Thursday, October 8, 2009

It's a blunt instrument.

The truth of it is that there are no shortcuts. There isn't an easy way. Its unbelievably hard and exhausting. It can be tremendously scary. It takes time and gobs of patience. Its repetitive. There's no faking or avoiding the hard parts. And any therapist that has a shortcut or wants you to believe its easy, can't really help you. 
The patients that show up now.... more than ever before, are in more pain yet also demand a quicker answer.
 I get it. I wish I could give them what they want.... but I can't lie... therapy is a blunt instrument and its heavy and could be the hardest of all life's undertakings. And all any therapist can do is go through it with you, but you do all the work. Its a lot of work.
Its hard to make that sexy for people. Its not spray tanning or life coaching, or instant transcendence, and it just isn't for everyone. 
But its real, and it works. Especially if you can see it through. And even if you cant get through the whole thing... sometimes doing a piece is enough for now. As much as I love seeing someone through the whole thing, doing a solid piece is great stuff too.

Don't get me wrong, its not all doom and gloom, there is a lot of light, hope, and laughter (*with symptom reduction and inspired moments). Its that its not easy. Change never is.

Thursday, October 1, 2009

the escape is usually the problem.

You can't die from feeling. People die every day from trying to escape feelings. So, on the most basic level, the therapy is about exposing the patient to their own feelings, and inoculating them to withstand the feelings they dread, resist, and fear. Imagine the psyche as a digestive process..... and feelings as the nourishment to be both held onto and used, integrated, and you know... eliminated. One has to use the whole metaphor....

It's the frantic attempts to avoid feelings that makes things messy. Avoiding one kind of pain by creating other pain simply creates more pain. Ironically, the therapy itself can resemble the pain you've spent your whole life resisting, and that's when the anxiety about showing-up for session presents itself. The therapy gets too inconvenient or expensive, or you have what we call a 'flight into health'. Not because the therapy isn't working or doesn't feel good, but because it represents the self in pain. When you build a life around disconnecting and constricting parts of yourself in service of your own survival, plugging back in can be terrifying. If you wander too far afield, the coming back to yourself becomes impossible (the image of Michael Jackson comes to mind as I type this and think about what it looks like when you run from unbearable feelings to such great effect, that you lose yourself).

Some classically trained therapists see therapy as the process of interpreting resistance. The patient will do to the therapy what they have done to themselves... with the best of intentions they will avoid treatment just out of the habit of avoiding those very parts of themselves that they can't digest. A big piece of the work is preserving the therapy as the therapy, with an eye still towards keeping it spontaneous, genuine, and real, rather than as just methodology, theory, canned empathy, and technique.
So within the therapy there is the push and pull to keep the therapy going. As I see it through the eyes of my patients, that's the hardest tightrope to walk. Knowing how hard to fight for the therapy and to interpret resistance, versus  completely backing-off and encouraging them to come and go by how it feels.  Part of the magic of the therapy is knowing when and how hard to press, and knowing how to genuinely let go (and doing all of this ethically and with no mind on sustaining one's practice, or in some sadistic way rejecting the patient).