validation

March 12, 2017

Where Therapy Starts: Witnessing Another’s Suffering

I was reminded of a basic human need — a therapeutic need — in the middle of a boulevard. Recognizing another’s pain happens routinely in therapy, but this unfolded outside, in public, on a windy winter afternoon.

Imagine a wheelchair-bound, middle-aged black man. His clothing dark, his appearance unremarkable but for the machine he sat in. I hardly noticed him and he was not aware I was standing a few feet behind and to his right. We shared only the patience of waiting for the electronic sign to brighten and whiten — for the Michigan Avenue traffic to stop in Chicago’s downtown.

The walk signal came on and the red light turned green, permitting cars and pedestrians westward travel on Lake Street. Perhaps another second passed before a northbound SUV ran the red light in front of the chairbound man, within a few inches of the chairbound man. He’d just started to maneuver off the sidewalk. Had he owned a motorized device, a quick start would have put him in the SUV’s path. There was no hit and run, thank goodness.

Even from behind his upset was evident. The driver of the tall car must not have seen the artificially short man, diminished by his seated position. The near-victim of the near miss shouted something indistinct in a voice lacking force. He raised a left fist, impotent because it lacked a goal. The hand held only frustration and great sorrow. The vehicle was past him, the driver oblivious. People stepped into the street. No one recognized the close call, the tragedy averted, the remaining distress.

Not quite. My wife did and so did I.

I caught up to him in mid-Michigan Avenue, said I saw what happened. He described the event, needed to tell his story even though I gave my own report. The man related the brief tale twice. I mentioned I was glad he was safe and put my left hand on his right shoulder. He thanked me. The sitting soul needed to talk, needed someone to mark his words. All this in a few seconds, in the time required to cross the boulevard. The stranger wished me a pleasant weekend and again repeated thanks and his hope I’d have good fortune ahead. His speech carried some urgency and offered more gratitude than I expected.

What had I done? Nothing remarkable, but something necessary.

A man in a wheelchair is an easy target. Imagine his life. People are always passing by, speeding up, trying to get away. You have no stature. In a measuring world you are deficient. Your presence sets others to flight, instigates multiple small rejections. You are identified not by your human qualities but a machine; as an encumbrance, an obstacle to be negotiated, a thing. Does such a one feel helpless? This person appeared to. I could not climb down into his head, but I wondered later if the incident made him feel less of a man.

I deserve no special credit here. This is not about me. This is about humanity, our needs. On big city streets we are invisible or objectified, even the handsome and beautiful. But we are people, not furniture, not newspaper kiosks, not light poles. We suffer, we laugh. We create, we love. We live and die. All this is personal, treated as impersonal. In between the two sides of Michigan Avenue a man was witnessed. An anonymous individual became a person. Dignity returned to him in some small measure. At least that is what I imagine.

In giving the stranger my focus, perhaps I provided a bit of repair to someone who was otherwise not even an afterthought. Therapists do this in session. We validate and acknowledge; we listen, note the hurt and give it weight, meaning; extend a metaphorical helping hand, a meeting of the eyes, an affirmation.

Recovery often sounds complicated and often is. But remember too, life is full of simple things; simple but valuable things a therapist offers: everyday gestures that do not always happen every day.

We humans do not ask so very much.

—

The top photo is of Franklin Delano Roosevelt in a wheelchair. It is the work of jimbowen0306 and sourced from Wikimedia Commons.

October 2, 2009

What Happens in Psychotherapy?

What does psychotherapy do and how does it do that? Good questions, and even some therapists might have a hard time answering them. Of course, some of the goals are obvious: reduce depression, have better relationships, eliminate anxiety, enjoy your life more, and stop worrying. But what are the elements that get you there? I’ll give you a sense of some of the factors that permit those goals to be achieved.

1. Trust. Many people entering treatment have trust issues: they trust too easily or not at all, usually the latter. Trust will start with the relationship between you and the therapist. Simple things: does he listen? Does he understand? Does he seem interested and dedicated? Is he dependable? Does he care? If the answers to these questions are “yes,” then it will be a bit easier to begin to trust others. The experience of a benign relationship with one person can open you to the possibility that this experience can be achieved elsewhere in your life.

2. Validation. Many people coming into psychotherapy having been told that they should “get over it,” that they “shouldn’t feel that way,” that they shouldn’t complain or “whine;” or having been ignored, dismissed, or criticized too often when trying to express themselves. Some folks believe feelings are unimportant; others might state that it is not “masculine” to feel too much, and so forth. As a result, many new patients have so buried their feelings that they are alienated from themselves and don’t know whether it is appropriate to think or feel as they do. A good therapist creates a safe place for talking about such things (trust again), and gives the person a sense that there is value in what they feel and think. Over time, this action, by itself, can help improve self esteem and reduce sadness and alienation.

3. Grieving. If one has not had supportive relationships (with people who are both trustworthy and validating), the sense of loss or absence contributes to sadness, and sometimes to depression. The relationship with the therapist allows you to express the emotions related to loss (both sadness and anger) to someone who listens patiently and shows concern. As you process those feelings of loss, your sadness should gradually diminish. The therapist serves as a witness and again, as someone who validates your pain. Grieving in isolation too often contributes to the feeling of disconnection and alienation from the world. Grieving with someone who cares reconnects you to one of the things that can be good in life: human contact.

4. Learning new things. Any good therapist needs to provide some guidance and tools that enable change. This might come in the form of helping you learn and practice new social skills (including acting these skills out with the therapist), assisting you in changing how you think (cognitive restructuring) that helps you reduce self-defeating thoughts, training in how to be assertive (again with role playing in the therapy session), or meditation.

5. A change in perspective. A good therapist will provide you with new ways of thinking about the world and about your life. Since he can see you from the outside, he is more likely to see you in a way that you cannot see yourself.

6. Facing things, not avoiding things. We all practice avoidance some of the time, and some of the time it is a useful thing. Unfortunately, many of us practice it all too much. We distract ourselves from pain and avoid challenging situations. We can use food, TV, shopping, sex, drugs, alcohol, the internet, and computer games to get us away from whatever it is we can’t handle. We worry about problems rather than coming up with a plan of action and taking them on. We don’t ask out the pretty girl for fear of rejection, or say “no” to people who want to befriend us for the same reason. We stay at a “dead-end” job because of our insecurities. And, of course, unhappiness is the result.

A therapist can assist you in identifying the patterns of avoidance, help you to gradually become able to tolerate anxiety (by use of such things as cognitive restructuring, role playing or meditation) and give you tasks that gradually increase in difficulty so that you reduce avoidance and begin to take action that works.

7. Acceptance. By acceptance I am referring to acceptance of the nature of life and the discomfort that comes with living; acceptance of the fact that being open to life allows you to experience satisfaction and joy, but also opens you to pain; and awareness of the temporary nature of most of that discomfort. The more that you take life on its terms, the less you will be trapped by it.

Remember playing with the Chinese Finger Puzzle as a kid, the cylindrical woven structure made of bamboo, open at both ends? You put your two index fingers into it, but when you pulled hard to get your fingers out, you became more stuck. Only by releasing the tension and moving your fingers toward the center of the device, did it collapse and no longer held you tight. Life is a lot like that to the extent that we must stop engaging in behaviors that only make us more “stuck.”Acceptance allows you to free yourself, at least somewhat, from what is distressing about life.

8. Valued Action. If you are caught in the struggle with your emotions, or focused on avoidance of pain, what is good in life will be hard to achieve. Therapy can help you to think about the life you would like to lead, the life that is consistent with your values, and help to relieve you of the habits that keep you so wound-up that you don’t have time to think about what it is you would really like to do, and what it is that would lead you to a sense of satisfaction and accomplishment. What is your true self? Therapy can help you find out and encourage that person to exist in the world.

The description I’ve given you is based, in part, on my experience in life and training, especially training in such therapeutic approaches as cognitive behavior therapy (CBT), mindfulness-based behavior therapy, Acceptance and Commitment Therapy (ACT), and psychodynamic psychotherapy. Other therapists may have a different view of what is important and how to help you get to the point that your life is more satisfying and less fraught with depression, anxiety, or chronic relationship problems. But here, at least, I hope that I have given you some sense of direction and some reason to be hopeful about the possibility of change in your life.