Psychotherapy Blog

Once upon a time and many years ago when I was a very new therapist, I worked with a client who had completely made herself up. A lot of things never added up with her. For starters, there was her presenting problem. Some days she would report a diet of jelly beans (not many) and carrots, and yet she was never low weight. But since clients with eating disorders are so often metabolically out of sync, it didn’t seem completely unbelievable...

A close friend of mine is a wonderful therapist, a child of the 60s, a gifted man, large-souled, big-hearted and wise. His practice nourishes him and is saturated with life. He is committed to a worldview that eschews anything close to greed. “I won’t ask my patients for more, at least not if I can avoid it,” he says. “Often I will wait years to do it.” My friend’s position makes perfect sense to me. He is a thoughtful and principled...

There’s a beleaguered mom on the couch in my office, and she’s feeling skeptical about my idea that she needs to “double-up on self-care.” She shakes her head—tosses it—and says, half-pitifully/half-defiantly: “Even if I had a few minutes alone, I don’t even know what to do to take care of myself. All I want is to sleep. Creativity is not even really a need right now—it’s like wishing for the moon. I just want to work, pick my kids up...

Although we have evolved many schools since Freud articulated psychoanalytic theory at the turn of the 20th Century, in almost all of them conspicuous analytic features remain. These are so familiar that for the most part they exercise their dominance without our being aware of them or their origins. We may think psychoanalysis has been discredited and that almost no one practices it any longer, but there are ways psychoanalytic theory is present in our listening and thinking because of...

In my work with clients who were severely traumatized in childhood, I sometimes feel hopeless in helping them to address and deconstruct their inner critics. I feel daunted by the viciousness and incessancy of their self-attack. When a child is relentlessly rejected by contemptuous parents, she mimics them and learns to obsessively scorn herself. Like them, she focuses only on her defects and deficiencies; like them she radiates hate and scorn at herself. Her superego grows into an outsized critic as...

On this past Sunday’s broadcast of “Weekend Edition” on National Public Radio, the focus was on the 50th anniversary of Betty Freidan’s The Feminine Mystique. In this book Friedan raged against the status of women in the 1960s. Although millions of people have read this feminist manifesto, it seems very few presently understand how anger in general and Friedan’s anger in particular could be a source of insight, motivation, and personal and social transformation. Anger is an emotional state that has...

Two statements from the Dalai Lama suggest a conflict between the approach of Buddhist meditation and the type of self-awareness we develop in psychotherapy. The first statement has fascinated and puzzled me for decades. A friend, who meditates regularly, repeated to me that the Dalai Lama had said the following in conversation with an American psychiatrist: “When someone has been shot with an arrow you psychologists ask how the arrow got there, who shot it, how long ago, with what...

Lisa hefts herself heavily up the stairs to my office. She must come up two feet to a stair, like a small child. She is breathless by the time she gets to my office and has to take a few moments to collect herself. As she settles in, I realize she has gained even more weight in the few weeks since I last saw her. She is huge, solemn, powerful, inert. Once she is seated, nothing moves but her head and...

In Greek traditions, Medusa is the notorious stone-cold killer who was well known for turning people into statues. Her reputation became so brutal that she was often depicted as evil itself. However, like everyone who eventually comes to hurt others, Medusa had a life before she was the snake-haired statue-maker, but few seem to remember that. This is that story: Medusa was a stunningly beautiful young woman. She was so striking, in fact, that everyone around her pursued her and longed...

The couple in my office is connected mostly by the spaces they hold between them. Sitting on the loveseat in my office, they do not touch, although their arms, legs, and elbows and hands shift in an unconscious echo of each other’s movements. They are not so much mirroring each other as performing an elaborate dance of avoidance and retreat, their bodies’ dialogue spoken even through their many silences. On a larger scale, the same thing happens where they live:...