Therapist’s Journey

I sometimes say to clients and often think to myself that one’s mind is not one’s own. While I consider myself reasonable, thoughtful, and capable of sustained focused activity, the periodic intrusion of obsessive ideas and vindictive phantasies, not to mention the nightly dream world casts my mind as a most intimate, yet seemingly autonomous other whose machinations, conceptions, and misconceptions seem to originate from some nether world.

Freud’s brilliance was to capture this unsettling uncertainty of mind by describing the intricate relationship between primary and secondary processes. The limitation in Freud’s approach was his privileging integration, stability, and the executive function of ego at the expense of vulnerability and fragmentation. Although contemporary psychoanalysis embraces the idea and theorizes about multiplicity, there is still a tendency to view fragmentation as representing a primitive mental organization.  This tendency is present within the phenomenon of the Borderline Personality Disorder.  Along side this conceptual tension, the individual continues to suffer the “slings and arrows” of this illusory notion of ego and persists in the embodied conviction of an integrated, executive self.

A client was trying to decide whether or not to move back with his girl friend after some time had passed following a break up. In one session he described obsessing about doing the right thing.  The obsessions focused on seemingly unimportant decisions like does he go to see his girl friend immediately after work or does he first go home, exercise and then go. Simple choices overwhelmed him with indecision. While he felt that moving in with his girl friend was the right decision, the difficulty making this decision led him to doubt his general ability to make decisions. His increasing indecisiveness in making simple decisions led to a general feeling of self-doubt and paralysis. He felt that he couldn’t trust himself to make the right decision about moving in with his girl friend.

I suggested that he might be feeling ambivalent about moving in with his girl friend.  In other words he was of two minds. This formulation provided brief clarity to my client and helped him explore his reluctance to move back in.  Before he could trust his decision-making and re-attune his relationship with himself, he needed to recognize this conflict and acknowledge his less acceptable feelings.

Understanding that the mind is intrinsically split, fragmented and organized more like the micro climates of San Francisco than the grid of Manhattan is central to establishing an ability to know and accept one’s self.  Context sensitive emotional states structure the expressions of the self. One thinks, perceives, and acts differently when angry compared to sad, anxious or ashamed.  Conflict exacerbates the intrinsic tendency of the mind to split. The individual deals with upsetting feelings by denying, splitting, and separating them, not so much from consciousness but from the idea of how the self should be.  The experience of not feeling oneself is often a reflection of the emergence of a non-preferred aspect of the self.  Paradoxically the splitting that occurs under the pressure to deny aspects of the self strengthens the need to feel integrated and increases the gradient of splitting. This protective process builds on the illusion of integration as health and involves a magical wish to rid the self of unacceptable parts in order to achieve wholeness.  The effect of this process is depletion and discouragement.

Realizing that optimal development doesn’t lead to a unitary, stable, cohesive self but to increasingly complex, disparate, and context sensitive states enables a more realistic and less judgmental appreciation of the workings of one’s mind. Rather than a unitary, autonomous structure, it is helpful to view the self as a composite of multiple parts that represent different qualities, some parts complimentary and other parts contradictory.

Having the capacity to live with ambiguity, multiplicity, and conflicting feelings is critical to living well and wisely. Being able to hold and contain these disparate parts of self and examine them non-judgmentally is a signifier of health.

Within the muddle of multiplicity there exists the possibility of an observing ego, a valiant small-t truth-seeker and internal consensus builder. The most important function of the observing ego is the ability to reflect on experience, especially in times of stress. Gaining perspective involves identifying, listening to, and understanding the multiple feelings and conflicted parts of oneself. The simple yet daunting solution to the complexity of mind and life is to be open to self-experience, to invite all the disparate, contradictory feelings to the table.

It is a foundational principle that trust is essential to intimacy and the growing edge in deepening the psychotherapeutic relationship. Most of the focus on trust in the psychotherapy literature has examined the client’s trust of the therapist. Yet, trust is a mutual albeit asymmetrical phenomenon in the psychotherapeutic relationship.

Trust is so basic to the deep structure of personality that it breathes through us and seamlessly influences the professional dimensions of our personality.  It sets implicit parameters that tone our reactivity, particularly to those therapeutic events that activate our attachment anxieties and narcissistic vulnerabilities.

Some questions to consider: What is the nature of our attachment to our clients?  In what ways do we emotionally depend on the consistent presence of our clients?  What personal factors influence our trust of a client? How does this dependency influence the therapeutic frame and texture the therapeutic relationship?

The way we learn about the underside of our professional selves is often unexpected, through mishaps, the potential “now moments” that happen to us and expose our vulnerabilities.  Our professional role tends to shield us from these qualities.  Yet, the idiom of our personality is embedded in the way we have structured our practice: the length of sessions, the way we start and stop sessions, the promptness in how we return messages, and numerous other administrative arrangements that convey an emotional quality.

Let me present an illustration. Years ago a client told me how she noticed that after she leaves a session l immediately checked my voice mail. She would hear the beeping signal of my phone as she walked down hall, feeling “out of sight out of mind.”  After she brought this to my attention, I became more conscious my behavior at the end of sessions. I realized how I would automatically check for voicemail messages as soon as a client left the office. As a result of my client’s communication I also learned that my behavior had an unintended effect on at least one client. The client felt that I didn’t care about her, which was not how I felt.

From this experience I glimpsed how my separation anxiety and dependency needs was toning my practice.  In this example I was unconsciously filling in my experience of disconnection by checking for messages. I took in the message “out of sight out of mind,” and realized how abandoned I felt when clients left after I ended a session.

This insight led me to examine my reactions to gaps in my contact with clients: when a client comes late or cancels, or unexpectedly terminates. I became aware of how separation anxiety was an ever-present backdrop to my psychotherapy.  When waiting for a relatively new client who is late, I repeatedly check the clock and phone for messages as I attend to some mind-distracting task. Questions rumble beneath these compulsive behaviors: Will the client be coming?  Has the client decided to stop therapy?  Relief attends the signal light turning on. I quickly walk to the waiting room with my trust renewed like the anxious child who feels comforted as the parent enters the darkened room.

Within the therapeutic relationship, the therapist experiences an invisible gradient of vulnerability.  Along this gradient grows the potential for acting out. In The Shadow of the Object Christopher Bollas describes the “psychoanalyst’s practice as countertransferenece.”  He states, “what Freud couldn’t analyze in himself – his relation to his own mother – he represented through the creation of the psychoanalytic space and process.” This idea strongly resonates with my experience of vulnerability as I struggle to understand the presence of those unanalyzed parts of my personality in the psychotherapy encounter.

30 years ago I strongly indentified with what was then the prevailing classical psychoanalytic paradigm characterized by a belief in the Oedipus complex as a central psychological organizing event, the tripartite model of mental structure consisting of ego, id, and super-ego, and adherence to the austere treatment etiquette of abstinence, neutrality, and anonymity.

For the first 15 years of my career I was a child Psychologist, who also worked with adults, and was fearful of working with couples and groups. Reflecting on my initial therapeutic style and presence, I believe that I was detached, formulaic, most likely too tentative, and extremely anxious and self-conscious as I struggled with the tensions between my personality and the standards of psychoanalytic treatment.

The road to the present has been remarkably long and in so many ways unanticipated.  Along this road I’ve discarded theories and techniques that I once valued, if not over-valued, developed a practice that I never imagined developing, and have found the impetus to change in unexpected places. Change is what happens when you change directions.

From dogmatic psychoanalytically informed psychotherapist, I have become a card-carrying theoretical agnostic, aka eclectic. Now I work with adults and couples and older adolescents in a form of collaborative therapy that has no allegiance to specific theories except to the goals of understanding and helping the client. I answer questions, make jokes, stay engaged and attuned to the client’s needs and the mysterious ebb and flow of the therapeutic relationship guided by the illusiveness of our unconscious processes.

Change is the calling card of our profession. We are in the business of facilitating change. So it is incumbent upon us to apply the frameworks of change to look at our personal/professional evolution.  It is also incumbent upon us to look outside our frameworks to see what we might be missing and how to read the history of our development and to see the limitations of our ideas.

Change is intrinsic to life. While development is an unfolding process of continuous change, psychological change seems to happen slowly, and sometimes not at all, at least the change of longstanding patterns of feeling, thinking and behaving.

Change encounters resistance as tire hits road. Individuals tend to repeat the same patterns over and over again. Some people won’t change until they hit rock bottom.  Some people need a lot of help, often more help than therapists or most therapists are willing to provide. Some people are continually moving but not getting anywhere. The default of Being seems etched in stone and riveted in neurochemical pathways.

Change happens unexpectedly! This is what is meant by “now moments.” Through a study of psychotherapy process, the Boston Change Process Study Group has found that the “mutative” points in therapy occur at “unpremeditated moments.”  They call these points  “Now Moments:” unplanned, affectively charged situations that destabilize the therapeutic routine that create the possibility for authentic engagement and change.

Change occurs when the guards are not watching.

Change courts acceptance like an unhappy suitor. As one slams up against the wall of limitations, finally through the acceptance of limitations that for so long had been a futile signal to change, one sees a crack in the wall and discovers freedom of movement.

Change fights acceptance like an enemy. Change is surprised when the tables are turned.  “Who is resisting change now?” asks Acceptance.

Change occurs through surrender, not by giving up.

Change is fragile. Relapse is the rule. The phrase “two steps forward and one step backwards” conservatively conveys the difficult, uneven, path of change, and often leads to resignation and sometimes to paralysis.

Theories of psychological change have to contend with these troublesome, contradictory, and unruly aspects of life. Our theories have tended to privilege the notions of the autonomous individual, action, and will as qualities promoting change. Two ideas that contrast this bias point to an ecology of change that situates the interdependent individual within multiple contexts of influence.

In a wonderful and difficult article titled “Masochism, Submission, Surrender: Masochism as a Perversion of Surrender,” Emmanuel Ghent  discusses the difficulty of distinguishing between surrender and submission in interpersonal impasses.  He states,  “Whereas submission carries the connotation of defeat and is accompanied by resignation, surrender means, not subjugation, but transcendence and acceptance.”

Most of us at the behest of our ego chose not to surrender.  Yet, surrendering to another’s point of view, to another way of seeing the world is not only a means of resolving conflict but is also a means of seeing differently, of transcendence and change. The moment of change is often presented as an unseemly choice where every fiber of ego is poised to protect its way of being and seeing.

The second idea comes from non-linear Dynamic Systems theory, an outgrowth of intersubjectivity theory. (Coburn 2007)1 This theory has adapted elements of Chaos theory to psychotherapy.  With respect to the change process, it has introduced the ideas of novelty and context as conditions of change. This approach emphasizes the context and system over components. People don’t change, systems do.  Change occurs at points of instability and turbulence in a system. New solutions emerge from “chaotic environments.”

To the extent that individuals establish routines of habit and thought and reinforce these habits with rituals and memberships in professional associations and institutes, the probability of change will diminish. Go through a different door and you will most likely enter a different room.  A simple example illustrating this concept is a colleague of mine who is a psychoanalyst. After being in psychoanalysis for many years, when he returned to therapy, he chose to see a Jungian analyst.

The ecology of change represents an interactional view of change. The vectors of change are bi-directional moving from Individual to contexts and from contexts to individual. By acknowledging the power of place, we overcome or allow for a strategy of change that confronts our resistance to change that formidably resides within the compound of our comfort zone.  In a prior post I wondered about the value of passivity as a devalued asset of the individual. I stated that “Passivity, as a suspension of what the “healthy ego” would “normally do” in the service of understanding and mastery is integral if not the penultimate expression of individuality: the capacity to be present for another.”   It seems that passivity, the action often required for change, is all too often turned into an action that impedes change.

1. Coburn, W. (2007) “Complexity Made Simple: Exploring a Non-linear Dynamic Systems Perspective,” Paper presented at the 2007 Self Psychology Conference. Los Angeles.

In the middle of an otherwise super busy November, I ventured off the well-trod path and participated in a 3-week Webinar on the Lithuanian philosopher Emanuel Levinas.  It was hosted by the International Association for Relational Psychoanalysis and Psychotherapy and attended by 75 individuals from around the world. Donna Orange who has written extensively about philosophy and psychoanalysis was the presenter.

Levinas who was imprisoned by the French during WW11 and had most of his family exterminated by the Nazis believed that ethics is fundamental to philosophy. His writings examine the nature of personal responsibility to the Other, defined as stranger, the one who is different, the marginalized one.  While it is impossible to summarize his views in a paragraph, his ethics of responsibility speak to a radical in his words “infinite” acceptance of the Otherness of others. He stated, “Knowledge reveals, names and consequently classifies. Speech addresses itself to a face. Knowledge seizes hold of its object. It possesses it. Possession denies the independence of being, without destroying that being—it denies and maintains.”  Individuality is housed in this recognition.  He states, “It is my inescapable and incontrovertible answerability to the other that makes me an individual ‘I’.  This idea translates into a principal of “hospitality” where one puts aside one’s assumptions, prejudices, beliefs, and convictions, and stretches to view oneself and others through the eyes of the Other.

As the webinar progressed, the moderator observed that a large number of individuals were silent, not an unusual phenomenon in conferences. She invited those on the sideline to join the dialogue, expressing concerns about the reasons people were not participating.  Early in the webinar I had shared some personal experiences that had not been responded to.  Typically this is a moment of retreat. I stepped forward and posted that I was disappointed and hurt when my posts were not acknowledged.  To my surprise, not only was my comment welcomed, but over the course of the webinar, others spoke about feeling marginalized and insecure about presenting their ideas. I was hardly alone.

The conference developed into a “multilogue” exploring Levinas’ complex ideas, punctuated with self-disclosures, and marked by several conflicts that  threatened rupture. From my experiences in groups and conferences, the emergence of conflict often becomes a turning away and shutting down point rather than a growing point.  This conference created a bridge among selves struggling with acceptance of Otherness and self-acceptance, between the need for personal recognition and the capacity to recognize others.

Through participating in this conference in ways that stretched beyond my safety zone that is  bounded by fear, shame and judgment,  and with the help of other participants, I became more hospitable. With the recognition from others I became more individuated.  I wonder if passivity, a pre-condition to being hospitable, is an important and unrecognized aspect of identity. Passivity, as a suspension of what the “healthy ego” would “normally do” in the service of understanding and mastery is integral if not the penultimate expression of individuality: the capacity to be present for another.

“What can it [that attitude toward insoluble problems] be?… . I have the idea of a possibility in which the impossible may be sleeping.”

— Levinas (1999) Alterity and Transcendence.

It is a challenging and unique aspect of our profession to have one’s professional identity so intimately linked with one’s personal self. Becoming a therapist is a state of mind, a sensibility, a never-ending process of developing an identity, a solution to a deeply personal problem, as well as learning a body of knowledge, a set of techniques, and establishing a career. The therapist’s identity is an amalgam of professional role, which grows around a personal amorphous core. The professional and the personal dimensions of self are variables in a complex equation describing the therapist’s identity,

 

The practice of psychotherapy isn’t for everybody. We have chosen a most interesting and difficult job where satisfaction, challenge and peril co-exist. We are privileged to a special intimacy. Day after day hour after hour we hear the most intimate details of a person’s life. What we hear from our patients triggers pain within ourselves as we suffer the same symptoms and difficulties in our lives.

 

What is the relationship between the difficult, symptomatic aspects of oneself and therapeutic behavior, between the professional  and personal dimensions of oneself? How does the cultivation of a professional identity over the span of training and practice assimilate these unhealthy aspects of self?  How do we learn to use our Self including the “unhealthy” parts when what is split off and dissociated by the individual is also devalued by the professional community?

 

The paradox we experience as therapists is that while we work tenaciously and compassionately to heal our patients, we tend to close ourselves off to those unhealthy wounded parts of our personalities. We have struggled with our wounds, which often was motivation for becoming therapists and have fine-tuned our ability to help others. At the same time these wounds continue to be present and provoke shame. We feel considerable pressure to present a normal, competent, professional self to our patients, colleagues, and even to ourselves.

 

The socialization of the self into a professional role and the ongoing expectations attending a successful practice create the conditions for splitting within the therapist’s self, where the professional holds the “preferred (idealized) version of self and the personal holds the remains, including what is messy, wounded, inadequate, and unacceptable.

 

What motivated you to become a therapist?  What life experiences influenced this decision and shaped your development?  I welcome your comments.

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drlarrybrooks

Larry Brooks, PhD

Licensed Clinical Psychologist
License # PSY 8161

138 N. Brand #300
Glendale, CA 91203
(818) 243-0839

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