Category: Therapeutic Issue

The Rolling Stones and the “Age of Anxiety”

Posted on by Psychotherapy.net Team

As I tap away on the first installment of a my little blog about mental health in music, I sit only a hundred yards or so from a Chinese restaurant in my little East Texas town where, legend has it, Mick Jagger was at one time known to dine on occasion with his former paramour, model Jerri Hall. Hall is or was the owner of a ranch in the general vicinity, according to local lore. In any case, while wondering if Mick and I may possibly have in common a love of the establishment’s sumptuous Pu Pu Platter, I find myself also musing upon the 1966 Rolling Stones classic, “Mother’s Little Helper.”

This twangy two minute and 40 second tune is a scary short story of ennui and substance abuse set to music; complete with the trendy-at-the-time spooky sitar riff (which according to some experts may instead be a rather less-exotic electric 12 string guitar.) It tells the tale of the growing disenchantment of a mid-century suburban housewife and her descent into a rather tenuous pharmacologic subsistence. The mother sung of, it seems, has a doctor who writes her prescriptions for a “little yellow pill” even “though she’s not really ill. ” The listener meets the doleful protagonist at the point she has begun to rely more and more on this ostensible remedy for her world-weariness and to make it through her “busy dying day.”

The medication Jagger and the song’s co-author Keith Richards mention by size and color but not by name can be pinpointed by those details, the song’s context and a little knowledge of cultural and pharmaceutical history as Valium in 5mg dosage. A blockbuster product launched in 1963, the same year Betty Freidan published her best seller The Feminine Mystique, Valium promised prompt relief from what Friedan’s book called “the problem that has no name.” The pharmaceutical industry and advertising wizards of the era took a shot at naming it anyway and came up with “psychic tension.”

As the song progresses, Jagger disdainfully warbles on about the mother of the title exceeding her dosage (“Outside the door, she took four more”) after pleading for what probably was an early refill (“Doctor please, some more of these”) and alludes to dark consequences if things keep on this way. And in point of fact, Andrea Tone, in her 2008 examination of America’s troubled love affair with tranquilizers post WW II, The Age of Anxiety, seems to feel that the lady in the song is a goner. The “busy dying day,” Tone suggests, is actually a day in which mother’s busy dying. However, absent co-ingestion of potentiating substances, medical literature finds benzodiazepine overdose to generally be associated with low levels of mortality. (Not that it is a “safe” drug to consume counter to a prescriber’s instruction by any means–no drug is.)

But nevertheless, the wife and mother (the primary social constructs that much of society at the time, and probably she herself would employ in her cultural categorization) sounds as though she is falling victim to the all too common misconception that prescription drugs are harmless. Since her trusted doctor blithely prescribes her little yellow pills, and he in fact keeps giving her more, they must by definition be safe. If a little is good a lot is better.

While the song is a fictional vignette, it is perhaps rather representative of the negative potential of the power differential between physician and those in the patient role (particularly suburban homemakers) in the period before such considerations were even a matter of concern in care delivery. In a 1979 qualitative study seeking to determine social meanings of tranquilizer use, researchers Ruth Cooperstock and Henry Lennard identified “the culturally accepted view that is the role of the wife to control the tensions created by a difficult marriage” and an accompanying “implicit” acceptance “that drug use is justified in order to accomplish this.” All gender politics aside, mother’s negative feelings do abate for a time after the pills are taken. It’s just that she’s swallowing more and more pills, more and more often.

Yet sooner or later the haze lifts, albeit briefly, and there remains, as there always remains, that same unappreciative spouse, those same unyielding children and that more recently arrived acrid stench of burnt steak and cake resulting from stuporous attempts at cookery. All of which drive her to the distraction of her little yellow pills and further along the road to overdose and subsequent rest cure in a nearby sanitarium (this song is perhaps backstory for The Stones’ earlier hit, “19th Nervous Breakdown”). After all that there may indeed be “no more running for the shelter of a mother’s little helper,” at least not in the form of diazepam. The song’s good doctor would probably just scribble for something newer and “safer” when mother’s discharged with a clean bill of health. After all, she “isn’t really ill.” She’s just suffering from an unwanted buildup of psychic tension that can be washed away with the right chemical, as is the waxy yellow buildup on her lime-green kitchen floor.

The underlying human desire to avoid or extinguish psychic distress is of course much older than even The Rolling Stones (formed circa 1962). From the beginning of time, people in pain have sought what frequently turn out to be illusory or half-measure methods (e.g. a bottle of little yellow pills) to escape it. Often doing so to their greater disadvantage. Another Pop (psychology) Icon R.D. Laing, who somewhat coincidentally gave refuge to a confused gentleman who believed himself to be Mick Jagger at one of his “therapeutic communities” in the 70s, had this to say about such evasion, “There is a great deal of pain in life and perhaps the only pain that can be avoided is the pain that comes from trying to avoid pain.”

Louis Cozolino on the Integration of Neuroscience into Psychotherapy—and its Limitations

Posted on by rezendevknowfully.com

Neuroscience or Neuro-psychobabble?

Sudhanva Rajagopal: Lou Cozolino, you are a psychologist and professor of psychology at Pepperdine University, where you were a teacher of mine. You’re a prolific writer and researcher on topics ranging from schizophrenia, child abuse, the long-term effects of stress, and, more recently, neuroscience in psychotherapy and the brain as a social organ.As a clinician in training, it seems like there is a lot of neuroscience talk out there in our field, and it gets used to legitimize anything from specific interventions to whole theoretical orientations. My first question to you is, for the clinician in training, how do you recommend that we see through the noise of all that to what is actually helpful in the room with a client? How does knowledge of neuroscience play out in the room and what is actually important for the clinician to know?

Louis Cozolino: There are two main realms where neuroscience can aid clinicians. One is case conceptualization and the other is for clients who aren’t really open to a psychotherapeutic framework or an emotional framework. For them a neuroscientific explanation or conceptualization of their problem is often something they can grasp while they can’t or won’t grasp other things.

People who learn a half a dozen words about neuroscience think they’re neuroscience literate.

But there’s so much psychobabble and neuro-psychobabble out there, and the thing is if you say something is the amygdala as opposed to saying it’s anxiety or fear-based, you haven’t really upgraded the quality of the discourse. You just substituted one word for another. So the risk is that people who learn a half a dozen words about neuroscience think they’re neuroscience literate.

Learning neuroscience takes dedication. It takes work to get beyond the cocktail level of conversation and clichés. It took me ten years to feel like I had any sense of what was going on and I studied it pretty intensively. So I think we all have to be careful, but even more importantly, just because you know some neuroscience doesn’t mean you know anything more than the therapist who doesn’t. It’s really about how you use that information to upgrade the quality of the work you’re doing.

SR: In your book, Why Therapy Works: Using Your Mind to Change Your Brain, you say that science in many ways is just another metaphor. Do you think there are dangers to people using neuroscience to legitimize their work?
LC: Well, sure. There’s a fellow, Daniel Amen, who does these SPECT scans of people and he’s been selling them for thousands of dollars for probably 20 years now. It’s hard to know whether any of his data has any meaning. All we know is he’s made a hell of a lot of money doing them. The danger is in selling things before you know that they have any legitimacy, so you have to watch out for snake oil salesmen just like you do when you’re buying carpets and used cars.
SR: So how do you recommend that someone like me goes about finding and learning about neuroscience in a way that’s helpful? How do I avoid the snake oil salesmen?
LC: It’s important to realize that knowing neuroscience doesn’t make you a good clinician—in fact it doesn’t make you any kind of clinician at all. So I would say for beginning therapists, it’s probably best not to pay too much attention to neuroscience.Learn a few things about it but focus on getting the best supervision you can in a recognized form of psychotherapy—psychodynamic, cognitive, behavioral, family systems, etc. And avoid the passing fancy of all of the new therapies; every day there’s a new therapy with a new set of letters in front of it.

SR: Yeah there are so many different kinds of therapies these days.
LC: Try to learn something that isn’t just a fad, because the fads—I’ve watched hundreds of them come and go over my years. But if you cleave to psychodynamic training and cleave to cognitive behavioral, Gestalt, family systems training—those are the things that you can hang your hat on. Then you can learn the fads to add to your tool box. The fads are very sexy and they create the illusion of understanding because they’ve got fancy terms and nice workbooks and such, but really you’re not a thinker when you’re doing those things, you’re more of a mechanic.Now neuroscience is sort of like a sidecar to conceptualization, but you’ve got to remember the motorcycle is the real tried and true way of thinking about clients. You know, what is a particular problem? What is mental distress or mental illness? Where does it come from developmentally and what are the tried and true ways of approaching it and treating it?

Every Therapy is Embedded in Culture

SR: Speaking of tried and true ways of thinking, you say in your book, “Psychotherapy is not a modern invention, but a relationship-based learning environment grounded in the history of our social brains. Thus the roots of psychotherapy go back to mother-child bonding, attachment to family and friends, and the guidance of wise elders.” My question is, where do you think psychotherapy fits in to the context of healing traditions that have been around for millennia?
LC: Well, I think one thing that seems to be different over the last hundred years in psychotherapy is a kind of structured recognition of the fact that the therapist is imperfect and contributes in a lot of different ways to the problems. The tradition of wise elders was one of an authoritarian stance: This is the truth and I’ll take you on this journey with me to change you into my likeness. To whatever degree psychotherapy has evolved past that has to do with the self-analysis of the therapist and the recognition that whatever pathology exists in the relationship between client and therapist, some—hopefully not the majority, but some—pathology in the relationship comes from the therapist.That type of recognition is a step forward. There are probably some steps backward too. Often psychotherapy is ahistorical and acultural—or at least tries to be—but every therapy is embedded in culture. There is a kind of pretense about an objective scientific stance that is just a fantasy. So in some ways, wise elders in a tribal context with a long history are probably advantageous for some people as compared to psychotherapy.

SR: I was flipping through the index of your book and noticed the word “culture” appears exactly once, though you do talk about the wisdom of the ancients, about Buddhism and Confucianism and some of the Indian traditions. Seems to me that once we start relying on these kind of generalized, evolutionary, and biological forces as explanations for things, there’s a risk of painting people’s lived experience with a pretty broad brush. What’s your take on the importance of culture as it relates to neuroscience and psychotherapy?
LC: From an evolutionary perspective, a basic principle is biodiversity, and culture is too blunt an instrument to understand people because there are so many differences within culture. I think in terms of every individual being an experiment of nature. Every family is a culture in and of itself, and the more different someone’s cultural background is from mine, the more there is for me to learn. I think that culture needs to be interwoven into every sentence of every book, not just included in some special chapter of a book.
SR: From my point of view, many of these older cultural practices have been repackaged and rebranded as psychotherapy theories and techniques. The “mindfulness revolution” and transcendental meditation are based on ancient cultural traditions, but they are marketed as if they are especially effective because they are “new” and “evidence-based.” What is your stance on that?
LC: Having studied religion and philosophy and Sanskrit starting back when I was in college in the 70s, the self-awareness of meditation has been part my worldview since long before it became a cottage industry. But even back then there was the Maharishi Mahesh Yogi and the Beatles, and it was coming into the cultural context. Now people have figured out how to package it as a way to sell more therapy, which isn’t all bad, but runs the risk of becoming “the answer.”

I think we’re in a race between global destruction and global consciousness, so we’ll see who gets to the finish line first.

What I’ve been hoping for since I first discovered Buddhism in the 1960s, is that as the world gets smaller and as people from different cultures communicate more, the wisdom of the ancient Eastern philosophies will be interwoven with Western technology and we’ll come to some higher level synthesis of understanding and consciousness. I think we’re in a race between global destruction and global consciousness, so we’ll see who gets to the finish line first.

SR: Can you say more about that?
LC: Well, it’s a slow evolutionary process for the types of awareness that people four or five thousand years ago discovered in India and Tibet, in China, in Japan, to penetrate Western culture. The Western world view is so different—for so many people it’s almost impossible to conceptualize an internal world; everything is external. Everything is about creation, growth, and, in a more destructive sense, conquering and genocide.So there are forces of destruction—of each other and of the planet—on the one hand and then there are the forces of consciousness and wholeness and a sense of oneness of the species on the other. So will we understand that we’re all brothers and sisters on a spaceship before we destroy the spaceship?

“There only needs to be a piece of you that’s a psychologist”

SR: How can psychotherapy play a positive role in this race you’re talking about? Or psychotherapy as we know it in the Western world?
LC: Well, one of the problems with psychotherapy as I see it is that psychotherapists tend to be sort of passive—they retreat from the world of leadership and create very insulated relationships in their consulting rooms. But for the field of psychotherapy to have any impact, it has to be expressed politically and socially. The types of ideas and theories that we’ve researched and studied, like the importance of early child rearing, self-awareness, authoritarian personalities, positive psychology and so much else, need to become part of political discourse both to elevate it and also have an impact on how resources are distributed.

One of the problems with psychotherapy as I see it is that psychotherapists tend to be sort of passive—they retreat from the world of leadership and create very insulated relationships in their consulting rooms.

Evolution is a slow, meandering process. All you have to do is watch the Republican debates to see that. It reminds me of junior high school in the Bronx in New York where we used to engage in chop fights, which was all about humiliating the manhood of other guys just to get a one-up. It doesn’t make me optimistic about the evolution of consciousness, but we’ll see what happens.

SR: I want to move onto something you said in your preface that I liked a lot: “Like monks and soldiers, therapists of all denominations assume that God is on their side.” What do you think are the limitations of psychotherapy and where does it come up short against the human condition, cultural walls or seemingly immovable, systemic injustice? In other words, when do we have to admit that psychotherapy is just not helpful or effective?

LC: The risk with psychology and psychotherapy is that it can lean too much in the direction of helping people tolerate rather than fight against oppression. Self-awareness and self-compassion are crucial experiences and skills that we foster as psychotherapists, but there needs to be a balance there. You can’t become too much of a psychologist. There only needs to be a piece of you that’s a psychologist and there’s another piece of you that has to be willing to go out and fight for systemic change.

As I said before, psychologists tend to watch from the sidelines, and that’s why as a field it has relatively little impact. In fact, the profession gets a lot of bad press because there are plenty of famous psychologists who do staggeringly immoral and unethical things. They are the basis of the cartoon version of the therapist nodding their head and going, “uh huh.”

SR: You talk about psychology as being an essentially solitary profession. Are there people you can think of who aren’t standing on the sidelines?
LC: Psychologists you mean?
SR: Yeah, psychologists.
LC: No. Can you?
SR: Not off the top of my head.
LC: Psychologists are really good at telling other people they should do something. It’s sort of like life by proxy.
SR: Indeed.
LC: Another problem in psychotherapy is a lack of appreciation or respect for anger; anger is always something you’re supposed to manage. Or you’re supposed to learn how to behave appropriately in society, but that’s not always an appropriate response, especially if you’re a member of an oppressed group. It’s really important sometimes to go on picket lines and carry bricks and defend yourself and make a lot of noise.I very much respect the Black Lives Matter movement and I watch them in these Trump rallies, and they’re getting pushed around. It breaks my heart because it reminds me of a lot of bad memories from childhood during the Civil Rights Movement. And I’m sure you’ve seen pictures too of what happened in India with the British, of people being hosed and slaughtered. There’s a tendency in human behavior to objectify differences and we really need to fight against and not tolerate that. I’m hoping that, given that Trump is consolidating and activating the anger of people in this culture against immigrants and foreigners and God knows what else, that it also energizes the liberal base and brings out a new progressive movement as well.

SR: Absolutely, but this idea of psychologists carrying bricks and taking up arms seems really at odds to me with this image we have of psychologists as dispassionate observers, people who are sitting in their therapy chairs saying, “uh huh.”My interests lie in political action as well and I do remember, at least from my dad’s generation and my grandfather’s generation, thinking about British rule and the independence movement in India and the idea of people really taking a stand. But that doesn’t seem like something psychologists really do. Even in the room with a client, we’re not taught to take a stance on things, you know?

LC: In fact it’s the opposite. Everything that we believe is interpreted as countertransference and non-neutral. It creates a real rift in people. It’s hard to imagine that a lot of younger psychologists with any sort of a political drive would be attracted to psychology. It will continue to attract people who want to stay on the sidelines in the world or avoid the conflict.
SR: How is that going to change?
LC: In truth I don’t know. In the 60s we had something called community psychology, which was very radical at the time and which still exists, but it’s not prominent at all anymore. One of the main focuses of community psychology was to identify those people in the community or in the tribe that other people went to for assistance—people like hairdressers and bartenders and cab drivers. These are the people that folks in trouble tended to talk to, so community psychology emphasized educating people in the community that were sort of hubs of interaction. The field has gotten so much more insular since then.

Transitioning From a Beta to an Alpha

SR: I want to go back to something you said about anger that intrigued me. I’m just thinking back to discussions and supervision I’ve had in training, and whenever anger comes up, you’re told there’s something “behind” the anger. You know, there’s shame behind the anger, or sadness behind the anger. How do you feel about anger as just a primary kind of emotion? And do you think it has value both for the therapist and for the client?
LC: If you’re going to become empowered, if you’re going to transition from a beta to an alpha in your life, you really need to be able to get back in touch with your anger because it can be very propulsive, very helpful in life. It evolved along with caretaking and nurturing because it’s not just necessary to feed and nurture babies, but to protect them.Anger is the only left-hemisphere emotion that we consider negative, but anger is a social emotion, unlike rage. It can be engaging, relational, constructive. In order to combat the social programming that leads to shame, we have to get at least somewhat angry—at both the voices in our head and out in the world that shame us, disempower us, keep us from speaking up.

When I think of somebody like Gandhi or Martin Luther King, Jr., I think of the courage it took to walk into angry crowds. It’s so moving to me and such a powerful act. We can’t just be passive about these voices in our head and in society. We have to get angry because our anger and our assertiveness and our power are all interconnected. If you give up your anger, you give up your power.

SR: Agreed. Tell me a little bit about your idea of the social synapse.
LC: The more I studied different physiologies, social psychologies, organisms, the more I realized that there is a very complex highway of information that connects us via pupil dilation and facial expression and body posture and tone of voice, and probably a hundred things that we haven’t even discovered yet.What we’re doing in psychotherapy, and in any relationship where we’re trying to be soothing and supportive and nurturant, is connecting across the synapse between you and someone else. You’re trying to create a synergy between the two of you and have an effect on their internal biochemistry that enhances their physical health, their brain development, their learning. If you’ve ever been with a really good teacher, you know that in part because you feel a lot smarter because you’re connecting with someone who’s stimulating your brain to work better. If you’re with a bad teacher, you feel dumber, and you get pissed off and angry. And there are not a lot of good teachers out there so you’ve got to cleave to the good ones.

But also there’s a different chemistry between different people. Someone who’s a good teacher for one person may not be a good one for another. Same thing with therapists. Every therapeutic relationship creates a new organism—a dyadic field— and sometimes it works and sometimes it doesn’t. The chemistry part we often don’t have any control over.

SR: Going back to the brain and neuroscience, where do you think we are in right now in the field and where are we headed?
LC: Well, we’re all over the place in brain science, but there is a great deal of focus right now on genetics. In other words, looking at the relationship between experience and interactions and how the molecular level of the brain gets constructed and changes over time in relation to the others and the environment. I think that the translation of parenting and relationships in psychotherapy into actual protein synthesis and brain building is an incredibly complicated but very important paradigm shift that is going to be playing out probably over the next century at least as we uncover those things.Another shift in neuroscience is getting past the phrenology of looking at individual brain regions related to specific tasks and starting to look at these new technologies that measure brain connectivity. In other words, how do different areas connect to regulate each other and synergize? The next step will be figuring out how two or more brains interact and stimulate each other.

I don’t know where the technology to research that is going to come from but I think it’s on the horizon. We’ve got to get beyond thinking about brains as individual organs and think about how they weave into relational matrices so we can understand human connection and have a scientific view for the types of things that Buddhists and Hindu meditators and Tibetan scholars have been thinking about for the last several thousand years or so.

Why Does Neuroscience Matter?

SR: How would you explain to an existential psychotherapist why these advances in technology and in brain science are at all important to what they do?
LC: I don’t know if they are important to what they do. I don’t think neuroscience is more important than Buddhism—it’s basically just another narrative.
SR: Interesting.
LC: It’s just another way of looking at things. Think about when you’re at a museum looking at an exhibit and you’re walking around it trying to experience it and appreciate it from a number of different angles.That’s pretty much what reality is. We walk around it and we have these different ways of thinking about it and explaining it that are partially satisfying and partially unsatisfying. Buddhism is incredibly satisfying a lot of the time and very unsatisfying some of the time. So when you get bored with one way of looking, you want to look at something in a different way. For me it’s interesting to combine and integrate different perspectives but I don’t think that you have to subjugate one to the other.

In the 1950s Carl Rogers was talking about how to create a healing relationship. Fast forward 65 years and now neuroscience is discovering pretty much what Rogers was talking about. Am I better off talking about it from that perspective than listening to Carl Rogers? I don’t know. But it makes me appreciate what Rogers says even more and in a deeper way when I can see it from this scientific perspective.

SR: That makes sense.
LC: If Buddha were alive, he’d say, “Of course,” right? “There’s 5,000 research studies you did, but all you needed to do was read the Sutra and you would have figured it out.”But I think it’s interesting to just keep learning about life from as many points of view as possible. When have your read enough novels?

Each novel you read is a new way of capturing the universe, and they’re entertaining and stimulating and make you feel human. I feel the same way about the sciences, which is why I love reading E.O. Wilson’s work on ants, because I learn a lot about humans by reading about ants. So many things we do are very ant-like. Plus, ants are interesting.

Nobody Has the Answer

SR: Ants are very interesting. That’s a great way to look at it and I completely agree. Moving away from neuroscience for a moment, I’m curious about how your clinical work has changed over the years.
LC: It’s changed constantly. When I started as a student of pastoral counseling at the Harvard Divinity School, Carl Rogers was one of my teachers, so my first real training was Rogerian. The reason I got interested in counseling in the first place was reading Fritz Perls’ Gestalt Therapy. Then when I ended up at UCLA I realized you have to learn cognitive behavioral therapy whether you like it or not. So I was trained in that. I did a couple of years at a family therapy institute in Westwood in L.A. My supervisors were psychodynamic and my therapist at the time was a Jungian, and then I had a couple of other therapists who were psychodynamic and Gestalt.I was working with people who had been severely traumatized as kids, so I got interested in neuroscience through a study of memory, trying to figure out what the heck was going with the memories of people who’d suffered severe trauma.

Since then, my heart is more in the object relations world, I think mostly because it matches my personality and the type of relationships I like to create with people. But I’ve woven in neuroscience, attachment theory, a bit of EMDR, some meditation and self-awareness exercises. It’s a hodgepodge of all the different things that I’ve learned, but I don’t really feel like I’ve got a hammer and everybody who comes in is a nail. It’s more like I’ve got a toolbox of 30 or 40 years of things that I’ve been collecting and I try to figure out how to match as best I can to the needs and the interests of the client.

SR: Is there a certain population or certain pathologies that you’ve been working with more lately or that you’re more interested in?
LC: Not really. My practice is pretty general and I like to keep it that way. I don’t really like to see the same problem over and over again. I always think of psychotherapy as kind of like a collaborative research project. People come in and we work together to figure out what’s going on—how did it arise? Is there any hope of making it better? I really like having problems I haven’t dealt with before.
SR: What do you wish you’d known as a beginning clinician?
LC: When I started, I was looking for an answer and I wanted to know who had the answer. So

I tried to become a disciple of one person or another person. It took me quite a while to realize nobody has the answer. Everybody has a little piece of it.

And what I’ve got to do is just learn the best I can and then sacrifice and move on. This is a very ancient Rig Veda philosophy—every day you wake up, you sacrifice the day before, you move on, you create a new reality.

Had I understood this, I would have spent a lot less time worrying about finding the truth and being acceptable to whatever godhead I happened to run into at the moment. I think idolatry is the problem. Idolatry and objectification.

SR: It’s hard to avoid being exposed to that as a student. At least in my experience, in every new class you’re exposed to something people think is the answer, the best way to look at things.
LC: In my experience, the degree to which someone is enthusiastic and adamant about having “the answer” usually reflects the degree of insecurity they have and their lack of ability to tolerate their own ignorance. If we’ve learned anything, especially when it comes to diversity, it’s that we have to embrace our ignorance and be curious as opposed to leading with certainty.Jacob Bronowski was a physicist who died about 20 years ago, but he did this wonderful documentary about visiting Auschwitz, where his whole family was slaughtered. He waded into the mud behind the crematory and grabbed a handful of mud, realizing that his ancestors were part of this soil, and said, “This is what happens when we’re certain.”

Certainty leads to ideological beliefs that supersede humanity. At a less dramatic level, we get so enamored with our philosophies and our therapeutic beliefs that we miss our clients because we’re so convinced that we’ve got to convince them we’re right about the things we believe should be true.

SR: So last question here; where do you think the field as a whole is going?
LC: Well, I don’t think mental distress is going anywhere. I think that more and more people are going to be having psychological problems as society and civilization become increasingly crazy. No matter how many therapists the schools pump out, the world is creating plenty of suffering, so there will always be a need for therapy.And though there will always be therapists trying to create revolutionary new therapies with great acronyms, I think that the tried and true methods will remain strong and stay strong because they’re tapping into fundamental constructs in human experience—the need to connect with other people, to be able to leverage our thinking to modify our brains, to ask questions about ultimate meaning and existence.

Where the field is going to have to upgrade its sophistication and quality is in the areas of like pharmacology, epigenetics, psychoneuroimmunology, diet. All of the actual mechanisms that create and sustain our brains will have to become part of the dialogue about how we help people sustain and maintain health. This might just be my Eastern philosophy bias, but we’ll probably be moving in the direction of more holistic, integrated thinking and treatment—not just combining East and West, but integrating scientific discoveries into our case conceptualizations and treatments.

Finally, I hope that psychology becomes more integrated with education. I have a book series that I’m editing for W.W. Norton which is on the social neuroscience of education, and we’re pushing to have psychologists, neurologists, neuroscientists and educators communicate more so that the things we’re learning can be integrated into each field.

SR: Well that seems like a great place to end. Thank you so much for taking the time to share a bit about your work and your life with the readers of psychotherapy.net.
LC: It was a pleasure, thank you.

Intuitive Therapy

Posted on by Psychotherapy.net Team

Janice is sitting on the loveseat in my office. The sun slants through the Venetian blinds behind her, casting a warm glow that looks like an aura around her. She is a beautiful woman. This is just a fact.

“I was talking at a meeting at work. I really think the policy they’re considering is dangerous. I was ticking off point after point for some of the unintended consequences I see in the distance, and it’s like . . . like they weren’t even listening to me.”

. . . Because they all think I’m just a dumb blonde, are the words in my head that spilled into my awareness at the end of her sentence.

Where did these words come from? What do they mean? What do I do with them?

For many years in my career as a therapist I noted that the words popped up, and filed them away. Maybe somehow at some later point I’d understand their place.

Kimber is draped across the same loveseat. I’m absorbed in her posture, her rhythm, her tone of voice. “I want to go on vacation next month, but my boss told me that she really needs all hands on deck. She said I need to hang in there just another month.”

The word “boss” feels electric to me. It’s hot and bright. Where does that feeling come from? What does it mean? What do I do with it? File it away?

No, I say it out loud. “Boss. Can you talk about that?”

Kimber begins to unwind a long-standing schema that has been at the core of a lot of pain in her life.

Intuition has been the red-headed step-child of psychotherapy since Freud. While he publicly decried the occult, there are private correspondences in which he confessed that he thought that “telepathy” was an important part of his work.

In the world of risk-management and Evidence-Based practice, intuition is scorned. Even so, therapists have admitted in several studies that intuition is an important part of their clinical approach.

The good news for those clinicians is that there is growing research that, if not supporting the use of intuition, is at least legitimizing the existence of the phenomenon. Currently among cognitive psychologists there are two dominant models for what constitutes this phenomenon: the Heuristic model, and the Learning Theory model.

One of the better-known proponents of the Heuristic model is Kahneman. He has suggested that intuition is a quick-and-dirty problem solving strategy. Which variables get considered in this strategy are based on ease of retrieval. Ease of retrieval is highly influenced by emotional valence, which means that intuitive judgments are likely to be highly biased by emotion. Not too reliable, the heuristic camp warns.

The Learning Theory perspective has looked at the question from a different perspective, and has a different opinion on the reliability of intuitive judgments. From this perspective, intuition is the fast implicit processing of past experience and learning. These researchers suggest that “professional intuition,” or a judgment regarding an area of repeated experience and expertise, is often highly accurate.

Many psychoanalytic thinkers have developed an understanding of intuition as a form of unconscious communication. This communication can be explained by direct right-brain-to-right-brain communication, as the neuroscientist Allan Schore suggests, or by the operation of mirror neurons. In either case, the communication involves micro-expressions, or subtle changes in muscle tension and movement, along with para-linguistic aspects of speech such as tone, rate, volume, and prosody of speech.

There is one other theory that appears in the psychoanalytic literature. This is field theory. Field theory comes to us from the world of physics. Matter emits force. We know of two such forces: gravity, and electro-magnetism. The earth has a gravitational field that keeps the moon in orbit; the moon has a gravitational field that affects the tides on earth. The fact is, the force that the moon emits and the force that the earth emits intermingle. So really, both the earth and the moon exist in a force-field that is co-created by and effects both bodies. Some analytic theorists have suggested that this is a good metaphor for what happens in therapy. The existence of a co-created field allows therapist and client to be affected by each other’s unconscious processes and content.

I don’t know which, if any, of these theories is right. Maybe they all are. Maybe intuition is not just one thing. What I do know is that when I allowed myself to bring the words that pop into my head into the therapeutic conversation, when I repeat the “hot” words, or those that pop into my mind in my client’s voice, therapy goes deeper more quickly than it did when I kept these musings to myself.

Robert J. Lifton on Political Violence, Activism and Life as a Psycho-Historian

Posted on by rezendevknowfully.com

The Psycho-Historian

Deb Kory: Robert Lifton, you’ve long been one of my heroes, and I’m delighted to be able to interview you and share your work with our readers. For those who may not know, you are a psychiatrist, researcher and writer, and have written many books on the psychology of political violence, the effects of such violence on both perpetrators and victims, totalitarian ideologies, the traumas of war, the threat of nuclear weapons, and much more.
I’m an early career psychologist and I started my doctoral program back in 2004, just before revelations emerged about psychologist’s involvement in torture at Guantanamo and other CIA black sites. It would turn out that the involvement went up to the highest levels of the American Psychological Association, but outside of a small group of activist psychologists, nobody in the field of psychology was talking about it. You were among the few mental health practitioners who publicly denounced this collusion with torture from the very beginning. When I wrote my dissertation on this subject, I drew heavily from your writings, particularly The Nazi Doctors: Medical Killing and the Psychology of Genocide, to help me understand and contextualize how seemingly normal, good people can commit evil acts.
As I came to learn through reading several of your books, your activism and commitment to social justice has been a fundamental and inextricable part of your professional work as a psychiatrist, researcher and writer.
Robert J. Lifton: Well, thank you.
DK: Your most recent book, Witness to an Extreme Century: A Memoir, weaves together your various works with your personal life, and the ways in which witnessing atrocities—you were a teenager during WWII, for example—impacted the course of your life. In it, you call yourself a “psycho-historian.” Can you explain what that means?
RL: It means applying a psychological approach to historical events, which requires a handling of psychology that is open-ended and sometimes outside of the orthodoxies within our field. The derivation is from Erik Erikson, who used the term as an adjective—he spoke of a “psychohistorical perspective.” It’s probably better to avoid the noun.
DK: When you say applying psychological methods, are you talking about research methods in particular?
RL: In my case, I’ve systematically used a psychological interview. I believe very much in the interview method. Though I haven’t spent much of my career doing psychotherapy, I have done a kind of equivalent by means of interviews. I think that the psychological interview is a beautiful instrument if one is careful and rigorous about the context. And it’s underused, even in the profession of psychology.
DK: How so?
RL: In terms of psychological research, the interview has become much less popular—the tendency is more toward questionnaires or statistical studies these days. The interview method that I have made use of is a modification of a psychoanalytic method. I was trained in psychoanalytic psychiatry, as we used to call it, and then had some training in psychoanalysis, but there was a kind of paradox for me. I thought then, as I still do, that psychoanalysis has been a great intellectual movement; but in its more rigid and dogmatic form, it can undermine the very historical approach that one wants to develop. So I modified it quite a lot.
DK: You talked in your autobiography about studying at the Psychoanalytic Institute in Boston and how you found some similarities between the kind of totalitarian mentality that you’d found among survivors of Chinese thought reform and the atmosphere at the institute. Can you say a little bit more about that?
RL: I was careful about how I wrote about that. I didn’t dismiss psychoanalytic training and, as a matter of fact, I learned a great deal from the psychoanalytic training that I did. But I found that there was an inherent problem in psychoanalytic institutes. Many others had spoken of it, but I had studied Chinese thought reform as well as the Cultural Revolution and so had that framework. The difficulty in psychoanalytic institutes at the time was that one was simultaneously a student, a candidate, and a patient. In a sense, the same people were one’s teachers, one’s therapists, and one’s judges in terms of whether one was accepted into the profession. There was a danger of requiring adherence to the existing doctrines as a necessary element for success, as opposed to originality or a creative perspective.
So I said those things, and I made the comparison with a thought-reform like environment. I did it carefully, but it was a fairly bold thing to do at that early stage of my own work.
DK: Were you ousted?
RL: No, no, I wasn’t ousted at all. There have always been within psychoanalysis people who are more open and more critical of their own group. Erikson was like that himself, as have been many other psychoanalysts whom I’ve known over the years. In fact, over time psychoanalysts have invited me to their programs—I’ve spoken at various institutes and groups. I chose to discontinue psychoanalytic training when I received a chair at Yale back in 1962, both because I had reservations about the dogma, but also because I had no need to become a psychoanalyst in terms of the direction I was going in my research. But, still, psychoanalytic tradition has a lot to offer and has been important to me in my work.
DK: You also wrote that breaking away from the Institute and the psychoanalytic framework allowed you to approach Freud in a new way and to connect to some of his more radical ideas.
RL: Yes, that was important to me. Back then, Freud had almost a deified kind of standing at the institute, and there were constraints on criticism and open-minded thinking that might find him lacking in any way. And so it was more difficult for someone like me to really engage with his ideas in a creative way. Later when I left the Institute, I was free to do that and did so in particular in relation to death and death imagery, which I was exploring after my study of Hiroshima survivors. I found that Freud had a lot to say about these things if one could translate the instinctual rhetoric into a rhetoric of symbolization. That’s what I tried to do in relationship to death imagery in one of the books that I wrote in those early years, in 1979, called The Broken Connection: On Death and the Continuity of Life. It was about those issues as they affected psychological and psychiatric thinking in general.

Hiroshima and the Symbolization of Death

DK: Can you explain what you mean by the symbolization of death? It sounds in some ways like an existentialist perspective.
RL: I don’t call it existential or phenomenological, but it resembles that kind of approach in many ways. What I mean by a symbolizing approach is that Freud did speak of symbols in his work, but it was more in terms of one thing representing another. A pen symbolizes a penis or whatever. But a broader approach to symbolization came through Ernst Cassirer and Susanne Langer, symbolic philosophers. Their idea of symbolization is that the mind can perceive nothing without recreating it, at least during adulthood and during mid and late childhood. We are inveterate symbolizers. And that means that every perception includes a recreation with this wonderful and sometimes dangerous gray matter of the human brain, so that we recast every perception and have no choice but to do so.
That’s what symbolization really is. And in that sense, although Freud rightly emphasized denial of death, I could evolve making use of his work and also the work of Otto Rank, a great early psychoanalyst, the idea of the symbolization of immortality—not as a denial of death, but as a symbolization of human continuity. Because we’re a cultural animal, we need to feel a continuity with those who go before and those who will go on after what we know to be our limited life span. And that is a symbolization of immortality rather than a literal claim to it, which of course is never realizable.
DK: It sounds like a non-religious way of thinking about what happens after death. Did these ideas emerge out of your study on Hiroshima survivors?
RL: Much of this research about death and death symbolism did evolve from my work in Hiroshima. And it’s my way of developing a secular perspective—because I remain secular—that takes into account some of the insights that have been developed in relationship to death, but also in relationship to what is thought to be immortality or some kind of afterlife.
My approach is a natural one. It’s never supernatural. But what I’ve learned is that the mind and the brain are extraordinary instruments that, in extreme situations, can go places that we find hard to imagine.
DK: You have been exposed to a great deal of death imagery not only through your research in Hiroshima, but with Vietnam vets, Nazi doctors, and other research you’ve done. What do you think drew you to this kind of work and to these questions?
RL: It’s not easy to answer that question, and I don’t think there’s any single characteristic or single experience that drew me to these events. I hadn’t probed the issue of death and death symbolism until my Hiroshima study, and I came to my Hiroshima work through a certain kind of activism leading to scholarship, rather than in reverse, as we usually think about it. It was through my exposure to a group called the Committee of Correspondence in Cambridge [MA] led by David Riesman in the late ‘50s. He was an early antinuclear academic, a sociologist who probed ways in which nuclear weapons were harming our society and our social institutions.
It was because of him and others in the group that when I was in Japan subsequently in the early 1960s to do a study of Japanese youth, I decided to make the trip to Hiroshima.
I was stunned to find that nobody had ever done a comprehensive study of that first atomic bomb. I developed a principle, which may not always hold up to scrutiny, that the larger a human event, the less likely it is to be studied. It’s difficult to study large events, and we don’t like to get out of our comfort zone, which a study like that certainly required.
I was then just beginning my chair at Yale and I was able to work out with the chairman of my department an arrangement to stay on in Hiroshima for six months to do the study. But it was the exposure to activism that led to the scholarship, and then I tried to do the work very systematically through interview methods in a modified way. The book I wrote from that study, Death in Life: Survivors of Hiroshima, was my scholarly contribution to antinuclear activism.

Combining Scholarship with Activism

DK: You say in your autobiography, “I was groping for ways of expressing in my work and in my life deeper opposition to what America was doing and becoming. The sequence involved for me consisted of first outrage, then research to deepen knowledge, and then protest in the form of writing and action.”

Most people don’t associate psychiatry and psychology with activism. Did you feel like you were forging a totally new path? Or were there other psychiatrists doing what you were doing?

RL: I was intent on combining scholarship and activism. I didn’t call it that at the very beginning, but I came to the realization that I wanted to combine them over time. There were a few others doing it at the time and I think there always are people doing it in any given field. I think each of us who tries to combine scholarship with activism does it in his or her own fashion.

There’s great value in obtaining good training for one’s profession, in deeply learning the trade we’re doing and combining that with activism. One can make certain kinds of contributions through professional knowledge that enhance activism in a way that contributions without that professional knowledge wouldn’t be able to do.

There are always some people, however few, who can look critically at their profession and yet see value in its tradition. In the case of psychology, as you know, there have been quite a number of very good psychologists who have spoken out passionately in opposing the American Psychological Association’s involvement with torture.

DK: Yes, like the folks at Psychologists for Social Responsibility who kept this in the media and fought against it for over a decade, finally getting a resolution through the APA to remove psychologists from all national security interrogations last year in 2015.
RL: They’ve always been there. And one no doubt has to seek them out and work with them and find ways in both one’s training and in one’s life to combine scholarship with activism. It can be done.

Of course, institutions can be backward and can, as we saw in the case of the American Psychological Association, take dangerous directions. But mostly if one is rigorously combining scholarship and activism, one is not really that condemned and on the whole one is honored for the effort. It’s demanding and it can lead to moments of conflict and difficulty, but it’s also rewarding.

DK: Well, it requires going against the grain, right?
RL: It’s going against the grain of the mainstream, but there is much in cultural experience that goes against the grain of the mainstream. One way of looking at it is that every profession has an ethical dimension as well as a technical one, and it’s a good thing to be well trained in the technical aspects of one’s profession, but not at the expense of ethics.

I was very aware of this in relation to studying Nazi doctors. Some of my friends warned me against doing it because they thought I would simply reduce them to psychopathology and lose sight of the ethical issues. I thought that was a fair warning and decided that whatever I did, I would look to both psychological and ethical elements, never leaving out the latter.

DK: That must have been difficult.
RL: In my work on Vietnam, I talked about the scandalous moment that we reached during the Vietnam War, where the duty of psychologists and psychiatrists was to help soldiers, traumatized by what they were seeing and doing, return to duty and daily atrocities.
DK: That reminds me of the army resilience training that positive psychologist Martin Seligman has been doing at the University of Pennsylvania. Among other things it’s designed to help troops better withstand multiple deployments in places like Afghanistan.
RL: When this was happening in Vietnam, I began to study the history of the concept of “profession.” It was originally a religious concept, a profession of faith, and then with our secular age it became more and more technical. Professions became learning technical details specific to that profession, and that technicization was highly overdone at the expense of the ethical dimension. We need to newly incorporate the ethical dimension to combine it with the techniques that we learn in our profession. That idea has been a common theme throughout my work.
DK: How do you imagine the ethical dimension being reincorporated into training? It strikes me that in the ethics classes that we take in psychology training, often times we’re dealing with thorny individual situations—when to break confidentiality, what’s the best way to protect yourself from lawsuits etc.—but we are rarely taught how to break free from toxic groupthink, how to stand up against immoral ethical transgressions like what happened in the American Psychological Association, how to dismantle unethical systems that might be contributing to the mental illness of the patients we see. We’re not often tackling these larger ethical issues that are deeply wounding and affecting the people we see in therapy. It can feel like a kind of resilience training we’re doing, helping people better navigate an unjust world without tackling the injustice that brings them to us.
RL: I think each of us can question things in the world around us, but there is no perfect answer to this problem. It’s not always possible to combine one’s activism with one’s professional work, sometimes they are things you do in parallel ways. Sometimes that means working with an institution that doesn’t live up to one’s activist principles, one’s activist desires, but I think it’s a constant balance one struggles for within oneself.

In work with patients, even if one doesn’t impose on them a full expression of all that one believes about how the world should be, every patient in psychotherapy has a strong sense of the ethical and political qualities of a therapist.

Even when things are not said. One’s holding to these principles does make its way into the relationship. And, of course, these are things that can be discussed in therapy, though one has to use one’s judgment about that. But I’m not one to give extensive advice about therapy. It’s not an area of expertise of mine at all.

DK: What went into your choice to not become a clinician?
RL: I was trained in psychotherapy and I did some of it early on, but relatively little. I began doing research and I found that the research I did was so involving and I was so intensely bound up with it that I wanted to deepen it and extend it. Doing individual therapy in a way was a distraction from that kind of research. Individual therapy requires one’s presence and a lot of one’s imagination. It’s very demanding and it’s also very satisfying. I felt its demands and I even enjoyed it, but I really preferred to develop the research, which I did with great intensity, and that required giving up the work in therapy.

The Nazi Doctors

DK: You’ve written many well-known books, but Nazi Doctors is one of your most well-known. When I read it, I was shocked that you were able to have so much face-to-face time with people I assumed would have been in prison. They had obviously perpetrated or witnessed a great deal of atrocity, some were still Hitler enthusiasts, and they were just living life in post-war-Germany like everything was dandy.
RL: It was the most difficult study I did. It was hard to sit down with Nazi doctors, you’re right. Most of them were not fanatical, but they tried to present themselves to me as conservative professionals who had experienced pressures during the Nazi era and tried to handle them as well as they could.

They knew I didn’t accept that self-presentation, but I worked from a standpoint of probing them and constantly asking questions and then asking more questions rather than confronting them and calling them evil or anything of that sort.

What happened in general with most of them was that they were surprisingly ready to talk to me, but behaved as though that person during the Nazi era was somebody different from the person sitting with me in the room, and that he and I were talking about that earlier figure as a third person—a kind of extreme dissociation.

I studied as much as I could about the particular person I was talking to, what people in his situation with the Nazis actually did, so I had a considerable knowledge of the context in most cases before I even sat down with them.

There were one or two who remained ardent Nazis in a way, but mostly they didn’t. Still, it was very uncomfortable and partly I could manage it because I knew I would have my say in the book I would write. And I deeply valued the research enterprise, its potential to say something that other studies of Nazi behavior couldn’t say.

DK: I researched those studies for my dissertation, particularly Stanley Milgram’s studies on obedience around the same time that Hanna Arendt was writing for The New Yorker about Adolph Eichmann’s trial in Jerusalem, both of them coming to the conclusion that normal people can, indeed, commit atrocities. It was a big scandal to say at the time that Nazis were human beings, not monsters. Were you worried that your work would humanize them too much?
RL: Some people were worried about that. But, you know, they were human and that was the problem. They were human beings. They were human beings who did evil things.

Evil things are only done by human beings in my view, not by god or by the devil, but by fellow human beings. And in that sense, yes, I had to encounter all of their sides. Not humanizing them to the extent of leaving out or negating their evil, but rather recognizing and trying to probe ways in which human beings are capable of evil, or what I came to call the psychological and historical circumstances that are conducive to evil.

DK: What you call, “atrocity-producing situations?”
RL: Yes, atrocity-producing situations are those in which ordinary people may be socialized to evil. They come to belong to a group in which the norm is destructive—murderers in Auschwitz, let’s say. Or even in Vietnam. And since we are social animals and we all belong to groups, we never work totally in isolation intellectually or emotionally. If one enters into a group which holds an ideology of genocide or mass killing, one tends to internalize much of that ideology. That is a way in which human beings carry out evil projects and, of course, do so as human beings.
DK: Was one of the difficulties of doing this work that you could sort of imagine yourself in their shoes?
RL: One has to wonder that. If I had been a German, would I have done some of the things that they did? I wouldn’t necessarily condemn myself and say I would have, but one has to ask oneself that kind of question. And one has to also come to value, as I did, those who opposed the Nazis. For instance, I became a friend of two of the few psychoanalytic heroes I know of, Alexander and Margarete Mitscherlich, a husband and wife who were anti-Nazis and were part of the underground during the Nazis era at great risk. He reintroduced Freudian psychoanalysis into Germany after the war and was the first to expose, on the basis of the Nuremburg medical trial, the deeds of Nazi doctors.

I also met Jewish survivors of Auschwitz who had managed to remain healers while in Auschwitz. So there were people one could admire in those extreme situations and one could at least hope that one would have been among them, should one have been exposed to that sort of pressure. But who can be sure?

DK: Do you hope through this kind of research to prepare people to be among the helpers, the healers?
RL: Yes, the research is very much meant to expose the destructive behavior, the killing, and assert its opposite, the healing. In all of the studies I’ve done, I’ve looked at the alternative to the extremity of behavior that I was studying. Even in my first study of Chinese thought reform, which applied great pressure in coercing change in people, I had a long concluding section on what I called “open personal change.” All of my work is in the service of openness and healing and ultimately justice, even though—or particularly because—it studies the opposite.
DK: Do you think that people who deny their own darkness are more likely to act out in evil ways?
RL: I think we all have a potential for destructive or evil behavior. When I completed my work on Nazi doctors, people would say, now what do you think of your fellow human beings? And most people expected that I’d completely lost my faith in humanity, but what I said was, “We can go either way.”

I haven’t lost my sense of possibility in human beings. And, yes, we do have a potential for destruction. Somebody wrote a book called We Are All Nazis and I didn’t like that kind of approach because it ceases to make distinctions. Having the potential for evil is very different than actually engaging in evil behavior. But we all have a potential for destructive behavior and it’s well to look at that.

I think that the relationship to ideology and groups that form around ideology has a lot to do with which direction we take. By ideology, I mean idea structures that have intensity and which explain aspects of the world to us. This is something we all engage in, even though we Americans like to think we’re non-ideological. The kind of idea structures we embrace and the groups that we immerse ourselves in have a lot to do with which aspects of the human potential we find ourselves expressing.

DK: Is your concept of the “protean self” a counter to this more strictly ideological way of being?
RL: Well, the protean self is a counter to the more rigid, fixed self and to the totalistic tendencies that I am averse to or even allergic to. The all-or-none kinds of totalism that I studied and wrote about in my first study of Chinese thought reform in particular. What I found is that the reverse of totalism is a kind of proteanism, which has surprising capacity for change and transformation and for a multiplicity of elements in one’s character or personality. This has its vulnerabilities, too, but at least means that we needn’t be stuck in totalitarian dogma. To the extent that we are protean, there are constant opportunities for new beginnings.
DK: Does it mean just being a flexible, open person?
RL: Yes, it does, but also more than that. It’s consistent with flexibility and openness, and a capacity for change and transformation.

Apocalyptic Violence

DK: In your book, Destroying the World to Save It: Shinrikyo, Apocalyptic Violence, and the New Global Terrorism, you do a study on the Japanese cult that released sarin nerve gas in the Tokyo subways. We’re certainly living in a time of apocalyptic violence and I’m wondering what your study in this book has to teach us about it more generally.
RL: The Japanese cult, Aum Shinrikyo, was notably apocalyptic. The guru and his close disciples believed passionately in the end of the world, and in actively contributing to that end. It was an example of what the ancient Rabbis called “forcing the end.” I write of an ancient rabbinical dialogue about whether it’s correct for people, for rabbis, to advise joining in the violence to force the end of the world and help bring about the appearance of the messiah. The rabbis decided against it, saying that only god kept that timetable.

But some of the most extreme groups do embrace violence to bring about the end of the world, as did Aum Shinrikyo. And there are certain American right-wing groups that have that intent, who have tried to destroy the government through acts of violence, and contribute to an apocalyptic vision, as well as to forcing the end.

But there’s also a lot of apocalyptic thinking in this country without necessarily resorting to violence. There are confused, highly fundamentalist groups in America with an element of apocalypticism who, for instance, deny climate change. They say that only god could change the climate, that it would be impossible for human beings to be responsible for it. And some of those people are in the mainstream of American political life in the Republican Party. That’s a fundamentalist approach that can also be apocalyptic. It isn’t necessarily violent, but it can be highly dangerous.

DK: Do you think that the war on terror, particularly as it was waged by George W. Bush, had elements of apocalypticism in it?
RL: Yes, it did. I wrote about this in my book, Superpower Syndrome: America’s Apocalyptic Confrontation with the World. George W. Bush saw it as a war against evil and that takes on something close to an apocalyptic tendency. To destroy evil is to create an endless war against an enemy that can never be destroyed. It also is to polarize the world into one’s own good and the evil of the other. It’s that tendency that we’re seeing now with regard to terrorism.

Terrorism is real. And ISIS is a real danger. And it’s a highly apocalyptic and murderous movement. But there’s a tendency among some groups in this country to view it the way that communism was viewed in the past as absolute evil in contrast to our absolute good. That radical polarization of the world is enormously harmful and can feed violence ultimately rather than diminish it.

DK: Is that the kind of historical issue that you bring your psychological methods and moral complexity to, for purposes of understanding the “other”?
RL: That’s right. Moral complexity becomes extremely important. That’s where we psychologists and psychiatrists can have something to say.

Climate Change and the Nuclear Threat

DK: Right now you’re working on a book about climate change and you are also making a connection between the antinuclear movement and the climate change movement. You basically never hear about nuclear proliferation these days and I’m wondering why people aren’t more freaked out by it. To my knowledge, the world’s arsenals have only gotten bigger.
RL: Yes. The nuclear threat is still very much with us and there are people who are saying this, but it has lost its visibility in a larger society. So there’s a gap between mind and threat. During the ‘80s, the heyday of the antinuclear movement, when there was the million-person demonstration in Central Park and the nuclear freeze or moratorium, there was a certain amount of fear that was useful. And there was a closer relationship between mind and threat.

I don’t equate nuclear threat with climate threat, but I look at the nuclear threat and the antinuclear movement for both parallels and differences in order to think more critically and understand the challenges of climate change.

They both are realities that threaten the human future; they both have world-ending possibilities—yet they both are movements that the human mind is capable of addressing. We haven’t figured this out in time to prevent enormous amounts of suffering because of climate change, and there’s a great amount of work that has to be done even to limit that suffering. Nonetheless, there is a demonstration of what I call “formed awareness” about the nature of climate change that has great value to us because it’s the basis for anything constructive that we do in that area.

DK: But there’s not that sense of imminent crisis that the threat of nuclear war gives us.
RL: The comparisons are complicated because, yes, there’s something about a bomb—it’s an entity, it’s a thing that explodes and destroys a city. We saw that in Hiroshima and Nagasaki and I’ve experienced it viscerally by studying it in Hiroshima. Climate doesn’t do that. It’s a slower incremental series of changes, but what’s changed now in relation to the climate threat is that it’s become more active. We’ve had hurricanes and floods—
DK: Super storms.
RL: We’ve had coast lines being destroyed. It’s closer to us. The gap between mind and threat is narrowing. Climate change has become not just something that will become much worse in the future—it will if we don’t do more about it—but also something that’s now affecting and threatening us in profound ways at this moment. So, that distinction between the two is still there, but it’s lessening. And climate change is closer to us as a real threat.
DK: Well thank you so much. This has been such an interesting conversation.
RL: You’re very welcome.

Bad Therapy: When Firing Your Therapist Is Therapeutic

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The Nail Biting Maternal Yes Woman

I was never taught how to recognize and deal with therapy that was more subtly bad.

I have been in psychotherapy at various times throughout my life, and I must acknowledge that I have always felt like a difficult client. I am a passionate and devoted psychotherapist, but I have been a reluctant, suspicious client. I know this is a deficit. I recognize how crucial it is for me as a therapist to see my own blind spots. Throughout the years of working with different therapists, I’ve never really loved being in therapy. But oh, I would love to meet the right therapist for me, if there is one out there, and experience meaningful, utterly significant therapy. At times, I feel bad that I am offering a process in which I haven’t wholeheartedly engaged from the other side.

Part of what has made me feel difficult as a client has been my intense aversion to being told what to do—I don’t like feeling forced into anything I haven’t chosen freely. I felt trapped and pressured when I was six years old and taken to see a therapist because I had anxiety about having a small heart operation. Therapy felt like a punishment; I missed birthday parties and play dates and instead spent hours feeling judged by a very earnest and unrelatable man for having “worries,” as he put it. My “worries” had gotten me in trouble!

The more I complained about therapy, the more my parents insisted I continue with him. I remember clearly when I figured out that if I pretended not to be worried about things, not to show my emotions too strongly, and not to show that I cared one way or another about going to therapy, I would be better off. Sure enough, my show of insouciance succeeded. Pretending to be indifferent released me. When my parents and the therapist told me I could now stop treatment, I didn’t dare show my sense of joy or liberation.

I always questioned the quality of therapists I saw briefly at various times in my teenage years and early twenties. When I moved from New York to London, I was happy to leave a therapist who emailed me after her hysterectomy to request that I purchase and send her a specific type of fudge that could only be found in Covent Garden. The first therapist I saw in London increased her fees significantly without telling me. I only discovered the price hike in the invoice she sent me after two months of weekly sessions.

For the first two years of my clinical training, I had an unbelievably gentle, humanistic therapist. She was sweet and supportive and I cried and offered up morsels of vulnerability and she praised me relentlessly. It was all unconditional positive regard. She was the boring, uncritical motherly type in contrast to my own, and her niceness felt soothing until her flattery struck me as hollow. I showed up for a session on a rainy morning and she applauded me for making it to the session, given the pouring rain. “She said yes to everything I said, praising me for simply existing, bit her nails compulsively, and never challenged me.” I disqualified her harshly for these things. It felt like skiing the bunny hill. I wanted to develop, to grow, to be stretched!

When I finally expressed my discontent with our work together, and said I wanted to be challenged more, she suggested that I consider the challenge of not being challenged. I was outraged by her inadequate response to my attack, and I left abruptly and felt guilty afterwards. I was in my mid-twenties and I was flighty, cocky and insecure. I sometimes recognize versions of this sort of behavior in my practice—the angsty twenty-somethings who start off treatment showing receptivity and curiosity about themselves; they think they’re psychologically-minded and ready and willing to do the work. They want to please, and they agree to a weekly time, to the financial and emotional commitment, to the whole thing, and then they reveal their ambivalence, missing scheduled appointments, claiming not to have realized that the following session was arranged for the agreed time.

I understand this combination of inconsiderateness and desperation to please. So in this sense, my experience of being a bad client has expanded my repertoire of understanding as a therapist. I recently emailed this therapist to acknowledge and apologize for my abrupt departure all those years ago. She wrote back a warm and friendly email.

The Bad Referral

E. seemed smart, rigorous, and her approach was intellectually appealing to me—relational, attachment-based therapy with a psychodynamic conceptualization of development mixed with gestalt elements. I found her manner a little austere, but I assumed I was projecting and I thought her briskness might mean she’d challenge me and not just agree with everything I said. I also assumed that there were certain cultural factors at play—she was British and I was American (though I’d spent the last decade living in the UK). It was typical for an emotionally-forthcoming American to feel that English people could seem remote. I told myself I had to respect her minimal way of showing feelings.

As months and then years passed, E. continued to seem chilly, but my strong sense of being a difficult client left me not trusting my judgment of our therapy for a long time. I assumed I was impossible to please, so the fact that E. and I didn’t form a rapport didn’t set off alarm bells. I didn’t think I could do better, and I thought the problem was with me, not her. I think I displayed a fearful avoidant attachment style in my therapy with E. I wanted very much to connect and express my needs, but I didn’t think my needs could be met, so I tried to stay away from too much exposure or vulnerability.

As time went on, I struggled to trust E., both in concrete ways and in a larger sense. I felt paranoid that E. would gossip about me with my supervisors and lecturers, whom she knew from her teaching days. She felt like an authority figure who could get me in trouble. I didn’t want her to see the parts of myself I disliked.

"Reassurance is Never Reassuring"

I voiced my fears to her and she neither confirmed nor contradicted them. I think I wanted her to reassure me. I asked for this once. “Reassurance is never reassuring,” she quipped. Oh, but sometimes it simply is. Especially when it comes to something as vital to the work as the therapeutic relationship. At least probe my anxious concerns, be curious about me and ask me to go deeper, explore further. She wouldn’t speak about these things. “The more she withheld, the more emotionally hungry I became.”

The mutual mistrust played out around money. Her invoices frequently billed me for extra sessions we had never scheduled. The first time she overcharged me, I was embarrassed. I pointed out the overcharge with a degree of shame, and only after I’d meticulously confirmed in my head beforehand that the mistake was hers. She argued and insisted the bill was correct until finally she saw that she’d charged me for two extra sessions on days when she’d been away. Most of her invoices contained extra charges. Could I just pay each week, I asked. Or pay the set amount, knowing what I owed? No, this was me trying to break the frame, wanting special treatment, not knowing how to play by the rules.

When I pointed out the routine overcharges, she said I must always check her calculations and insisted it meant nothing. But her mathematical mistakes only ever overcharged me—the inaccuracies never went the other way. At the end of every month, I would open her invoice knowing I had to scan and detect the overcharge and go back to her and point out a mistake. Did a part of me delight in finding fault with her, knowing she was in the wrong? Sure. Especially given her absolute insistence on analytic neutrality when it suited her, her financial distortions seemed like frame deviations on her part. But any delight I felt in catching her errors was overshadowed by the feeling of chaos and unease these mistakes brought up for me. She was supposed to be the adult in the situation, yet it was up to me to fix the mistakes, and she didn’t acknowledge the burden.

Money in our work felt personal (it often is, of course). I paid her in cash; she counted every bill in front of me, licking the tips of her fingers to shuffle through each note. Her overcharging and her counting each note (I always paid the correct amount—not once, in all the years of working together, did she discover I had stiffed her, but the suspicion never lifted) wasn’t open for exploration, even though I felt convinced that the repeated overcharging revealed her wish to get more money for having to deal with me.

In my practice, I have made occasional mistakes with invoices, once under-charging (I’d forgotten about an extra session and the client graciously pointed this out) and recently, charging for a cancelled session that I had agreed I wouldn’t charge for. In both cases, I acknowledged my mistakes and gave the clients room to air their grievances or feelings of any sort. I praised them for pointing out my errors, and invited them to express whatever my mistakes might have evoked. Perhaps I overcorrect, but in these small ways, I attempt to repair some of my personal therapy wounds by trying to do better with my own clients. I try to handle my mess-ups honestly and thoughtfully. I know how much a therapist’s righteousness can hurt.

In the beginning phase of therapy with E., I found myself chatting about issues that were somewhat relevant to my life without being really pithy and significant. This was my classic resistant manner of seeming open and self-revealing but in a safe enough, limited way. Except that my carefully constructed issues were actually significant for me, and I longed for E. to understand me and help me understand myself.

Heaps of Rubbish

“What if one day you realize you wish you still had the old chair you got rid of?” she asked. But the chair was broken and wobbled and I didn’t like it much anyway. I was okay with not keeping the chair. Why wasn’t she? I struggled with her insistence because I needed to consolidate and clear space and get rid of things I didn’t need. I felt discouraged from letting go of things, which was an issue that had troubled me and which I was trying to overcome.

Only two months into our work, E. had announced that she would be moving her practice to the other side of London. What had been a three-minute walk door to door would now be a sixty-minute commute on the underground. I agreed to make this move, but resented it. I wasn’t delighted with our work together but I felt committed and somehow obligated to make the move to the new location. She wouldn’t tell me if this new address was her home or a separate consulting space. I figured out quickly when I showed up for our first session in the new location that it was where she lived. And I discovered the moment I arrived that she was a hoarder.

Piles and heaps of rubbish lined the hallway. I could see stacks and stacks of boxes of newspapers in the window of the living room as well as the room above the consulting room. There were mountains of post that made it difficult to fully open the front door, and there were unopened letters marked URGENT underneath old mugs and broken china. There was a horrendous odor of detritus and filth and I don’t know what.

Suddenly, E.’s urging me to hold onto things made sense. I didn’t acknowledge the piles of stuff that invaded the therapeutic space because it simply didn’t feel right. I didn’t want to embarrass her, or bother her, or seem critical, even though of course I felt all sorts of things I wish I had been able to express. So we pretended the stuff wasn’t there.

“When I asked if I could charge my phone one day, E. insisted on a very lengthy interpretation of my need to get energy from her.” It didn’t match my sense that she had very little energy to offer me, but I suppose I was often emotionally hungry and felt underfed. I think of this every time a client asks to use an outlet in my consulting room to charge his or her phone. Sure, there’s some symbolism, but in my work with E., it didn’t match my perception.

Rupture Without Repair

I arrived for a session on a crisp spring day wearing a grey dress I had recently purchased which made me feel cheerful and attractive. I came into the room feeling chirpy, and before I’d sat down or spoken, she looked at me quizzically. “You look like you’re dressed for a funeral,” she said. When she did break the silence, her statements were wild.

“I felt like dressing up. I’m going out for dinner after this and I wanted to look nice.”

Silence.

When I felt morose and down, I felt as estranged from her as when I was upbeat. She kept an incredible distance which I found painful and cold. My wanting closeness was not unreasonable or something to be ashamed of. I struggled incredibly to make sense of this really pretty terrible and very long therapeutic experience.

I felt the negative transference heavily for the five years that we worked together. I brought this up again and again, and E. met my statements with silence. I would ask for more feedback, and she would refuse to speak. I wondered if there were a rationale for her obstinate silence, and she wouldn’t offer me one.

It began to emerge that the therapeutic approach she aligned herself to professionally didn’t at all match my experience of her in the room. Attachment theory? Where was the attunement, the reparative emotional experience, the nurturing, and the secure base? Perhaps it wasn’t just my fantasies, paranoia, or projections. Nor was it simply the distortions of negative transference. E. really detested me. That was my overruling sense, and I said this to her tearfully in a session one day. Stony silence. I pressed her, feeling desperate and distressed by her refusal to reassure me or challenge my perception. “So am I right in thinking that you just don’t like me?” I cried.

“I never said that,” she said.

“But you’re not saying otherwise,” I said. “I feel like you just don’t get me—you don’t like me—I feel it strongly. I feel like you’re never glad to see me. I’m not sure why we’re still working together. Can you help me understand? Do you think we should still be working together?”

“You’re wanting this to be about me and this is about you,” said E. Yet she claimed she was relational.

“Please,” I begged. “I know my feelings are strong right now, but I want to understand which feelings belong to me, which belong to you, and which we’re experiencing together. I want to understand how you see me.”

“This is about you,” she repeated, and she wouldn’t elaborate.

“But how do you see me? I want to understand.”

Silence.

I’d gone from the Maternal Yes Woman to the therapist who refused to mirror me at all—who was there but not there—someone who was technically present but emotionally absent. Thinking about it now, “I wonder if she simply couldn’t bear her feelings towards me and so she partitioned them off and tried to extinguish her presence in the room altogether.” She couldn’t engage fully because it might have exposed her unruly feelings about me so she had to withdraw and disconnect emotionally to keep the space manageable.

This is all speculation, of course. She would never help me decipher what was my stuff, what was her stuff, and what was our stuff together. It was all my stuff. Except that her stuff was everywhere. In the hallway, stacked behind her desk, heaped next to the armchair where I sat, brimming everywhere. And despite her efforts to clear out her emotional responses to me, I felt them heavily. They were everywhere, even if they couldn’t be talked about or acknowledged.

The Dirty Underwear Incident

On this occasion, I went into the bathroom and there was a pair of underpants on the floor filled with blood. It was a startling sight and I wasn’t sure if it was blood or feces, or both. I went upstairs and told E. what I’d seen. Silence. I asked if she could please explain what I had seen. Silence. Did she think I was making it up? Could she go see what I had just seen so we could agree on this reality? Silence.

“If her silence was justified by her psychoanalytic stance of abstinence, then surely allowing me to witness underpants filled with a huge amount of blood or feces was a frame transgression and not in keeping with therapeutic neutrality.” Please could she confirm reality? I felt alone. Alone with my perception, alone with my feelings: isolated, unthought-of, and disliked.

I realize that my bringing up the unsightly bathroom discovery was perhaps my own aggression coming out—I felt righteous and somewhat gleeful at the same time that I was distressed to have discovered proof of the horror I felt all the time in that house. But E. would not acknowledge my attack on her. That would be admitting that I mattered enough to hurt her.

When I announced my engagement, E., who knew I’d longed for this moment deeply, didn’t show any pleasure in witnessing my joy. She often took my husband’s side when I brought quarrels to the sessions, but that felt like her way of suggesting that I should hold onto any man who loved me. When I was animated about a therapeutic idea I’d read about or something I’d experienced at one of my clinical placements, she met my enthusiasm with a look of boredom. Of course, she didn’t confirm or contradict my sense of her feelings, but her feelings were still there, coming out in myriad ways, even if she didn’t acknowledge them.

Pregnant Silences

“You’re making this about me, rather than staying with you,” she said in a clipped, measured tone.

“I want it to be about us just a little, maybe so I’ll feel less alone with my pain,” I said.

“Perhaps you find it difficult that other people don’t share this with you, that other people can get pregnant instantly and you can’t.”

I mulled this over. I felt like she was encouraging me to feel jealous… jealous of her? Envious that she might have had no trouble getting pregnant? I had once glimpsed her daughter. Did she want me to envy her? What was going on? But I had to limit my queries about our relationship or what was personal for her because it would be interpreted as me being intrusive, me making this work about her and not about me.

As my struggles with infertility continued, I became increasingly interested in the idea of adopting a baby. I felt excited and enlivened by this possibility, and my husband was open to this potential path as well. I brought this up in a session, excited and relieved by my own enthusiasm and renewed hope. “Adoption is second best, and you know it,” E. said. I became livid recalling this comment, and I brought it up in the following session. E. defended her statement, saying that adopted children inevitably have attachment difficulties, and it’s second best to having your own biological child. We argued and argued and couldn’t reach resolution on this issue.

Her heavy-handed insistence on burdening me with her personal views on adoption upset me intensely, and I discussed this with a couple of close friends who were also therapists. One of the friends suggested I report E. to the ethics committee. I thought about it but decided it would be like suing someone for breaking your heart—my case against E. was so emotional, so intensely personal, and it all felt nebulous and highly subjective.

The Challenge of Leaving

I wish that my extensive psychotherapy training had offered trainees more tools for recognizing and dealing with inadequate therapy. “For all of the rigor and scrutiny that goes into honing the craft of psychotherapy, we are not sufficiently educated in knowing how to evaluate our own personal experiences of therapy.” There is still a sense, as a trainee, that the therapist is the expert and the therapist in training is the student.

For all the discussions and studies on endings in therapy, it was only when I’d finished my training and qualified that I felt able to end my bad therapy. Perhaps it was her hoarding ways that allowed E. to hold onto me even if she didn’t consider me that valuable—she held onto ancient junk mail, after all. But she too should have let me go—if the work is life-diminishing, the therapist owes it to the client to at least acknowledge the impasse and danger of carrying on in a destructive and unhelpful way.

I finally ended my work with E. a month after I had completed my clinical training. That extra month was probably my last rebellious expression against being told what to do—now that I was no longer required to be in weekly therapy, I had to end my therapy on my own terms, and it wouldn’t have felt right for our last session to coincide precisely with the end of my training. I actually really needed therapy at this time in my life. I was still struggling with infertility and my anxiety and obsessive thinking around this issue was corroding my sense of self and affecting all areas of my life and even my work.

In anticipating our ending, E. had often suggested that we would finish at least temporarily when I had a baby. This contingency plan made me feel that pregnancy and motherhood would be the only legitimate excuses for getting out of this relationship. And the fact that I deeply longed to become a mother, and felt deprived and frustrated by my difficulties becoming pregnant, made me feel all the more trapped and stuck, in therapy and in life.

Finally, still not pregnant, still in weekly therapy with E., I arrived for a session and told E. I just didn’t think that continuing therapy was a good idea for me. “I don’t think you like me, and that feels like a big problem for me. Call it my narcissistic wound—in fact, I would love to know what you think, if you think it is my ego, or my distorted perceptions of how others experience me, or if I’m picking up on your real feelings—please do tell me if you can, but in any case, I want to stop. I don’t want to come here anymore.”

“Fine,” she said. I asked her to elaborate. She wouldn’t. I asked her—no—I begged her, to tell me what she thought about my sense of her sense of me.

“Please, could you give me some parting words, some closing interpretations I can take away with me, so I can look back at our years of work together and have some solid sense of your ideas about me?”

She responded with this: “Charlotte, you have been coming here for five years. You know my interpretations. You know my ideas about you.”

“I really don’t! I really, really don’t! I often feel as if you don’t like me. I don’t know if I should trust my sense of this or not. Please, even if you think you’ve said it all before, please say it again. Do I sound borderline, demanding this from you? Paranoid? Perhaps. But please, do it anyway! Tell me what you think of me!”

“You are like a ram with horns,” she said. “You press, and you press.” All true. Actually useful feedback, even if it seemed harsh. I appreciated her directness.

“You’re bright; you’re beautiful. You know that,” she said, looking utterly fatigued.

I felt like crying, though the tears just didn’t come. Was this everything I had longed for? Did her praise mean more to me because she wasn’t emotionally generous and she’d been so withholding all this time? Was it worth it? Not really. But it helped. Though her comment about my looks seemed odd and out of character. I didn’t dare ask her to say more. That was enough.

I wanted to end the work thoughtfully, especially given how long I’d stuck it out up until this point. I had to justify the long and grueling struggle. E. disagreed with my sense that we should have a termination phase, and said that “given the givens,” we could end the following week. I found this notion cryptic, but that was nothing new. I left our final session feeling buoyed by the freedom to walk away from something that doesn’t feel healthy or good. The following weeks, I breathed more easily; I felt lighter, freer, empowered. It was that glorious feeling of finally letting go of something that’s bad for you and that you don’t actually need.

The Happy Ending

I ran into E. at my training institution a couple of weeks later. I walked through the turnstile with my student ID which had not yet expired, and saw E. struggling to get through from the other side. I was never sure if she had poor peripheral vision or simply pretended not to see me on the few occasions I’d spotted her out in the world. Her stuckness was awkward and she snapped at the receptionist that she should not have such difficulty. I decided I had to have one final encounter, and I was desperate to tell her my news.

“E! Hello!” I said, meeting her on the other side of the turnstile. She smiled opaquely. “I’m so excited to tell you some news,” I said, grinning unabashedly. “I’m finally pregnant. It’s early days—five weeks or so—but at least now I know I can get pregnant, whatever happens.”

“Yes, indeed,” she said, allowing a smile out. “Five weeks. Hmmm. Perhaps it was my parting gift to you.”

“Yes, I like that idea. I wanted you to know because it felt really significant that it happened the same week we ended.”

“That’s interesting,” she said. ?

“I’m so happy to finally give you this news,” I said. “I’ve wanted to be able to tell you this for a really long time. So thank you.”

“You’re most welcome,” she said. And that was that.

My work as a psychotherapist has helped me see that my wants and needs as a client were legitimate. They were nothing to be ashamed of, or hide, or regret. “I had a right to want more from my therapist, and I encourage my clients to expect nurturing and care from me.” I encourage them to want connection and attunement. I give my clients what I wish my therapist had given me, so in that sense, my work has also been therapeutic for me. And my experience of bad therapy has helped me become a better therapist because I know very well what doesn’t work and what isn’t helpful.

I also trust my clients when they talk about bad experiences in therapy. If E. did dislike me (or whatever she felt about me), I wish she had found a better way to deal with, or even use, her own countertransference. Recognizing negative feelings about a client can be helpful, and even illuminating and transformative, if a therapist deals with them properly.

Finally, in supervision recently, I brought up my unsatisfactory therapy with E. My supervisor told me that he and E. had been colleagues for many years. I’m very fond of my supervisor and we have a strong rapport. He asked if I wanted to know his opinion of E. “Yes,” I said, “desperately!” I’m not afraid to show him how I feel, and I don’t have to hold back.

“Oh dear,” he said. “I find it bewildering… You, with your warmth, your vivaciousness, your joie de vivre, were in therapy for five years with E? Dear oh dear. I understand your disappointment.”

“Tell me! Oh please, tell me,” I said.

“She’s just, well… she’s just so cold,” he said. “She’s cold, cold, cold.”

“What a relief,” I said. “So it wasn’t just me. Well, it might have been me too—she might not have liked me, but it wasn’t just me finding her cold all those years—my perceptions were reasonable after all.”

“Yes,” he said. “What a mismatch. Why did you stay with her for so long?”

“Because I kept thinking things would turn around; that I could get something out of the whole thing; that it was me, not her; that I was projecting and imagining things; that getting her to like me would be some kind of victory; that the difficulty of each session was somehow useful; that the struggle had merit; that I couldn’t be understood by anyone so I might as well stick with the familiar therapist even if she didn’t understand me or like me; that I couldn’t do better. That’s why. I’m sure it was more perverse than I realized. I thought that if I could warm her up, I could play against the house and win—I would succeed in getting her to like me and that would count for something, but it never happened, of course. Talking with you now has made me realize that, actually, she wasn’t the right therapist for me.”

I stayed with the wrong therapist for far too long. I didn’t have the confidence to trust my feelings and opinions sufficiently and end the relationship sooner. There was detritus and filth and junk right there between us and surrounding us and I felt it and sensed it and experienced it once a week for five years, even if the person sitting across from me denied the problem. Something was severely wrong in our work together. I’ll never know if she felt it too.

Afflicted with Affect

Posted on by Psychotherapy.net Team

*Janelle sits on the edge of the loveseat in my office. Her knees form perfect ninety degree angles. She pulls her head up, her shoulders back and down, and looks me square in the eye with a set jaw.

The word “formidable” pops in my mind.

But immediately her shoulders curl forward, her head sags. “I want him to tell me how proud he is of me.”

The formidable woman suddenly sounds like a child.

“I raised over ten thousand dollars for pediatric cancer research last week.” She pulls herself up again. “He told me ten thousand dollars wouldn’t cover the cost of a single research assistant. He called it ‘trivial.’”

I work in a town with a large university and teaching hospital. A good portion of my clientele is comprised of the partners of physicians and professors. For a small subgroup of my clients, a common story has started to emerge.

“I was in grad school. I saw him at a party standing in a corner by himself. He looked so lost.”

The story goes like this: girl meets genius. A great guy. Well, truth be told, maybe a little less amorous than she would have liked, but a really great guy. She could tell he needed her: other people didn’t seem to be able to see past his awkwardness.

“I felt sorry for him. He just seemed so uncomfortable. Except when he was talking about his research. Then he’d get really animated.”

Girl marries genius: She manages her growing family, and more. She works on boards, does amazing fundraising, and volunteers for various charities.

As the family grows and thrives her husband pulls farther and farther away. At first she chalks it up to his demanding career. Then it becomes apparent that he really doesn’t like being at home.

At some point, the husband begins to criticize her emotionality, solicitousness, and superficiality. He blames her for being overbearing and boring.

These women are intelligent, well educated, and energetic. They all have very high social and emotional intelligence, which makes them highly attuned mothers, and the center of a large network of people and activities. All of which their husbands seem to resent.

Julie brings up a psychiatric referral. “Last week I tried to talk to my husband about our son. He won’t bring any friends around. He says his dad is too weird. Chip told me that he doesn’t want any more kids around the house, and besides, it’s probably because I’m so bossy.” Her eyes well. “I got angry. I yelled.” Her chin drops to her chest. “He told me that he can’t stand my histrionics. He asked me if my therapist knows how over-emotional I am. He said maybe I need some meds.”

It happens almost imperceptibly. Confident women begin to doubt themselves. They have been repeatedly told that what makes them inferior to their brilliant husbands is that they are afflicted with affect. If they could be rational, perhaps they wouldn’t be so intolerable. By the time they see me they believe that their emotional intelligence is a sign of weakness, or worse. They want me to cure them from having feelings.

It took me quite a while to figure out that a significant subset of my clients were married to men who were very high functioning on the Autistic Spectrum. It seems that the way these men cope with their relational limitations is to frame them as a sign of superiority. They convince themselves, then their wives, that social intelligence is a disorder, and emotional matters are mundane.

Once I figured out that my client’s husbands were on the spectrum (which in many cases was confirmed by independent evaluation), I began to wonder what took me so long to figure it out. Why was I ready to believe that clear signs of high social and emotional intelligence were signs of dysfunction? My head was full of theories and symptom clusters and stereotypes. “Helicopter Moms,” “labile emotions,” “undifferentiated,” skewed my perception.

Affect is not pathological. Nor is being highly attuned. It is pathogenic to convince someone that having emotions is bad. Now when a client tells me her partner thinks she’s overbearing, I ask myself where the pathology actually lies.

Helping our clients who are married to people who are very high functioning on the spectrum means taking several steps. Helping them recognize and come to terms with their partners’ limitations is vital.

Helping them value their own social and emotional intelligence is essential. Of course, we, their therapists, must value these virtues if we are to help these clients to thrive.

“Janelle,” I lean forward. “The grad student who’s getting a research assistantship because of your fundraising does not think ten thousand dollars is trivial. Congratulations. Well done.”

* The people in this piece are not actual clients. They are composite characters.

Look at me!

Posted on by Psychotherapy.net Team

Many people struggle to fully meet their therapist’s eyes the beginning. Particularly those who are shy or introverted.

The warmth, care, interest or love that we may perceive in a therapist’s compassionate gaze may seem “too much” or even unbearable for many who missed or never received it from their original caretakers.

Rachel was my first therapy client totally unable to tolerate the eye contact during a session. The first time we met, this lack of eye contact made me sense her anxiety; she looked like a captured bird, scared and ready to fly away at the first occasion. I thought she would not come back for another session, but she eventually did.

Rachel stuck to the regularity and timing of our sessions, but I kept having an uneasy impression that she was not entirely there. She had been in therapy previously for several years, and her previous therapists had seemed to accept her lack of eye contact without questioning it.

We were doing interesting work, she was open and honest, but my feeling of unease grew. So I decided to address it in the “here and now” with her.

What sense did she make of her avoidance of eye contact?

It helps me to not be really here. At the same time she readily admitted that she wanted to be in therapy and was coming willingly. But to be fully present was “too much.”

To avoid looking into other’s eyes is a very primitive and powerful defense mechanism. For human infants, it is not only a natural way of attracting attention and maintaining it, but also an efficient way of grading the intensity of contact. When we look away and avoid eye contact in a crowded subway train, we expect others to do the same and to not push in, staring at us. When somebody does not respect this tacit message, we may feel invaded, intruded upon in our private space.

Rachel had experienced sexual abuse in her childhood. When our freedom is restricted and we feel trapped (this is what any victim of sexual abuse goes through), the only way we are able to escape, at least partly, the abuser is to close our eyes or to look away. It then becomes the unique way of measuring the quantity of contact, a desperate hope to gain some control over an uncontrollable situation.

I felt compassion for the little girl that had been abused and silenced, but at the same time my frustration with her kept growing. I knew that somehow without confronting this problem our work would get stale.

Talking this through with Rachel helped us put the problem on the table. She was entirely conscious of the impact of her avoidance on our interaction, but still unable to take the risk and meet my eyes.

Look at me! I would I have screamed, had I not been aware of my countertransference.

But with the risk of repeating a traumatic experience, I needed to be patient and “to stay with it.” Her need for security and control was to be respected.

After a while, Rachel felt safe enough to share some painful details of her past. When her abuser, a family member, was with her in the room, she felt too terrified and ashamed to scream. Her parents “were not noticing” what was happening to their young daughter. Years later, when she could finally tell them what had happened, they still chose to ignore the uneasy truth and did not estrange the abuser from the family.

Rachel, a mature adult now, had to face her childhood nightmare, her abuser, at every family gathering. How did she do this?

She learnt to ignore him, to avoid looking at him. This strategy helped again to gain some form of control, an illusion of not entirely being there. Once again, this was the only thing in her power.

With time, I got used to her way of being only half-present, her need to securely preserve some parts of her self. I still enjoyed our dialogue, and the work we were doing around her artistic expression as a cello player.

After a year or so our work came to a natural end. Rachel was doing reasonably well, and she had played successfully at the audition she had initially been so anxious about. As result she landed her dream job in an important orchestra.

At out last session, before saying our goodbyes, Rachel’s eyes briefly met mine. I was now used to this fleeing, light contact between us and appreciated its meaning.

Thank you for not forcing me to make eye contact. When I was abused… he kept saying : “Look at me!” But I never did.

And she gazed at me steadily.

She seemed strong and composed: that looking away had preserved something precious in her; this is how she had defended herself and stood up to the abuser. The new Rachel was able to esteem herself, to fight, to win, and to be a passionate musician.

House Call Revival

Posted on by Psychotherapy.net Team

Welcome to my house.

We had been meeting for a month already, but this was the first time Nick connected from his flat for our weekly online psychotherapy session.

Because of our time difference—I am based in Europe, and Nick lives in the US, we were usually connecting during his early morning hours. I was by now fairly familiar with his work surroundings: a small office cubicle, neon lights, grey doors shut tight.

This time everything was different, and Nick looked younger and more relaxed. He was sitting on his tattered couch, and I could spot on the wall behind him a superb black-and-white photo of a beautiful model. It was certainly one of his own works—Nick was a successful fashion photographer.

Suddenly he volunteered to show me around, surprisingly eager to invite me in. And I quickly discovered, why. A wobbly image appeared on my screen: a tiny flat, barely lighted from a single window, some dirty dishes in the kitchenette, and a messy pile of clothes on a chair.

Up until this moment, I had seen Nick as anybody else “out there”—an extremely successful, nice-looking and polished man with a promising future in the glamour industry.

But now, he trusted me enough to show the other, well hidden, side of his identity—the one of an immigrant from a poor background, fighting for survival in a foreign capital.

Now I had an opportunity to appreciate first-hand the contrast between the two facets of Nick’s inner reality. As I discovered during our session, his “glamorous” dates had usually disappeared from his life after seeing this “other,” shadowy side of him. After a glittery night in a fashionable club and a drink at his place, they would dissipate in the morning light. They would never return his calls afterwards. Sharing this, a deep feeling of shame emerged in Nick.

As I expected, after this “house call” Nick cancelled the following session, and during several weeks tried hard to make me feel useless. But our therapeutic relationship survived, and once the shame finally stepped back, we could resume our work together.

Our further work naturally evolved from exploration of this internal split. Nick was now ready to get in touch with his more genuine desires and motivations.

“Do home visits,” Irvin Yalom advises in The Gift of Therapy.

And this is exactly what I am doing in my online practice. Or, at least, this is the way I like to see it.

“Home visits are significant events, and I do not intend to convey that the beginning therapists undertake such a step lightly. Boundaries first need to be established and respected, but when the situation requires it, we must be willing to be flexible, be creative, and individualized in therapy we offer.” Yalom wrote these lines at a time when online counselling had not really developed yet.

Decline and Revival of the House Call

From the earliest days of professional medicine to fairly recently, it was common for doctors to make house calls. Usually it was a general practitioner, a family physician armed with his Gladstone bag, coming to the patient’s bed. And if somebody were suffering from a mental problem, he would be seen by a priest, rabbi or any relevant spiritual authority, or left alone, living within the society as the village foul.

With the general specialization of medicine and its technological development, mental health practitioners have ended up locked in their therapy rooms, well protected from the unexpected. In America, house calls have fallen steadily down the list of medical priorities since the end of World War II. And the same trend has affected all Europe.

But recently there have been signs of a revival of the house call; for example this story published in the New York Times about a physician's assistant making house calls in New York. This initiative is isolated though.

Oliver Sacks had also visited one of his patients in her home to explore her way of dealing with a rare neurological condition: “I could get no idea of how she accomplished this from seeing her dismal performance in the artificial, impoverished atmosphere of a neurology clinic. I had to see her in her own familiar surroundings.” But these reassuring visits from an audacious doctor are rather an exception, mainly reserved for the rich and mighty. Most of the American and European population makes do with the “impoverished atmosphere” of a medical practice.

Why, apart from the time and money aspects, do home visits seems so bold and risky.

This warning from Counseling Today, a publication of the American Counseling Association, seems to answer this question: “A private, sterile and quiet setting for counseling may be difficult to realize in the home. Expect the unexpected. Other family members, pets and visitors may not respect or be aware of the boundary issues inherent in a counseling relationship.”

This “expect the unexpected” sounds familiar to any therapist who practices online through videoconferencing. Sometimes our webcams let us see our client’s children and pets, as explored by Joseph Burgo in the New York Times. As result, managing the boundaries easily turns into a tricky task.

When we enter the physical realm of our client, we instantly meet with the full complexity of his current existence, and not only its inner components. There is so much more to deal with than in our own “private, sterile and quiet” therapy room.

From the professional anecdotes shared by my colleagues, as well as in my own experience, the online setting brings up anxiety and suspicion amongst some of our peers working in a more traditional setting.

In other words it also feels bold and risky, exactly as the practice of the home visits does.

Lightly or not, any therapist starting to offer his services online undertakes such a “risky and bold” step automatically. The problem may lie within this “automatic” component: connecting with the client through a videoconferencing system, we are almost instantly propelled into his physical realm. The client’s interior opens up for us with just one easy click. In the past, to make a home call, the therapist had to drive or to walk; some conscious physical effort had to be made before he would stand on his client’s threshold ringing the doorbell.

When we meet with our client in his own home, we gain an instant and direct access to some of the things clients usually “tell us about.” These unexpected intrusions and visual clues enrich the peculiar “here-and-now” of every session, with, as counterparty, a loss of control over the environment.

Something similar happens whilst working online: anybody can enter the room from which the client connects, and thus interrupt the session. Distance makes any direct impact on the client’s space impossible. The therapist does not have any control over it; he can only witness what is happening “on the other side of the screen.” This situation naturally triggers therapist’s anxiety.

Boundaries, previously so neatly limited by the walls of our therapy rooms, get more easily blurred in the online work. Clients tend to feel less committed to this “virtual” relationship, and they do not grow attached to a specific physical place. In the peculiar online reality, we are introduced into our client’s homes before properly attending to the boundaries.

To deal with this situation on a daily basis mindfully demands flexibility and creativity. Friends and colleagues often ask me which way of conducting therapy I find easier, in person or online. I generally find that the online work is more demanding for the therapist, often draining. There is more to deal with, in particular all the unexpected intrusions and the wealth of material spontaneously emerging from the visual clues received from my client’s environment.

In the example of Nick’s session, the effect of his dirty laundry and unwashed plates was added to the normal unconscious processes happening between the two of us. As doctors who have been practicing home visits for years, an online therapist develops with time a particular mind-set, a lynx eye for the visual clues and a new, very particular pair of “rabbit ears,” adapted to this specific “here-and-now.”

A few years back, I saw a client in the hotel room where he was staying, grounded by panic attacks partly triggered by the coldness of that very room. André had reached out to me as I was at the time practicing locally in Spain but in his native French as well. He was in Spain on a 4-week business trip, but could not get out of his room on the third day, out into this foreign city that he perceived as dangerous and unfriendly.

I drove to his hotel daily for two weeks, usually in the evening. On that dark road in the middle of some unfamiliar outskirts of Madrid I felt anxious and unsettled by this potentially unsafe situation. I made sure my supervisor was aware of this happening and a friend had the hotel’s name and was waiting for my call at the end of every session hour. At the end in that hotel room there were two people scared to death, and I was the one attending to all this fear.

Now, a few years later, I would have simply connected with André through a videoconferencing system. I would certainly have felt safer, separated by the physical distance from this stranger in pain, but would I have been able to respond as effectively to his panic attacks?

Let’s explore what would eventually have had been different.

The fact that I was willing to make such a considerable effort as to drive to his hotel located far away from the city center facilitated the development of our therapeutic alliance. André got strong and tangible proof of his own importance to me. As result, he could trust me quickly, and a very particular kind of kinship (we were both strangers in this city) developed between us.

This alliance would have been much more difficult to build in an online setting, and very probably André would have not been able to engage with me in the same intense way.

Being physically let into this anonymous hotel room helped me to relate more authentically to André’s current experience. The anxiety I was experiencing was partly my own feeling in response to the unsettling conditions of our sessions, partly his mirrored terror. That hotel room was an unfamiliar, foreign space for Andrew as well as for me. I could easily relate to his experience of being lost, trapped and terrified.

When he was lying on the top of his bed, battling with overwhelming symptoms of an acute panic attack, I was able to hold his hand. At moments he was convinced he would die in this foreign city, and as he shared with me later, reflecting on these first days of our work together, this simple physical contact was what allowed him to believe in transience of this terrifying experience. He suddenly was not alone in that dark and deadly place.

This simple physical touch would have not been possible in the online setting. I would eventually have managed to compensate with some verbal stroking, but that would take much more time to sink in. And, maybe André would not have believed my willingness to be there for him after all.

I am also aware of the fact that maybe at the time when André reached out to me, his level of anxiety was such that he would not be able to tolerate the frustration and separation anxiety, that are intrinsic to the distant nature of online therapy.

When André’s panic attacks stepped back enough in order to enable him to fly back home, we eventually reassumed our work online. Through the webcam’s eye I could now discover some of his original surroundings: his bedroom, his office…

That was a very different experience altogether. I was not physically there, and some of the information was out of my reach (the smells from the kitchen where his wife was cooking dinner, or the view from the unique window of his room). But I was still able to grasp some precious components of his existence: the picture of his wife and kids on his office desk, or his surprisingly assertive and slightly aggressive voice that he used when a younger colleague would suddenly introduced himself into his office.

Working with this particular, moveable (as he kept connecting from different spaces at different times) “here-and-now” I could gain some further understanding of his life in that particular place—a small French city that I would almost certainly never visit.

Soon after returning home, André decided to stop therapy… abruptly and too soon, as I thought at the time. But he felt that his partner, who was now aware of his mental health problems, was now able to give him the necessary support.

Transitioning from one type of space to another—from that concrete hotel room to the virtual space of the online—was certainly far too premature for our new born therapeutic relationship. But somehow the authenticity and the immediacy of the experience we both had in the two weeks of my “home visits” gave him enough relational nurturing in order to strengthen his relationships at home.

“…We must be willing to be flexible, be creative, and individualized in therapy we offer.”
Both online work and home visits naturally induce therapist to a greater flexibility and creativity. Every client’s physical realm is unique, shaped by the realities of the place itself and the people who inhabit it. When the therapist is immersed, physically or virtually, into this realm he can only feed the work on it, adapting the therapy he offers.

Putting the online work into this perspective, allows every session to develop into a particularly significant event—a second best for a home visit.

Maybe the house call is finally back, but in a new form. Technology has developed, allowing therapists to penetrate into their patients’ homes without moving from their own practices or apartments. This change can become an opportunity to revive the old home-visit tradition—the most relational and supportive approach to healing. And this now can be achieved with a reduced cost and an extremely inclusive reach, not limited by the geographical location of the therapist or the client.

The Socially Awkward Therapist

Posted on by Psychotherapy.net Team

Everybody knows: therapists are all crazy. Right?

Where did this idea come from? For some of us, perhaps it’s our social skills. Some therapists can come off a bit . . . well . . . awkward in social situations. Perhaps you know a Socially Awkward Therapist (SAT)?

SATs even find each other off-putting. I had a SAT friend who was talking about another therapist friend.

“She’s unsettling.” He shrugs. His eyes drift down and to the right.

I catch the glance. I automatically register what’s going on in his head. He’s remembering a conversation he had with her. I’m processing the fact that he probably can see it in his mind’s eye, and hear their conversation.

He looks up at me. His eyes, slightly squinted, zero in on mine. “She looks at you too intently.” He nods slowly. “And she nods too much when you’re talking.”

He’s right. SATs have a hard time with casual conversations. We’re not simply noticing, but carefully weighing, evaluating, and interpreting facial expression, tone of voice, body language, rhythm, inflection, and word choice, all in minute detail.

We’re not diagnosing. We’re not pathologizing. We’re not judging. We are quite simply fascinated. We want to know what it’s like to be another person. Not just what they’re thinking or feeling, but to understand their unique experience of life.

So when you meet one of us at a party, we start out okay. But after the “where are you from?” and “how do you know the host?” and “what do you do for a living?” we run into trouble. We want to know how much you like your job, what really makes you happy, what kind of relationship you have with your mother.

And we do this while maintaining complete opacity. We don’t do the conversation dance. You know, where you tell me something about yourself, then I tell you something about me. We just keep asking questions, without any self-disclosure.

Anyway, if we did tell you what was really going on in our heads, it would just confirm how crazy we really are.

“How was your trip to New Orleans?” my neighbor asked me. The only reason she knew that I was going is because my husband asked her to pick our newspaper while we were gone. It would never occur to me tell anyone that much about myself.

Really, how was my trip to New Orleans? I saw some homeless adolescents in the French Quarter. One boy had a sign that read “I need $$ for booze.” I was transfixed by this kid when he made direct eye contact with me. His face was smudged with street grime. His hair hadn’t been washed in so long that the oily clumps didn’t move when a stiff breeze kicked up. His red-rimmed eyes held on to me and begged me for something more than money.

What’s it like to be that kid? How did he end up here? What did it mean to him to be sitting there with his sign? What did he see when he looked at me?

And I was equally fascinated by the couple who were right in front of me when I passed the kids. They were post-middle-age, carefully coiffed, dressed country club casual. They turned their heads and sped up when they noticed the kids.

What did it feel like to put so much effort into ignoring those adolescents? What did they think led to those kids being there? What’s it like to be their kid?

So, when my neighbor asked me about New Orleans, I know she wanted to hear about beignets and bars and bands. But that’s not what stayed with me from the trip.

So yes, some therapists are a little crazy. Their social skills are a bit off. How can it be that a person who makes their living talking to people doesn’t seem to know how to talk to people?

Really, SATs can’t chat. When we talk to people we want to know them. We feel the flow of their affect and then swim with their current. Unfortunately, if you’re feeling demoralized or detached, if you find yourself yearning for some kind of real connection in a virtual world, you’re not likely to look for it in some generic social situation. These days you’d probably go to therapy for that.

The Imprisoned Brain: Psychotherapy with Inmates in Jail

Posted on by Psychotherapy.net Team

Officer Smith

There’s a strange smile I get from one of the correctional officers at the county jail where I do psychotherapy with inmates. The correctional officer?—?let’s call him Officer Smith?—?presides over the maximum security wing where one of my clients is housed. Officer Smith is not a talker. None of the small-town, yessir/nossir politeness or the jocular workaday chit-chat of some of the other COs. Just that smile?—?every time he buzzes my client out of his cell, shackles him up, escorts him to the multipurpose room where we do therapy, right up until he locks us in and steps away.

It’s an iceberg kind of a smile?—?the only visible portion a slight jut at the corner of the mouth; the rest of it looms somewhere beneath. And it conveys something different to me every day?—?anything from benign fascination to good-humored skepticism to impatience, disapproval, or even outright disdain for what I do (some COs refer to the jail counseling program as the Hug-A-Thug program). When Officer Smith smiles, I find myself smiling back, and I find myself feeling those same things?—?ranging from fascination to disdain?—?for what he does too.

It occurs to me that Officer Smith and I have been smiling at each other for months now across some kind of unbridgeable rift, and I’ve gotten to thinking about what that rift might be. We are alien to each other in so many ways. But strip away titles for a moment, his of Correctional Officer, mine of Psychologist-in-Training. Strip away disparities in age and physical stature. Strip away hierarchy and authority. Strip away every other superficial difference and I’ve realized that what really stands between officer Smith and me is this:

Mario

My client. His inmate. We’ll call him Mario. A lifelong addict who nearly killed a cyclist during a meth-induced paranoia. A man facing 25 to life for a third strike offense. A survivor of horrific, repeated, unchecked sexual and physical abuse since the age of four. A gentle, remorseful, introspective man who would almost certainly use and hurt someone again if he were to be let out of prison. A man who has sought professional help since his teens to no avail. A criminal and a victim who embodies the saying “Hurt people hurt people.”

And this is the rift: Every week Officer Smith and I smile at each other across Mario. And Officer Smith’s smile is saying “You think you can change him, but you can’t.” And my smile is saying “You think he can’t change, but he can.”

And my intractable fear is that Officer Smith may be right.

During a recent session Mario presented me with a thick document compiled by his public defender. The document presents a detailed, chronological account of the sexual and physical abuse Mario endured as a child, as well as his early exposure to drug-use by his own mother. Mario wanted me to read it because he didn’t feel comfortable talking about it. He sat there as I flipped the pages and I don’t know if my expression changed when I read the phrase “screws and bolts forcibly inserted into the anus,” or any of a dozen other phrases like it in the document. And then there were the accounts of his own crimes. His addiction and extreme aggression. The police report describing the raw and bloodied face of his ex-wife. The abject deeds done to support his habit.

Beautiful and Precious

Sometimes life just boggles the mind. It can so quickly overload our meaning-making engines?—?“hope” is one of these meanings, just like “justice”?—?that we are left slack-jawed and blank. During so many sessions Mario talked about what he would do if he got out?—?how things might be different for him. But at the end of each session Officer Smith would be there to unlock the door, and his smile would be there too, saying, “This guy?—?he’s gotten out before. He’s used again, hurt someone again, and gone to prison again. You think talking is going to change that? Talking?”

He has a point. And after reading Mario’s file I’ve felt the searing truth of that point?—?the cold, hard biology that I believe is the real mass beneath Officer Smith’s iceberg smile: that the human cerebral cortex doesn’t stand a chance against the reptilian brain. Reason, Abstract thought, symbolism, language, complex planning and executive function?—?the mainstays of talk therapy, and the very things that we insist set us apart from and above the rest of the animal kingdom?—?are imperfect and meager evolutionary tools in the context of our animal condition. My inability to make sense of the horrors of Mario’s life; Mario’s repeated relapses into drug use and violence. Inevitably?—?Officer Smith’s smile would surely insist?—?the higher brain fails to explain the world, and it fails to legislate our behavior in it.

Of course as a therapist, I’m trying to give Mario an emotional experience, not just a cerebral one. But it doesn’t change the fact that my tools for doing so are words and gestures. Mario’s own limbic system has far more potent tools?—?tools that can make even our highest, most uniquely human endeavors seem trifling. We revel in the fact that art can move us to tears, churn our stomachs, increase our heart rates, make us laugh, fill us with desire. But the limbic system can evoke these sensations with less effort and a great deal more intensity. A breathtakingly attractive person could walk by. A spider could scurry from beneath the blanket. You could be beaten, isolated, drugged, fed, fucked. Threat, reward, pain, appetite?—?art is nothing compared to this. Art is the neocortex trying desperately to emulate its older, more successful sibling. In the process it squawks and hollers about truth and meaning and humanity. But what do we generally know about the loudest ones in the room? They’re usually the weakest. The mammal in us is a quiet, ancient, powerful force. Our cortex is a small, yipping dog, ever making threats and pronouncements it can’t back up.

“Life is precious,” it insists. But I’d guess Mario has had a decidedly more animal experience of it; to the criminal justice system, to his community, to his own family?—?life was and is cheap, violent, and appetite-driven. “Life is beautiful,” our meaning-making machine cries. But it is also ugly and terrifying and senseless and painful. Nor, as we would sometimes like to believe, is even ugliness the sole domain of human behavior. Reading about Mario’s childhood, I was tempted to think, “Only humans are capable of such atrocities.” But this is just another way of setting humans apart, of maintaining our own centrality in the tapestry of life. Copernicus might have warned us of the unfolding truth?—?that the great discoveries have been a series of decenterings, of dethronings. The Earth is not the center, nor is the sun. The possibility of life beyond this planet is now a probability. And everywhere there is life, there are atrocities. Sea otters rape baby seals to death for sport. Chimps kill and dismember their own kind. Infanticide, gang rape, and physical and sexual abuse of the young and helpless are practiced?—?in the complete absence of any threat to survival or territory?—?by all manner of mammals including lions, dolphins, penguins, and meerkats. Put a rat in a cage with a lever that dispenses an opiate, and the rat will choose that lever over food, family, and ultimately, survival. We are distinctly human, yes. But far more damningly than the human condition, we inhabit the Animal Condition.

That is what Officer Smith’s smile tells me. “Let it go. They’re animals. We all are.”

And I’m almost convinced.

Except that when he smiles, I’m smiling too. And what’s that about? Defiance? Wishful thinking?

The validity of Officer Smith’s skepticism of psychotherapy is not lost on me?—?and in fact it’s helpful. When we attempt to impose the will of the higher brain, we should know what we’re up against. Any addict in recovery will tell you: taming the mesolimbic pathway?—?the brain’s reward system?—?takes a cortical feat of immense, sustained, almost unbelievable proportions.

And yet people do it.

In the overwhelming majority of significant battles, the animal brain may win; but every now and then, for some reason, it doesn’t. A torture victim finds a life beyond nightmares and flashbacks. A serial abuser tames the animal urge to hit, to hurt, to maim, and talks instead. An addict finds a way to stay sober in the face of blaring environmental and emotional cues to use.

But the thing is, the vast majority of these people?—?the ones I know of anyway?—?were only able to pull off their supermammalian feats in the context of relationships. Healthy, loving relationships. And that is what Officer Smith is missing?—?that therapists bring something decidedly animal to the table, something that a man like Mario has likely never experienced, not even from his own parents. Call it what you want: attachment, safety, nurturing, connection, love. This is not a higher function. It is basic and mammal and ancient and powerful and adaptive, just like fear and aggression.

And this, I hope, is why I smile back at Officer Smith. Because at the end of that session with Mario, after I’d finished reading his file, it so happened I had to inform him that I would be missing the next week’s session due to a medical procedure. And he’d responded, “You gonna be okay, man?”

And I’d said, “Yeah, Mario. Nothing serious. I’ll be back in two weeks.”
And just as Officer Smith opened the door to let us out, Mario said, “Well, shit, take care of yourself, brother. I’ll be sending you good thoughts.”

And in that fraction of a second?—?it was just a flicker?—?I saw Officer Smith’s smile falter.

Note: I have grossly simplified the structure of the human brain in service of clarity and meaning. And of course, personal details have been altered to protect confidentiality.