Should Therapy Be Forever Introspective?

                                                                                                                          And then the day came,
when the risk
to remain tight
in a bud
was more painful
than the risk
it took
to Blossom.

This poem, long attributed to Anaïs Nin, but more recently to Elizabeth Appell, unwittingly touches on a therapeutic problem:

What if the person “tight in a bud” is captured by the safety of a therapeutic process: too long within the bud, not beyond its green wrapper reaching toward the light?

Does therapy sometimes risk cocooning the patient too long, uncovering and uncovering and uncovering depths of feelings and insights at the expense of progress in the world outside of the therapist’s office? Put differently, if “the unexamined life is not worth living,” as Socrates tells us, is the overexamined life unlived?

I am accustomed to self-reflection both inside my head and in my practice, but I think we do have to acknowledge each side of the question. We need self-awareness, but the place where it resides is sticky, full of creatures who grab us and hold us fast. At least, they try to.

Life is something of a leap, a challenge: a reach for love, learning, helping others, and fulfilling the “becoming” still unrevealed in us. The world offers us differing models, from arrogant, thoughtless, unreflecting leaders who are, nonetheless, men of action; to those of us whose exploration is more inward, but may be confined by that inwardness.

We are offered fictional and mythological models, too. These are all people of action. When they go underground to visit dead souls, as they do in Dante’s Inferno and Homer’s The Odyssey, they are struck by how out-of-place they feel. They must, inevitably, return to the world of the living.

One version of hell on earth is an endless preoccupation with grave feelings and haunted days; consumed with envy of those who live with abandon. How ironic that some of the externally risk-averse accept a familiar hell in a box. As Nietzsche wrote in Also Sprach Zarathustra, “Verily I do not want to be like the ropemakers: they drag out their threads and always walk backwards.”

I helped many untangle themselves from the grip of dead or distant childhood abusers. I learned, too, by examining my own history from an over-the-shoulder perspective. We must be careful, however, to avoid an endless backward look; especially if one already has an inward bent. Walking backwards will then be the only direction available.

Action, usually taking the form of work, is an antidote for brooding. Passive distraction such as video watching is not the answer. The mind is like a device attached to rubber band: unless engaged (or retrained by a serious meditation practice) we are subject to the pull of the elastic, snapping back to troublesome preoccupations and general discontent.

Insight comes not only from focusing on the past, but experience in the present. You will never resolve everything in your history. You can resolve enough to free yourself – enough to act. Sometimes therapy does require years. Know, however, what your goal is. Consider a move toward it at the earliest appropriate time even if the bulk of your therapeutic process is still dealing with yesterday’s wounds. Work with your therapist to fashion a path down and in as needed – yes – but also identify and step into the road up and out.

A good therapist can be your guide in both places. A more limited one may lead a fine tour of Rembrandt, the seventeenth-century Dutch painter, but ignore the glories of contemporary art.

Each one is a worthy escort, properly placed and timed.

Don’t stay in either gallery longer than you have to.

The top photo is Grand Central Station – (1957) by Brassai. Next comes Alberto Baumann’s Introspection (2003) and then Rembrandt’s Man in a Golden Helmet (1669). All are sourced from Wikiarts.org.

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.

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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.

Will Your Therapist Leave You? On Parting, Hints of Rejection, and the Dread of Abandonment

Koryusai_woodcut_parting

Saying goodbye occupies a different place in our lives than it has for most of history. It is the pain of parting I’m about to ponder, with a focus on counselor vacations and the fear of more permanent departures.

First a little perspective.

The average sixteenth-century man didn’t worry about therapist holidays. No therapists! Parting from others, however, was both a greater and smaller dilemma for a person of his time as compared to our own. This ancestor was probably a farmer. He worked the ground only a few miles from where he was born. Travel consisted of taking his crop to market. Hardly the sort of goodbye from his family we think of. Hardly the kind to break the heart.

With the improvement of transportation, the beginning of a time apart created more drama, as in an ocean voyage or a tour of duty at war. These emotional separations were not regular occurrences. At some point, however, long distance transportation — at first by rail, then automobile and plane — became commonplace. Thus, in 1927 the statesman and author, George Kennan, wrote “our arrivals and departures are no longer a matter of emotional debauches — they are too common.”

The world of relationship endings — dissolutions — is different.  Human reactions to them overlap with, but are not identical to temporary separations. For example, the aforementioned sixteenth-century farmer might never have heard of a friend’s divorce. Yet losing a wife to childbirth was well-known to him. Indeed, he could have lost children this way or in their early years. Familiarity with the death of adults was just as common. Those who died of illness usually expired at home. In effect, our predecessor of 500 years ago had less knowledge of temporary partings and far too much of permanent ones.

Consistent with this difference in present and past experience, being jilted by one admirer for another was rare in the short period of the farmer’s pre-marital life. Back then, cohabitation meant marriage, most likely at an early age.  In rural areas few competed for affection. The community enforced standards of faithfulness by its ability to shame an adulterer, thereby further reducing infidelity. The lovers of our day live together or marry with less assurance of relationship permanence than their ancestors. Much more fleshly opportunity and anonymity exist in the big city, easing the way to change partners. Nor do we experience the pressure to conform socially once imposed by religious institutions.

When this kind of particularized goodbye occurs in a romance, it includes the element of rejection not present in a long trip or a death. Placement on the discard pile is about you. You not measuring up. And if a few of these disappointments are strung together, they contribute to self-doubt. Should such a person then enter psychotherapy, he is sensitized to anything hinting of a perpetual break from the therapist, at least once a good connection with the counselor exists. The pattern of previous relationship disappointments, including those from childhood, can prime the expectation of more hurt to come.

Will he come back? Is he actually taking a vacation or just a break from me? What if he dies?

The fears pile up and lead to more.

He’ll decide to live somewhere else or give up doing therapy. What if he gets seriously ill? Might he retire? I seem to be too much for people, even strong people, even people who promise never to leave. I don’t care if he denies that, I know he will flee!

Therapists approach this by providing reassurance. Some permit email access during vacations, but, to me, no respite for the therapist is to be found in doing so. Nonetheless, the therapist’s holiday provides the potential for a learning experience: for the patient, over time, to obtain the answers to all those questions:

  • Yes, he’s always come back.
  • No, he didn’t take the vacation from me alone. (Choose your own way of making certain).
  • No, he didn’t die.
  • No, he is still doing therapy right here, in the same old place.
  • No, he hasn’t gotten sick so far and seems to be in good health (I hope).
  • No retirement yet (although he will, at some point).
  • No, I’m not “too much” for him.

And an answer to an unstated question also follows:

  • No, he isn’t like the others. He hasn’t abandoned me.

512px-The_Parting,_Roland_W._Reed

Then, if the rest of the treatment is working, the client gradually revisits other ingrained beliefs about himself:

  • I thought I was unlovable. Well, since he returns repeatedly and hasn’t referred me to someone else, perhaps I possess some value.
  • Maybe I’m not as worthless as the others made me think. They were wrong.
  • It’s possible I can survive my therapist’s absences. In fact, I’ve been surviving particularized rejections all my life.
  • I’m stronger and better than I thought!

The above outline of a hypothetical course of treatment ignores the possibility that the patient contributes to his rejection history by his actions or words. That issue might also require therapeutic focus. Once any necessary attention has been paid, however, there is still the matter of the shrink’s vacation to survive. Some time ago I offered direction in dealing with a therapist’s temporary absence here: Managing the Dread of a Therapist’s Vacation.

I’ll add one more method to calm and comfort you while the time seems to stand still — while you cross off dates on a calendar as if you were serving a prison term.

In 1809 Ludwig van Beethoven wrote a 15-minute sonata for piano, a solo piece in three short movements. Apart from its sheer loveliness and musical logic, he could have written it for you and about you. Here is how Beethoven biographer, Maynard Solomon, described this composition in his book, Beethoven:

The beautiful Piano Sonata in E-flat (Lebewohl or Farewell), Op. 81a, was composed for Archduke Rudolph following his departure from Vienna during the French bombardment of 1809, and its expressive movement titles — Farewell, Absence, The Return — may tell us something about the depth of Beethoven’s feeling for his young student … On the sketches Beethoven wrote, “The Farewell — on May 4th — dedicated to, and written from the heart for, His Imperial Highness.” A decade later, on the autograph score of the Missa Solemnis, Beethoven wrote a similar dedicatory message to Rudolph, for whom the Mass was composed: “From the heart — may it return to the heart!”

Beethoven knew separation. His attempt to achieve a permanent romance was a lifelong, futile struggle. When, finally, the progression of deafness closed access to the world outside, his music remained to give solace to himself and all of us.

Accept his gift and listen to his heart rejoice at the moment of “The Return” (10’21”). Perhaps yours will too.

 

I shortly will write an essay on those conditions that can cause a therapist to refer you to someone else.

The first image above is an 18th century woodcut by Isoda Koryusai, photographed by Helena Roslavets. The next photo is by Roland Reed. Each one is called, The Parting, and are sourced from Wikimedia Commons.