Therapy’s Ultimate Goal: Embracing Life

Are there endangered emotions in the world, much like endangered species? The ones that disappear? Most of us had sentiments and enthusiasms as small children we now rarely experience. What might they be? Can we get them back?

The greatest events of life, I’d argue, are fleeting. The birth of your first child is one. An early, electric kiss. The clichéd “thrill of victory” as it is felt, not reported. A musical performance of sadness or exultation so powerful you float and reverberate for days. Immediacy, intensity, and loss of self-awareness are found in these moments. Routine breaks. One is swept away.

What do we try to do with such things? Extend them, for sure. Go back to the source and regain them. Produce more children, maybe; more kisses, for certain. Play in additional ball games, too. Perhaps attend the repeat-performance of the concert the next day. But, the repeat almost never captures the wallop, the poignancy of “the first time.”

Does the picture of a speeding bullet seize the essence, help us remember and relive it? The most precious things and people are priceless, in part, because of their short supply and elusiveness. Here and gone. No matter the effort, we can’t catch an emotional deluge in a bucket and keep it in the fridge, just so.

Yet still we try. We want the honeymoon to be endless. We want our child’s spontaneity to continue forever. We think the earth-moving moment should be mounted in a frame or frozen under glass, but its soul is in the movement, not the stillness. The carefully preserved butterfly does not fly.

Some of us, as we age, lose even the ability to be astonished by life, bowled over by happiness or love, sensation or tenderness. Most want a bit of protection, so we add, without thinking, one layer at a time, beginning in youth. Seems safer, more necessary, less risky. The arrows of fate then won’t pierce as far, hurt as much, or so we believe. We want to escape fatal bullets, but unintentionally kill ourselves – the life in us – by trying to avoid them.

The bravest therapy patients attempt to change no one but themselves in their effort to recapture the innocent wonder they had at the point of creation, or grab the life-enkindling thing for the first time. They have the courage to recognize the mirror’s image, to overcome the pain of treatment, to outlast and out-will the unendurable: a kind of therapeutic integrity not to be denied. They grip tragedy and wrestle him to ground. They rip the emotional scabs off their being and bleed until purified and joyous. I still cannot believe how open they are.

As an observer of myself, I can characterize personal life from my 20s to the present as an opening more than a closing. My work required this openness, but so did full immersion in the best private moments as they happened. To my continuing surprise I become more open, not less, even now. Saying what others might not say, but only think; expressing the deepest part of myself to those who care to listen. Looking into your eyes if I am touched by your being. Life hurts more this way, but feels right and perhaps I have no choice: I became and am becoming such a person with little intention. Who knows what version of myself might appear tomorrow?

Death sets the border on everything. The cliché tells us the cemetery is full of irreplaceable people, the last stop on a human world in transit. The trains of life’s are always in motion, much as we want them to wait a minute. The best of them are swift. That’s what makes a train. No picture of a locomotive moves at 60 mph unless you throw it across the room.

So my advice to all of us is this: eyes open, heart open, stay alert, let down your guard as much as your dare; but don’t lose the best of yourself. Make love to life as if she were your first and last, both. She just might be.

Of course, I’m uncatchable, but catch me while you can.

As the advertisements tells us, we are all on sale for a limited time only.

The top image is called Berliner gör’n by Till Krech and is sourced from Wikimedia Commons.

Are You the Perfect Therapy Patient?

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The blogosphere is full of worried therapy clients. They believe they are “not enough:” not interesting enough, not clever enough, not progressing fast enough. What then are therapists looking for? Are worried patients right to be worried?

Research is limited. An over 50-year-old model based on a survey of 377 counselors by William Schofield revealed what was believed to be the perfect client — the so-called YAVIS prototype: one who is young, attractive, verbal, intelligent, and successful. Schofield saw this as a bias toward patients who exhibited these traits, not careful science identifying those who actually were best suited to treatment. Psychotherapy was then a male-dominated profession, perhaps also contributing to a preference for female clients.

Psychologist Paul Meehl, among others, critiqued this model. He feared practitioners would make “hidden” or biased decisions toward YAVIS therapy candidates and against those who were not YAVIS. A counselor might, for example, work harder with YAVIS individuals because he thought them more likely to benefit from treatment. A self-fulfilling prophecy in other words. By the same token, the mental health professional would perhaps instinctively recommend medication for someone who, according to the YAVIS model, was not typical of those who profit from “talk therapy.” The YAVIS syndrome raises the possibility of other biases, not all of them conscious, including the possible refusal to take on patients of certain racial, ethnic, or socio-economic groups.

We don’t know who today’s mental health professionals would pick for their ideal client. Nor do we understand what attitudinal differences toward patients exist among practitioners depending on their own personal characteristics. Do older clinicians, for example, prefer different kinds of clients than younger ones? Do male counselors hold the same patient preferences as female therapists?

I’ll offer a few thoughts on the broad subject of “ideal” patients. No gospel is here offered, just one person’s ideas. I’ll start by considering the YAVIS profile:

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YOUNG: Let’s set age 40 as our arbitrary limit on “youth.” Let’s also stipulate that you can be “old” before your time. Meaning what? Too set in your ways, rigid in attitude and behavior, closed to new ideas and risk-taking. By this standard, youth holds the advantage of openness to change. Moreover, those clients who are “too old” have an increased likelihood of experiencing regret that cannot be erased by future action: the inevitable foreclosure of some opportunities in life when we pass the “use by” date on our early, fleeting talents. I’m speaking not only of career possibilities (athletics is an obvious example), but regret over having been a poor parent to offspring who are now adults. The absence of children would be another loss for women of a certain age who desired off-spring of their own flesh.

We can come to terms with some of our past errors, but we don’t always get a “do over.” Youth, therefore, owns the advantage not only of its openness to change, but a plethora of doors not shut to entry. Yes, there are other avenues to pursue for most of us who are past our physical prime, yet they are now different and fewer in number.

ATTRACTIVE: Although one might discuss this characteristic in several ways, I will opt for the obvious: a patient who is sexually appealing. I would be lying if I said I never noticed a beautiful new client in the waiting room. A colleague described the “energy” within the office when treating such a person, at least on early visits. The energy he spoke of was his own.

While feminine beauty has a potential downside (read Beautiful and Smart but Unlucky in Love), a male therapist can unconsciously work hard at his profession to achieve an appealing woman’s approval.  The man might seek a beguiling female’s admiration unaware of what is driving him: captured by his senses but not his sense. The counselor, however, should give his best for every patient. His first steps toward reducing bias are to recognize the danger, look at his reaction to a beautiful new client, and be certain he gives equal effort to all. Indeed, this was possible even though some women made obvious attempts to draw my attention or offered themselves to me as sexual companions.

Experience and conscientiousness, not to mention adherence to professional ethics, reduce a client’s distracting physical desirability. Moreover, I discovered — as I suspect you have — that my perception of another’s external qualities changed as I got to know them. Some become more attractive, others less. A few days ago on a New York subway I noticed myself looking at a rather plain (to me) young woman sitting opposite me. Lost in her thoughts, she had the most touchingly pensive expression concentrated in the unconscious, tender positioning of her mouth. Put differently, a good therapist can find almost all his patients attractive. Indeed, we look for the best in people on every level.

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VERBAL/INTELLIGENT: In talk therapy — a treatment involving many words — an inarticulate client is a challenge. I recall a bright man who lacked verbal fluency and had a limited education. He progressed well, but the demands on me to understand ideas and emotions he could not express with ease made treatment challenging. I was able to overcome the obstacles, in part, because of his patience and my persistence. Just so, those whose intelligence is below average may have trouble understanding concepts like transference. On the other side, one also deals with individuals lost in their own intellectual/verbal juggling act — preoccupied with the word play in their heads. A different form of challenge, then. Still, a therapist prefers a patient with a decent command of language.

Understand please, I’m not referring to those who are afraid to be open with their feelings and thoughts, but rather men and women with difficulty expressing themselves while trying hard to do so. Fear of self-disclosure is a different story. Counselors find female patients are generally more comfortable revealing their emotions, no small point when the individual comes to treatment because of mood issues. Thus, the therapist faces some clients frightened to say what they feel, others who don’t have the words to make themselves clear, and a few who struggle with both. The clinician does his best regardless.

SUCCESSFUL: A lack of “success” can prevent the patient from affording treatment, adding an additional hurdle to the therapeutic project. Many clients, however, came to my office thinking themselves unsuccessful. Some were correct from an objective, financial standpoint. An absence of success as defined in the materialistic USA is no automatic impediment to a good psychotherapeutic result. Success did, however, sometimes signal I was in the presence of a person who had surmounted past life challenges, and therefore predicted a capacity to take on those emerging in therapy. To me, high accomplishment by itself never meant the course of treatment would be easy. Indeed, some of the wealthiest clients I met were poor patients, often because of ballooning egos and a narcissistic inability to look into the mirror and witness an accurate reflection.

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What else made a client into a promising therapeutic prospect in my mind?

  1. MOTIVATION: In the best case these folks led the therapy, doing everything they could to make their lives better. More often it was enough if they were responsive to homework assignments, thought about the sessions rather than forgetting them after they were over, brought in issues for discussion, and recognized treatment needed to be a joint effort, with two people pulling the same sledge to a better place.
  2. OPENNESS AND A LACK OF RESISTANCE: Some clients fight the therapist, summarily discounting any ideas or interpretations suggested by him; reflexively saying “I’ve already tried that.” They were like giant tin cans in human form, well-versed in how to resist the can opener, aka the doctor. The best clients are emotionally available or learn to trust the clinician enough to permit a gradual revelation of difficult issues and feelings. They don’t make the “fifty-minute-hour” into a battle.
  3. CONSISTENT ATTENDANCE AND PAYMENT: Regularly missing sessions makes it impossible to get anywhere. Woody Allen denies saying “Ninety percent of life is showing up,” but (whoever said it) there is truth in the expression, even if one might disagree with the exact percentage. With respect to payment, a counselor doesn’t want money to be an issue between himself and his client. Many accept either pro-bono or sliding-scale patients who pay nothing at all or something less than the customary fee. Others will let clients in difficult circumstances run up large tabs. Usually you get paid at some future time, sometimes you get stuck. Such is life, but again, if a therapist has a choice, he’d prefer to deal with what makes sense, not cents.
  4. THE ABILITY TO TOLERATE DISCOMFORT: Change is rarely easy. The more damaged the patient, the more courage required. As a mental health professional you bring people along slowly not to overwhelm them. Nonetheless, therapy is a challenge and at least a bit of heroism is necessary.

What is left to say? It’s all very good to minister to a “perfect” client, but most therapists don’t waste time dreaming of that impossibility. By definition we receive those who are struggling. The entry to my office didn’t resemble an amusement park ride with a height requirement and a linear measure to make certain you were tall enough.

Sublimely well-functioning creatures, if there are any, don’t seek mental health professionals, nor do counselors have a waiting room runway for beauty pageant contestants. If patients were motivated, hard-working, communicative, showed up without urging, and were open to the challenge and pain of the process; then, in general, I had all I needed to do my best work. A sense of humor was a bonus. Most counselors are patient and don’t believe in miracle cures. Nor do we need to be entertained.

Hang in there. Do your considerable part. Misguided therapists surely have dumped patients in an unfortunate fashion, but this is rarer than suggested by tragic internet stories. Even if you don’t see over the hill yet, keep going. I never treated a walking, talking, human work of artistic perfection, a painting of Monet or Rembrandt in the form of a mortal being. If you were “ideal” I never got to meet you, in or out of the office.

Mental health professionals are not like the ancient Greek philosopher Diogenes, holding his lantern in a fruitless search for an honest man. We do not make our own nightly, flash-lit quest for a perfect patient.

Since no ideal therapist exists, neither is an ideal client required to achieve the best that therapy can do. Indeed, I learned far more about courage from imperfect patients than they ever learned about it from their imperfect therapist: me.

The first image, Lilium Pink Perfection, is the work of Ulf Eliasson. The second photo displays Claire Parker with Her New MGI Crown, photographed by Ecprpageantnews. A Portrait of Albert Einstein by Hermann Struck follows. All of these were sourced from Wikimedia Commons. The final image is a cartoon figure long associated with the game Monopoly.

 

Dealing with People Who Say Therapy is a Crutch

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It is so easy to judge. Legions of “friends” and acquaintances evaluate your decision to enter treatment. Some signal thumbs up and applaud your courage. Others gesture thumbs down and render disapproval:

It’s not as bad as he thinks.
He needs to suck it up.
I’ve been through worse.

While many people are understanding, critical voices say you betray weakness by reaching for this “crutch.” Surprisingly, those who have experienced a similar problem are often less empathetic than the rest. If your friend also got over a traumatic accident like yours, research says he is probably less sympathetic than people who were lucky enough not to have had that piece of bad luck. The closer your experience is to one the other person triumphed over, the more likely he is to think your adversity is manageable. A pity, because when you reach out to the buddy you expect to be most soothing, you might discover he comforts you not.

Sometimes we must give up on such “friends.”

Nature fashioned us to survive. Like athletes trained to forget their failures quickly, we are more content if we get past the pain of remembrance. Thus, our own photo-shopped recollection of triumphing over the bad breaks of life can make us less sensitive to fellow-men when those traumas are akin to ones we once endured. Arm-chair chest-thumping is like the braggadocio of a political office-seeker who tells us how easily he would fix a national problem if only he were in office — condemning the effort of those who now grapple with the job. The sideline of life is a place where judgment produces cheap and imaginary victories rarely duplicated once the judge steps out of his robes and into the game himself.

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes (up) short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory nor defeat (Theodore Roosevelt, 1910).

Adding to our misfortune is the tendency to condemn ourselves. History offers examples of people who triumphed in extreme situations. We get the sense such folks are plentiful because they are the objects of story and song — as numerous as the apples on a fruit tree. If we buy-into the ease with which people survive and thrive we compound our already miserable state by observing the contrast with our own plodding struggle.

From the therapist’s chair, survival and persistence are, by themselves, heroic. Perhaps not the heroism of a Shakespearean tragic figure like Coriolanus, but admirable nonetheless.

I treated just such people in my therapy practice. For a time, sometimes for months or years, they were immobilized by the hammer blows of fate. Signs of resilience and the will to fight slowly emerged. Not always, but often.

The art of life is more like the wrestler’s art than the dancer’s … it should stand ready and firm to meet onsets which are sudden and unexpected.” (Marcus Aurelius, VII, 61).

Like the athlete thrown to the floor, in time you must get up.

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The moment of resurrection is different for each of us. On the wrestling platform of life no referee demands a speedy rise. Ah, some in the audience will criticize, but they do not writhe in your anguish or see the torn sinews beneath your skin.

The effort to stand again is not over until you say so. Those who judge are unaware (or have forgotten) how they would react in a similar situation. Some resort to a kind of cheap self-flattery to quell anxiety at the possibility of themselves experiencing your adversity. “Oh, I would have been able to handle that” is soothing to say and makes them believe they are resilient and brave, but is lots easier from the grandstand than on the field.

Your misfortune is also a cruel opportunity, but an opportunity nonetheless: to triumph over fate. Sometimes victory is just persevering.

When Shakespeare’s flawed hero Coriolanus was banished from Rome, his mother lamented his departure. He attempted to console her with words she taught him. The perspective he learned from her was that a crisis was a chance to distinguish himself as better — more heroic — than the average person:

Where is your ancient courage? you … used

to say extremity was the trier of spirits;

That common chances common men could bear;

That when the sea was calm all boats alike

Show’d mastership in floating …

In other words, it is easy for us to sail along without concern when the water is smooth.

You who are in pain would give up the suffering if only you could. Now, however, you will find out who you really are. The rest of us are waiting for whatever challenge drops on us for the chance at such knowledge. I am not suggesting we seek it. Yet, once fate arrives, do battle in whatever form you can however weak you feel. Even if taking a breath is, for now, all you can muster.

For those of you in the fight of your lives, I salute you.

The Wikipedia “Fight Back!” logo is the work of Kasuga-commonswiki.

How Therapy Fosters Courage

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You came to the therapy session. Courage was required. You admitted things were too messy, desperate, painful. A brave step was needed. Despite hesitation you took the road less traveled.

The therapist was not a monster. He invited you into his office. Your courage was reinforced.

Now you find he hears your words, watches without blinking. The attention is encouraging. Few ever took you seriously, showed patience, gave you their time — listened with quiet intensity.

You discover the contact has value — the relationship is worth something. Again, the effort didn’t meet with the disaster you expect as a matter of routine. The reinforcement makes future risks more likely. You begin to wonder if perhaps you previously fulfilled some of your own dire prophecies.

The counselor is reliable. At first you think he is a unique example of dependability in an undependable world. What luck! Later you recognize the truth: others as good, or close to it, might exist if only you raise your eyes to look. An intrepid search begins for those who are also decent and caring.

Issues too deep for words are exposed in session. You surprise yourself with your openness. Your vow never to make yourself vulnerable again is set aside. Courage grows.

Perhaps you begin to recognize grit is not always a matter of physical bravery. Indeed, you identify its presence when you look in the mirror. Especially if you face your short comings in the reflection. Change takes more bravery than what is demonstrated on the football field. Your moral muscle increases in size. Your heart becomes toned. You develop something called “therapeutic integrity:” to stick with treatment despite the punishment it inflicts. Your head is held higher. Avoidance is less often your first choice.

Yes, the rose of life is full of thorns, but the scent and beauty are worth an occasional prick. Your bravery makes this revelation possible. You learn to survive such pricks and avoid them when you can. Especially the human kind.

You voice strong opinions to your counselor and the world does not end. He applauds the growth to which he is witness. You begin to internalize his approval and the strength in you he identifies. More and more you come to lead the process — more evidence of therapeutic integrity.

The things you never thought possible — the behaviors others could enact but you didn’t — are done. You explain this not by some sort of therapeutic magic, but by the virtuous qualities inside you of which you had no awareness.

More chances are taken. You learn to say no, to travel alone, speak your mind, grieve, enjoy a restaurant dinner solo, date again (or perhaps, for the first time), recognize the toxic takers, act in spite of fear, dust yourself off when you’re down and come back for more. Your pulse quickens not with fear, but a lust for life.

Your intrepidity manifests itself in “baby steps” at first. Later they are well-placed strides. Eventually you run with joy, recognizing life is in the running, not always the winning of the race. You have discovered you can “take a licking and keep on ticking.” The scars you were ashamed of become badges of honor. The lines in your face are earned. They enhance your beauty to those who recognize the richness in you, not just your sausage casing.

Lord Byron wrote in Prometheus Unbound:

To suffer woes which Hope thinks infinite;
To forgive wrongs darker than death or night;
To defy Power, which seems omnipotent;
To love, and bear; to hope till Hope creates
From its own wreck the thing it contemplates;
Neither to change nor falter nor repent;
This, like thy glory, Titan, is to be
Good, great and joyous, beautiful and free;
This is alone Life, Joy, Empire and Victory.

“Good, great and joyous, beautiful and free …”

Blame and lament are past. Fear is no longer a constant companion.

You are your own self, the maker of your life in so far as we are ever able. Take up your chisel and approach the marble — create the art that is your life.

You’ve learned the sculptor’s hand is never finished with you; and that fate is but one sculptor.

You are the other.

Courage made it possible.