transference

February 14, 2021

How Insecurity Can Be Created and Overcome

The absence of self-confidence is easily misunderstood. A 400-pound bag of feathery old criticisms, easy to brush off one at a time, still weighs 400 pounds. Small additions to the weight seem insignificant. Their accumulation can break a child’s soul.

The psyche is porous. If your guardians show sufficient disrespect for your shoes or judgment or the way you play soccer (football), unless they target one of those categories alone, the words can be channeled into an overall belief in personal inadequacy. Adequate counterbalancing opinions received from people who carry equal weight to the boy or girl are rare.

This is not the lone way insecurity is created, but all therapists are familiar with this one.

Think of internal emotions as a system of waterways. If there are many such comments in multiple channels, the rain becomes rivulets; the rivulets become brooks, then streams, then rivers. Each of these gush into a lake of a person’s being extending from heart to head.

At worst, the fluid sense of self is poisoned in a general way, not sectionalized. The doubts flow out in the individual’s hesitation, avoidance, uncertainty, action, or inaction in the same generalized fashion. Or they are disguised beneath external charm or boldness — a masked man who performs well in public but remains unknown and unhappy in private.

The “objective” viewpoints of outsiders and latecomers to your life carry less importance than those upon whom your existence depends. Their messages trickle in but can be swamped by the major tributaries to your psychological state.

For a while, at least, it is more comforting to view your guardians as knowledgeable and powerful protectors than to believe nothing will win their approval. No swarm of adults offers alternative homes. By agreeing with your label as “the problem,” hope stays alive: the dream you will change something about yourself to persuade the parents of your worth.

Would you dare to conclude your caretakers are cruel or crazy instead? No escape is then conceivable. All other grown-ups are strangers, not benefactors of equal power and wisdom, or so you believe. They don’t know you as well as blood relatives. The love you want is from mom and day, not a counterfeit substitute.

If the growing youth counters parental condemnation by stating, “They like me” — referring to teachers or neighbors or employers — he often hears, “That’s great, but if they spent more time with you, they wouldn’t.”

The child unconsciously persuades himself he still has agency — he can prove himself. Thereby he is not helpless. This continues until many teens realize the parent holds significant responsibility. Yet, the tattooed, imprinted sense of disqualification lives on. Now the not-quite-so-young person has two selves: the one who remains the flawed object his folks described and the one who is something different and better.

The youth’s task is to disentangle the various messages and take the risks necessary to find a less complicated passage to accomplishment and love. Far too many never begin or stop along the way. A great number fail to recognize any therapeutic burden to take on.

Another thought. Almost every story can be topped by tales more desperate. How does one know whether and how to convey ancient personal injuries? Does one make too much of them or too little? Does the troubled soul possess justification to say anything at all?

Holocaust survivors usually didn’t share their calamity until the end of their lives, if at all. After the war, they observed all the pain around them of infinite shapes, sizes, and intensities, whether one was Jewish or not. They carried guilt for having lived when so many others died.

The task of making a life “after” didn’t offer the luxury of emotional space to “process” their experience and affliction. No name had yet been given to the events they endured. The word “holocaust” referred to fire or nuclear war alone. Nor had the concept of Post Trauma Stress Disorder (PTSD) entered the mental health lexicon.

These people didn’t believe they would be believed. Even if they were, no outsider retained the capacity to “understand.” No one had the imagination to conceive of what they’d lived through.

When the victims thought about what happened, it seemed like a visit to a world beyond conjuring or hallucination. Who could fathom a years-long abduction from earth to another planet, followed by a psyche-destroying ransom impossible to repay and a later return to an unpeopled, remembered world in ashes?

Patients in psychotherapy often face something similar but on a scale more modest and not so strange. How can they claim the right to talk about their lives? Others survived comparable misfortune with less damage, they reason.

Feel-good stories in the media emphasize personal triumphs. Happy endings are always needed. Hope must triumph over hopelessness if one is to progress. Moreover, such hopefulness helps us achieve things we might not attempt otherwise.

In some communities, garden variety misfortunes are well-known. The list includes corporal punishment, dads who drink too much, parents who argue too much, ethnic or religious or racial enmities, and financial problems. Men must learn to “be a man ” without complaint.

Why make a big deal about it? The New Testament tells us, “All things work together for good to them that love God, to them who are called according to his purpose.” (Romans 8:28). A handful of Christians tell a church-goer who is not healed he has failed the implicit test of faith in such biblical passages. Indicting the Deity would be sacrilege, as well.

Since life must go on and making a living and raising a family takes priority, ugly recitation of dead history offers no appeal. The demands of the present and future argue against the idea of a backward turn.

An additional complication exists if there are brothers or sisters. Two factors play into the potential client’s dilemma and reverberate if he chooses to seek psychotherapy.

First, he might have received different levels of attention, affection, and respect from his parents than they did. If so, his history is not theirs, perhaps by a large degree. Second, almost by definition, if he “sees” the family maelstrom for what it is, he may possess a double-edged gift of perception unavailable to anyone else in the household.

Put differently, the distribution of psychological defenses among close relatives can offer siblings the metaphorical blinders he lacks. His vision is too bright, too acute for him to ignore what is happening in his home. Moreover, to the degree he exposes heinous parental acts like sexual abuse, the remaining family members frequently deny his truth and disavow him. The clan stands together, declaring him troubled and worthy of contempt.

Fortunately, the therapist’s job doesn’t require sharing the patient’s many-faceted distress. Such a task is impossible in any case. The doctor and patient should be grateful for this because anything different would leave the treater and the treated unable to assist each other, both struggling within the same debilitating emotional space. The counselor can afford to be touched and sympathetic but not afflicted by the identical disabling wound.

Beyond sympathy, he must validate the client’s report and extend a metaphorical comforting hand — to abide with him while he grieves. The healer does his best to stand guard. A kind of psychological resuscitation shall be attempted.

The healer hopes his serious concern for the sufferer will make an impression. His offer of time and thought to the multiple losses, humiliations, and complications all serve to acknowledge the person’s story. The counselor’s words, posture, eye contact, and tone of voice all communicate the value of the subject’s being.

Perhaps for the first time, the client accepts the credibility of an authority who believes he deserves a chance at fulfillment (even if he does not). The therapist lights a torch, held at a distance, a symbolic flame. It represents the possibility the patient will one day lift the lamp by himself and step into a dimly visible path to something better.

The therapist’s respect, arcane knowledge, and kindness can make the psychologist something of a parental substitute. The patient’s growing attachment allows the doctor to become the carrier of a positive message acceptable to the client, offering a less damning interpretation of why he failed to achieve parental love.

Now, at last, is a countervailing, affirming judgment the patient is ready to consider, one he is not impatient to disqualify. The process encourages the client to believe in his own capacity to set aside the burden (not the memory) of the identity his parents imposed on him.

The therapeutic contact also opens the door to validation from the world of other people and events. In the best case, he receives sufficient acceptance and approval to internalize a different vision of himself. The most important applause becomes his own.

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The first portrait is of Constance Talmadge, 1921, taken by Lumiere. The Missing Painting is the work of En-cas-soleil. Finally comes a Self-portrait of Utz Rothe. The author is recorded as W. Helwig. All are sourced from Wikimedia Commons.

February 16, 2020

The Therapist as a Secret Keeper

 

If Zora Neale Hurston is right, the “oldest human longing (is) self-revelation.” But to whom should we show ourselves? How much is safe to disclose? When? At what risk?

We’ve all thought of this, but perhaps not of the costs and responsibilities of the one who listens to the secret.

I’ll try to address both the teller and the Secret Keeper.

The act of unveiling is fraught. We believe the uncovered one is alone in taking a chance. She gambles with her psychological nakedness.

Will she be mocked, rejected, used? Will her confidence be shared with others, publicized? Will the knowledge that comes to the listener/observer be turned against her? Will her vulnerability be exploited?

Priests hear confessions, therapists too: the speakers are ashamed or tentative. Their confidences are like objects packed with care, wrapped in cellophane, new and easily damaged. They’ve often never been opened.

To the client, they seem tarnished, in need of cleansing, but impossible to free of stain.

The disclosures must be understood as a gift. Here is the most delicate and fragile beauty the individual owns, no matter how ugly he believes it.

The “oldest human longing” takes the form of “admitting,” out loud. “Admitting” as in a ticket to enter and a statement of guilt. The terror in the treatment room bursts the confines of a confessional space because here, unlike in church, the listener also sees you.

Your face is known.

Though priests in the confessional want to know everything, counselors should be hesitant. To the extent they control the conversation, timing is critical. A too-early disclosure might cause the patient to flee therapy, overwhelmed by the early exposure, his armor melted.

Whether in or out of psychotherapy, most of us share parts of our lives. The external elements include appearance, words, and actions: the public portion of ourselves. Though this evidence of our person carries dangers (as when we make formal presentations), it is commonly without oversized hazards.

Not so our “off the record” existence. Think of the whole of your history, personality, and behavior as individual pieces of a mosaic, like a stained glass window. All the excellence and perfections, flaws and cracks: the light and the dark.

Some parts are shared with some people, but often not enough for them to imagine the assembled multicolored glass. The therapist, however, comes to know the entirety of it or can conjure a perceptive, imagined awareness of the nondisclosed portions.

He should ask himself a question. Does he want to possess the most sensitive, private, anguished knowledge of you? What is the cost to him of keeping safe what he hears? He, too, is at risk. A different kind.

The more the psychologist knows of untold stories, shames and “weaknesses,” hurts and horrors, the more he might be perceived as an indispensable and unique person to the client.

The giver’s sense of debt for his acceptance of the gift and the tenderness with which the counselor treats it, the bigger the challenge and responsibility. Some think of the Secret Keeper almost as a being out of fiction, one who holds the divulgence in his soul.

For therapists, this can be too much for the small enclosure in which it is contained. If he cannot help to disentangle the patient’s transference toward him, his overlarge hopes and expectations, growth and eventual termination become difficult.

If the sufferer does not come to take risks and confide in others, the pedestal on which the healer finds himself is too high for his client’s benefit and for his own long term occupation.

Most of those in psychotherapy detach without a long lingering empty space which the practitioner used to occupy. The aura of absence shrinks as the patient’s world widens. If the therapist was skilled and his patient courageous, growth and awareness of new possibilities lead to unveilings and disclosures outside the clinic.

The analyst is a guide and an expert, but his job is temporary. Enhanced flourishing gained through treatment doesn’t smooth all the roads ahead.

At its best, the patient becomes a better driver over and around those potholes and a more resilient survivor of the worst of them. He seeks places and people new to him, free of the claustrophobia of his head. Reward and compatibility with others encourage the continuing adventure.

The encounters with new people and their acceptance of him might call up thoughts of the counselor, the one who first saw and valued what he disclosed.

Now, however, there is a larger, freer world elsewhere.

_______

The second image is The Whisper by Charles Blackman, sourced from Wikiarts.org/ The final object is Whispering Zephyr by Thomas Ball, sourced from the Art Institute of Chicago.

November 17, 2019

Understanding Your Parents

We can blame, accuse, or praise our parents. These acts come to many of us with ease. A more complicated task is to understand them.

An old friend told the following story. His mother was waiting for a baby sitter when he was little. Like all tots, he was attached and needed the security of mom’s nearness.

Having nothing better to do, she decided to hide behind a sofa. No warning was given to her son, no announcement she’d be playing a game of hide-and-seek.

When he called out, she didn’t answer. He ran around the apartment looking. The boy’s search turned into a frenzy. Soon came his screaming breakdown into tears.

Mom jumped out laughing. As my buddy asked me many years later, “What was she thinking?”

Here are some suggestions to help you understand your own parents: what they do, what they don’t, what they think, and how their particular brand of humanity came about:

  • Talk to your grandparents if you still can. Try to find out how they raised their children. Ask them to remember what their small ones were like before and after school arrived in their lives. Observe how these elders connect with their offspring today.
  • Look at old family photos. Ask your folks about them. Who are the unrecognized friends and relatives? What became of the relationships with them?
  • Are the people in the photos happy? If you are captured there by the camera, what was your mood? Was the youthful version of those who parented you remarkably more attractive before time’s transformation? What effect might the change have had?
  • Uncles and aunts are sometimes essential sources of illumination.
  • If you have children of your own, watch how mom and dad interact with them. People do alter, but not everyone does. Their behavior is the closest visible example now available of how they brought you up.
  • One by one, do life history interviews if your father or mother cooperates. Some oldsters will be flattered; others will say no. The reason for their choice might be enlightening.
  • Learn the background of their early years: the places, neighborhoods, and economic circumstances that impacted them. Did they change residences and schools often? With what consequences?
  • Find out about significant life events, the downs and ups of love, vocation, and health. How did they respond?
  • Ask about religion, including movement toward or away from the faith. Do they expect you to “believe” as they do? What values do they hold?
  • How do your caregivers talk about their progenitors? Look at their faces for evidence of emotion. Listen to phone calls between them and your grandparents.

  • Attitudes toward money, status, and material things are useful to know.
  • Friends of the family can supply relevant information if they offer you a factual account. Do your parents maintain long-lasting friendships? Why or why not? When buddies depart or are banished, who gets blamed? Do they make new friends?
  • Research the educational and employment time-line of mom and dad. Did they achieve what they hoped for? How do they explain their success or failure? Do they live to work or work to live?
  • If your folks hold racial, ethnic, or religious biases, attempt to uncover the origin of such beliefs. How do you explain their embrace of diversity or its absence?
  • Do you remind either one of somebody from their past? Were feelings toward those individuals transferred to you because of your likeness? Transference grows not only in a therapist’s office.
  • How do your begetters get along with each other? Who is in charge? Does one criticize the other in your presence or privately express spousal grievances to you? Did you ever occupy the role of a confidant or consoler? Was the keeping of secrets required? Was your well-being considered when they overshared?

  • Do mother and father accept responsibility for their actions? How affectionate are they, how distant?
  • Might they play favorites among their children? Are the ones who gave you life reliable and honest? Do they display preferences among their grandkids? Why?
  • How do these guardians deal with their physical issues, as well as illnesses or injuries you have?
  • In what ways are you like those who cared for you? Don’t say there are no similarities, there always are.

Consider this a start. The understanding of another (not to mention yourself), comes from thinking like a therapist. I’ve offered you questions as a launching pad for your inquiry.

Your understanding will change as life proceeds. Until you reach the stage another person passed through, you lack the knowledge such passage provides.

Attaining a complete grasp of the nature of any life is never achieved in full. In the meantime, remember to live not just a good life, but one enriched by experiences. The clock on your time here is always in motion.

—–

The above images in order: 1. Willem de Kooning, Untitled XI, 1975. 2. Pablo Picasso, Head of a Woman, Summer 1909. 3. Paul Klee, Blossoming. Jackson Pollock, one of his untitled, numbered paintings.

April 9, 2017

What Does Your Therapist Dream About?

Therapists tell you little about themselves, especially their dreams. Why would they? The woolly, wild world of the unconscious might suggest the counselor is a rapist, murderer, or thief.

Looking at him through the lens of the dream makes the treatment about the practitioner, not about the patient. It cripples the client’s ability to project his own long-standing issues onto this person: react to the counselor as if he were a father or mother identical to the real dad or mom.

A crucial part of classical psychodynamic treatment relies on the client playing-out his long-standing relationship problems and historically driven expectations of trauma or rejection within the session. The patient is unaware, at first, of the “mistaken identity” going on, where his reactions are more about his own past than the practitioner. If the therapist reveals too much about himself, he risks becoming the man of his chaotic dreams to the patient, not a benign, but blank canvas upon which his client throws the paint of his own internal life.

Dream interpretation is an art, not a science. Its value is difficult to demonstrate, though some therapists swear by it. Too many possible interpretations, no way to validate them. Yet they can be helpful. Certainly they may enlighten. Regardless, dreams are hard for the patient to resist discussing. An open therapist needs to take in all the uncensored data provided, the better to serve him.

Though I claim no specialty in dream interpretation, what I offer here is a partial explanation to those who wonder about the kinds of dreams therapists have.

The simple answer is, I doubt they are much different from those of people of similar upbringing, temperament, and overall life experience. I might add two exceptions:

  • Certain kinds of dreams are recognized as symptoms within the diagnostic framework developed by the American Psychiatric Association. For example, one possible symptom of Post Traumatic Stress Disorder is: “Recurrent distressing dreams in which the content and/or affect (emotion) of the dream are related to the traumatic event(s).”
  • Conventional wisdom tells us that high achievers have recurring dreams dealing with things like being late or unready for tests. Since people with advanced degrees prepared well for examinations (and took so many of them), the unconscious disquiet of discovering you are not ready or present for a test, a crucial appointment, or a presentation requires no leap of insight. Many of us were either driven to succeed, afraid of failure, or both.

Ah, but this discussion is rather impersonal, so I will offer an actual dream of one person I know well and present you with two interpretations. Moreover, I invite you to take the interpreter’s role yourself: be the therapist.

Whose dream shall I speak of?

My own.

Get ready. Prepare yourself for the unexpected nature of the story. The partially unclothed aspect, too.

I was sitting in the smallest room of my old office suite. Yes, the washroom. Some vulnerability here, don’t you think?

The door to the W/C led to the waiting room, the lobby of the office suite. I shared the workplace with other therapists. Unexpectedly, one of those counselors opens the door to the washroom. A man. He walks through a side entrance I hadn’t noticed and was never there before. I pushed him out and spoke with him soon after.

The extra door was installed without my knowledge, he informed me. Even though all the other counselors rented the space from me, they somehow did this unilaterally, without discussion with me, and with no warning.

Several of them were in a meeting which I joined. I talked to them. I spoke of the danger to our patients, our duty to protect, and our professional liability. Since our clients all used this facility, I stated this unlockable entrance would constitute malpractice. The head of the group argued back, though I can’t recall the details of her rejoinder. The assembly of counselors was mostly docile and unpersuaded by my logic. In the end I went off, saw my next patient, and did my job.

What should be made of this, if anything? Well, I can recall failed attempts at rational persuasion dating back to my childhood. Mom ran the roost, like the female leader of the other therapists. My mother was a tough cookie and dad worshipped her. No amount of logic or effort were enough to effect changes in the family dynamic. Should I leave the interpretation at that or try another tack?

Let’s visit recent events as possible triggers of the sleepytime return to my professional practice. I read two disturbing books in the days before the dream. As Dr. Michael Breus notes, some believe dreams are “a means by which the mind works through difficult, complicated, unsettling thoughts, emotions, and experiences, to achieve psychological and emotional balance.”

The Souls of Black Folk by W.E.B. Du Bois and The Revolt of the Masses by José Ortega y Gasset both carry profound messages about the dark side of humanity. The first deals with American slavery, the second with the growth of a naïve, destructive, anti-intellectual “mass man” who may destroy the pillars of Western civilization. Du Bois led me to watch Slavery by Another Name, a superb, but equally unsettling documentary on the color-line that existed in the South even after the emancipation of blacks. Their forced-labor and imprisonment by legal and extra-legal means was new to me.

I was powerfully affected, but not, I thought, to the point of emotional distress. Still, these books and the movie offered a larger vista on what happens when reason fails and men know only rights and not duties to something virtuous and greater than themselves.

One more feature of my dream was a lack of control. Being interrupted in the washroom by a stranger is profoundly threatening. One is literally caught “with his pants down,” though I felt more surprised and angry in the dream than in danger.

The books also might have amplified my personal concerns about the current state of Western democracy: another possible precipitant of the strange story. If this is so, then perhaps I should alter my life: dip a toe into the ocean of earthly woe, not bathe in it. Rather ironic, in light of what I did during my career, which on some days was a daily if not hourly immersion.

Other interpretations are possible, of course, but I hope you get the idea.

Your own analysis might tell you about both yourself and me. Do remember, that the therapist must remove himself from his issues when doing therapy, including his investigation of dreams. Freud was a notable exception who performed a self-analysis.

So, you now get to be the psychologist. Complicated, isn’t it? Give it your best shot.

—

The first image is called Think Different by Neotex555. It includes within it a statue plus a portion of Kandinsky’s Fugue, the entirety of which makes up the painting that follows. Finally comes Sean Foster’s Cloud Frenzy. All are sourced from Wikimedia Commons. For more about the function of dreams, you might want to visit a very fine post by Dr. Michael Breus.

October 9, 2016

Are You a Good Judge of Character?

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Just as most people with cars will tell you they are better than average drivers, I suspect most of us believe we are pretty good at knowing others: estimating their worth, determining their reliability, pegging their level of integrity.

Not so fast. Some of those confident in their capacity to size-up friends and strangers are poor at it, in my estimation. Here are a few of their (and our) possible errors:

  • Believing people are motivated in the identical way we are. This amounts to the expectation that you can judge another’s intentions and actions by asking the question, “What would I do in his shoes?”
  • The tendency to discard important evidence about personality. I wish I had a million dollars for every time a female patient uttered, “Oh, he wouldn’t do that to ME.” The action they referred to was a betrayal, almost always sexual. The man, of course, had already revealed a history of infidelity. Call this willful blindness by the unlucky lady.
  • Sticking with a wrong opinion. Some of us are slow to revise a long-standing error. Even if our original measure of an individual is right, we are in danger of failing to register subtle changes morphing him into something less honorable. One might also miss the ripening of a condemned personality into someone sweeter. It is as if, once done labeling, we are free to put our brains asleep. Richard Posner, a public intellectual and judge, rightly asks the question, “If we sentence a 21-year-old man to life in prison, are we still punishing the same man when he is 71?”
  • The difficulty of thinking psychologically, Part I. Most of us base our understanding on surface impressions. A plausible explanation of a person’s behavior “makes sense.” Freud knew better. Actions can be determined by multiple motivations. Many of those are unconscious. A quick acceptance of a single reason to explain the world risks simplifying the complex.
  • The difficulty of thinking psychologically, Part II. In observing others we tend to assume a personality is something objective, like pulse or blood pressure or height. Might it be more accurate to think of mental makeup as a creation of our perception, a combination of what we encounter in the other and how we interpret what we encounter? To a significant extent we translate our experience of a man, his words and actions, filling in the many blanks with our history of similar persons and a few educated guesses. Much is lost in translation. This is usually done without careful study, no training, by instinct. How else might you account for the neighbor of an ax-murderer telling the TV reporter he appeared to be a good guy?
  • We tend to believe the best of members of our in-group and those we are attracted to.
  • We tend to believe the worst of those we dislike, members of an out-group, and people against whom we compete. They become stereotypes.
  • The influence of the opinions communicated by friends, relatives, and co-workers. Research demonstrates we are influenced by group opinions even if asked to estimate which of several straight lines is the longest, discounting what our senses tell us if the rest of those present offer different answers. We do not form judgments in a vacuum. Millions of advertising dollars are spent on attempts to modify thought and action — yours and mine.

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  • We believe people will behave in the same way regardless of the situation. Few of us observe even our best friends in a variety of circumstances. We don’t watch them preparing their tax forms, at work, or facing a moral dilemma.  Courage is in short supply. Not everyone can resist taking a surreptitious unfair advantage. Self-interest is a powerful motivator and easily rationalized. Evidence for this opinion is to be found in the large number of political candidates who throw in their lot with a yahoo-like scoundrel and justify it by loyalty to their party.
  • Expecting others to be consistent and whole, all good or all bad. Again, public office-seekers provide the example. They are flawed, as are we. Yet there is the tendency to understand people globally, as undifferentiated and organically whole: honest or dishonest, virtuous or criminal, black or white. The best person on earth has secrets, has made mistakes, and will make more. No man deserves a halo, but many benefit from a halo effect or are harmed by its opposite.
  • Our limited perspective. We experience everyone from a unique view point: through our eyes and our buzzing brains. The reason pollsters sample large groups is because any one person doesn’t reflect everyone’s opinion. We bring to our understanding of life a very particular set of experiences and beliefs that shade and transform all we think and observe.
  • A tendency to judge others more harshly than ourselves. “I wouldn’t have done what he did” is easy enough to say (and thus condemn) because we are not in the identical situation as the one being judged. “He should have known she was no good” is an opinion lacking knowledge of all the history, emotion, and experience which might explain a failure to “know.” Meanwhile, automatic psychological defenses blind us to our own foibles.
  • The shifting perspective created by aging. How can a 20-year-old fully understand a 40-year-old? How can a sixty-year-old understand a 20-year-old? Not only do these people have the advantage or disadvantage of years, but of times. Life today is not what it was in the ’50s or ’60s or ’90s. Time machines cannot take you forward and back with appropriate adjustments of your age.
  • Transference. Transference is not limited to the counselor’s consulting room. It is like a mistaken identity. While we might have feelings for the therapist derived from our relationship to a parent, we can also react this way to a stranger or friend, a lover or a boss. They too may remind us unconsciously of some other past human contact and reproduce many of the sensations and emotions evoked by the original person.
  • The intentionally misleading quality of public faces. Humans try to make themselves “presentable,” just as a gift, an award, or an object of art is better looking when dusted off, retouched, and nicely framed — now suitable for viewing. X-ray vision through and beyond the public face is unavailable, Superman excepted.
  • The influence of our off-kilter emotions. Here is an example of how feelings can distort our estimation of another. An insecure person prone to injury by a word or a look is more likely to believe the other harbors a negative attitude toward him, thus overestimating his neighbor’s dark side.

Though subject to the foibles just described, I nonetheless possess considerable experience (personal and professional) in trying to understand others. If I am better than most in making those judgments, I am far from perfect. To whatever extent I can demonstrate success, it is because I benefited from large data sets for thousands of patients with whom I spent many hours. They offered information often not provided to those closest to them. I received instruction in the manner of asking questions, analyzing the answers, administering and interpreting psychological tests, formal education, and supervision. And still I am not perfect.

We do our best, therapists or not, to hone the observational knife to the point of precise dissection of another personality. Or we do it casually — all too confident — and don’t look back. No one, however, gets a complete grasp of the social world. To do that we would have to be both inside the other and outside of him, combining the perspectives of those who know him best and those who are more distant — like a baseball game viewed from different angles by multiple cameras.

A 24/7 off-the-field videographer might help too, making his visual record during all the hours before and after the contest, even when our subject is asleep. We would also need to speak with our subject’s lover, children, business partners, garbage man, and valet, if he has one. Not to mention the person who does his laundry.

And there is the rub, my friend. Not even your therapist wishes to know everything about you.

—

Are YOU Playing Square? is a World War II poster of the Office for Emergency Management (Office of War Information). It requires a bit of explanation. During World War II the US government created rationing  and price controls on certain commodities. This was done to ensure that the people at home faced no shortages, while the armed forces were themselves well-supplied. Nonetheless, a black market existed in which one could get more than one’s proper share of a rationed commodity by paying an inflated price. Thus, “playing (fair) and square” meant respecting the rules, not participating in the black market. The poster is meant to suggest that cheating undermined the war effort and thereby endangered the soldier pictured. The second image of Wisdom is the work of Matt Lawler. Both of these pictures were sourced from Wikimedia Commons.

May 22, 2016

Why You Want “More” From Your Therapist (and Why He Can’t Give It)

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You think of your therapist as a special person, at least some of you do. His kindness and attention can not only generate gratitude, but affection. You are aware of his boundaries and you can be frustrated by a professional stance limiting the kind of contact you’d like: a favored position, not someone put into a time slot with a financial transaction attached.  Perhaps, however, there is more to this than an ethical code. Why might his viewpoint as a therapist make what you want difficult to obtain? And, no, I’m not talking about sex.

Consider the role you play and the role he plays. You are likely talking about emotionally charged issues. Your feelings are front and center. His are not. Indeed, he is thinking about what you are feeling and doing.

You come to the clinician because of problems on which you are intensely focused. Thus, you are internally directed to your issues. The counselor, on the other hand, is not attending to his concerns, but to yours. He is looking outward, you are looking inward.

The counselor is not exposed. While you can find out some things about him, the treatment is not about him. You do not keep his secrets, but he wants to keep yours. You are encouraged to open yourself in order to heal. He is closed, assuming a relative position of safety and authority no matter how much he tries to be gentle and helpful.

Your session is of singular importance to you. It is one of many sessions for him, focused on you and a full complement of other patients. That makes him more important to you than you are to him. It does not mean he is indifferent to you. The doctor may well have tender feelings for you and enjoy your company, care genuinely, and approach you somewhat differently from the way he approaches others. Still, he is your only therapist, while you are not his only patient.

The counselor spends a limited time with you. He will then meet with someone else and switch his concern to the newly arrived individual. In a sense, however much he is concentrating on you while you are with him, he must develop an ability not only to be “in the moment” with you, but switch to another person after a brief interval. You do not switch. When you leave, your concern is still on yourself and the relationship with the therapist. A mental health professional is like an athlete in this way. After the game is over, he quickly puts the contest behind him so he is able to bring all his skill and attention to the next game.

To the extent that the therapist makes himself a blank slate and reveals little about his life, it is thought you will play out your emotional issues in the form of transference: experiencing him, to some degree, as similar to an important person or persons in your life, especially if your parental relationships are unresolved. Your transference toward him provides important material which he will help you work through. In doing so, you cut the trip wires of the past that continue to harm you in the present.

The counselor, of course, can also have countertransference toward you: experiencing you and reacting to you as if you are someone about whom he has unresolved feelings. However, to the extent he gets to understand the intimate details of your life, he is likely to be less prone to such emotions than you are in response to him. You are not a blank slate to the therapist. Thus, his likelihood of projecting his issues on you is at least a bit less probable.

Now let’s switch focus. Imagine what therapy would be like if these conditions were not typical of a therapeutic interaction. In which case:

  • The therapist would reveal as many of his issues as you do of yours.
  • He would be focused on himself as much as on you.
  • He would have less control over his emotions in session.
  • You might come to know disqualifying things about him.
  • The counselor might break down in session when you are overwrought or because of his own life problems outside of the office.
  • Consolation from you may well be required to stabilize him.
  • When you are in session he could be preoccupied with the last patient he saw before you.
  • Your relationship to him would approximate the kinds of contact you have with friends and co-workers.

I wrote this essay for the purpose of helping you understand a therapist’s perspective, his limitations, and his boundaries. Without those walls, little benefit comes from treatment. This is not to say your therapist doesn’t care about you. It is to say his care must remain within limits. In the absence of those limits, no matter how much you believe you’d like something more, counseling leads to something less.

Sometimes in life we do not know what is best for us. Then we are lucky — very, very lucky — that our wishes are not granted.

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The photo of the 45 rpm disc was sourced from Wikimedia Commons.

September 22, 2012

What Do Patients Think About Their Therapist? What a Counselor Does About “Transference”

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Patients wonder what their therapist is thinking. Therapists wonder what their patients are thinking. It is not much different from what happens between husbands and wives, parents and children, bosses and employees — or is it?

I’ve written about what doctors think about their patients before: What is Your Therapist Thinking? But today I’ll focus on what the patients are thinking about their counselor and how therapists are “supposed to” handle that. I say supposed to, because we don’t always do it well. It is one of the trickiest parts of a counselor’s job.

Patients have feelings and expectations about a counselor, in part, because he resembles someone else. This is called transference. In other words, the client’s sense of this new person is transferred from someone else who is important to him, simply because the new acquaintance resembles the old one. It happens automatically and without thinking; a kind of mistaken identity.

No, you don’t think your therapist has red hair if his hair isn’t actually red. But you do see him through the lens of your past experiences, and react to him because of certain real or imagined similarities to others. All of us do this in all sorts of relationships. It occurs whenever we have unconscious feelings and assumptions about someone who reminds us of someone else; which is a lot, even if we don’t know it. The feelings toward the old person (be it a parent, a sibling, a boss, or a lover) can become quite mixed up with the real human qualities of any new individual, including a new therapist.

Indeed, this is made easier by the fact that the therapist limits how much the patient knows about his personal life. In effect, the shrink is a kind of blank slate upon which the client “fills in the blanks” left empty by a lack of real information. Not surprisingly, all of us are prone to repeating old behavior patterns in new relationships; and, to the extent that a new person evokes old feelings about what the relationship is and what it can become, the transference can play out the patient’s repeated relationship difficulties right in the therapist’s office.

Take a hypothetical situation. Let’s say that your dad was a hard guy. He was critical of you, didn’t give you enough attention, and seemed to favor your siblings. Now, many years later, you meet your new therapist. Is he any of these things? To some extent it doesn’t matter. For example, the fact that your shrink only sees you once a week can reopen the tender wound of your neediness — your failure to win your father’s time and attention. You might feel that your doctor isn’t as available as you’d like him to be, in person or on the phone. You might interpret some of his statements as being disinterested, even when they are not so intended.

The counselor can be more important to you than he would otherwise be because of your unresolved, unconscious desire to get the affection and approval of this admired authority figure, who, like all authority figures, can easily remind you of dad. The hurt and/or anger that you feel when the shrink does not fill your need for a “good” father is almost inevitable. You might want to leave therapy because of it.

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What is a therapist supposed to do when this happens? If he reacts defensively to the patient’s demands or disappointments, he is unlikely to do him any good. In fact, the counselor who responds angrily can create one more injury of the same kind that was inflicted by the patient’s father, thereby adding to the client’s mistrust and misery. Even if the healer tries hard to give him what only a father can give, the patient will still not be satisfied. After all, the therapist cannot literally fulfill the childhood yearnings that come from anyone’s vanished youth. The hunger of a 10-year-old for good parenting can no more be satisfied when he is 30 than can a literal hunger for a good meal at age 10 by a delicious dinner 20 years later.

What the therapist can do is the following. First, he can be compassionate and understanding. He often anticipates that the patient’s old losses and resentments (his past disappointments concerning his dad) are likely to play out in the therapeutic relationship. When they do, the psychologist will try to gently assist the client to see that the feelings bubbling up are not fully appropriate, but come from the historical emotions attached to the father that have been superimposed onto the shrink. If the patient is open to exploring this, he will gradually be able to purge his internally complicated connection to his parent. This is a grieving process, a cathartic expression and understanding of the sadness and/or anger that continue to live inside of him, even if the parent is dead.

If all goes well in therapy, the therapist will eventually no longer evoke the transferential emotions; no longer remind the patient of the parent. And not only will his relationship with the therapist be less complicated, but so will all those other interactions with lovers, bosses, or friends which used to unconsciously trigger the same feelings. Finally, the old injuries will be healed sufficiently to be set aside, clearing the way to better social interactions in the future.

I am certainly not saying that all of the feelings that patients have about their doctors are mistaken. Therapists have the same potential flaws as everyone else. They can be good or bad, attentive or unreliable, too easily hurt or too distant. Some want your admiration and some don’t much care. They have feelings about the patient that grow out of their own relationship history. This is called a countertransference. Regardless, the potential for the transferential issues I’ve described is always there, just as the therapist’s countertransference toward the patient must be carefully watched to prevent the damage that it can do.

Do you find all of the above some sort of psychobabble that doesn’t apply to you? Trust me, transference is real. The more that you believe your relationships are “logical” and that your past doesn’t reach into your present, the more that it probably does, unless of course you have dealt adequately with it in some sort of therapeutic process, whether in treatment with a professional or in your own self-analysis.

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Therapy and transference are much more complicated than I’ve described. What you’ve read is a simplification based on a hypothetical relationship between a father and his adult child who is in therapy. If you are not in therapy, even if your relationships are going quite well, it still may benefit you to take a look at patterns of connection you make with friends or lovers: the kind of people you are drawn to and the types of individuals who usually “push your buttons,” get you angry, or disappoint you in some way. We can all learn a lot by just connecting-the-dots of our life history, seeing the resemblances among the people who keep returning, even if their names are different the second or twenty-second time around.

It is easy to blame others when relationships fail. Relationships aren’t easy. But, the more unsatisfactory and repetitious your social life is, the more likely that something in you needs attention.

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The top painting is called Therapy by Gerhard Gepp. Apparently, the patient (a soccer ball or football) is thinking about being kicked around. Might he have transferential feelings toward the therapist and feel badly treated by him, as well? The second image is a photograph of Sigmund Freud in Session with a Patient, from the Seventh International Sand Sculpture Festival in Portugal. The artist is RHaworth. Finally, a cartoon of Freud Treating Moses by Moa1. All are sourced from Wikimedia Commons.