Haunted by Lost Love: Escaping Our Preoccupation with the World Inside Our Head

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We live in two worlds: the real one around us and the one we think about when we are by ourselves. The “inner version” contains past loves, loves unavailable now in the actual world. Within us we can access fantasy and memory, a bygone time of affection and its disappearance. Thus, those lost relationships can “live” inside of us, even if we never see the object of our romantic attachment again. By the end of this essay I hope you and I will share a clear idea of the differences between these two worlds; and a sense of what to do if you are captured by the troubling and stirring inner world of lost love.

I’ll concern myself with two kinds of love and the overlap between them:

  • Romantic love you once had and lost: love lost because someone broke your heart.
  • Romantic love you tried for but didn’t win: love unfulfilled. This category would include everyday unrequited love, as well as erotic transference toward a therapist.

Where does love begin? With reasons or emotions? Most would say the latter. Language is telling. We are “swept away.” We “fall” in love. We become “love sick.” Note the passivity of these descriptions. Love is not caused by logic or careful analysis. Romance “happens.” Once the love blooms, however, reasons follow and justify our feelings and continuing preoccupation.

The person preoccupied with vanished affection is also occupied by it: occupied in the military sense. An emotional army invades and takes control of our head and heart. These are the soldiers of the cruel King of Hearts, the man who now governs our internal life. The monarch makes sure the idea of the beloved — the image of the beloved, the fragrance and touch and voice of the beloved — cannot be escaped. The heartless King of Hearts insists we review our life of heartbreak. Review and review and review, enacting a repeated agony.

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The one we love now has two lives. She is “out there,” living a life on planet earth; and she is “in there,” living an existence unknown to her, experienced only by us. The manufactured being does not think and act identically to the being in the world. We only think so.

We spend time wondering about her. What is she doing now? Who is she with? Does she think about me? What does she think about me?

We are neither voyeurs nor mind readers. Her real identity is a mystery, while her created identity is made up of the language with which we form her life inside of us. The more enchanted our inner life of unreality (and the more distant we are in time from the relationship’s termination),  the greater the disparity between this person as she is now (outside of us) and who we imagine her to be. Ironically, the creature we most want to know we unwittingly make unknowable in the act of obsession. “Make,” however, may be too strong a word. Obsession is, perhaps, not a choice, but a thing that just happens to us, like the love by which we were captured.

In either case the lady leads a double-life, one-half of which is a false representation enhanced and enlarged by our emotional and mental process. We trap ourselves by creating a divinity, a goddess requiring worship, with an internal shrine of our own making. Meanwhile, our regular-sized existence is diminished by the outsized, manufactured mirage. How can we then fail to think we would be happier if only we were with this person, this entity who is more magnificent than humanly possible? Better, indeed, than she was when she was with us, in most cases. Did we filter out some unpleasantness from our memory?

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We are tortured in the process of obsession, including the endless review of small events. Things said casually, unimportant comments and facial expressions that meant nothing we make into something: something fraught with meaning, something important, full of sharp edges.

We run through imagined scenarios. What if I’d done X? What if I’d not done X? We kick ourselves over actions and omissions that, in reality, probably made no difference. Our preoccupation with this past keeps our love alive.

Our love is placed on life-support. So long as the ritual homage we pay to her continues she will not die as a love object. We exercise the terrifying curse of regret-filled imagination to create a posthumous life for the love we feel and the one we love. Thus, like a person traveling to see a sick relative (someone who remains barely alive), we journey to make internal “hospital visits” and drain our days of the energy and time needed to do anything else.

Once the love is history — when the act of chasing and wooing and trying to impress is over — the memory and fantasy stay behind as a cruel, unchanging mockery. Objects of memory don’t age. The longed-for beloved doesn’t get a cold or brush her teeth. She isn’t inconveniently tired. The target of our obsession can’t lose concentration or temper, fail to laugh at our jokes, acquire friends we don’t like, show-up late, or look washed-out before she puts on her lipstick. She is an ageless dream and daydream.

I would not recommend searching for the reasons we maintain the “romance” of a dead romance, to the extent it is a choice. We are not logical creatures, especially when in love. Perhaps we find sustenance in the possibility, however small, of a realization of the love we hope for. “She still might come around” (one says to oneself), acknowledge the error of her ways, plead for a second go. Perchance the lovely Frankenstein someday will turn gentle and reciprocate our affection.

We wait for the phone call, the email, the tweet opening romance’s door. Perhaps we keep love alive because we think this supersized version of yesterday’s love far surpasses what any real, mortal, new person could offer us today. No satisfaction can be found, unfortunately, either in regret or the hopeless hope of a happy ending.

Might we simply not have enough going on in our lives? Is the daily, dull, dreadfulness we think of as real life relieved by a remembered, glorious preoccupation? The fantasy never fails. The ghost is dependable, always there, ever ready to stir us. Pain, after all, can create its own ecstasy.

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And so we travel places where our lost love might still be observed or perhaps even met face-to-face. We seek those people with whom she has contact, friends of hers who might know what she is doing, share something she said about us, advise how to win back what we lost. The truth is, however, that every relationship in our life — business, family, friendship — pales in comparison to “the creature.” We suffer a preoccupied inner life at the additional cost of a diminished outer life, a life in the world of touch and taste, of face-to-face interactions and smiles and bruises and sweet perfume you can smell, not just imagine smelling.

What then? Say you’ve had enough pain and want to wrench yourself from all the tendrils holding you back. You go to a therapist. He will, almost certainly, recognize your need to grieve: encourage an emotional processing of the events revolving carousel-like inside of you. The goal is to end the spinning in your head, get you off the torturous wheel. The grief-work allows you to take the memories a step-further than you have until now: to give up hope; to shed tears with a compassionate human, not in isolation; to become angry with the ghost and finally to bury her. Only those we first reduce to human size can fit into a normal grave.

You might ask, doesn’t this “solution” just keep you in your head? Yes, and for that reason therapy is not yet complete. You still must seize the life outside. Treatment isn’t over until you return to the world of possibility and lived experience. The cure must diminish your use of fantasy and memory going forward. The process of burying your late love affair also requires the exhumation of a different person from another grave — a real person who can live in the world and act on the world.

Who might that be?

You.

Yes, you.

You must make history, not regurgitate it, and thereby escape the long reach of your past and present fantasy. You must tear yourself from the metaphorical hand holding you back.

You can do this.

You must accept the knowledge that some of what is in your brain lives only there; that some of what is in your skull could never and can never come to be. Fantasies are like that, otherwise we would call them by a different name.

In this awful truth is encouragement to get past your preoccupations and move on to your occupation with life, accomplishment, friendship, joy, learning, and growth: that which is still possible within the breathing world. And possible only in the lived experience, only in movement, only when you lift your eyes from the darkness to the sun.

Even, perhaps, to find new love.

The top image is called Mariana in the South by John William Waterhouse (ca. 1897). Buddah Head Carved into Living Rock is a photo taken by Photo Dharma in Sadao, Thailand. Finally, Please Touch Gently is the work of Marcus Quigmire. All are sourced from Wikimedia Commons.

Part III: So You Say You Want to Know Yourself? Thoughts on Examining Your Life

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In the last two posts I offered a set of questions — hypothetical choices — designed to help you think about your values. The first piece of writing was devoted to the complete list of 13. The second one offered you my personal answers to the initial seven of these, with no suggestion that my responses were better than yours might be. So, if you are familiar with the previous publications I suggest you scroll down to #8 on this one, where I will give you my thoughts on those I didn’t get to a few days ago. Those who haven’t read first seven answers, however, might wish to start with #1 here:

1. Someone asks for a year off your life — a transfer of 365 days from you to him in return for money. Would you accept? How much money seems sufficient? The old Twilight Zone TV series presented an interesting story involving such an offer: The Self-Improvement of Salvatore Ross. I can imagine circumstances in which I would take the offer. If I needed money to save the life of someone I loved, for example. Otherwise, probably not. But then, I am financially comfortable. Were I not, perhaps I’d be more inclined to accept. I’d not care to get a bigger house, win status, or travel the world. Nor would I give the year for any charity short of enough dollars to change thousands of lives. There are limits to my altruism.

2. If you could trade one extra year of good health and youth for one less year of longevity, would you make the exchange? Everything else being equal (which is never the case) this is attractive. Pain can be instructive if you are young enough and the suffering is defeated. Living longer, at least into an old age suffused with agony, has no appeal for me. Leon Kass, physician and philosopher, however, argues that discomfort and gradual loss of our abilities combine to make us less resistant and more grateful for the release provided by death. Note that my answers to all of these questions are personal. You might well offer ideas at least as worthy and persuasive, perhaps more faith-based.

3. What would you die for? My post What Would You Kill For? includes many thoughtful responses I received from friends and acquaintances.

4. What would you kill for? The same essay deals with answers to this query as well.

5. Imagine you are given the opportunity to improve your physical beauty by 25% or your intelligence by a similar percentage. One or the other, just by saying so. Please discuss your decision and justify it. Were I a deformed young man, enhanced beauty would be difficult to resist. The importance of what meets the eye, of course, depends on the individual’s self-image and how much else recommends him to others in the mating game. The hand of time steals pulchritude from us all, a dime’s worth here, a nickel’s worth there, until at last those who once possessed surpassing beauty often sustain the most damaging psychological losses. We witness what some will buy from surgeons to fight the clock. The world pressures women more than men with regard to appearance, another consideration. At this point in my life, however, I’d take 25% more intelligence, being without an outsized vanity regarding how my externals are judged. Yet I wonder if the added cognitive burst might then separate me from friends and loved ones, literally change my thinking, our mutuality, and increase their discomfort in my presence. The value of relationships means more to me than becoming Einstein. Had I been given the offer of a bigger brain in my school years, however, I’d likely have accepted. We tend to think of ourselves as a kind of unitary everlasting whole, despite the changes we go through outside and inside. For a number of the questions in this essay, consider whether you would answer the same way when youthful, in middle-age, and in old age.

6. You are offered the chance to live one day over again. A “do-over.” Which 24-hours would you choose, if any? Describe what led you to this determination. My first thoughts here were focused on my youth, when confidence and self-assertion were wanting. On the other hand, life worked out before long. Moreover, any edge won with increased bravado would have been temporary, or (as Rosaliene Bacchus commented in response to the original post) might have altered the course of events in ways I didn’t predict. For example, had I been more masterly with some young woman in my single days, perhaps I wouldn’t have met and married my wonderful wife, produced our two great daughters, etc. No, I’d let the opportunity for a “do-over” for the chance of self-advancement pass by, but take advantage of it with respect to someone I hurt. My answer to question #10, based on regret, offers the details.

7. A genie will give you the ability to relive one day of your life just as it happened, without change. Which would you choose? Explain. My post What Memory Would You Take To Eternity? describes a heavenly reward consisting of living forever in a single, precious, blissful moment. I chose the instant I treasured most and treasure still, described therein. However, if I had 24-hours to live over again, I’d probably conjure up my father when I was a small boy, maybe three. He created a pretend radio show for me using the nozzle of our vacuum cleaner (hose attached) as a mock microphone. We played different parts, at least as the story was related to me much later. Though I lived it, I own no memory of the event. I’d like to visit him again in the fizzing sparkle of his relative youth, when his heart fairly burst with love and pride in his first born. The pictures of my dad with me show how overwhelmingly happy he was, beside himself with joy. I remember my own experience of this dad role with my children and watch it duplicated today whenever I go over to the home of my youngest daughter and son-in-law Keith with their wonderful boy — my grandson, of course.

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8. The gift of immortality on earth is yours — to live forever, never aging beyond your current age. Do you want it? Check out this post: the downside of immortality as seen by a werewolf. Put simply, eternal existence changes everything you think you know about your values and the way you are inclined to live. Much that is precious is given worth because it is either in short supply or temporary. Never-ending life makes choices less important since there is always more time try another path. I’ll take this life, thanks. I want a life where my decisions have meaning.

9. In your travels you come upon a fountain of youth enabling eternal earthly life at whatever chronological age you choose, with only the knowledge and experience you possessed at that time. To what moment would you return? Might you decide not to drink from the fountain? Tell me more. If you believe in “necessity” — that events happen and actions are taken in a predictable and unalterable way — then you’d be returning to a life identical to the one you had, like a TV rerun. Moreover, as an immortal you’d also have to deal with the problems of a never-ending life mentioned in the downside of immortality. Perhaps a more interesting question is whether you’d like to start over from an early age with the only guarantee being that your life course would be different, not a repetition of what you lived. I find this intriguing. I can imagine other careers, reconsidered decisions, a changed set of relationships and chance meetings — perhaps dozens of alternative ways to reach a life worth living. This isn’t meant to suggest dissatisfaction with my history — rather, curiosity. But you know what they say about curiosity and cats!

10. Who is the one person living to whom you most owe an apology? Why haven’t you expressed your regret? An old girlfriend with the initials MC is the person. Really, a sweet young woman when I knew her. I dated MC for several weeks in graduate school (she was not a schoolmate) and I left the relationship angry, not because of any betrayal by her, but due to my own immaturity and selfishness. Curiously, I didn’t think I needed to apologize until years later and recognized my fault. I suppose this is a commentary on how one’s view of events alters with time, circumstance, and self-evaluation. By then there was little chance of finding her short of hiring a detective. We often don’t know whether our impact on someone else is lasting unless we are told. The rear view mirror fails to inform you of how a lover’s future turned out. Sometimes he or she doesn’t remember the event at all. I hope MC was either less hurt than I believed or healed quickly and completely; and that her memory of me vanished with the wound.

11. Imagine you can live the fantasy of succeeding in everything you try and being continuously satisfied by the progress of your life. It will be experienced as absolutely real, even though you will be in a chair connected to a machine keeping you healthy, supplying you with food, and fooling you into believing you are elsewhere. Alternatively, you can try to make your way in the real world as you do today. Which would you opt for? This hypothetical machine and the “pleasure-button” I will describe in question #12 are “thought experiments” derived from the three sources: 1. The “Experience Machine” imagined by philosopher Robert Nozick. 2. The examples present in the novel Infinite Jest by David Foster Wallace, and 3. The Matrix. The real question here is what choice you will make when given the opportunity, not after being plugged into the machine or starting to press the seductive “pleasure button” in item #12. Once you choose either of these experiences you are hooked. In the first example, you immediately believe it is real and therefore don’t even think of returning to real life. In response to question #12, you become addicted to the ecstasy within your reach (pun intended), better than any drug. Underlying these queries are others: How much do you value genuine achievement (as opposed to the false belief of successful accomplishment, like getting an A on a test because you cheated)? Are you responsible to make the real world better, even if only in small ways? Would you rather strive for actual (imperfect) relationships or interact with fantasy friends and partners? Do you believe life allows us to achieve a sustained stratospheric level of happiness or that pleasure and satisfaction only come in inconsistent bits? Those of you familiar with my writing can guess my answers.

12. You are offered a risk-free, brief surgery permitting you to give yourself ecstatic pleasure by pressing a button whenever you want: the most powerful mood-changer ever invented. The marvelous joy beyond joy lasts only 10 minutes, so if you want more you have to press repeatedly. Do you accept this “gift?” See my answer to #11.

13. You are given a trip on a time machine, enabling you to go back to the moment in history in which you’d prefer to live, in whatever place you’d like, though you’d remain your current age. The journey is one-way — no coming back. Moreover, you can bring only one other person with you. Would you do so and with whom? To what historical place and time? Elaborate your deliberation process. My first concern is whether I’d be open to losing all the relationships I have, but one. The answer is no. If I were willing, however, the question then becomes which moment in time would be superior in fascination to the current one? A different way to view this is to see the choice as a kind of test, where the qualities needed to have a satisfying life might be more necessary in one historical epoch than another. Finally, consider this comment made by Al to the previous blog:

I think my soul belongs to the depression era. My soul feels comfort in hardship. My mind wants a simpler life with less advancement and technology. I need people and to connect. So, even though life would be hard, I believe my tortured soul would feel comfortable. I enjoy working hard and reaping the benefits. This would force me to not sit tight and work. People were the entertainment. I would like that. I’d be forced to live in reality. No work, no pay.

I hope this set of uncommon questions has been amusing and perhaps, personally informative. They’ve touched on the value of time, the question of whether you can create a scale to weigh time and experience in terms of dollars, what you think about money, the importance of memory, the place of regret in any life, the danger of addiction, the benefit of relationships, whether you’d prefer reality or an escape to fantasy, the role of apology, the way we change over time, the difficulty of predicting what will be important to us in the future, etc.

As I said in the first part of this three-part series, no grading, no right or wrong answers. You alone are the judge of your own responses. It is your life.

The top painting is The Body of Abel Found by Adam and Eve. The second is called Cain Fleeing From the Wrath of God. Both are by William Blake and sourced from Wikimedia Commons.

Insecurity and Our Preoccupation with Appearances

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We try so hard to make a good impression, don’t we? No one enjoys a disapproving audience. We dress well, hide our inner turmoil, and smile. We comb our hair, clean our clothes, and wash pretty often. Why do we care so much about the opinion of onlookers?

The simple answer: because it was historically dangerous to be unattractive, unsuccessful, and unliked; dangerous to survival and damaging to our chances of finding a mate. Most importantly, those historical facts continue to influence how we live today. They have major implications for the type of person we seek in a partner; why we compete in business and games; why loneliness feels so terrible and why personal insecurities are widespread. Let me explain.

Evolutionary psychologists think about us in terms of the qualities that enabled our survival through thousands of years. Of course, our long process of descent from prehistoric ancestors required them to complete two missions: staying alive until sexual maturity and making babies who lived beyond them. Whatever innate preoccupations and skills enabled early humans to meet these two criteria were passed down in their genes as part of the never-ending chain of life, like a relay race in which the baton has now been given to us. The inborn talents or defects of those who didn’t survive didn’t get handed off. Those folks aren’t our ancestors.

Now, you may be saying, OK, but I’m pretty smart and I make my own decisions. I don’t need to be like people who lived in caves and wore animal skins.

Not so fast. Think about anger. It helped our forefathers defend against attack by enemies and hungry carnivores. You live with their capacity to defend yourself. And some of us blow-up at those we love, commit murder, and make war.

Or let’s say you are a guy. Remember back to your childhood when girls were yucky? Then one day you had an erection. I doubt this was a well-reasoned and much-desired gift you put on your Christmas list — unless your parents were more liberal than mine, that is. Not everything you do is a matter of thoughtful choice, unmotivated by Mother Nature.

We are wired to survive and to mate with a member of the opposite sex who is capable of producing and supporting a new life. So whom do we choose? A woman at the dawn of human existence had to be especially concerned with finding a man who could defend her and provide for her when she was pregnant and vulnerable. Evolutionary researchers believe several qualities signaled such ability: physical strength, intelligence, stamina, the capacity to work in groups, leadership, etc. Thus, when a woman is in the market for a man rather than a fling, she is influenced by her ancestors’ inherited tendency to find one who can make a living and create a safe residence. Yes, I know women are no longer uniformly dependent on men, but the ladies’ genes didn’t receive the memo.

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What about physical appearance? Women notice handsome men as much as men recognize the beauty of the fair sex. Unlike men, however, who place physical appearance at the top of their wish list, attractiveness is further down her tally of desired attributes in a permanent sexual partner. Why? Again, because of the historic vulnerability of women carrying and bearing their children. A female can only afford to be picky about noble features and hot bodies if she has a choice among men who first can accomplish the things she and her future children will need. Thus, a lady cannot allow the luxury of opting for surface qualities over those more essential to her safety and her child’s well-being.

Men are more likely to be motivated by just one thing: a healthy and fertile appearance (which is correlated with youth and beauty). Nature permits them to indulge themselves because the physical cost of producing a child will be borne by their partner. As the famous trial lawyer Clarence Darrow said, “There is no such thing as justice — in or out of court.”

Of course, few of us think about these things when we are on the prowl. Remember, too, I am simplifying the story for the sake of brevity.

Now, on to the origins of insecurity. Competition is built into the system. Should you want the most attractive female (the best potential mom in evolutionary terms or the hottest mama in your feverish dreams) you must stand out from the crowd of other men in some way suggestive of your superior ability to be a provider. Thus, men have historically tried to make lots of money (even more than necessary to live), achieve high status, display their excellence in the performance of an activity (business or sports) and impress with their intellect and cleverness. Men size up the competition to get the best of them. Insecurity — the preoccupation with where you stand in the pecking order — necessarily follows.

Females compete for males as well. The cosmetics and fashion industries thrive on the genetically fixed desire to catch the eye of a husband. Again, however, when out shopping you aren’t likely to think, “those jeans will improve my chances of getting my genes into the next generation.” Instead, you say to yourself, “Wow, those jeans look good on me.” Only people like me think of genes, not jeans. And, if you repeat similar questions often enough — what looks good on me, what doesn’t, how do I compare with the others — the insecure background of one’s thought becomes the norm.

Earlier I said it has been historically dangerous to be unattractive, unsuccessful, and unliked. If humans of antique times couldn’t find a sufficiently enterprising and healthy sex partner, that person’s genetic line would end. Those who didn’t make friends found their chances of survival on their own were poor. Thus, whether looking for a mate or a group affiliation to increase their odds (against other tribes, animals, and nature) they needed sensitivity to any word, expression, element of body language, or deed signaling another person’s disinterest, dislike, or disaffection from them; in addition to those indicators communicating they were welcome or pleasing to the crowd. Unfortunately, the ability to determine how they were coming across to others required a preoccupation with other people’s opinions: a recipe for insecurity and self-consciousness. Those who didn’t care how they were being received didn’t hand down their genes successfully.

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How does loneliness fit in? A soul contented in his isolation didn’t mate. Women and men satisfied just with the company of their sexual partner reduced their chances of survival compared to couples who had alliances with others. Individuals who were happy when alone, therefore, didn’t pitch their genes forward into the next generation. Men and women discontented when by themselves, however, would have wanted to join up with other creatures. Since group participation increased the chance of surviving, procreating, and raising a child, their unhappiness when separated from humans is a quality we now have: it motivated them to take an action useful to staying alive.

There are other factors beyond evolution influencing you today. Your upbringing, your own life experiences, and the individual set of incidental personality traits nature handed to you. But, back there somewhere is the long reach of the instincts that survived the evolutionary relay race. The ways in which we react, think, and act are more determined by the successful tendencies of our ancestors than (I suspect) most of us consider or believe.

In short, having a mind drawn to thoughts of both friends and strangers comes naturally. Our preoccupation with status and money, even though it can create misery, is a quality that long ago began to improve the chance of survival and is still in us. We operate according to a program written by nature on the men and women who lived here an eternity before we jumped out of mom’s womb.

The aim of evolution was never to make us happy. We can only challenge ourselves to deal with the insecurities and preoccupations it deposited in our genes. Those instincts don’t always work well in a world that, for the most part, is much different and safer than the natural state of man’s life, described by Thomas Hobbes as “nasty, brutish, and short.”

In our search for satisfaction we must grapple with a biology that often makes us discontented and wary, replicating what our ancestors did to live. Understanding this gives us a better chance of remaking ourselves the best we can to suit not their time — but ours.

The top image is Toilette der Venus by Peter Paul Rubens. The second painting is The Persistent Suitor by Frederico Andreotti. The cartoon was created by Welleman and is called Lonely Guy, Shadow as Friend. All come from Wikimedia Commons.

On being Insecure and Alone

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We are small creatures trying to be large. Or perhaps we are incomplete beings trying to be whole. Do those words sum up the human condition? How do we deal with our essential loneliness and insecurity? I’ll get to that.

Man begins incomplete, both in the womb and out. Your newborn is unable to tell the difference between himself and you. The trouble starts when he figures out that he can’t live without you. No wonder he cries.

Insecurity is in the nature of life. Indeed, if I met an entirely secure person I’d ponder how he managed to miss so much about the “simple difficulty” of living. A contradiction in terms, I know.

From the infant’s first tear begins a lifetime journey to complete himself, to escape solitary confinement. Most of us don’t want to be alone — a vulnerable and separate existence. The punishments in the Bible begin with being “cast out.” First, Adam and Eve were expelled from Eden. Then Cain was exiled for the murder of his brother. “You are on your own” is not a friendly statement. In truth, we are all on our own, in our own skin, unique in the vista we observe from the elevated wrapper we call the head.

What to do? Let’s start with what some of us do most of the time and all of us do some of the time. We attempt to incorporate other people into our lives. Intercourse achieves this physically. No wonder sex is bliss.

Next best is to embrace — get physically close, but still outside. Neither an embrace nor copulation last long. The problem of separateness resists a resolution.

Social — not physical — affiliation is a pleasing substitute. Where intimate friendships are absent, group connections take their place. Team membership has its satisfactions and avoids the “left out” experience of children’s games. The “we’re number one” sports fans gravitate to a similar, but vicarious category of connection and solace.

We put up with a lot to be with our fellow humans, part of a group. We try to “play nice,” even when not treated well. It’s better to be in the tent pissing out than outside the tent pissing in, as the crude saying goes.

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In the absence of human contact, some ingest food. Sustenance substitutes for love, lacking only the touch of another. Too much nourishment and the grub “joins” with you — becomes a larger and larger part of your body. The meal is now a permanent addition inside.

Humans make an effort at self-display, all the better to draw others to them. We want to be like magnets so that passers-by will “stick.” Clothes, hair style, makeup, and hair pieces are “attractive,” designed to “pull” the stranger close and prevent a solitary state. Sometimes external charm leads to the physical joining discussed earlier.

The “selfie-stick” generation takes this tack a step further. Not only do their public picture portraits cry out for crowds of onlookers, they offer the photographer, like Narcissus, a fascination and merger with his own creation: the glorified image of himself. Who needs intimacy when you can fall in love with yourself?

The computerized world provides an incomplete union with others, lacking the satisfaction of flesh. The fusion we seek is not electronic. You cannot crawl into the iPhone or laptop. A community of Facebook “friends” or a large blog following has its pleasures. Recognize, though, what social media alone can never be.

Some people acquire external objects, creating a kind of imagined fusion with a thing instead of a person. In effect, the buyer takes the material creation from the outside of himself to change his emotions inside. Goods define some people and become a point of pride, something “incorporated” within the identity.

Status and wealth, similarly, can be internalized to diminish a sense of naked, solo vulnerability. Those of a more academic bent might choose to pour knowledge into the brain, hoping for the same result.

Religion also reduces life’s insecurity — its essential isolation. Here the goal is to lose oneself in a complete identification and contemplation of God, at least in a hoped-for, heavenly afterlife.

In this world, however, none of the solutions I’ve discussed does the job fully. Sex acts are temporary, embraces are momentary, and the emotional benefits of eating and drinking are short-lived. Clothes and other objects make you feel complete for 10 minutes or 10 days. Knowledge acquisition is a treadmill marathon you can never finish. High status only lasts as long as the next TV season or term of office. To frustrate us even more, there are all those celebrities — owners of dazzle and accomplishment — we compare ourselves to. Their presence on earth is a kill-joy. We cannot merge with them. Instead we fantasize about them, creating an amalgamation in our dreams.

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All this points to some common, but flawed notions of how to complete ourselves and have a more satisfying life:

  • The pursuit of stardom is a fool’s errand. No, not because you are unlikely to reach the heavens.  Rather, aiming for glory for its own sake ignores the work it will take. “Look at me!” is the selfie-stick generation’s solution to an existential crisis: like a drowning man who ignores a lifeboat, he instead reaches for a plastic comb floating on the water.
  • All the material “stuff” ballyhooed constantly by advertising will only make you whole temporarily. We are leaky vessels. Commodities plug the holes too briefly.
  • Looking for the true, perfect love — your soul mate — can be sensational if you find her, but still leaves you in your own skin, dealing with your own demons. Relationships are wonderful, but don’t cure you of the human condition. Love is not medication. Not so sure? Go to the pharmacist and request “One soul mate, please. A 30-day supply.”
  • Moving to California is the “I need a change” solution. Yes, we do need to change, but traveling across the country “looking for yourself” reveals only one thing: you are the same guy who began the trip.
  • The more time you spend in front of an electronically lit screen (computer, phone, TV, or movie) the less time you have for satisfying intimacy with someone nearby. Yes, I’m aware of looking at such a screen right now. Introverts do need more time alone!

So, what is the answer? Well, if I had a perfect one, I’d be famous. That said, I do have ideas:

  • Recognize that real people are better (even if more dangerous) than virtual friends. Even so, they are not enough. You still need a life of purposeful action.
  • Try to get outside of yourself. Things can’t be incorporated inside you and humans tend to resist ties that bind too much.
  • You can’t bring the world within, so meet the globe halfway. Break out of the prison — the solitary confinement — of a repetitive, obsessive look in the mirror.
  • Avoidance is a dead end. No satisfied or satisfying people live there. A life of adventure won’t invade your home and drag you out.
  • Find captivating employment, generous and interesting people, and stimulating things to learn. Not to build your image and draw others to you, but because they are worthwhile in themselves.
  • Recognize that you can’t have everything in life, but life can be delightful if you are lucky and wise. Stop multi-tasking and focus on the small number of things you believe have real value. Get off the treadmill of routine.
  • Don’t run yourself ragged. Don’t be a human doing, always in a frenzy. You are a human being.
  • The path to a portion of happiness might include meditation, intensely noticing the everyday world around you, and being sufficiently active to lose yourself in it. Think less and live more in the joyful instant. A baseball player trying to catch a long drive is not wondering about his acne.
  • Accept the planet for what it is, which is a pretty messy place, but the only one we’ve got. Change the world if you have the energy and talent. If you don’t, accept what can’t be altered, at least by you.
  • Know yourself. Everyone thinks he knows himself, but few approximate full self-knowledge. Figure out what you can do: those activities you might excel at with some practice, guidance, and effort. And recognize the tasks you should never even try. If you are a 5′ 4” male, don’t pin your hopes on playing professional basketball. If you are introverted, don’t become a political candidate. Value yourself for the best in you and make better what is amenable to alteration.
  • Learning, however essential, will not always be fun and will often be painful. Sorry, I didn’t make the rule.
  • Think for yourself. Received wisdom is frequently a worthless commodity. Live by a moral code you take a hand in fashioning, not something handed to you. This will require you to think and study. Most people will not or cannot make the effort, they just assume they are good.
  • We create history, but mustn’t ignore the history we’ve already lived. Some amount of knowing where you’ve been is required, lest you revisit pitfalls and repeat mistakes.
  • Having a personal mantra of “life is unfair to me” will not get you far. Better to adopt this paraphrase of the motto of the fine blogger, What It Takes To Be Me: life wasn’t meant to be easy; it was meant to be worth it. It will only be thus if you make it so despite the obstacles.
  • Even if you accomplish all this, your life still won’t be perfect. You will continue to be in your own skin. Insecurity won’t have completely vanished. Yeah, a bummer. Get over it.
  • Once you figure out who you are, wipe the blackboard clean. As my friend, Phil, likes to say, “I try to reinvent myself every day.”

Phil, by the way, is a smart guy. Listen to him.

The top photo is called Meall Ghaordaidh Behind Bars, sourced from Richard Webb’s transfer to Wikimedia Commons. The University of Chicago t-shirt comes from http://www.zazzle.com/

How Would a Friendship with Your Therapist Work?

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The fantasy of having a closer relationship with one’s therapist occupies the mental space devoted to imaginary things. It must, because few counselors permit such a connection. Professional ethics generally prohibit the dual role of therapist/friend and therapist/lover. Yet, there is value in fleshing-out what this double-bond would look like in practice.

Responses to my recent post, Being Excluded From Your Therapist’s Life, suggest the fantasy dies hard. What follows is an effort to describe how the relationship would function if brought to life — the day-to-day lives of a shrink and his patient. I invite you, dear reader, to think along with me. Let me know if my concerns are off-base. Even more, once you finish reviewing my ideas, I’d love to read your own notion of how to create the connection some of you want with your therapist: an outline better than the current prohibitive model you say is frustrating.

I will use myself as an example. First, were I to lower therapeutic barriers, I’d accept only unsolicited volunteers for friendship. No direct invitation would be addressed to patients. I’d then need to consider who I’d enjoy having as a friend from among those who expressed an interest. Let’s assume three people both want this and seem a good fit for me. Any number I might choose would be arbitrary. Pick a different one if you like. Remember, however, the bigger the numeral, the harder it will be for this system to work.

FIRST PROBLEM: Even without an announcement, I assume some folks would become aware of my possible willingness to pass time with them informally. This might happen by word of mouth, within a written statement of clinic policies given to patients beginning treatment, or due to a general change in the ethical guidelines applying to all clinical psychologists.

A therapist is human. He finds some people more compatible than others. This doesn’t mean the potential chums are better than anyone else, only that they possess the kind of personal qualities the doctor enjoys socially. Unfortunately, “no” would be the message delivered to some people. Imagine how those “blackballed” might be affected, including the negative impact on the therapeutic alliance. In effect, my partial openness to friendship necessarily establishes a three-tiered clientele:

a. Those clients who do not request friendship.
b. Patients who become friends.
c. The unfortunates who get rejected.

Might some occupants of the lowest tier infer I offer them professional services only to make a buck, since I don’t want to socialize? While not true, any alternative explanation sounds hollow, at least to me.

SECOND PROBLEM: How might I differentiate between time spent as a therapist and hours passed as a pal? That is, what if a client with me at Starbucks begins to talk about personal problems? How should I respond? I’d need to choose among three roles:

a. A sympathetic friend.
b. A therapist doing an unscheduled session out of the office.
c. A doctor who thought he was off-duty.

If I react as the doctor I must then remind my coffee-partner I am not at work. Indeed, I might emphasize that we are having a non-therapeutic relationship at his request. What do I do, however, if my friend ignores the boundary or gets emotionally overwhelmed in the restaurant? In addition, how do I deal with the question of a fee for my service if I find myself doing lots of therapy outside the office?

THIRD PROBLEM: I am the proud owner of a good social life, as complete as I’d like it to be. In our example, it has suddenly been enlarged by three people. My downtime instantly becomes “jammed-up.” My freedom to enjoy family and personal connections already present, many of long-standing, is now reduced. Disappointments among both chums and loved ones are inevitable. This will be predictably stressful. How do I choose which relationships to honor? Would arguments or resentments follow? Would some of my patient/friends experience surprise or worse when their expected access to me is less than they dreamed? Might this add to the history of rejection that triggered at least a few of them to enter counseling in the first place?

FOURTH PROBLEM: As noted in “Problem Three,” the abrogation of my former ethical restrictions leaves me trying to find time to do what I want, including contact with children, spouse, old buddies and recent dual role chums. Perhaps you’d advise me to limit new patient/friends from the start by saying to volunteers, “Yes, I’m open to being your friend, but I can’t because I just don’t have the time.” I doubt this would satisfy them forever and might seem phony.

Remember, too, I am introverted by nature. Were I to add the three newbies and try to keep the rest of my social network unchanged, I imagine draining myself. Might I become resentful about this? If so, would anger and fatigue intrude on all my relationships, as well as diminishing my competence as a psychologist? The answer would be “yes” to both questions.

FIFTH PROBLEM: Let’s assume the new ethical guidelines still prohibit sex, broadly defined. In other words, kissing, fondling, and everything more. Further imagine I have a fulfilling marriage (which I do). Now, however, I am spending time as the “friend” of a woman (or women) I find attractive. Age is not important, type is not important, whether you’d be attracted to them is not important. The only consideration of consequence is my susceptibility to the allure of such a person or persons. Yes, perhaps I could screen out those whose magnetism I felt from the start, but this wouldn’t prevent attraction from developing in the course of the friendship. Nor do I assume that both of us would experience the same beguilement, but I’m expecting sometimes we would.

You all know nothing stops two people who begin a relationship (casual, professional, or otherwise) from becoming sexually intimate down the line. All of us are the offspring of ancestors who had intercourse. Lots of it. We are built to reproduce. Oscar Wilde put it best, “I can resist anything except temptation.” Under my new rules, however, I’d have to do just that. Had I maintained the previous metaphorical moat between myself and my patients, those ethical principles would have helped in cementing this boundary. Avoiding temptation is far easier than resisting it. Our hypothetical scenario puts me pretty much on my own, doing enjoyable activities — as one does with platonic companions — a few of whom happen to be “hot.” The slope is slippery and my skis are on. If I begin this downward adventure I will destroy my patient, my family, and myself.

SIXTH PROBLEM: The decision to permit friendships with clients rests on an implicit assumption: I have something to offer as a friend no one else can provide. This is absurd. No practitioner I know, including myself, is unique in his capacity for understanding, affection, loyalty, wit, and all the other qualities present in a good chum. It only seems so to the client.

Moreover, by becoming the buddy of the person to whom you are ministering, you reduce his incentive to develop healthy connections outside of the office and to take the risks necessary to do so. Stealing the initiative of the people you serve harms them.

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By now you’re either on board with my concerns, believe I’m unnecessarily worried, or think I’m just plain wrong. What I hope I’ve done, however, is to make it clear that an extra-therapeutic relationship with a mental health professional can’t measure up to an imaginary nirvana. It holds enormous risk for the parties in the consulting room and dares causing permanent damage to each of them, as well as to others. By giving in to a client’s idealized dream of having MORE time and tenderness, the chances are increased of making a nightmare of complexity and disappointment for patient and doctor alike.

I know I have not dealt adequately with the depth of heartache experienced by those who suffer unrequited affection for their therapist; or perhaps I should say “unrequited access” instead. I can do no better than refer you to a wonderful, but exquisitely painful post written by such a person. Indeed, her blog is called Life in a Bind — BPD and Me, the first four words of which serve as a stand-in for both her topic and mine, examined from different perspectives.

You might not like the rules I chose to live by when I practiced, the same rules about which the American Psychological Association gave me no choice. Those ethical guidelines simplified my life and benefited my patients. They permitted me to focus on the most important responsibility my career demanded: helping people. Yes, they limited me and limited those on the other side of the therapeutic moat. We — both of us — needed some boundaries.

Perhaps it is too much to call the doctor’s office a “sacred space.” Yet, the external regulations enforced on patient and therapist are designed to protect each from the other; and, to safeguard each party from the injury he might do to himself if the barriers were lowered. As a therapist, you are therefore unable to assist people in the fulfillment of their dreams about you. As compensation, you have a chance to guide them safely to a healing place. We cannot permit you everything, but in our prohibitions perhaps we can enable you to find everything elsewhere.

In the end, if you don’t like the obstacles erected by all responsible therapists, I invite you to describe a more perfect system. Ideally you will design a new set of ethical principles superior to those psychologists use, less fraught with the problems I’ve described and others just as bad.

Good luck to you. I look forward to reading anything you fashion.

The first photo is called Joy in Arm Wresting by Bernd Schwabe. The second picture is Two Interlocking Braided Hands by M. Koenitzer. Both are sourced from Wikimedia Commons.

 

How Finding a Therapist is Like Visiting a Dating Site (Only Worse)

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You didn’t want to. In fact, you tried everything to avoid it. Nothing worked. Now you will do the thing you never thought you’d do: go to therapy.

Here is what you weren’t told about the people who guard the gate to the counselor’s couch.

You didn’t know the entrance was guarded? Few therapy-virgins do. Most people have a better idea of how to buy a car than how to obtain a counselor. What’s more, car research is interesting and test-driving is fun. When you are in the market for an auto, your head is relatively clear. You know your budget. You understand safety ratings. You owned a car before and drove it thousands of miles.

The search for a head-shrinker is different. You are depressed, anxious, confused, grief-stricken, or all the above. Perhaps a crisis is occurring. Perchance you lost your job, your dog, your lover, or your parent. Losing your mind is next. Now you must get a grip and research a therapist.

The best of us are not at our best under the pressure of pain. Patient study is compromised. You want help now. You ask a friend or your primary care physician for a referral. Or you call the insurance company because your informational booklet so advises.

Ringing them up is a bit like phoning your mum and asking her to fix you up on a date. Her list of priorities in making a match is different from yours. To the good, we hope she cares. But her agenda is not your own and her judgment is suspect. Indeed, she resembles the gate-keeper to whom you will speak when you call the number on your insurance card.

Let’s say you or your employer purchased medical coverage through Fly Right Insurance Group of Historic Transylvania, aka FRIGHT. Remember when your brother told you he was afraid of FRIGHT? He was right.

FRIGHT’s rules are typical of most, but not all of those created by the insurance industry.

The voice on the other end of the toll-free number asks you a few questions and appears most concerned about where you live and work, how far you are able to travel, and getting to the next person in the phone queue. Unless you are suicidal, that is, in which case you are told to go to the ER.

The process of personal disclosure you’ve begun will most likely continue, with the counselor’s assistance, once you are in treatment: the world of Big Brother welcomes you. Your initial conversation can be recorded, coded, and kept in your medical file. Indeed, the U.S. government can take a look at some of your therapy records if it believes national security is at stake.

I am not making this up.

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The insurance employee offers you a few names or directs you to the “providers” listed on their website. Beware the word “provider.”

The noun suggests FRIGHT views therapists as no different from any other member of the service industry — for example, a man who is going to “provide” you with a paint job, a shoe shine, or dry cleaning. FRIGHT seems preoccupied with the commercial transaction involved in obtaining treatment — the cents and dollars at stake.

The word also seeks to knock the doc off his pedestal. “Doctor” is almost a mystical noun, complete with associations to being a good parent, an all-knowing chief of the tribe (“medicine man”), and a wonderful soul who can be trusted with your life. A provider, by contrast, is just another guy trying to sell you his work. No knock on those who shine shoes, but I imagine you’d want your insurer to be more concerned with the quality of the therapy service than the brilliance of your shoe shine. Their choice of terminology makes you wonder whether they do.

In general, the panel of practitioners is limited. The insurance firm’s protocol is the same when you sustain a car accident and need to take your vehicle to a repair shop. In both instances you are given a reduced group from which to choose. In the former case, you receive the names of those therapists with whom FRIGHT has a contractual agreement. The same is true of auto repair establishments. A similar written commitment applies to them.

It is important to understand why FRIGHT created its own panel (network or list) of shrinks. Equally, you will be curious why those same counselors (or auto body shops) agree to the insurer’s conditions. For each party, financial concerns drive the process. While insurance companies usually indicate that the contract’s conditions have been “negotiated,” FRIGHT and most other insurers operate on a “take it or leave it” basis.

The shrink promises to discount his fee in return for being on the list. There are three factors at play with respect to fee reduction: one benefits the insurance company, the second helps the patient financially (but reduces his choice of therapists), and the third is in the interest of those providers who agree to the insurer’s terms, but not without a cost to them:

  1. The insurance company’s payable portion of the fee is reduced. In other words, if the full value of a therapy session is $150 and the insurer pays 80%, FRIGHT would have to lay out $120 per session. But, if the charge is discounted to $100, the company’s outlay is only $80 ($100 x .80). The insurer saves $40.
  2. Similarly, the patient’s part of the bill is also reduced. He is responsible for only $20 (20% of $100) instead of $30 (20% of $150). In other words, the client saves money IF he goes to a provider on the approved list. If not, he discovers the policy will pay a lower percentage of the fee for out-of-network professionals. This has the effect of saving the insurer money on fee payments to those individuals and discouraging the patient from selecting anyone who has not been impaneled, costing him more to visit.
  3. Why would a therapist agree to a fee-cut on the order of 33%? (The size of this reduction is not unusual, by the way. It can be more or less). The answer is simple. He wants the referrals: a flow of new patients he anticipates from having his name among those recommended by the insurance company. By receiving more referrals he hopes to offset the reduced income due to his discounted fee.

All of this demonstrates that therapy is a business as well as a healing art, treatment is expensive, and the proliferation of shrinks (especially in big cities) causes competition among them. Economic times have diminished the ability to pay out-of-pocket for treatment. Both the insurer and the patient have an interest in reducing costs. The patient is constrained from being treated by anyone he might choose, but is compensated by a lower per session therapy cost and a lower insurance premium. The counselor would benefit if he could keep his fees high, but is willing to lower them if he can fill his schedule with more patients provided by the insurer.

None of this focuses on quality of care. FRIGHT does not make a strenuous effort to evaluate the skill of their “providers” (admittedly a difficult task). They don’t know whether the people they refer you to are the best in their field, average, or below average. Beyond the confirmation of the practitioner’s license to practice psychotherapy and an absence (probably) of discipline by legal authorities or ethics boards, you are on your own in determining his excellence.

For the most part, insurers take a therapist’s word for his expertise. He states his range of skills: diagnostic evaluation, cognitive-behavioral therapy competence, psychodynamic treatment experience, etc. The qualities are simply checked-off by the therapist from a list required by the insurer.

What you are dealing with, then, is something like the self-descriptions on a dating site. We know how trustworthy they are.

The dominating dictate of the dollar determines which therapists you are encouraged to consult by your insurer. Money is also a significant consideration for the therapist, who not only takes a smaller fee if he wants to receive potential referrals, but agrees to other conditions FRIGHT will impose on him once you walk through his door. He creates a description of himself according to FRIGHT’s guidelines. You are expected to take him at his word, just as you are expected to take your insurance company’s word that the list they have created is comprehensive and the professionals on their website are adequately vetted and good at what they do.

Incentives exist for both parties (the impaneled therapist and the insurer) which have nothing to do with your treatment. Those motivations go beyond your well-being and are sometimes in competition with your well-being. If you don’t pay attention to them, no one will do this for you other than your suspicious brother who warned you about FRIGHT.

I should point out that without such cost-saving mechanisms, the price of psychotherapy would be higher than it now is. Decades ago insurance firms discovered how they could artificially restrain costs and guarantee profitability by so doing. In the process, they dampened the increase in health care costs for their customers, but also limited their choice of doctors, ancillary health care professionals, and hospitals.

Many practitioners are driven to discount fees as a simple matter of economic survival. Most would prefer not to deal with insurance matters at all. A small number refuse to submit claims and have flourishing practices nonetheless.  Such, however, is not the typical reality of delivering the services for which treaters trained. Your therapist’s calling to help humanity probably did not include a vision of the red tape involved.

The intervention of insurance giants in the counseling marketplace and their influence on treatment is not limited to what I’ve described. Additional concerns come into play once you reach the inner-sanctum of the therapist’s office. The long, tentacle-like arms of insurance companies reach everywhere.

I’ll talk about this more in another post.

Boo!

The top image, Frightened Girl, is the work of Daigo Oliva. The Halloween photo is the work of Policia Nacional de los columbianos. Both are sourced from Wikimedia Commons.

Five Things You Wanted to Know About Your Therapist but were Afraid to Ask: The Answers

psihoterapie-validTherapists sometimes reveal themselves despite their training not to. For example, in psychoanalytic treatment, Freud made himself a blank slate. He thought the patient’s troubles would become evident if he didn’t intrude upon the process. Remember, Freud sat behind the patient lying on the couch. Sigmund’s facial expressions and body language could not be observed. He said little, instead encouraging the analysand’s free association of thoughts. Then, if the client displayed positive or negative feelings about Herr Doktor Freud, the psychiatrist believed it due to underlying unresolved issues, usually about mom or dad. The heart of the problem having thus been uncovered, Dr. Freud could begin his “heart” surgery.

Still, patients wish to know “personal” things about the mysterious humanoid who treats them and will comment on the imbalance in unfolding that which is most intimate: the therapist gets to ask, the patient mostly does not. Spacefreedomlove, a provocative and prolific blogger, raised worthwhile queries in her post, Five Things You Always Want to Ask Your Therapist but are Afraid to Ask. I will try to answer, speaking only for myself. I encourage other therapists and clients to add or subtract by posting comments.

Question 1. “Do you ever wish you never met me or that you referred me out after the initial consult?”

A therapist works hard to find the best in the people he treats. This is a cliché, but it is true. You otherwise make both yourself and your patient miserable. I rarely if ever wished I had never met a patient, but occasionally thought later it would have been best to refer them. Careful readers will distinguish two questions here:

A. “Do you ever wish you never met me?”  The reason I’m glad I came to know my entire clientele is because they enriched me in knowledge and experience. I grew because of them. Many are wonderful people with whom it was a privilege to work.

With respect only to my enrichment, however, I would even say I found value encountering some nasty folks outside of work. Of course, I didn’t love those who did me wrong at the moment of injury. Strong feelings of anger and dislike touch everyone, therapist or thespian, “butcher, baker or candlestick maker.” A psychologist realizes he learns from some lessons only pain offers. Thus, if you ask me, “Do you ever wish you never met me?” I can pretty much say no, because you taught me about life, work, and myself. Past your tutelage, however, I might say I’d rather not meet you twice! This last comment refers to only a few people I met in the office, however.

B. “Do you ever wish you referred me out after the initial consult?” The simple answer is yes, but read on before taking the statement to heart. First, a different therapist might have worked wonders I did not. I remember one intelligent and sweet young woman early in my career who I didn’t diagnose as Bipolar Disorder until she arrived at the clinic with a bunch of “gifts.” The package included a box of condoms for me! She was hospitalized soon after. Had I been quicker to make the proper diagnosis, she might well have avoided being temporarily institutionalized. The young lady had some bad feelings about me as a result and I deserved them.

Therapists don’t predict the future without error. Only in retrospect do we realize an earlier referral was required. That said, I think the real issue being raised by spacefreedomlove is found in her second question:

Question 2. “Am I too much? Do I wear you out?”

The answer is yes, counselors get worn out, but not necessarily because of you. Once the therapist realizes he is exhausted, two more queries should pop up: a) Am I trying to do too much instead of allowing the patient’s own energy to carry therapy forward? b) Do I have some countertransference issues? Countertransference refers to the feelings the therapist has about the client, negative or positive. These can go back to the therapist’s own unresolved emotional concerns, so I’ll address this in response to Question 4. “Do I remind you of anyone from your past?”

As a young psychologist, I was keen to heal the world. This delusion is common among new therapists. Experience informs you of your inability to save everyone and, indeed, perhaps you can’t save anyone! By that, I’m thinking of the lifeguard who tries to rescue someone trying to drown himself. In other words, you need a person who isn’t going to fight your efforts every session and who has the therapeutic integrity to endure the pain of treatment. He must do everything he can to wrest a good life from the wreckage of his previous existence.

Therapists can burn out if they don’t recognize and calm their own frustration when progress is stalled. A counselor might exhaust himself by meeting his patient too early or late in the day, discounting fees to the point of feeling ill-compensated, and by overworking. Phone availability is still another potential complication, especially in non-emergency situations. Private life stressors create a trip-wire, as do multiple late cancellations without strong reasons.

A wise doctor will discuss issues during appointments, but not before healing himself or seeking his own outside support if the problem is his, not the client’s. Psychologists need to set limits. Being “on call” day and night can feel like guard-duty in wartime, causing sleeplessness and fatigue to the point of being less good when it really counts, in session. Remedies might include talking about the patient’s level of determination; a change to the time, day, or frequency of sessions; renegotiating the fee or the cancellation and phone policy, etc. Without improvement, referral is another option.

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Question 3. “What do I bring up for you? What do you struggle with in our sessions?”

As stated earlier, I only speak for myself. The best answer I can give is a long one, so I will refer you to a post called, What is Your Therapist Thinking? In addition to what is contained there, I struggled with how best to be helpful. Were a patient decompensating (getting worse) as the session progressed, I considered how to get the train of treatment on track to a safe place. The post I linked illustrates the manner in which your “doctor” head can be in a number of different places depending upon the flow of the therapeutic encounter as it happens. After the appointment, the counselor needs to reflect upon his efforts and whether they helped, were ineffective, or indeed caused the decompensation.

An inexperienced healer risks identifying with his patient’s pain so much that both he and the client are adrift at sea, and he is unable to offer a steady hand from the shore. Experienced therapists, on the other hand, risk becoming jaded to the point of equally worthless emotional distance. I believe I was eventually able to find solid ground in the middle.

Question 4. “Do I remind you of anyone from your past?”

Much like parents who are better suited to raising one child than another, counselors are not equally well-suited to each client. This can be a matter of skill, temperament, age, experience, or background. The question, however, seems to suggest you (the therapist) suffer issues from your past impinging upon your relationship with your patient in the present: your patient’s resemblance to someone else is the trigger. I remember a 16-year-old victim of sexual abuse. Her face reminded me of an old girlfriend, who I met when she (the girlfriend) was only a year older — 17. In the session during which the abuse surfaced, the client’s pain contributed to my own. While this was not a unique experience (my eyes can moisten hearing such stories), I was more than usually touched because of the invisible presence of tender feelings toward someone I’d not seen in many years. Nonetheless, my emotions settled and did not appear to derail treatment progress.

A few patients reminded me of my mother, with whom I had a “complicated” relationship. Please do note the euphemism! Once, however, I resolved my “mom” issues, I observed such similarities without undue emotion interfering in treatment. So, at least, I told myself.

Question 5. “What would you say to me if you were not my therapist?”

I am a pretty direct person. Not undiplomatic (most of the time), but direct. From childhood I found it almost impossible to be false. Should you care to know more, an amusing post on this congenital failure describes a kindergarten catastrophe: Gone in Sixty Seconds: How to Lose Three Girlfriends in a Minute. I don’t take full credit for my discomfort with being disingenuous (since I seem to have been born with it). Nonetheless, because of the trait, my client heard whatever I thought was most important to say. I tried to hold a mirror so that he might better recognize himself. If his vision was cloudy and it was essential that he perceive more (in my opinion), I often said more. I made good use of Socratic dialogue, asking questions designed to lead to self-awareness. Telling someone he is missing something is rarely helpful. A therapist says things like “What does that way of being cost you?” in the hope of allowing the patient (upon answering and thereby taking responsibility for his behavior) to grab the therapeutic initiative to change. The same comment in the form of a statement, by comparison, might cause him to feel scolded. It is easier to reject the therapist’s conclusion than your own.

No one gets to know every thought a therapist or a friend thinks about him. The truth of the previous statement does not mean, however, you would hear more from me as a friend than you would as your therapist.

In the end, as worthwhile as the above questions are, I believe it is most important a therapist know the truth of what Leo Tolstoy described in War and Peace — the role of medical doctors in early nineteenth century Russia:

“They satisfied that eternal human need for the hope of relief, the need for compassion and action, which a human being experiences in a time of suffering. They satisfied that eternal human need — noticeable in a child in its most primitive form — to rub the place that hurts.”