance in developing a method — a way of living “differently:” a “practice” designed to enable a more satisfying and manageable life.

Perhaps our desire for someone to “make it better” goes back to childhood. Indeed, depending on people is, for many, an endless and desperate project. We look for them to put things right, whether to captain our team, lead our country, or reassure us everything will be OK. Unfortunately, however, there are no magicians, only experts. They cannot be with us forever and, even if they could, our excess dependence would transform them into the human equivalent of a security blanket.

If life is to be lived with adequate confidence we need a method to practice regularly, not another human as our permanent rabbit’s foot or talisman. Not a replacement for an inadequate parent. Not excess dependency, but self-reliance coming from the development of a new “groove:” a repeatedly rehearsed approach to the challenges particular to our life.

How can we carve out such a path?

This is a big question. Usually, however, other questions take precedence. Will I wear out my therapist? Will he leave me? Will he ever say he cares about me in a convincing way?

The unstated belief is that the mental health professional is essential for my well-being; and the hope he will be there as long as I need him. In effect, he possesses the magic, I don’t. You hear this in the lament of the lonely, as well: I cannot do this by myself and my life can only be better when I find “the one.”

Therapists, at least with most of their clients, recognize they need to be transitional objects. A portion of what they do is to enable the patient to develop a method of living designed to make him (the doctor) unnecessary. Put differently, the client learns to master his problems most of the time.

Many patients resist the notion to the point of hoping to become the friend (or lover) of the counselor after treatment ends. Just as we look to our aged parents for wisdom or reassurance, we want not only the therapist’s attachment, approval, and security, but his guidance, as if he can never be replaced, least of all by relying on ourselves.

The idea of “a practice” is not always mentioned by counselors. Oh, the clinician will assign homework, but he might never say homework must continue when treatment ends. Leaving the therapist’s office upon termination is not enough. Rather, the client must continue to do work on himself, climb even higher, take on different versions of the same challenges, and bounce back when thrown to the floor. He needs to remind himself of his strengths, his successes, and what he must do now. This is a practice: “repeated exercise in or performance of an activity or skill so as to acquire or maintain proficiency in it,” according to the Google online dictionary.

images-2

Your program might involve regular, organized self-reflection; journaling, mindfulness enhancement, recitation of those people and things for which you are grateful, time set aside to challenge negative self-talk, a plan for increasing your compassion, writing down all those difficult moments you’ve overcome; and a step-wise, graduated list of challenges you want to take on and a chart of your progress.

You may already engage in other such practices. Daily meditation would be one. Daily reading of passages from a religious text is another. Professional athletes and body builders maintain a regular workout routine, even in the off-season. The goal is to solidify your thought and action, create a habit, improve your focus, rely on yourself, and beat back whatever might encroach on past gains.

One of the best examples of this idea is found in Plato’s Phaedo, the story of Socrates’s last day. Knowing that he will shortly drink hemlock to fulfill the state’s death sentence, it is perhaps unsurprising that Socrates speaks with two younger philosophers (Simmias and Cebes) on the subject of mortality and whether an afterlife for the soul can be foreseen. Despite his attempt at philosophical “proofs” of the likely existence of an eternity, they acknowledge the extent to which they (and we) are like children in search of a magician for reassurance. They despair that once Socrates is gone, no such person will be able to provide his kind of logical, well-reasoned, persuasive confidence in the possibility of a life after death.

Socrates gives Cebes the following advice, as applicable to therapy as to facing one’s mortality in a philosophical way, in both cases to dispatch fear:

What you should do, said Socrates, is to say a magic spell over him (the scared child in each of us) every day until you have charmed his fears away.

Cebes persists, believing only Socrates, soon to be dead, has the necessary sorcery.

Greece is a large country, Cebes, he replied, which must have good men in it, and there are many foreign races too. You must ransack all of them in your search for this magician, without sparing money or trouble, because you could not spend your money more opportunely on any other object. And you must search also by your own united efforts, because it is probable that you would not easily find anyone better fitted for the task.

Thus, Socrates has advised these well-trained philosophers to repeat their own magic spell over the child within them: to seek the wizard in themselves to calm their anxieties by way of what he has taught them and whatever further ideas they can reason out on their own. In effect, to develop a practice maintaining or enhancing proficiency in dealing with this challenge of life.

The proper approach for the therapy patient might be said to take whatever he has learned in treatment and make it a practice. Yes, this is lots of work, but what is the alternative? Life will not hesitate to provide you with more challenges. We stop growing at our own peril, just as the athlete risks getting out of shape by abandoning his practice routine. Concern for your psyche is not like a diet, to be ignored and replaced with poor nutritional habits once the target weight is achieved.

Whether you maintain a practice or not, your counselor will still be there in most cases. But don’t you think you would be more secure by taking your life in your own hands once he passes the baton?

Your therapist does.

The top sculpture is The Thinker by Auguste Rodin, sourced from Hiart at Wikimedia Commons. The second photo is of Baseball Hall of Fame pitcher Bob Feller.

The Challenge of Pain

512px-Antoni_Madeyski_-_Ból

Two years ago I suffered from nerve pain of an uncertain cause: excruciating discomfort below the right side of my rib cage, like a burning cigarette against my flesh. I could not sit for more than a few minutes without a growing conflagration. Trying to sleep on my back delivered the same distress. I spent every day and night for a month standing or on my side. Upon making my return to a humanities class I still had to remain upright for long periods on the commuter train, with frequent episodes in a vertical position in the seminar room. Eventually, medication eliminated my symptoms and life went on without ever knowing for certain what caused the problem, even after extensive testing. I’m long past the treatment and the pain, but my experience was a trial.

I cannot draw parallels or contrasts. Not with you or anyone else, except those who suffer worse for far longer. Too many of you, I know. At the time, however, such knowledge counted for little. I lacked a yard stick to measure the combination of severity, the fraying of the soul, the psychological darkness, the difficulty of passing the minutes without counting the time, the presence of a thing I didn’t understand and couldn’t will away. The worst part? Not knowing if the unseen torturer had plans to leave.

As I mentioned, the most acute stage of the process lasted a month and over two months passed start to finish. The physicians were excellent. One idea persisted: not fear of death, but a life of endless illness. I would be ground to little bits like flesh subjected to mortar and pestle.

Pain tests you. You are asked what you are living for. The longer the pain, the greater the uncertainty of its duration, the louder the question.

Time stretches, food becomes a necessity — not a pleasure. Some folks you tell, others you don’t. The best of those informed remain concerned and supportive. A few disappear, usually to protect themselves from your travail and their fear of contagion; contagion of your distress or, just as often, the idea something else will target them.

Illness does not wait until all else in your life is ready to take on the burden. Issues with which you are struggling pile on, like a football team that’s already tackled you and enjoys the thrill of seeing how many bodies can be stacked on top of your own.

Joy flees, laughter is brittle — a momentary distraction. The “tough guy” images on TV don’t help, but suggest everyone else is more durable. The future — imagination of time ahead that would normally give anticipatory pleasure — slips away. All you want is relief. You work to hold on to your self, the one who prided himself in taking on difficult things, facing people, being a man. Self-image alters. Perhaps you are not who you thought you were; or perhaps you were that man, but are no longer.

You lack control of what is outside and what is inside, all except your response. The messiness of the world you thought you organized is evident, like carefully arranged blocks now scattered beyond reach.

What do you hang on to?

For some it is future plans, jobs to be done, achievements targeted long ago. Gratitude for what you still have is a mental weapon pitched at the physical giant set against you. Meditation can be a salve, but only if you are already an expert.

I had an uncle who was so into technology he wished to live to witness how men might change the world. I know of a former patient who stays alive because almost her whole family died in the Holocaust. She will not give away by choice the thing taken from them without choice, no matter the suffering she endures.

512px-Madeyski_Pain

Perhaps you reframe the challenge before you as a test, the way a Stoic philosopher would. They thought pain was something unremarkable because such a time comes to most of us. Greatness, they say, is the product of the bravery you show only when events turn against you, not on the sunny days.

God can figure in, though individuals so sustained would not all give you the same definition of the role he plays. Then there are people toward whom you feel love and responsibility. You persist because of what they mean to you and what your absence would do to them. Made aware of the extent of your distress, they offer support and love more strengthening than water and food.

If, like me, you are lucky, the crisis ends. You recall it, but as an idea, not a sensation. Now, however, you are different. It is time to make sense of what happened, who you have become, and whether you wish to live in the same way, with the same values and expectations as before. You did not predict your response to the pain any more than you predicated its onslaught. One day you were fine, the next day you were not.

My friend Rick wrote a profound comment to my last post: “these are emotions we are normally unfamiliar with until the event happens, and so we do not know how to deal with them.” The surprises of life, especially when they are as terrible as he described (the suicide of his mother), leave us unprepared. Moreover, they can cause us to redefine ourselves. Those who act heroically or stoically perhaps think better of themselves. More commonly, however, we struggle with the blows life delivers and our self-image also becomes one of the casualties or, at least, one of the personality characteristics transformed by our bout with suffering. Perhaps the pain provides an opportunity to grow, but if so, without a guarantee.

You have been marked. Remember, though, that in the Hebrew Bible, there is also a story of being marked. Cain murdered his brother Abel, for which he received the “mark of Cain.” This, however, was not to harm him, but God’s warning to stop those who might wish to punish Cain for the crime.

For the rest of us there is no such indelible symbol evident to the world. Whether God has used a different way to safeguard you is for you to say. For myself, however, I was lucky to have a sustaining love and enough will to keep going. Objectively, the time was short, however much it seemed endless.

True, I know more about human frailty and my own limitations now. I think I am more humane, but do not think me a hero. I wouldn’t have chosen the ordeal had I been promised some great reward for my persistence. Nor would I volunteer for such “learning” again.

We are clay and sculptors of that clay, both at the same time. Its final form, however, is not our work alone. Unseen hands offer their careful, kind, or calamitous touch.

The photos are of the sculpture, Pain by Antoni Madeyski. The first of these was provided by A blakok. Both are sourced from Wikimedia Commons.

 

 

Another Side of Suicide: The Strange History of Punishing the Deceased

51lLVfOUCFL._SX330_BO1,204,203,200_

Would you talk to a casual acquaintance about suicide? Probably not. Such weighty conversations most often occur with someone intimate  — a therapist or close friend. Without such discussion, full knowledge of suicide becomes difficult. Moreover, even those who understand the psychology of suicide are unlikely to know its history. They are unaware, for example, that suicide victims in Europe during the Middle Ages were often punished for the act of self murder.

I imagine you are asking, how can a person who is already dead be punished? Leaving a body unburied was one way. An ancient example is found in the Sophocles play Antigone, where Polynices is prohibited from burial because he participated in a failed revolt against Thebes. The rationale for this disrespect went beyond the expectation of a corpse ravaged by animals: the absence of proper burial would prevent him from going to the Underworld, the Greek’s version of the afterlife.

Of course, Polynices didn’t kill himself. By the Middle Ages, however, Christian clerics ranked suicide as worse than murder. In their opinion, taking the life of another did not rob the victim of his soul. The soul of the deceased was expected to find no difficulty in making his way to heaven. A suicide, on the other hand, killed both body and soul; in effect, a double murder. No room for repentance existed. Suicide was a crime against God.

Local authorities went to astonishing lengths to exact retribution from one who had killed himself. The body was sometimes preserved via embalming and salt to put the deceased’s remains on trial. The corpse might be hanged head down, strangled, whipped, or thrown from his window or roof. Such public displays were intended to discourage others from attempting similar self harm.

Other punishments included dragging the body by a horse through the street; being pulled apart, burned, decapitated, and quartered; or put into a barrel and thrown into a nearby river, thereby ensuring the remains would be the problem of a downstream community. It was also common for the victim’s property to be destroyed until authorities realized this cruelty harmed the person’s spouse and children. Thereafter, the family received some consideration. Nonetheless, a Christian burial was out of the question.

512px-Samson_and_Delilah_mg_0034
Exceptions to the negative judgement of suicide were rare. The church, however, did let the famous strongman of the Israelites off the hook retroactively. Samson’s strength depended on his full and lengthy head of hair. Once the Philistines discovered this (thanks to Delilah), his locks were shorn. Samson was taken prisoner and blinded by his enemies. Some time later, the biblical hero was tied to the pillars supporting their temple and made a spectacle. Unbeknownst to his captors, however, his hair had grown back sufficiently to return his strength. In an act of revenge and suicide, Samson pulled down the structure’s supporting columns, causing the death of all, himself included. The church forgave the suicide by assigning responsibility for Samson’s self-destruction to a divine command.

The religious prohibition of suicide had unexpected and unfortunate consequences. A German jurist, Karl Ferdinand Hommel described one example in 1766. Hommel realized the Christian position on suicide unintentionally encouraged the murder of children, something he called “indirect suicide.”

According to the jurist, some of the faithful who wished to kill themselves hesitated because they would be damned to hell. More than a few, however, realized they could murder an innocent child and still have time to repent before the public execution they desired, thus achieving their own death without causing eternal damnation. The deceased youngster, they reasoned, would go directly to heaven.

Over time both the religious and the public view of suicide began to change. In some circles, life came to be seen as something belonging to oneself, not to the state or to God. Suicide was increasingly thought of as a mental disorder or a medical problem, not a moral failure, despite lingering negative judgment against it. Laws gradually changed and self murder became decriminalized. Although the practice of punishing the deceased ended in Europe long ago, not until 1983 did the Bishop of Paris state that self-destruction was no longer a sin, but rather a disgrace. He recommended mercy toward those who committed suicide.

Should you wish to know more about this interesting topic, you will find it in a fine book used as source material for this essay, Marzio Barbagli’s Farewell to the World: A History of Suicide. If nothing else, Barbagli’s volume reminds us that in a world where savagery still exists, we have nonetheless made great progress in the name of the living as well as the dead.

The cover of Farewell to the World: A History of Suicide is followed by Guercino’s 1654 painting Samson and Delilah.

Marilyn Monroe and Rachmaninoff: Can Movies Sell Music?

Sex sells everything or so it seems.

My earliest recollection of any connection between sex and music was the 1955 film The Seven Year Itch, with Tom Ewell and Marilyn Monroe. The former imagined seducing the latter when a combination of circumstances fueled his fantasy: a stale, seven-year-old marriage; his wife’s temporary absence; and the availability of Ms. Monroe, his smoldering new neighbor. Ewell’s plan was to use Sergei Rachmaninoff’s Piano Concerto #2 to win her ardor. The scene above depicts his strategy.

Classical music in film usually isn’t intended to engender lust, although the cinematic hit 10,” starring Bo Derek (with Dudley Moore playing the Ewell-like role), gave it a try in 1980, with Ravel’s Bolero serving to keep the erotic pace. Various recordings of the piece dominated the pop and classical charts in the months following.

The use of such music raises the question of whether a movie featuring a classic opus can open the audience to classical scores beyond those pieces featured in the film. Favorites like Richard Strauss’s Also Sprach Zarathustra (2001: A Space Odyssey), Samuel Barber’s Adagio for Strings (Platoon), or Mozart’s Piano Concerto #21 (Elvira Madigan) raised interest in the featured works, but not other selections from the oeuvres of those composers. In light of these failures, should a film be expected to convince a classical newbie to dive deeper into the world of symphonic music simply because of its connection with a single appealing piece?

Let’s start with the music attached to Ms. Monroe and Ms. Derek in the already mentioned films. Does any lonely soul watching Tom Ewell or Dudley Moore think he might achieve his romantic fantasy solely by his choice of CD while on a date? Surely no man with a recording of Bolero or Rachmaninoff playing in his living room regularly brings sex to the mind of women. Thus, a film’s featured sound track, if it is to cause anyone to listen after the cinema’s end, will have to stand on its own. Powerful men have an evolutionary/sexual advantage connected to the need of our female ancestors to find a protector and bread-winner. Contemporary males who listen to Bruckner give their dates no clue to those talents.

20454_2

Nor is film likely to create wide interest in classical music without a sexual connection to ladies like the two featured above. No boom in the record sales of Richard Strauss’s other compositions was created by Stanley Kubrik’s use of Also Sprach Zarathustra in Space Odyssey, nor did Mozart’s 600+ compositions fly off the store shelves because the slow movement from his Concerto #21 was featured in an art film hit.

Those who believe cinema might increase the classical audience should consider what must be overcome to do so. Music used in movies competes with dialogue, scenery, and plot for the viewer’s attention. By comparison, the standard concert hall symphonic fare offers no dialogue, no story, and the unremarkable sight of a group of sitting musicians — usually at a distance — fiddling, drumming, and blowing; all dressed in similar outfits.

Music at a concert is supposed to speak for itself, while a movie’s narrative line is intended to transcend the background audio. The implied message is that the score is secondary, designed only to create a mood. If the film tunes are being given second class status by the movie makers, why would anyone believe the rest of the composer’s works were worth their time?

Then there is the obstacle classical music confronts when it is heard by an audience of the uninitiated. The standard wisdom of the crowd is that classical music is “relaxing” at best, boring at worst. If they listen to something attractive on the film’s soundtrack, most may conclude the beauty or excitement is an anomaly, nothing like the standard classics they know or think they know. Surely this belief doesn’t spur the listeners to explore beyond a particular piece that, for them at least, is the exception proving the rule.

One more challenge stands in the way of the film-goer’s transformation from someone who doesn’t listen to many classics to one who does: effort. Anyone who wishes to learn to love the classics must put in a good deal of time. The Beethoven Symphony #5 takes somewhere in the neighborhood of 35 minutes no matter what. A Rodin sculpture, on the other hand, can be observed for whatever unit of time you wish to put into the examination. Concert promoters do what they can, but they cannot generate motivation or cut the score without mutilating the art.

millennium-park-crown-fountain-06

Don’t underestimate the effort required to become a convert to an unfamiliar art form, even in the case of visual art. Chicago’s grandly successful and much visited Millennium Park was expected to generate increased attendance at the nearby Art Institute when the former opened in 2004. The failure to achieve the expected bump in Art Institute admissions was “a puzzle” to the museum because the art repository was only one block from the new outdoor venue. Perhaps part of the answer then, is that movies are movies, paintings are paintings, and Bolero’s ability to attract an audience guarantees no crossover even to another of Ravel’s famous works, like La Valse. Those who go to a public park want a park experience, not one authored by Van Gogh. Those who visit a Chinese restaurant aren’t looking for pizza.

Presenters have added movie screen close-ups of the players to the concert experience, big screen painting reproductions to enhance performances of Pictures at an Exhibition, iPads to provide a technological jump from the old style paper medium of program booklets, and lectures before concerts to tell the audience what they might want to notice when the program starts. In the end, however, do these produce the “buy in” intended? Doesn’t the music live or die on its own merits?

Concert promoters have tried about everything to expand the audience for the classics, with questionable success. What can one say that hasn’t already been said? Two things:

  1. In the words of impresario Sol Hurok, “If people don’t want to come, nothing will stop them.”
  2. If you have a seven-year itch, try some talcum power.

Following the scene from The Seven Year Itch is a poster from the movie “10” featuring Bo Derek. The bottom image is the Crown Fountain (facing Michigan Avenue), part of Chicago’s Millennium Park.

Can a Therapist Know How You Feel? Must He Have Courage? Thinking About Essential Qualities in a Counselor

512px-Misty_morning02-1

Does a therapist “know how you feel?” No. How could he?

But he may still be able to help you even without such knowledge.

Why don’t I know how you feel? I am not you. I am not your age or perhaps your gender. We may not share the same faith. I wasn’t born in the same place under the same circumstances. My parents made more money or less than yours, lived with extravagance or pinched pennies. They survived the Great Depression well or badly or not at all; and so forth.

A counselor is not in your skin, so can’t know the sensations which comprise your life. Yet he can have some idea, perhaps even a good one. What might that idea be based on?

First of all, you are both human and have a certain set of shared, although not identical experiences. Speaking for myself, as a seasoned counselor I talked to thousands of people who told me what they thought, revealed how they reasoned, and explained how events influenced their mood. I therefore became familiar with the range of what is possible in reaction to an enormous number of circumstances. I also read text books, received instruction from teachers, and shared in the richness of emotion, perception, joy, and adversity found in stirring memoirs, novels, plays, and movies.

Despite all of this, I am open to surprise. An example: my father died abruptly in the year 2000 at the age of 88. I’d known he was mortal at least since the time of his heart attack when I was a boy. Prior to his death I counseled many people who were suffering from loss. Still, despite dad’s advanced age, his demise was shocking. Like the flick of a switch — the “here today, gone tomorrow” unreality was too true. Unexpected fatigue lasted for months, as though the life force taken from him had been emptied from me as well. Even now, years after this loss, I can’t say for sure “I know how you feel” if you tell me about the death of your father. Your relationship with him and the circumstances of each of your lives might cause me to rely more on imagination than something closer to your lived experience.

I would argue we cannot even recall how our own pain felt once the distress recedes into the moderate or distant past. Big events do not remain unaltered in the museum of the brain. Rather, they are like a photo faded by the sun. We need painful memories to diminish, which would otherwise leave us in a perpetual state of agony. Even splendid, heavenly recollections, if remembered with their original impact, would compromise our ability to attend to the most crucial elements of each new day. To some degree we must unconsciously forget or transform our life history.

512px-Cirrus_clouds_with_3D_look

You might ask me: “How then can you help me grieve my loss if you can neither ‘know how I feel’ nor retain an unaltered remembrance of your own loss?” In several ways. I can listen to you and bear witness to your pain. I can be sympathetic. I can accept the emotions and stories you share: the varied combination of sadness, anger, exhaustion, and sense of separation from the world accompanying the death of a loved one. I can abide with you, acknowledge your suffering, and “be there” until it passes. If you will accept the comfort, our relationship will help to reattach you to life, even while you are grieving something that rends the same cord of attachment.

You will never be what you were before your loss, of course. But, you are more likely to heal if you share your grief. Holding it in or trying to “move on” too quickly — or shedding your tears only in private — can cause your sadness to pass by inches or not at all. Human contact in the aftermath of loss is crucial. A supportive spouse, friend or therapist can help. Time does the rest.

My sympathy for you doesn’t require I first possess knowledge of your internal life any more than enjoying milk requires a prior existence as a cow. Best not to say you know how another experiences his suffering. It is enough to tell him you care. Indeed, were you to fathom every detail of the emotions passing through another without caring, absolute understanding of his pain would count for nothing. Genuine concern — not some magical power to read another’s heart — is what counts. A patient will often forgive a therapist’s momentary failure to grasp his upset, but ought not to accept his indifference even if his knowledge of the patient’s emotional state is exact in every aspect.

The counselor carries an imperfect bag of tricks. Like the wounded soul who comes to treatment, he risks failing at the task he shares with his client, even if the courage demanded of the patient is greater. The therapist also assumes the frightful responsibility of caring for another with no certainty his effort will avoid tragedy, even if his burden and terror are less than the patient’s own.

The practitioner is always practicing. He must work to learn more and attempt to heal you no matter how much knowledge and experience he has. His therapeutic arsenal is never complete. Psychotherapy research is forever making new discoveries. Fortunately, if the therapist has the knowledge, dedication, and experience along with the courage to allow your heart to touch his, what he has tends to be enough.

In accepting you as a client, he risks injury to both you and himself. Why? In short, because you do matter to him. In treatment with the best healers, that is the one thing of which you can be certain, however much your relationship history causes doubt.

The top photo is Misty Morning by flagstaffotos.com.au/ The second image is Cirrus Clouds with 3-D Look by Simon A. Eugster. Both are sourced from Wikimedia Commons.

Whatever Became of Julius Rosenwald and William Schuman?

Have you ever opened the old photo album of a parent or grandparent and wondered, “Who are these people?” So many smiling faces lost to the passage of time.

We spend lots of effort at the job of being remembered. No one wants to be forgotten, unless, like the old-time actress Greta Garbo, you “want to be alone.”

Indeed, one of the chief reasons people skip high school reunions is the fear of not being recalled.

Look around you at the buildings. Once gone, the person whose name appears on the edifice loses control. Buildings get torn down, names get changed.

Take Dyche Stadium, Northwestern University’s football field in Evanston, Illinois. The edifice opened in 1926, named after William Dyche, an NU grad in the Class of 1882, who later became the Mayor of Evanston and oversaw the venue’s creation. To the dismay of the Dyche family, NU sold the rights to the name in 1997 to Pat Ryan, then the Chairman of Northwestern’s Board of Trustees. For eight-million dollars, Dyche Stadium became Ryan Field.

256px-Ryan_Field

Percy Bysshe Shelley would have understood. His poem Ozymandias tells a similar story about the collapse and destruction of an ancient monument to a once formidable and arrogant ruler. An inscribed pedestal is the only thing left:

“My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!”
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.

https://i2.wp.com/upload.wikimedia.org/wikipedia/commons/thumb/a/af/S_F-E-CAMERON_EGYPT_2005_RAMASEUM_01319.JPG/256px-S_F-E-CAMERON_EGYPT_2005_RAMASEUM_01319.JPG

If the exception proves the rule, then we should talk about Julius Rosenwald. You probably don’t know his name and Rosenwald wouldn’t have cared.

Julius Rosenwald (pictured at the top) was President of Sears, Roebuck, and Company from 1908 to 1924, and the Chairman of its Board until his death in 1932. In 1917 he established the Rosenwald Fund, a charitable enterprise designed to have no endowment, i.e. an untouchable bankroll to be invested for the purpose of the charity’s survival. Rather, Rosenwald intended the Fund to disperse grants “for the well-being of mankind” until there was nothing left. The money was gone by 1948; and with it, any chance we might hear about it in our time. Only a 2015 documentary on the philanthropist’s life has (for the moment) reintroduced his name to the public.

During its existence Rosenwald’s fund distributed about $70 million, with much money going to the establishment of over 5000 schools in the South, aimed at educating black youth. Rosenwald was also a principal founder of Chicago’s Museum of Science and Industry, seeding it with five-million dollars and serving as its president from 1927 to 1932. At the time, people in Chicago were as likely to refer to the structure as the “Rosenwald Museum” as they were the Museum of Science and Industry.

https://i0.wp.com/upload.wikimedia.org/wikipedia/commons/thumb/4/4e/Museum_of_Science_and_Industry.jpg/512px-Museum_of_Science_and_Industry.jpg

William Schuman’s name, on the other hand, was never a household word. But in his day (1910-1992), only Aaron Copland was a more prominent living American composer in the classical world. Moreover, as president of the Juilliard School and then of the emerging Lincoln Center, no one had a greater influence on serious music in the middle portion of the last century. Schuman also wrote 10 symphonies among other works, and won the first Pulitzer Prize ever given for musical composition. His Symphony #3 is arguably the greatest such piece written by an American.

William Schuman: Symphony No. 3

Yet, the centenary of his birth in 2010 was hardly noticed by performing groups and the major US orchestras pay him little attention. I asked an orchestral executive why, with few exceptions, deceased 20th century Americans like Schuman are not performed. His wry answer: once dead “it is easier to say ‘no’ to them.” All the friends in high places who programmed Schuman’s music are now gone, along with his music, except for occasional performances and recordings. The musicians and executives of our own time don’t know his work and don’t care, or so it seems.

Schuman would have agreed, I suspect, with the notion that a composer’s life is like trying to create art on a block of ice on a hot day in July, to paraphrase Arthur Miller. In other words, you hope those notes will last and be played, but the odds are against you.

Shakespeare treated the fleeting memory of our existence more gently in the words he gave to Prospero, the sorcerer, in The Tempest. Prospero’s comment comes as he ends a brief staged performance — a play within a play. What he says refers not only to the matter of creating illusions in the theater, but also to the insubstantial and temporary nature of life itself, not just our names:

Our revels now are ended. These our actors,
As I foretold you, were all spirits, and

Are melted into air, into thin air…

We are such stuff
As dreams are made on; and our little life
Is rounded with a sleep.

The irony implicit in Shelley’s and Shakespeare’s words is that while they talk of the transience of things, their names and works live on. Though it’s not called Dyche Stadium any more, the place Dyche built still stands along with the “Rosenwald Museum.”

Got to run. A recording of Schuman’s Symphony #3 is coming on the radio. Perhaps his music, like that of Gustav Mahler, will be revived 50-years after his death.

The future is full of surprises.

Who knows. Somebody at the reunion might remember you after all.

The top video is the trailer for the 2015 documentary, Rosenwald. The 1970 photo of Ryan Field (formerly Dyche Stadium) comes from Greenstrat. Steve F-E-Cameron is the author of the Temple of Ramses II, Luxor, Egypt. The photo of the Museum of Science and Industry is courtesy of Knarfol. All of these are sourced from Wikimedia Commons. The final image is the Columbia LP (long playing record) cover of William Schuman’s Symphony #3 with the smiling Schuman facing the photographer.