Dying to be Seen, but Afraid to be Seen: Where Insecurity and Invisibility Meet

The quiet ones envy those who are sociable. Not always, but often. They wish for an ease of contact which is not theirs. Too many hunger for understanding, for a kind person to recognize them, accept them; even love them. They are dying to be seen, but afraid to be seen.

Anonymity is the preferred choice. Many escape to the shadows, at least if they can.

Don’t raise your hand, says Mr. Anxiety, even if you have the right answer. Too risky. Your voice might quiver, your hand might shake, and there could be a follow-up question which leaves you speechless.

The insecure ones make a trade. They take the apparent safety of invisibility at the price of being ignored, misunderstood, or quickly forgotten. They leave no mark on the world, hoping to avoid criticism and ostracism. Better to take yourself out of the competition for attention than be told to go away. Of course, you wind up alone, but you persuade yourself this is better than rejection.

Instead of belittlement you opt for the shrubbery, hiding behind the bushes. True, sometimes you get wet when the lawn sprinklers go on. Occasionally a kid throws a ball that hits you or a dog sprays you, but you get used to it.

Group conversations are the worst. When might I jump in? My face will flush. They’ll think I’m an idiot, too boring. I’ll just sit tight or stand and nurse my drink.

Who would have thought a man could dive into his glass, hide behind its opacity? Or imbibe enough to shed his disguise and turn into a more outgoing, confident version of himself?

Once you sober up, you will still be like a person with a fire inside who is afraid of venting a smoke signal. The result? You are consumed from within and your glorious flame is unnoticed.

Mark Twain said, “The man who does not read has no advantage over the man who cannot read.” Change two words and the sentence becomes: the man who does not speak has no advantage over the man who cannot speak. Will you be thought of as the latter? Are you already?

Or have you become someone who is told what he thinks, afraid of challenging a rude or wrong idea? You will be outdone by those with half your intellect. They, the half-brained, are kings and queens in the land of the mute.

You remain unknown, even if others think they’ve sized you up. Many believe you are stuck-up because you avoid them. Some say you are kind, several imagine you lack “personality,” others reckon you stupid, a few timid: an easy mark to be pushed around. Most strangers form no opinion. Not one of them will be completely right, know the whole package. You won’t even be seen in full by yourself.

Your attempt to vanish is exhausting. The task is like running a race, trying to escape the eyes of others, but distancing yourself from yourself. If all escape routes close you will grab your throat and squeeze, stifle your emotions and ideas so as not to offend anyone.

Do you wish asphyxiation by your own hands?

I hear you gagging.

Do I know you? Not completely. But I’ve seen you and I might have been you a long time ago.

It wasn’t fun.

It’s not as if everyone else is completely visible. No one is. One might display an eyebrow or an ankle, even a heart: that most precious portion of ourselves when offered as a present. Such a one is trying, practicing, gathering momentum.

A gradual path toward self revelation can grow on you.

In the end, however, if you are seen but unseen, dying to be seen but afraid to be seen, you should realize something: you cannot be both.

You must choose or remain in torment.

The therapist’s door is waiting, but even there you can try to be invisible.

A pity.

Counselors, you understand, don’t do their best work blindfolded.

The top image is a photo of the cover of The Invisible Man by H.G. Wells. The cover was illustrated by Ludvik Strimpl and the photo taken by Gallica/Sudoc. The image was sourced from Wikimedia Commons.

A Different Form of Bravery

Most of us don’t think of ourselves as brave. We are not the kinds of heroes found in movies, wartime, or a burning building rescue. Yet one must become the hero of his own story. The reason is simple: there is no one else to do the job. If you are a supporting actor in the movie of your life, audition for a better part.

The clock never stops and opportunities, inevitably, diminish with age. Time still offers chances to change, to try, to dare, but we are captured by long-standing routines. One might say we have traveled the same rut for too long, the furrow deepening with each step. To get out we must climb a wall of earth with strength thought lost.

By 65, the age of my friend Keith Miller, some are already retired. But Keith had at least one more hurdle, one waiting for him over 40 years. Such youthful aspirations are patient, sitting quietly in the back of life’s class, hoping for attention, never raising a hand.

Long ago Keith attended a conservatory and took classes in conducting. He even conducted a chamber group a bit back then, more recently a stint leading a community band, no strings. Keith can’t be called a professional musician, though he has taught piano. The insurance company at which he works as a top-tier technical support analyst is not a wellspring of conductors.

Nevertheless, he had the nerve to apply to the International Masterclasses Berlin, where he would reside for six days in March; and, if he survived, lead the Berlin Sinfonietta in one movement of a romantic masterpiece. Keith was one of 11 students from Belgium, Germany, Italy, Spain, the Netherlands, Japan, South Korea, Taiwan, Argentina and the USA;  some working conductors with their own ensembles. Almost all were at least 30 years younger than my friend.

But, this is Keith’s story and he needs to tell it:

Packing my luggage for Berlin, I carried expectations, too. Not only from years of listening, but by studying the scores in the months before the masterclass: three symphonies by Brahms, Schubert and Schumann.

This was, after all, my inauguration into the world of orchestral conducting. Sleep medication was the only way to calm my bedtime energy. Most of the anticipation came from the unknown, all that is not in the musical score:

How might the maestro react to my lack of experience? How would I fit, being the oldest student? What of the orchestra’s cooperation and opinion? Would I make good music?

The first rehearsal generated the natural nervousness, heart-palpitations too, but also an internal reminder, “I can do this.” Maestro Shambadal’s steely eyes focused on me. The maestro, Principal Conductor of the Berlin Symphony, was born in Israel and studied with many “greats” including Giulini, Markevitch and Celibidache.

After a few deep breaths I began Schumann’s 4th Symphony. Quickly came a loud clap. The orchestra stopped. Maestro yelled from the back of the room, “It begins on the 3rd beat!” I made the correction and got through ¾ of the first movement before my time was up. A few other stoppages occurred for matters of technique and interpretation. I reminded myself I’d come for just such instruction.

I realized I needed to improve. My desire for the maestro’s approval quickened. The ensemble’s response to my leadership lacked enthusiasm and I knew it.

Three more rehearsals followed and group evaluations, as well, before the concert at which we would all perform. We reviewed videos of the 11 conductors, mine included.

Ugh! My posture was terrible. I looked like a bent old man. Maestro alluded to the same thing. I worked on straightening up, without which I couldn’t communicate command and authority. Here, perhaps, was the explanation for my initial failure to elicit what I wanted from the musicians.

I was selected to conduct the second movement of Schubert’s 8th Symphony at the concert. I marked the top of every page of my score with three words:

POSTURE. TEMPO. RELAX.

Keith worked with an experienced orchestra, many of the musicians retired members of the Berlin Philharmonic, Berlin Radio Symphony and regional orchestras, along with younger instrumentalists.

Hundreds of years of accumulated experience face a newbie. Some such ensembles take pride in being able to size up a conductor in minutes, and tear him down in less time. Or ignore him and give “their” version of the piece. Still, each player has a job to do: taking the conductor’s vision as achieved in rehearsal, and making the black notes on white paper sing. Keith learned the conductor’s job, too:

His score holds all the notes, every instrumental line on the same page: dizzying to see, much less read while everything is happening in front of him. There is no opportunity to search the lines, the musicians’ faces, and be the director, too. Without an instrument, armed only with certainty, the knowledge of everyone’s role, and his ability to persuade and inspire, he must make something old into something new.

Concert time at last.

Striding up to the podium I was confident and enthusiastic. I brought along a week’s education.

I led with warmth, lyricism, and the dark drama there in the score. The players were spot on: tempo, dynamics and music-making.

What was experience like? The most exhilarating of my life.

I turned and bowed to the audience. Smiles all around. When I asked the orchestra to stand, I saw many smiles among them, as well. I shook the first violinist’s hand and received one word enthusiastically delivered: “Bravo!” The first cellist gave me a hearty thumbs-up.

My mind was captured by one idea.

“I want to do this again and again!”

The previous conductor and I gave each other a big hug. Later, an audience member said the maestro was watching me with full attention and nodding (not nodding off!), as if to say “very good!” After the concert, he congratulated everyone.

Returning to my hotel after a celebratory dinner, I sat at the edge of the bed and cried. All of the emotion and memories, the anticipation and fulfillment, overtook me. Once composed, I began to pack for the trip home.

Courage takes many forms. Sometimes it is simply making the music that is in you, waiting to be made. Taking a risk, not asking permission.

As Oliver Wendell Holmes said:

Alas for those that never sing,
But die with all their music in them.

Here is a man who made his music:


The Therapeutic Journey and Our Problematic Concern with Destinations

We are an impatient race. Tasks don’t get done fast enough, the wait in line is too long, the computer too slow. Our destination looms like a slave-driver of our own creation, craving full speed to the end of our journey and the imagined prize awaiting us there.

What are we missing?

Many of those in long-term therapy are ambivalent about the inevitable end of the journey. They correctly recognize that accomplishment of one’s therapeutic goals means the terminus of the walk through the mine field of the psyche, the regular sessions, and the severing of the therapeutic relationship.

The mine field traipse is the only one they hope to dispense with. Indeed, most would say removal of unexploded emotional bombs caused their enlistment in treatment in the first place. By contrast, the absence of session-bound, intimate time with the therapist is dreaded, like ejection from a cocoon.

The story is even more complex, however; both for those who fear the loss of their road-trip, therapist-guide/companion and those who believe the journey’s end will bring nirvana, the permanent release from all suffering.

Consider: more than a relationship is forged in treatment. There is a process of struggle, self-reflection, honesty, learning. Perhaps nothing before — nothing the patient has tried or accomplished — has been so hard, but so rewarding. Each step in each session is enriching or intense — alive — even if fraught with portent and overlaid with tears. The furniture in the office stays the same, but the mental furniture gets rearranged, replaced, knocked-over, tested, taken apart, and put together. All this is “process,” not product. All this is overlooked when clients reflect on their ambivalence about the end of counseling and loss of the therapist.

In part, the problem is our instinctive goal-directedness. Often, however, the target — whatever it might be — is not as special as anticipated. Heaven does not exist on earth. We get used to even a transformed life, no matter how worthy. We become accustomed to our new, higher cruising altitude of emotional stability. The background activities — the daily maintenance of clothes, body, and living surroundings — still must be done. As the Zen proverb goes, “After enlightenment, the laundry.”

Therapy becomes a road traveled-well only if we try to notice everything, absorb everything along the way. It is not like pursuing a diploma: trudging through courses in philosophy or calculus that are endured, not enjoyed. The treatment isn’t like having an ice cream cone in its pleasure, but absorbs our entire being as a fount of learning. The engagement is total, the preoccupation remains in mind even after the session ends, the effort is important, the risks great. You are reaching for the next handhold on the mountain. Yes, you are doing so to reach the top, but you will be on summit for just a few minutes, a static place no one can live. You soon must move below. Life is in the movement. What you took away was the experience, the incremental achievement of all the concentration and self-surpassing courage you could muster.

Cervantes’s Don Quixote reminds us, “The road is always better than the inn.”

The post-war circumstances of military veterans add to the discussion. None of them want to relive the horror. Yet, some will say it was the most intense experience of their lives. Moreover, the intensity is missed, if not what created it. Thus, the therapy journey brings not only pain, but something of value in its dedicated, focused, life-on-the-line process. Not a deadened, dull, inert state of being.

Elite athletes, similarly, don’t enjoy every moment of their competition. The combination of actions and emotions includes strain, focus, effort, and fear of failure, as well as elation. We tend to think of goals and the pleasure associated with their achievement without full recognition of the other experiences they live while in motion, in process, and in the moment. Yet this is what any journey worth taking entails.

If you are currently in long-term treatment and agree with my description of the journey’s value, you might say: “Well, then. Now I’m not just fearful of losing my therapist, but the journey, too!”

Fear not.

If the treatment has been successful, a wider world has gradually opened to you outside the counselor’s consulting room. Many journeys beckon, inward and outward, outside your comfort zone, where all journeys live: more and different friendships, travel, new vocations and hobbies, increased openness to art or music, spiritual awakenings, returning to school; and, too, “thoughts that do often lie too deep for tears.”*

You will embrace some of what once frightened you or found you closed off. Not all things, but some things. Even from the defacing hand of age, a man of thieving heart, will you wrest unexpected gifts.

You never become indestructible, but you can move along in life more confident in the ability to manage most of the hurts; accepting that, they too are a part of the human experience, the beautiful/terrible richness of life.

You will not become everything you could be. No one does. But you will be alive to the world.

You cannot ask for more.

* The last words of Wordsworth’s poem, Ode: Intimations of Immortality from Recollections of Early Childhood.

The top photo includes Remains of the Via Appia in Rome, ner Quarto Miglio, by Kleuske. The second image is called Roma, via Appia Antica: Arco di Druso e Porta San Sebastian by Lalupa. Both are sourced from Wikimedia Commons.

Do Therapists Only Care about Money? An Airplane Morality Tale

I will not persuade you.

No, I will not persuade you therapists are not in it for the money. If all you see are greenbacks in their eyes (🤑), I don’t imagine I can dislodge your thoughts. I can’t deny we work for a living. Indeed, some of us live well, go on vacations, have pricey things. No, I will not persuade you, but instead offer you a story about one noble and gifted therapist.

Perhaps then you will persuade yourself.

Three people make up our cast. Two participants, one observer. All occupied one side of an aisle on a commercial flight. Little identifying information about the 30ish man in the window seat will be mentioned.

I had the aisle seat. Call me the observer. A pretty lady with thick brown hair sat between the young man and me. Bald men, at least this one, notice luxuriant hair!

As we waited on the tarmac, I saw the window-seated gentleman fanning himself. True, the compartment was a bit stuffy before take-off, but I wondered why he hadn’t opened the nozzle above to create a cooling air flow. Perhaps he hasn’t traveled often, I thought. I reached over the napping woman and touched his arm, pointed up, and twisted the nozzle. He smiled and the fanning stopped. I went back to reading my book.

The sleepy woman’s eyes opened:

I became aware of some intense breathing from the gentleman to my right, turned to look at him, and noticed he was sweating profusely. I asked him if he was okay, and our interaction began …

He told me he ‘hates flying,’ especially, the take-offs and landings. I recognized the brief conversation helped him to regain control of his breathing, so decided to continue distracting him by engaging in some light discourse. I was also very, very relieved he wasn’t having a heart attack! He told me he was traveling to visit his girlfriend, and when I joked it would be her turn to visit him next time, he laughed, ‘Oh no, she’s moving (here); I’m not doing this again!’ He shared that he has a young daughter who loves to sing and so I invited him to tell me more about her. He seemed to appreciate the distraction and smiled when he spoke about her.

My focus was to remind him to take deep breaths, attending to the slow inhalation/exhalation of his breath. This gentleman seemed somewhat embarrassed, but also quite grateful, and certainly did not eschew my help.

After we reached cruising altitude, he seemed much calmer. From time to time his breathing turned faster and more shallow, which would prompt me to engage in conversation to provide a distraction. We spoke about his destination. I shared some of my favorite places there and he told me what his girlfriend had planned. I encouraged him to enjoy the weekend, fearing he would worry about the return flight instead. I also supported his willingness to fly, given his clear dislike of it!

When we began descending, our fellow-passenger was in distress again. I turned my head toward him, and thought I was directing my voice quietly just to him, never imagining you (on the opposite side) would be privy to the ‘therapy.’ I was focused intently upon him, as a counselor would be with a client.

I used ‘grounding’ mindfulness, and ‘present moment awareness’ strategies to help him control his breathing, and distract him from his fear. I coached him through some diaphragmatic breathing by instructing him to put his hands on top of his ‘belly’ (which sounds less serious than ‘diaphragm,’ and somehow always prompts a smile).

I asked him to attend to the rise and fall of his hands on his belly, and the feel of his hands against one another. When I noticed he was holding a soft velour hat, I encouraged him to pay attention to its texture. I coached him to pay attention to the muscles in his feet, legs, arms, shoulders, and neck, to experience each area relax, to wiggle his toes — anything to take his mind off the descending plane. I kept cycling through the breathing exercises. It seemed to help him, fortunately.  Of course, I also supported his positive progress.

Once we landed, he again seemed quite grateful but a bit embarrassed. I worried for him on the return flight, so tried to empower him, as we regularly do with our clients, by reminding him he managed the trip with the help of some newly-learned techniques which he could do for himself.

What did I feel during this exchange? I focused on calling up anything I could think of to help him, and keeping my voice calm and steady, as he was struggling a lot! I was pleased in a wondrous way, that I happened to be there and able to help. Such serendipity in the world!

I was also a little embarrassed to discover my ‘therapy session’ was overheard. (The gentleman behind us caught my eye when we stood up to de-plane, to acknowledge the ‘session,’ as did another person in that row). I hoped he and others were not distracted by the repetitive refrain, and that my struggling seatmate was not self-conscious about anyone overhearing. I felt a bit of the ‘therapist’s high’ that happens once in a while, when we have helped another person to find the ability to succeed, and we hope, empowered him to use the new tools to help themselves going forward. I was amazed that by some coincidence I was in that particular seat, at that time and I forgot all about the nap I had eagerly anticipated.

If anything, Catherine “Candy” Davies minimizes all she did, and the gift she displayed in doing it. A tour de force for sure. For over two-and-a-half hours Candy worked with the gentleman, sped through a sandwich, read a few magazine pages, but retained constant awareness of her ‘patient’s’ emotional state. I congratulated her when we landed and she introduced me to her husband waiting inside the airport. Later I found her online and asked if I could share her story. She kindly provided most of the details you’ve just read.

Candy was not always a therapist. She earned an MBA and worked for a large corporation, as well as a non-profit. She’s also been a teacher of college business courses:

My ‘midlife crisis’ led me to a career change, and a return to school to earn an MSW.  I have been working at SUNY, New Paltz (the State University of New York, New Paltz Campus) since 2007 and am happily married to husband Bill. We have two grown children of whom we are very proud.

When I shared the story with Bill, he commented it was yet another example my career change was the right decision.  I agreed with him, for it put me in a place to help this young man.

Legendary basketball coach, John Wooden, said: “The true test of a (person’s) character is what he does when no one is watching.” Even though a few of us listened-in (you can’t hear everything on an airplane and my book was engrossing), I would remind you Candy remained unaware of her audience until the end.

Maybe now you have persuaded yourself — by virtue of my seat-mate’s basic decency and therapeutic talent — that counselors are not the self-interested rascals you thought we were. Then again, maybe not.

But regardless of what you think, Candy will still be out there, giving her best, healing when possible, living her values.

Biased though I am and special though she is, in my experience she is not alone.

Below “Candy” Davies SUNY photo, is a High Contrast, Stylized Vector Image showing hands helping each other, the work of Phollox. The last image is A Helping Hand, by Jean-Paul Haag. All but the photo are sourced from Wikimedia Commons.

What No One Mentions about Health Insurance

I am always amused by questionnaires designed to reveal whether we have enough money to last a lifetime. They are intended to help us plan for retirement. Yes, many of you are too young to worry about this, but humor me. One of the questions is some version of “How long are you going to live.” Another asks, “How much money do you expect to spend each year (for the rest of your life)?” Those questions are often enough to make us stop trying to fill out the form. Why?

Because we don’t know and it’s too scary to think about.

Which brings up the problem of choosing a medical or health insurance policy. I will use the words “medical” and “health” interchangeably to describe this insurance. I intend to target only two aspects of making a choice of health coverage, each of which follows from the questions above.

Simply put:

  1. We can’t predict how much health insurance we will need because we lack a crystal ball about our future health.
  2. Both psychological and intellectual roadblocks make it difficult to choose a policy. Thinking about illness and death, hospitals and doctors, is scary.

Despite all the words spoken about health insurance in the USA, no one discusses these two points and how they complicate the debate over what should be the federal government’s role, if any, in providing medical insurance for citizens.

I am therefore taking on the job. Again, humor me. This is important.

Lots of adults in the USA still get medical insurance from an employer, who might also insure the spouse and children. Most of you in the rest of the Western World receive government sponsored evaluation and treatment. But, historically speaking (if you are not disabled or “low-income”), in my country there are three choices other than a plan for which the employer pays a big chunk:

  1. Decide you don’t need or can’t afford medical insurance.
  2. Buy a policy on your own, one sold by an association (for example, by your college’s alumni program), or one offered in your state-run online marketplace.
  3. If you are a senior, sign up for Medicare, which is the coverage you get if your employer deducted a portion of your salary to make you eligible once you were old enough.

Our politics is dominated by the question of who makes the choice. Are you free not to buy medical insurance? Are you free to choose the kind of policy you want? One that pays for nearly all medical/psychological conditions or only some? Are you free to assume you won’t need certain medical/psychological services?

Some of the voices in this argument imply this is a rational choice, much like deciding whether you want to buy a car or prefer public transportation; and, if you do want a car, what model might you enjoy and how much are you willing to pay.

In fact, however, the decision is more complicated and not fully rational. Philosophers such as Martin Heidegger, a sociologist named Ernest Becker, and psychologists Sheldon Solomon, Jeff Greenberg, and Tom Pyszczynski have raised the issue of our discomfort with even the idea of mortality, let alone facing the reality of serious disease. Moreover, those social scientists created a body of research demonstrating our unconscious flight from the terror of our own personal end. No wonder Ernest Becker called his Pulitzer Prize winning book, The Denial of Death. No wonder the three psychologists do research on Terror Management Theory: not about terrorism, but the terror of knowing you will someday die.

Are you still reading or have you thrown a sheet over your computer screen?

If we cannot frankly face death without a secret shiver and a turning away, how then can we make rational choices about what health care we need or will need?

Will you or your child get depressed, need psychotherapy, or psychotropic medication? Become addicted? Have an accident? Face an unplanned pregnancy and need maternity and pediatric care? Be taken to the ER? Require a vaccination? Encounter a chronic, expensive illness?

No crystal ball, eh?

Few people seek out these unwelcome thoughts. We put them out of our minds when our health is good. Indeed, we must surely have inherited the ability to distract ourselves from life’s dystopian downside. Had our ancestors, broadly speaking, not had such an attitude, they wouldn’t have survived and we wouldn’t be here. They needed to attend to all the immediate tasks of living. “What if I get sick?” was not the most helpful question when the crops needed planting and harvesting.

A certain bravery is to be found in this optimism toward life. The attitude must come from half of our species, the fair sex bearing our children; those who (to quote W.E.B. DuBois) risked their lives and bodies “to win a life, and won.”

Illness and mortality are prospects most of us compartmentalize unless we are battling them. We will acknowledge the concerns, but in an abstract, impersonal way. They are “out there,” or “might happen someday,” but not today. We give these inevitabilities their own separate room within our psychic space, building the structure with bricks and mortar, double thick, the more to keep our emotions and thoughts untroubled. We wall-off potential weaknesses of our psyche and flesh, put them in isolation where we cannot be turned to stone by the prospect of serious illness, as if we faced Medusa.

My office manager routinely checked insurance benefits for new patients when I was in practice. Why? Because they usually did not know about their coverage. Some, in fact, were saddened and surprised to discover they had no therapy benefits and their insurance paid only for physical issues; that is, until the law required attention to mental illness.

Understand, please, my patients were almost all of average or greater intelligence. Still, most lacked knowledge of potential holes in what they considered to be their healthcare safety net. They trusted they were “well-covered.” Perhaps an insurance salesman told them so or their employer did the same. Or, maybe, after the Affordable Care Act (Obamacare) became law, someone assured them therapy was among the “essential health benefits” in their insurance contract. In the latter case, they did, indeed, have counseling benefits. Again, however, they tended not to know the details.

We live, as humanity always has, in a world requiring a significant amount of faith in other people. What I’m getting at, however, is more than trusting whoever designed your insurance or whoever is offering the product. In order to make thoughtful decisions about medical insurance we must face the issue of illness and mortality squarely, without evasion or distraction; and with a level of experience, intellect, and even specialized knowledge to do the job. We must do this despite our tendency toward mental and emotional evasion of illness and death.

To quote the title of a Tom Stoppard play, what we have here is The Hard Problem.

The top image is a Saddlebred Stallion in Harness by Jean. Balloons in a Car Lot in Normal, Illinois, by ParentingPatch, is followed by Caravaggio’s The Head of Medusa. All are sourced from Wikimedia Commons.

Why Therapists Leave

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Any beginning predicts an ending. Permanent relationships can become impermanent with time’s passage. That knowledge unsettles those in long-term treatment. Abandoned before, they wonder not “if,” but “When?”

Why do therapists leave?

An example: the man and woman had been married for six years. In mid-life, however, he was afflicted with a rapid and permanent hearing loss. In the midst of the crisis, his mother-in-law was diagnosed with cancer. She lived 1000 miles away. What was the wife to do? She chose to spend the last six weeks of her mother’s life with mom. She’d have done the same thing if she’d been your therapist.

Granted the departure was temporary, but such disruptions happen and are sometimes more lasting. A lovely psychologist of my acquaintance, a being so calming as to make quiet moments with her almost holy, fought illness off and on for years. Her resilience seemed infinite. In her ninth decade she banged against infinity’s wall and retired abruptly, having met physical problems even she could not shake off.

The choice is usually not so harrowing. My own retirement was the consequence of the increasing depletion I felt from doing my work. The weight of the problems of others pressed heavily, even though my clients were less troubled as a group than they’d been earlier in my career. Then too, books called out to be read, courses of study beckoned, and new wonders of the world awaited.

Therapists are notorious for burning out, though not all do. Unfamiliar places trigger our wanderlust. Everyone seems to believe California or some warm spot would be nicer, at least if you live in the Midwest. Grandchildren need attention while they are small. You cannot place their youth in a safe deposit box for later use any more than you can your own.

Life intervenes in unexpected ways. I do not mean to minimize the pain when a therapist departs before a patient expects the end of the relationship. I helped clients grieve such losses when they came to me afterwards. I also caused unhappiness myself by deciding to leave practice. Unexpected finishes, however, cannot be allowed to finish us off.

When I was about to embark on the capstone or giant-killer to a graduate education, the dissertation, my advisor disappeared, vanished. I found out he was going through a messy divorce. Fair enough, but to another state? Without telling me? I adjusted. I lined up a new dissertation committee chairman and was ready to proceed when my initial advisor returned, as unexpectedly as he departed. Granted, he was not my therapist, but still …

Therapists also, on occasion, change as people. Funny, one wants a transformative counselor, not a transforming one. The patient expects to be the only person to make substantial self-alterations, setting aside any desire for a reduction in boundaries allowing more intimacy with the doctor.

A young therapist/colleague became a carpenter in his ’30s. I met a lawyer with a towering income who opted out of his partnership to opt into a seminary. Charles Krauthammer, a syndicated conservative columnist, was a psychiatrist. Granted, not many established counselors change careers, but an occasional dropout happens.

long_boy_goodbye_ma_goodbye_pa_goodbye_mule_with_yer_old_hee-haw

Close to the end of my career I’d hear the question from a patient, “Do you expect to retire soon.” I think I answered, “I have no plans.” Until, of course, I eventually did and then announced my future unprompted.

We (and by “we” I mean you and me) have no crystal ball, no bewitched mirror on the wall. We don’t expect to divorce when we marry, don’t enter careers anticipating they will end soon, don’t fall into friendship with a vision of its erosion or collapse. I can only tell you — only tell myself — the things I know for sure. And sometimes what we think we know we don’t know. Fate’s hand spins the top of our lives in directions never imagined and, when the spinning stops, a new idea forms and informs us.

Therapists leave and it’s not personal, except it is. When you don’t think you are “enough,” a therapist’s departure (at least not one caused by a lightening-strike) says “You’re not enough to cause my staying at the job.” I get it and I also get the absence of an intention to harm.

So yes, your therapist might leave you, but your departure is more probable. The latter is best, for sure, if you’ve gotten what you came for. The good news is we have encouraging career-longevity data on doctoral level psychologists. The American Psychological Association’s Center for Workshop Studies reports that among those already “retired” in 2013, 42% were still working. The median age of retirement was 61, meaning half retired before 61 and half after. The sample included all doctoral level psychologists in the year of the study, not only clinical or counseling psychologists in practice.

Therapists, like most of the rest of us, are living longer and need to make a living. They have multiple incentives to continue. The satisfaction of meaningful work, the intimate contact with good people, and the words of thanks are enriching. The work is interesting and research offers us new tools. It’s an exciting time to be in the field, in the lab, and in the office.

We cannot guarantee our lives, any of us. The retirement or side-lining of a therapist probably won’t happen while you are in treatment. The answer to the “What will I do if it does?” question is that you will do what is required. In the meantime, avoid living the infinite variety of doom-laden scenarios available to imagination: a “thought-error” called catastrophization which can be treated with cognitive-behavior therapy (CBT).

Good advice comes from John Steinbeck’s The Grapes of Wrath and his character “Ma” Joad, the rock of a migrant family almost out of chances. She is the lady responsible for their emotional and physical sustenance, including cooking the salt-pork packed for the clan’s trip to an uncertain life in California. Her 16-year-old son Al asks:

Ain’t you thinkin’ what it’s gonna be like when we get there? Ain’t you scared it won’t be nice like we thought?

No. No I ain’t. You can’t do that. I can’t do that. It’s too much — livin’ too many lives. Up ahead they’s a thousan’ lives we might live, but when it comes, it’ll ony’ be one. If I go ahead on all of ’em it’s too much. … An’ (what I concentrate on is) jus’ how soon (the family) gonna wanta eat some more pork bones. That’s all I can do. I can’t do no more. All the rest’d get upset if I done any more’n that. They all depen’ on me jus’ thinkin’ about that.

The top photo is entitled Goodbye Grenada, Goodbye Karabik by giggle. The cover art for the sheet music for Long Boy (I imagine this means “So Long, Boy”) was drawn by Gar Williams. Both images are sourced from Wikimedia Commons.

What You Can Do When Trauma Reminders Intrude

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Victims are easy to identify — or so we think. We see them on TV each day. We are inundated with injury. Too many terrified people, mistreated people, and survivors of war zones and privation carrying their children and belongings. The images arrive from displaced persons camps, airports, and highways.

Look in the shadows, however, and you will find even more. Those are the second-hand souls, the past sufferers, the ones reinjured at a distance.

The men and women to whom I refer are recovering from Post Traumatic Stress Disorder. Some of them are rebroken by watching or reading about the latest victims and the menacing public statements of elected officials. They shudder at the unpredictability in the air. According to the conservative columnist David Brooks, we are witnessing  “a rising tide of enmity” in the USA. Indeed, swastikas have appeared in the public library men’s room of my own suburban Chicago community.

Yesterday’s unfortunates are reminded of their imperfect healing by the incivility and xenophobia around them. Their bodies respond by saying “fight or flee.” A sense of being flooded, overwhelmed — even to the point of collapse — sometimes is not escaped for minutes or days.

Retraumatization of this kind can leave the individual disoriented and dissociated. He may undergo flashbacks of his past: a psychic reexperiencing of the event. At the extreme, there is the loss of awareness of where you are, in what circumstances you are, what age you are. You time-travel to a place you escaped, reinstalled into a mental chamber of prior misfortune. Perspiration, nausea, tearfulness, and intense fear are only a few of the possible sensations and emotions.

You are alone, even if others are nearby. The triggered individual is often unable to describe his internal world. He is awash in a fetid river of word-preventing feelings. The proper vocalizations do not come.

What is one to do?

Here is an example of a young man who dealt with a mild version of the problem, but still enough to put him in treatment. He was in his early teens. A bike accident — he was struck by a car — left him with a painful recovery. Even after the physical injuries healed, the newspaper account of the collision — one which blamed him — still felt like an attack. Moreover, the intersection where he had been hurt remained dangerous. He felt both unfairly targeted and helpless to do anything either to vindicate himself or prevent harm to others. He continued to avoid the location, but traffic reports of pedestrian injuries (regardless of where they occurred) darkened his mood and made for painful and repeated revisiting of his experience.

One aspect of his treatment was a turning point. We talked about what he might do to get a sense of control and counter the wrong and wronging newspaper account. This thoughtful adolescent wrote a letter to the reporter who covered the event. Two things followed: 1. His comments were published in the newspaper. 2. The reporter researched the statistics pertaining to accidents at the place of injury and wrote another article detailing the danger. The city council then investigated the matter and made the intersection safer.

Where does that leave you?

You can, of course, hold your hands over your eyes and plug your ears. The avoidance of TV and radio is a close equivalent, as is holding to an agoraphobia-like self-protective self-confinement. Though understandable, these strategies must eventually be set aside lest you continue to remain terror-prone.

Another patient of mine, long after her father died and mother denied (in my presence) that any sexual abuse happened, chose to return to her childhood home. This was the site where years of sexual abuse by dad occurred with mom’s knowledge. She traveled 500 miles to get there. As it happened, the house was being redecorated and the new owner permitted her to look around. My client left the spot with a sense of palpable triumph. She had faced-down the ghost of her demon in the place of his iniquity.

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If you are pained by news accounts in the aftermath of the President’s Executive Order of January 27, other actions commend themselves to your attention. The American Psychological Association offered a concerned Response to this Directive on February 1, 2017. It reads, in part:

‘Refugees, particularly those displaced from war zones, experience stress, trauma and other serious mental health problems,’ said APA President Antonio E. Puente, PhD. ‘Denying them entry to the United States, particularly those who have already been vetted, is inhumane and likely to worsen their suffering. This conclusion is based on extensive research and clinical experience … .’

Such policies can lead to a perception of reduced freedom, safety and social connection for those directly affected, as well as for society at large (my italics) … .

Research has documented serious mental health consequences for immigrant children and/or their parents who have been forced to leave the United States, which may magnify earlier trauma experienced in or upon fleeing their country of origin. Sudden and unexpected family separation is associated with negative outcomes on child well-being that can last well into adulthood.

If you have been retraumatized by the human consequences of your country’s immigration policy, your decision concerning any response may be more personal than most. Others, perhaps less impacted in this way, have marched, attended town hall meetings, written public letters to news organizations; and visited, called, or emailed their elected representatives.

In the end, those without trauma histories would be wise to refrain from judging whatever action you choose or do not choose. The world presents many chances to reinvent ourselves and repair the injuries it inflicted.

Remember, however, that you and your therapist aim to help you distinguish the present from the past, both intellectually and emotionally: to realize you can act today in an effective way not possible before. And to keep the past from recurring in any form by your self-affirming assertive actions.

The top photo is a Syrian Refugee and Her Newborn in Ramtha, Jordan taken by Russell Watkins for the UK Department of International Development. The second image is a World War I propaganda poster called Every Girl Pulling for Victory by Edward Penfield, created in 1917. Both are sourced from Wikimedia Commons.