Friday, September 25, 2009

*everything i've learned from seeing couples in one sentence:

You never get loved the way you want to be loved, you get loved the way its offered.
It's hard to wrap your head around that isn't it? I think its what Rilke meant when he said, "Love is the first great aloneness". What I mean is that you have to surrender to who you're with and relate to them for who they are... and so there's loss in there to work through. There's a giving up of a sub-conscious agenda and there's a deeper experience of living in and working in the pragmatic reality, rather than relationship as power struggle or opera.

I'll get into it more later, and when I do I'll talk about the other great (couples) fallacy, "when two become one, as long as it's my one".

Monday, September 21, 2009

Can it be explained like this?

"If you bring forth what is within you, what you bring forth will save you. If you do not bring forth what is within you, what you do not bring forth will destroy you", *Gospel of St. Thomas.
Now, don't get me wrong... I've never read the Gospel of St Thomas, and the quote was cherry picked from a Vanity Fair article I read on an airplane. The thing is... it's true, and it absolutely can be appropriated to describe one level of the fundamental process of therapy.... the discovery and uncovering of the unexpressed feelings, and then the soft examination of those feelings as they get translated into language. Think of it as an existential sliver being removed from a paw. The sliver causes pain, the pain causes a limp, the limp inhibits mobility, the loss of mobility inhibits one's range, and the loss of that range reduces the scope of one's life.
That's one level of therapy. There's more.... but that's what I was just thinking about. 
If it stays at this place it becomes self indulgent naval gazing and perpetual woundedness... and it kills the therapy (people often get mired in this part and confuse it for the whole thing), but you can't get to the other parts until you get through this one. And this is a big one, because if you don't get through... it limits the scope of your life and then the wound is your life.

Sunday, September 20, 2009

Do you want to know a (therapy) secret?

Most people have no concept of how to be a patient in psychotherapy, and how could they?  In any other medical practice your role is more or less passive, you describe your symptoms and the doctor makes them go away. In therapy there isn’t a singular consensus on how therapy works, or what it can do. That the process requires your blind faith and resembles voodoo doesn’t make it any easier for the patient to actively engage, challenge, and utilize the therapy. Did you know that it’s the patient who determines the extent of the success of the treatment (according to the APA, successful therapy is due to “patient factors” rather than “therapist factors”)? The best metaphor that I can come up with is that you don’t lay the hammer next to nail and expect the obvious to unfold without some sort of involvement on your part. So much if this is on you, but it can’t happen without the hammer, nail, and the action between the two.
Therapy is expensive, it’s difficult, confusing, oftentimes involves pain and loss, but in the right hands it does amazing life-altering things. Do you know how to get the most out of therapy? Do you even know what’s possible within each session?  Do you know if your therapist is any good? How do you know if you should go to therapy?

I rarely see patients maximize the therapy’s potential to facilitate healing, change in self-concept, and the discovery of a more authentic life without first having to fight through  resistance. Patients waste enormous amounts of time fighting against the therapy in a Herculean effort to remain passive, and forever locked into an expectation that the world change for them, rather than understand how impossibly hard they need to work to manifest the changes they seek. Patients often intervene against the therapist in an attempt to undermine their own therapy or reject the therapist at the expense of looking at the therapy itself as a way to communicate injury and discover a remedy. And too often, the patient fails their job on the most basic level; they aren’t informed consumers of the process. The more informed the patient the more powerful the therapy. As a therapist, I’m tired of seeing the process diluted by the patient when there is so much more a kind of potency available to them in the room.

But before we can get to that, there's this first thing to get to, and that's all about why you're here. What was happening the moment you decided to call and book a session, and then, what you want to come next? People make the call because they're in pain, and nothing gets done until that pain is addressed and there's some sense of hope about what happens next.

Saturday, September 19, 2009

Shame is the improvised explosive device of emotions.

Shame is a really impossible emotion. *it takes a lot for me to draw a circle around one emotion and call it out as being good or bad.. because all emotions act as guides to our (unmet) needs, and therefore hold a ton of value as maps. But, shame... is a really shitty emotion. I'm always knocked on my ass by the damage shame does to people and for how much it distorts the world around them. so when we get to dismantling it... its a low velocity process, as in.... one brick at a time. Shame is the improvised explosive device of emotions.

And there's stuff underneath it. Usually some kind of pure affective experience, a lot of it is preverbal... it can't be broken down with words or given a narrative that makes the feelings digestible, or part of a something from which some greater meaning can be found. Shame just comes out in some huge chunks of feeling and it takes some fearless skilled hands to get to it. Getting through the shame is a deep piece of work.

Thursday, September 17, 2009

the two truths.

for all the therapy a therapist does to become a therapist, there are two essential truths i've stumbled upon along the way that keep showing themselves.

you teach what you need to learn.
you give what you need to get.

*its hard to hold the mirror and look in it at the same time.

I'm bad.

There's a kind of narcissism in depression. A point at which a person goes from the experience of feeling bad, to where they simply are bad. And at that point, the depressed mind can only access experiences that reinforce the depression. The disease of it is almost beautiful from the outside, for how well its designed to be impenetrable and self-sustaining. Its easy to treat if you can break the skin of it, and yet so hard to suffer.

As a clinician, its the hardest and the easiest thing all at the same time, because it creates its own universe and you can't engage it until the patient lets you into their world and trusts you enough to travel with you back to yours. So there's 2 points (among many) for the clinician: 1) allowing yourself to be present in the patient's subjective reality of the badness and pain, and 2) having a (less distorted) world to bring them back into that is genuine, functional, and not deceptive or fake. A good therapist knows that the therapy doesn't make you feel better, it makes you *feel more.

*the idea being that one learns to self soothe along the way. if you can get through the feelings you don't have to distort the world to avoid them.