When Therapy is Long Does Your Therapist’s Patience Grow Short?

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Some phrases never grow old, never become routine. “I love you” is one.” So is “I don’t want you anymore.” It is not that we’ve never heard the words before, but that they are so powerful and fraught with significance (or so hard to say or mean so much) either to the one who utters them or the one to whom they are delivered. In therapy the dread-laden expression is different: “I can’t do more. I need to refer you. Treatment has been long. The lack of progress means we must stop.”

Yes, perhaps it is said differently or becomes evident not through language, but impatience or facial expression or indifference. Where once enthusiasm and intensity bloomed, now the counselor seems to be enduring you, too conscious of the time, growing weary of your moments together. Two of my readers, Claire and Rosie, asked me to write about what permits a therapist not to take this dreaded path, the one leading to his desire to dump you — hoping you “never again darken my door” even if he doesn’t say the precise words I just used. Thanks to them I will try. I speak for myself, but know many therapists who would agree with much of what they will find below.

  • I like people. I like stories. I like individuals, not groups. I try to provoke meaningful conversations even with friends, not small talk. The time I spent with my patients was the perfect environment for me to look into a person’s history, history being a favorite subject from my early school years on.
  • I learned to notice small signs of progress. Sometimes we advance in microscopic steps. We reach a plateau on the mountain climb of treatment and then must catch our breath or wait for the storm to pass. The old Chinese saying tells us, “A journey of a thousand miles begins with a single step.” Therapists measure their work in moving toward a goal, not reaching it in quick time.

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  • The work is gratifying. Where else do people come to you, rather than requiring your travel? Watching others grow — helping them grow — generates good feeling on both sides. You receive thanks.
  • The work is an honor. New counselors find the responsibility almost overwhelming: another person places his well-being in your hands. A wiser, more experienced, older doc should know (or remind himself) of the implicit tribute his patients give him by their consultation and expectation of his help.
  • I received payment for my effort. It was easier to be patient with patients in the knowledge some of my compensation came in a material way. That said, in a handful of cases, long-term clients were thousands of dollars in debt to me before the sessions ended and they achieved the life they wanted. Yes, they did then pay me, usually over time. Healers must not be so self-sacrificing that they become resentful of those they treat.
  • The patient’s life was not mine or that of my spouse or children. While clients sometimes wish to be closer to their doctor, the therapeutic distance created by him makes it possible to put treatment still-points in perspective. I am less calm and understanding with my wife and adult children than with those who sought my professional skills. I cared about the people I treated, but (usually) not to the point of a disruption of my equanimity. Thus, I tended to be patient with a lack of movement, thinking of such episodes as a rather commonplace experience not usually requiring a desperate and immediate remedy.
  • I was responsible for making therapy fresh. A therapist’s job is to bring his intense focus to every session. He must also reflect periodically on whether he has missed something important. I reevaluated my patient and my approach, made course corrections as needed. A therapist who is often bored or unable to change perspective and look anew at the client is in the wrong profession. I kept it interesting both for myself and for those who put their trust in me. A patient is not your entertainer. The counselor should be emotionally and intellectually engaged on his own
  • Of course, if you aren’t putting in the effort, you might wear the therapist down. If you are simply paying for a friend, buying his time because you have affection for him (or using him to replace a missing social life) then he should recognize this and talk to you about it. So long as you rededicate yourself to “the work” of therapy, no ouster need be expected.

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  • Progress isn’t linear. I once asked my money manager, a professional analyst of financial markets, what he expected in the near term from the stock market. He answered, “It will fluctuate.” What he said was funny, but his comment acknowledged that no one predicts economic busts or booms, much as many people claim to. Therapy doesn’t move in a straight line of ascent from start to finish, anymore more than the stock market goes straight up or down in perpetuity. There are bursts of change, but more often, periods of little movement. I didn’t expect patients to be elite prodigies of self-analysis and courage, sprinting to psychotherapy’s finish line, so I wasn’t desolated if treatment took its time.
  • The therapist discovers value in challenges. If therapy were always smooth sailing, counselors would become bored with it.  They would learn nothing new because no greater progress could be made by doing so. Since I lacked a magic wand, I had to continue to consult colleagues, read books, and attend classes. Those who posed therapeutic dilemmas generated some of my growth as a counselor and a person. Why would I wish to cast aside people who were, in effect, helping me to do better?
  • Elite athletes are useful models for clinicians. Baseball players grind out a 162-game schedule from April through September, longer if they reach the playoffs. Successful athletes learn to put today’s failure behind them, lest they worry themselves into being unable to perform well tomorrow. I was better than many in my capacity to go home and think about other things, relate to my loved ones, and set the therapist hat on a closet hook. To do otherwise would have burned me out. I was not available 24/7, nor did I guarantee rapid responses to email or phone messages. I made sure I didn’t get used up. A doctor who takes good care of himself is less likely to get tired of you.
  • Buddhists provide yet another excellent example for therapists. You know the frustration of a long static line: a line where there is but one indolent checker or ticketing agent taking care of all those in the queue. You have places to go, people to see. Yet your reaction to just this type of setting — one seemingly out of your control — might determine whether you lead a satisfying life: 1) You can be frustrated and make yourself miserable. 2) You might jump to the line’s front and complain, which will not usually make the line shorter or the ticket agent more efficient. 3) You can reframe the experience. A Buddhist would say, in fact, you should be grateful for the line and the plodding employee because they are giving you the opportunity to learn patience. A lengthy term of treatment where every inch of progress is dearly won offers the same opportunity.
  • My job was a gift. I performed work that was not always “work.” A summer job during my school years in the 100-degree heat of a metal-stamping factory taught me how soul-killing “work” can be. I later came to make a good living in clean, climate-controlled surroundings as a psychologist. My patients helped me become more patient, more thoughtful, more loving — more grateful. I was my own boss and I took meaning from the relationships and the privilege, the stories and the intimacy. I used my brain, one of my favorite body parts! Living this professional life and remaining (mostly) grateful defused many frustrations.

The task of a therapist is not to say, “You’re fired,” but to find a way through or around, under or over; whether running, crawling, pushing, pulling, cajoling, asking questions, waiting, reconfiguring, staying silent, or getting his own help. Much as some of our patients worry about being put into a dumpster, we are working to get them out of one.

Rest easy.

The top photo is called Doraemon by istolethetv from Hong Kong, China. The second is named I’ll Miss You Dad by Cecilio M. Ricardo, Jr., USAP. The final image is a highway Sign at the Truth or Consequences, New Mexico Exit taken as part of an August 24, 2009 road trip by CGP Grey.

When Your Identity Depends Too Much On A Relationship

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There are people who define themselves by who they are with. Lots of them. Perhaps a few more females than males.

The effect is to give someone else the ability to determine your value and your happiness. You become hostage to the opinion of another. That is never a good spot for anybody.

Man or woman, one’s basic value is communicated early, from parent to child. Home is the place where identity begins — and begins to be established by the relationship(s) you are in. As time passes we experience life outside. We compete on the playground and in school. With the proper parents and enough applause our sense of being valuable is internalized. Without either, most of us keep searching for a way to increase the market for our presence in both companionship and work.

Those who monitor the applause meter too much are in trouble. You must value yourself from the inside, not from the fickle world’s viewpoint. Yes, you can be today’s hero, but you will eventually be yesterday’s darling, and tomorrow’s has-been. Yet you are the same man or woman. If you don’t know your worth you are like a tightrope walker on a windy day.

One sees the dilemma of insecurity within romantic relationships. Too much desperation, neediness, and fear of abandonment.

To avoid a sense of emptiness, some people must be in love — ecstatically so. Love of a more workaday kind is not enough. They are yearning for the fervid, moment-to-moment drama that carries one away, but cannot be sustained for long. Anything else — the rest of life — pales in significance. Too many seek a permanent level of spousal intensity requiring the partner to give up his day job and plug himself into the wall outlet for some extra energy. Anyone desiring this type of relationship believes only such a connection can make life complete.

You are in trouble when you expect and hope for someone to fill you up; when you are the human equivalent of a leaking gas/petrol tank always needing to be topped off.

You are even more out to sea if:

  • You buy into the notion of Hollywood happiness (as in the movies).
  • You view life as simple. You believe once you find “your soul mate,” you will be happy forever after.
  • You feel incomplete except in those moments when someone else is actively showing you attention.
  • You believe the “head over heels” dazzle and the dog-in-heat randiness of the honeymoon period will never stop. (A while back I heard a middle-aged woman interviewed on the radio following a mild earthquake. “The earth moved,” she said. “I’ve been married 25 years. It’s been a while since the earth moved. I kind of liked it).”

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You remain adrift if:

  • You can’t define yourself by your career, your intellect, your integrity, your hobbies, your passions and compassions, but only by the windblown opinion of someone else.
  • You believe a failure to find love is a verdict on your value. (I know many people of great worth who are without a romantic companion).
  • You think happiness resides outside of us, not inside of us, but in another person.

The day the love of your life arrives, even after you remove the bubble wrap, you will still possess the same insecurities as before you placed your order for him with Amazon. You will own all the same strengths and weaknesses yet to be improved, tested or avoided, as you choose.

You assume the soul mate is the key to everything good. That doesn’t make you more secure, but less. You are worthless without him and emotionally dependent.

Moreover, you still need other things: to succeed at something, make tough phone calls, look people in the eye, bounce back from losses, say no, and climb the twisting rope of life.

My advice? Work on accepting what you are, who you are, and learn to be adequate as you are. Not perfect, but good. And if not yet good, on the road to making yourself good. Challenges will still occur even within the relationship. Your bliss cannot be freeze-dried into permanence. No 24-hour dose of love potion is available to keep you walking on air.

Please understand. Love is wonderful. I am a satisfied customer, prepared to give a notarized testimonial and the highest praise to my wife and children.

A good relationship is supportive, warm, high-spirited, passionate, fun-filled, secure, and allows you a springboard to deal with life’s challenges. Love provides a safety net when you stumble. Successful coupling opens you to a possibility of which you were doubtful: your command of a top price on the world’s relationship market.

Immanuel Kant, the German philosopher, believed our happiness is not within our total control; and therefore certainly not dependent upon a choice of the right mate. Kant emphasized, however, the greater importance of something beyond happiness: to make oneself worthy of it by dint of moral courage and principle. To him, the highest accomplishment to which any of us can aspire is to be the best we can be; not in terms of success, but as measured by our basic humanity. You will then be someone who can be counted on, capable of taking a risk; a person who stands for something more than his own personal advantage. “A Mensch,” as such a one is called in Yiddish.

Becoming that is entirely in our power.

Should you achieve such a lofty human estate, I’m willing to bet two things:

  • Your chances of finding love will increase.
  • You won’t be dependent on love to know your real worth.

The first image: Русский: Нелли Жиганшина и Александр Гажи (Германия) на чемпионате мира по фигурному катанию 2012. The second photo is called Kissing the War Goodbye, a Times Square, New York photo taken on VJ Day (August 15, 1945), the end of World War II. Both are sourced from Wikimedia Commons.

Are You Too Emotional?

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You’ve heard it before — “You are too emotional!” Surely you heard it as a child, at least once. But, what does it mean? How do you know if it is true? What is the proper place of emotions in any life? And, if you are “too emotional,” what should you do about it?

First let us establish some ground rules. Emotion is necessary. Imagine a life without it. No  love, no families based on that love, no compassion, no empathy, no righteous anger. What would be left? A life of relating to others as objects, like chairs or tables, their only value in utility — the function that they perform; only reason would be left — cold computation of what to do and how to do it. No laughter, no tears, no gratitude, no passion.

If you agree with what I’ve just said, then it is clear that emotion has a place. It binds us to others, plays a part in letting us know when we have been injured, allows for the possibility of good relationships and a joy in living. It also creates an energy that is necessary for self-defense and for the pursuit of causes. Emotion motivates us and permits the creation of communities.

But, when you are called “too emotional,” the accuser usually isn’t referring to love or happiness or even anger. No, usually he means that you are too easily hurt. And, when you are young, especially if you are male, you are encouraged to “be a man” and live by the “athlete’s creed;” if you are hurt, in other words, rub some dirt on the injury and get back into the game. Don’t complain; that is for whiners and wimps and little kids.

Well, if you are an athlete, that is what you have to do. Think too much about the injury and you won’t be able  to perform. Moreover, if you even think too much about your past failure in the game, you won’t have the confidence and focus to be able to succeed in the remainder of the contest. So, under those circumstances, being “emotional” does, indeed, get in the way. Similarly, emotion interferes with necessary behavior in war-time or in other crises that require focus, indifference to pain, and steadfast action.

But how about situations that are less demanding and fraught with danger or competition?

For me at least, emotion has become, for the most part, a friend. I can be moved by the sadness of my patients and those in my life who I love. I do not consider it a weakness. It is simply a part of being the responsive, sensitive person I aspire to be. And I can be moved by music or drama, again to the point of a tear. Life seems richer, warmer, more eventful and worthwhile that way. I don’t feel the need to keep up a brave front, an appearance of having tamed my emotions.

No, I’m not often whipsawed by my feelings, but, in part, that is because I give them their place in things and don’t keep them all bottled-up, looking for a way to burst out of the container that I would otherwise have put them in. And, when it is required, I am prepared to seek solace from a few of those closest to me, just as I give solace to my patients and those I love.

True, being emotionally vulnerable means that you can be injured. But, don’t fool yourself, life will have its way with you whether you are deadened to feelings or not. By killing your emotions, you are probably only succeeding in limiting the fullness of your life while attempting to create an illusion of strength.

Put another way, it is only human to have emotions and best if you are comfortable with that fact almost all the time.

But, beware when the emotions have you!

At the extreme is a condition called Borderline Personality Disorder (BPD).

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, states that “the essential feature of BPD is a pervasive pattern of instability of interpersonal relationships, self-image, and affects (emotions), and marked impulsivity that begins by early adulthood and is present in a variety of contexts.” These folks are, unfortunately prone to “frantic efforts to avoid real or imagined abandonment,” instability, recklessness, suicidal behavior, rapid and intense mood changes, emptiness, and anger. They are the flesh-and-blood definition of what it means to be “too emotional.” And, not surprisingly, they are difficult to treat, although Dialectical Behavior Therapy is a treatment specifically designed to do so, and has demonstrated great promise with this patient group.

For those who are not categorized with this diagnostic label, how do you know if you are too emotional? Here are a few questions you might ask yourself:

1. Do people, not only family members, often tell you that you are too emotional?

2. In an over-heated moment do you tend to make impulsive decisions that you later regret?

3. Do you have many arguments and blow up easily?

4. Do friends and relatives have to handle you with kid gloves?

5. Do your emotions suck the life out of you, change easily and quickly, and generally whip you around?

6. Do you weep easily and often in the absence of major set-backs or great losses (I’m not talking about having a tear come to your eye here, but something more gut-wrenching)?

7. If you are in mid-life, are you no less emotional than you were in your teens? (Most of us become less volatile, more in-balance, over time).

If you’ve answered too many of these in the affirmative, you may want to seek counseling.

A last word or two. Life is challenging. We need to permit ourselves feelings and we need to express them, within limits, and to have a sympathetic soul there to bear witness and listen to us. Balance is the key most of the time. It may help to remember a portion of the “serenity prayer:”

God grant me the serenity

to accept things I cannot change;

courage to change the things I can;

and wisdom to know the difference.

If you do not “know the difference,” often enough and go to emotional extremes over the routine ups and downs of life, if even the small things seem too big, then it might be time to seek professional help. Not to kill your feelings, but to make sure that they don’t destroy your ability to have a good life.

You may find the following post of related interest: Vampires and Buried Feelings: The Therapy of Getting Over Your Hurt.

The above scene, Frenchman Weeps 1940, was used in the 1943 US Army propaganda film Divide and Conquer (Why We Fight #3) directed by Frank Capra. The photo shows “French people staring and waving at remaining troops of the French Army leaving metropolitan France at Toulon Harbour, 1940, to reach the French colonies in Africa where they will be organized as Free French Forces fighting on the Allied side, while France is taken over by the Nazis and the Petain regime collaborating with them.”

Wikimedia Source: Records of the Office of War Information, NARA. *Date: June 14, 1940 *L.

Surely, under the circumstances, this man’s emotions were quite appropriate.