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Posts Tagged ‘psychotherapy’


Last week I did a first session with a typical client – a young lawyer worried about starting at a big firm.

I couldn’t do real psychotherapy with this guy. Some lawyers are like that – they don’t trust anyone enough to open up. It was more like an awkward coaching session. When I tried to explore his feelings, he cut me off and got down to business.

He was fine, he assured me. He’d already decided he was going to take the money. He just wanted some advice. Then he related bad experiences from the summer program, and asked for my take on big firm life.

I suggested ways to maintain emotional insulation from the worst aspects of a big firm. I also proposed that he do psychotherapy, and maybe group psychotherapy, for emotional support while he was there. This didn’t make much of an impression. His mind seemed elsewhere.

He mentioned wistfully that he “wanted to be a writer, but couldn’t make a decent living at it.” I waited for more, but he changed the subject.

Eventually he left my office, and I thought that’s that. I’d never hear from him again – another unhappy lawyer who’d contacted me in a moment of weakness, then retreated back to his cave, alone.

The next day I received an email that pretended to be a thank you, but was really a warning from this guy not to mention his story in my column. It was a curt, condescending note which ended like a law firm letter, with “best regards.” Only a lawyer could write a note like that to a therapist.

I’ve received a few of these threatening notes over the years. I consider them a by-product of working with lawyers.

I know what you’re thinking. Yes, I’m a therapist, and I charge people for my services. And of course I disguise identities in this column to preserve confidentiality. He has a right to send me any letter he wants, and to have his confidentiality preserved.

But there’s a larger issue here. Trust. And sharing. And honesty.

My column and my work as a psychotherapist are intended to help people. I work with plenty of patients – most of them non-lawyers – who open up to me and find relief.

It’s always tougher with lawyers. They hesitate to trust anyone. That makes things harder for me – but incalculably harder for them.

Big firm attorneys live in a closet. Inauthenticity is the rule at these firms – it pervades the culture. No one admits what they’re feeling because no one is supposed to trust anyone else. The result is isolation, which exacerbates every other toxic element of that life.

It’s a kind of macho code: Act like you’re doing fine. No matter what.

One of my patients said she broke down in tears last week in the bathroom stall at her firm, after a partner tore into her for some screw-up. She chose the bathroom because of her firm’s “open door policy.” She wasn’t allowed to close her office door for privacy.

I asked her how everyone else at her firm was holding up.

She shrugged.

“Fine, I guess.”

According to her, about two-thirds of the associates were fleeing after three years. I doubt they’re all doing fine.

Lawyers are good at hiding things. Especially how they feel.

(more…)

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I can’t complain.

Really, I shouldn’t.

But I will.

Because it feels good.

We all need to ventilate anger.  That means containing it, taking it to an appropriate place (like a therapist), and putting it into words.

A patient told me last week about his elderly mother, who, after a long, healthy life, was struck down unexpectedly in her mid-eighties with a severe illness, and hospitalized for two months.

Now, recently released and confined to her bed, she is miserable – and making everyone around her miserable, too.

She has plenty of reason to be angry.  This illness was plain bad luck, and it seems unfair that it should strike a woman who has always exercised and taken care of herself and never before been sick a day in her life.

It’s a lot to adjust to.  She will require kidney dialysis every other day for the rest of her life.  Her limbs are swollen and painful. Her attention span is short, and she has painful headaches.  She was once an avid tennis player, but is now reduced to using a walker to get around.

The problem, my patient told me, is that his mother is taking her anger out on the people around her, specifically her long-suffering husband.  She barks at him, criticizes everything he does – essentially makes his life miserable.

I proposed psychotherapy, but my patient only shook his head.  His mother’s rule has always been self-sufficiency.  Asking for help is out of the question.  She survived the Holocaust, and she’s tough as nails.  It is a point of pride for her never to complain, and never to ask for any assistance whatsoever.

That’s a shame.  Admitting weakness can be a sign of strength.

The problem with my patient’s mother is that she’s filled with anger, but has no healthy way to express it.  Putting it into words – complaining – is forbidden to her.  Instead it leaks out as misdirected anger, which usually ends up aimed at those who happen to be closest to her but least deserve it, like her husband.

Since his mother absolutely refuses to speak with a therapist, I told my patient he’d have to fill that role – to try to be the therapist his mother refuses to see.  I gave him a few pointers.

First of all, he has to get her talking – and keep her talking.  That means staying syntonic – going her way, not offering any resistance to any of her thoughts and feelings, but encouraging them.  Active listening, or “mirroring” would help, too.  That’s a technique in which you repeat back snatches or paraphrases of what the other person is saying, so she knows you’re there, and that you’re paying attention.

Like this:

His mom – “I hate this damned walker!  It’s humiliating to be disabled like this!”

Him – “It must be tough for you to have to use a walker after always being so active.”

A couple more pointers:

He will have to monitor and contain his own responses to her.  It wouldn’t be very productive if he lost his temper in the middle of their time together and started yelling back at her.  I recommended he wear “emotional insulation” while listening to her.  He could have his reactions – anger at the outrageous things she might say, or fear at the terrible experiences she’d endured – but he would contain them so they didn’t distract from his mission.  He couldn’t lose track of the goal:  to let her vent her upset in a way that would provide her relief.

One final thing:  I told him not to try to problem solve.  His mother – and most people – don’t want advice.  They want to be listened to and heard.  Real problems don’t have easy solutions, and the person with the problem is best-positioned to find one if it exists.  The goal is to parallel process.  While he listens, she explains the problem – and in doing so, works out an answer on her own.

I warned him that it might take a while – maybe an hour, the length of a psychotherapy session – maybe several hours divided over multiple sessions.  But eventually, if he stuck with it and got her to vent some upset and unhappiness, he’d detect a change.  I would expect to see a lightening of mood, with a return of interest in other people.  She might suddenly snap out of her gloom and say, “wow – it’s good to get that off my chest. So how have you been?”

There are a lot of ways a psychotherapy session can play out.  One of them is simply a release of pent-up feelings.  It might not sound as inspiring as a breakthrough session in which the therapist produces a startling intellectual insight.  But sometimes just listening – good, focused, active listening – can make all the difference.  An hour of bitching and moaning to someone, who’s job is to listen, can feel good – and stop all that anger from leaking out or being discharged on some poor, unfortunate by-stander.

One of my patients said therapy sometimes feels to him like a psychic massage.  You walk out feeling relaxed, looser and ready to face the world.

That’s what my patient’s mother needs.  I hope he’s able to provide it.

We all need a good kvetch once in a while.  If you’re in a therapist’s office – or with someone who’s willing to listen and tolerate your feelings – I don’t see how it does any harm.

It might even help.

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How does psychotherapy actually work?

Good question.  The answer is interesting and has to do with how your brain works.

The basic idea of psychotherapy is that you take emotional content from a primitive part of the brain and bring it to another more sophisticated, thinking part, where it can be examined and understood.

Here’s a quick primer on the design of your brain.

Due to quirks of evolutionary history, the human brain contains three distinct parts, which evolved separately.

In the center, there’s a small, rather rudimentary brain.  It resembles the brain of a lizard.

Wrapped around that, a second brain evolved much later – the paleo-mammalian brain.  It resembles the brain of a dachshund, or any other warm-blooded animal.

Sitting atop these two brains, there is the cortex.  That’s the grey, wrinkly stuff that you probably think of when you think of a brain.  It’s much larger than the other two brains, and is unique to humans, having evolved only very recently.

Like all higher animals, you have five basic emotions:  anger, fear, caring, hurt and happiness.  They exist entirely in the two more primitive parts of your brain – the lizard and dachshund parts.

Your thoughts – and your sense of awareness – exist only in the outer, sophisticated brain – the cortex.

There’s a reason for this.  All animals feel some emotions, but only humans have higher consciousness.  We alone think. (Actually, it could be argued that dolphins and some higher apes do too, but I’ll set that debate aside for now.)

Anger and fear reside in the innermost, lizard brain, because they reflect the primitive fight or flight instinct.  Faced with a ferocious predator, a tiny lizard needed to reflexively know whether to get angry and fight, or get scared and flee for its life.

The other three emotions are located in the paleo-mammalian brain.  That’s because they relate specifically to childcare instincts.

A lizard lays eggs – lots of eggs, and it doesn’t invest much time in caring for its young.  But a mammal bears only a small number of live young, and its off-spring are helpless for a period after birth.  So while a lizard might ignore its own large brood of young (or even dine upon a few of them), a mammal, with its small number of helpless off-spring, developed three important emotions related to childcare:  caring, hurt and happiness.

These emotions, located in the paleo-mammalian brain, lead the parent to care for its young, love them, and find happiness in caring for them, or hurt if they leave before the parental bonds are detached.

That’s your emotions, explained.  Now for psychotherapy.

Speech, and communication in general, including non-verbal communication like art and dance and music, are located in the cortex.  Psychotherapy is talk therapy.  A therapist’s goal is to get you to put your feelings into words.  In neurobiological terms, the idea is to take emotional material from the two inner, primitive parts of the brain – the lizard and dachshund parts – and translate them into speech – forcing them through the neural passageways of the cortex.

In essence, the thinking you is forced to process material from the feeling you.

In Freudian terminology, the two inner brains are the “unconscious” (the superego and the Id) and the outer cortex is the “conscious self” (the ego).  By funneling primitive brain activity into communication, therapy forces the unconscious into consciousness, integrating the self.

It’s a bit like an intellectual holding a conversation with a lizard and a dachshund, which is why the process isn’t always easy, and can take a while.

In any case, it’s better than living unconsciously – walking around thinking you know what’s going on while a lizard and a dachshund are secretly operating the controls.

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Patients often arrive at my office complaining of feeling “stuck.”

“Stuck” means you’re caught in a stasis, balanced on the fulcrum between anger and fear.

On one side, there’s anger – frustration at not pursuing your dreams.  We all have dreams – that’s what drives us forward.  It is the most human thing in the world, and what makes living possible.  In the end, we all know where we’re headed (oblivion).  But we have the amazing human ability to ignore that, for the time being, and concentrate on that carrot dangling from a stick.  We want to chase it.

On the other side, there’s fear – old predictions from our past that warn us not to take risks.  Sometimes it’s what psychotherapists call an “introject” – an old voice, probably a parent’s – telling you that you can’t do it, that you shouldn’t expose yourself to the possibility of failure.

So you freeze up.  Stuck.

If you want to get un-stuck, it’s time to take a reckoning of your life.  Sound daunting?  Let’s make it easier.  Every life consists of three elements:  playing, working and loving.  We’ll take them one at a time.

Playing:  this is the fun stuff – enjoying yourself and relaxing.  Your hobbies.  The major challenge here is making friends – overcoming social anxiety and building a support system of people you trust and respect.

Do you have a network of friends you can count on?  Are they truly friends – people you can say anything to, and who feel the same way about you?

If not, social anxiety could be the issue, and it’s time to start thinking about becoming more conscious of your feelings around being with other people and sustaining an authentic contact with them.

Working:  despite rumors to the contrary, work is not something you do for money – you do it because it is a fundamental part of human life.  Your work reflects your essence.  It is what you “do” with your life, and what you leave behind you when you’re gone.

To know the work you want to do, you have to know who you are.  Discovering your work can be one of life’s most difficult challenges, but it must be tackled head-on.  Only you know who you are, and only you know your true calling.  Making that discovery can be the result of a long, honest conversation with yourself, and an exhaustive exploration of the world outside.  Eventually, when you find yourself smiling, and getting excited about getting down to work – you’ll know you’re on the right track.

Loving:  A satisfying relationship must be balanced – two whole people, not two half people, walking down a path together as equals, toward a mutual goal.  There must be attraction, trust and respect.  If you don’t have the relationship you want, or simply aren’t having fun in your current relationship, there could be a problem.  It might be time to ask yourself why you are where you are, relationship-wise, and whether it’s more about being stuck than addressing your needs.

Ironically, one of the reasons people get stuck is that they rush things.  Playing, working and loving are best addressed in order.

Your play – your hobbies and interests, and your friends – will lead you to the work you love.

Your work will help you discover who you are, and build your confidence to go out into the world to meet a partner.

If you try to skip a step – rush into a career before you’ve discovered what you enjoy doing for fun, or hurry into a relationship before you’ve found a satisfying career and know who you really are – it could contribute to feeling stuck.

Where can you get un-stuck?  Psychotherapy is designed to get you talking to yourself, hearing yourself, responding to your own needs.  If there’s anyplace in the world where you can get down to the work of breaking a stasis, it’s sitting in your therapist’s office, putting your thoughts and feelings into words.  If you’re feeling “stuck” – it’s probably time to call your therapist.

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Two famous pilgrimages:

The Journey to the West – the legendary voyage of the Buddhist monk, Xuanzang, to India to bring the Sutras back to China and establish Buddhism there.

Another, less celebrated Journey from the East – Freud’s parents, Ostjuden (Eastern Jews), emigrating in a horse cart from the ghettoes of East Galicia to Vienna.

The Silk Road channeled a rich current of human activity across Asia from China to Europe.  Along with the merchants and their caravans of camels laden with spices and luxuries, ideas flowed back and forth across the continent.  In the center, there was India.

It was in India that the powerful concepts of Buddhism originated, then spread East, to China, and West – ultimately, perhaps, to Freud’s office in Vienna, where so many of his ideas about living more consciously seem to echo Buddhist philosophy.

I’ll touch on two issues:  first, why Buddhism doesn’t have to be intimidating, and second, some interesting stuff it has to say about our daily lives:

You don’t have to think of Buddhism as just a religion.  The ancient India of around 500 B.C.E.,where the Buddha, Siddhartha Gautama, lived, was a lot like the historically contemporary Ancient Greece – the existence of a pantheon of gods and goddesses was taken for granted.  Buddha wasn’t interested in being a god – there were already plenty of gods.  His goal was achieving human enlightenment – a condition of peace and serenity.  Over thousands of years, Buddhism spread all over Asia and splintered into a thousand different schools and practices.  Some of them espouse devotional practices, complete with temples and incense and kowtowing before fat, smiling statues.  You can disregard much of that, and concentrate on the ideas.

To give you a taste of what I’m talking about, here’s the most famous single story in Buddhism.  There are a dozen variations, but this covers the basics.  See if it doesn’t leave you thinking:

The Buddha was born a wealthy prince.  Upon his birth, a fortune-teller issued a prediction that the young prince would eventually renounce all his wealth, and become a monk.  To prevent this, his father, the king, ordered that Siddartha be prevented from leaving the walls of the palace.  For 29 years, the prince was permitted to see only wealth and beauty.

Finally, perhaps on an impulse – some say a mischievous god was involved – Prince Siddhartha escaped for the first time outside the palace walls. Almost at once, he saw four famous sights, which changed his life forever:

He encountered an old man, and learned that he would not remain forever young.

He saw a leper, and learned of the existence of suffering and disease.  

He saw a corpse, and knew that one day he, too, would die.

He met a monk, and realized there were other paths to joy than the pleasure garden within the palace walls.

From that day forward, the Buddha became a monk, devoting himself solely to the search for enlightenment.

I told you this was a powerful story.

Opening your eyes to the world around you, and the emotions you carry within, stirs something in the human soul, which could change your life forever.

That’s what we do in psychotherapy.

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By all accounts, anyone who knew John Lennon learned to expect the unexpected – and sometimes the unpleasant.  That’s just how John was.

One minute soft and tender.  In a blink, harsh and cruel – with a legendary acid wit that didn’t seem quite as witty when it was turned on you.

The man who wrote “Imagine” could also write a song called “How Do You Sleep” and address it to his oldest friend.

Lennon was an example of the borderline pattern – a very common pattern of behavior that shows up, to some degree, in most people.  A therapist I used to work with defined borderline as “he loves you…he hates you…he loves you…he hates you,”  and that might still be the best definition I’ve heard so far.

The borderline pattern is simply an emotional gyration between vulnerability and rage.  One minute you’re opening up and seeking love – the next you’ve clamped down the defenses and launched deadly missiles.

In Lennon’s case, it isn’t difficult to see the basis for the pattern.  All Lennon fans know the familiar facts:

The father, Freddie, deserted the family when John was an infant.  The mother, Julia, warm and loving, if emotionally immature and a bit unstable, raised the boy for a few short years.  When John was barely kindergarten age, Julia, unable to balance her own life with the responsibilities of parenting, left John with her stuffy, emotionally distant sister, Aunt Mimi.  Julia re-emerged as a larger presence in John’s life when he started his early teens, playing the role of an adored, playful older sister more than a mother…only to be killed suddenly when John was 18, struck down by a drunk driver.

The pattern is hard to miss:  abandonment to nurturing to abandonment – back and forth and back and forth.  Lennon lost his father, but had his mother.  Then lost his mother.  Then had his mother again.  Then lost her again.  She adored him, but couldn’t keep him – so back he went to Aunt Mimi.  Then she adored him again, but died suddenly, leaving him utterly bereft and as afraid to trust love in any form as he longed for the love he’d once cherished.

All this set up a gyration from seeking love, and opening up emotionally – to closing down, spitting sharp put-downs, and even violent, often drunken, outbursts.

The borderline pattern is usually handed from parent to child.  The parent exhibits this switch from one extreme to the other, and the child, attempting to adapt in response, begins to gyrate, too.  In Lennon’s case, the events of his childhood were extreme, involving actual abandonment and the sudden death of a parent – so his pattern was particularly severe.  By all accounts, John could be a very difficult person to deal with.  His son Julian makes that clear in describing his few memories of his father, and even Sean, who barely knew his father, described him as having a strong temper and behaving unpredictably – affectionate sometimes, cruel and angry at others.  The man who wrote “All You Need is Love” was indeed warm and loving and sincere and idealistic.  He could also be vicious.  That was the fearful child in John, fighting, unconsciously, to survive in a world fraught with the peril of abandonment and betrayal.

The best approach to the borderline pattern in psychotherapy is to model stability.  The therapist becomes a stable object.  Every week, the same thing – safe and predictable, and utterly unlike the patient’s childhood world.

If I worked with John Lennon, I would seek meticulously to be the same stable object each and every time he saw me.  I would let him know I welcomed his anger just as I welcomed all his emotions, so long as he put everything into words instead of going into action on unexplored feeling.  I would make certain he never received a response from me other than acceptance and support.  The goal at all times would be to flatten out the gyrations – to offer a Middle Path, the path of the Buddha, the path of moderation.

Just like Pavlov’s dogs, you tend to make predictions based upon your past experiences with the people in your life.  That’s all John Lennon was doing.  He knew the world was not to be trusted because it had betrayed him, cruelly, when he was a child.

But, as they say on Wall Street, past performance is no guarantee of future return.

I would make sure Lennon knew I wasn’t like the people in his childhood.  I would be there, the same old People’s Therapist, each and every time – offering support and understanding.

Perhaps that’s what Yoko, his second wife, was able to bring.  She did appear to offer a measure of serenity in his final years.

Of course we’ll never know the man John Lennon might have become.  Or how learning to moderate the gyrations that unconsciously governed his behavior for so long might have affected his genius as a songwriter.

We are all poorer for that loss.

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It seems like Tiger Woods could use a visit, doesn’t it?

Everyone agrees he’s had a rough month.

So let’s go there.  What if Tiger showed up in my office?  What could the People’s Therapist do to help?

Patients often show up at my door when they’re in crisis.  Many people feel – wrongly – that they have to hit bottom before they call a therapist.  I’m guessing Tiger is feeling pretty shattered at the moment.  It would have been better if he’d shown up a few months or years ago, when he was in better shape, before all this bad publicity came down on his head. But you take ’em how you get ’em, and right now Tiger needs help.

My goal would be to create a safe space, and employ specific techniques designed to get Tiger talking, honestly and openly, as much to himself as to me.  We’re there to explain, not to blame.  He’s had enough of that to last a lifetime.

What I notice first about Tiger is that so many people hate him.  Mud is being slung from all sides, including the front covers of the supermarket tabloids, and even stuffy, anonymous Accenture, the management consulting firm, has dropped him as their representative. He can’t seem to do anything right lately.  It all blows up in his face.

This situation seems especially odd since Tiger is someone who’s spent his entire life trying to please.

That’s the root of the problem.

Tiger Woods grew up learning that good things would come to him if he pleased everyone.  As the greatest golfer in history, he had that lesson amplified by an apparently endless positive feedback loop.  He was able to consistently wow us, and we, in return, showered good things on him – money, celebrity, houses, boats, cars.

The problem was that Tiger never made the separation into adulthood.  That’s when you stop functioning as a child and start functioning like an adult.

If we’re operating unconsciously, we will all relate to the world around us as a child does:  the way we operated within our families – mostly the way we related to our parents.  For Tiger, that meant seeking to please, at all costs.

When you function as a child, you function as a parent-pleasing machine.  A child has to please the parent.  Like a baby bird in a nest, a child must scrupulously attend to pleasing its parents because it depends upon their care for survival.

An adult is different because he is self-sufficient.  He can feed and clothe himself.  He can decide for himself who his best self will be.  He can, like Nietzsche’s uber-mensch, decide on his own morality and ethics.

Let’s get back to Tiger.

Following the standard, societally-acceptable pattern, he married a beautiful woman and stayed faithful and utterly content in that relationship.  To all outside appearances, he was a paragon of virtue, a model citizen – exactly what we like to see.

Behind the scenes (at least, according to widespread allegations) we now know that wasn’t the case.  In reality, Tiger was cheating on his wife and acting out sexually – with multiple other women, including prostitutes.

Why would he do such a thing?

Because he wanted to.

The real problem is that Tiger was ignoring his own needs in order to please symbolic parents who had blown up into the entire world.

It is perfectly legal and acceptable for a man to sleep with just about any willing partner he chooses.  It’s called being single.  The only problem, for Tiger, was that he was doing all that and pretending to be happily married at the same time.  That meant he was lying to people, living inauthentically and damaging his relationship.  That was cruel and inconsiderate to all concerned and that’s why everyone seems to hate Tiger right now.

All Tiger needed to do was stop pleasing everyone else – acting like a child – and ask himself what he really wanted.

If he wanted to be married, which means being faithful to his wife, he could choose that.

If he wanted to be single, which means free to experiment sexually to his heart’s content, he could choose that.

But he had to make up his mind.

Monogamy is always a trade-off, but it’s not something that should be imposed on anyone.  Successful monogamy is really a form of mutual fascination.  Two people grow so fascinated with one another that they lose interest in sex with other people.  They come to see that an investment in one another will pay a richer dividend.

Tiger, on the other hand, created a seemingly “perfect” marriage to please the outside world.  Inside, he wasn’t ready.  I’m guessing he was angry, at some level, that he had to be what everyone else wanted him to be, all the while forced to sneak around behind everyone’s backs to get what he felt he truly needed and desired.  In the end, that situation ended up hurting everyone and making no one happy.

My work with Tiger would concentrate on making him conscious of his right to be an adult, and take care of his own needs first.  If he wants to be single and date many women and experiment with freedom, that’s okay.  The key is that he live openly as his authentic, best self.

My guess is that Tiger will take some time to explore his sexuality with a number of women, but that it will be open and honest this time round.  Eventually, he’s likely to find someone special, and monogamy will be a natural expression of that fascination with a special partner.

Tiger doesn’t have to change who he is.  He has to be more who he is – to trust his best, most authentic self, and simply be, as an adult, with no more pleasing others, and no more lies.

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