On Being a Psychotherapist

Clients, as well as friends, often say to me, "I don't know how you do your job," and then follow it up with one of the following questions or comments.

"Don't you get tired of hearing people whining?"

The answer:  Occasionally, but not as often as you might imagine.  For the most part, at the point someone picks up the phone to engage my services, they are ready to do something different.  They are suffering, or struggling, or overwhelmed at the moment,  and their usual ways of coping are not enough, or may even be making things worse.  And while they may be temporarily stuck in a state of victimhood, or self-absorption, or worst of all, hopelessness, the pain is real, and the courage and trust it takes to enlist the help of a stranger to find a way out of the suffering is a very good sign.  No one truly wants to be miserable; it may simply have become a habit, a default mode of existence.

That being said, I too am human, and occasionally when a client is going down that road AGAIN, I think of Billy Crystal (Dr. Ben Sobel) in Analyze This:  He is listening to a client, complaining about her boyfriend Steve for the umpteenth time, and he begins to fantasize a response:

Dr. Sobel: Well, what I think you should do... is stop whining about this pathetic loser. 
[Sobel stands up] 
Dr. Sobel: You are a tragedy queen! "Oh, Steve doesn't like me!" "Steve doesn't respect me!" Oh, who gives a shit? GET A FUCKIN' LIFE! 


"Isn't it hard to just listen all day long?"

The answer:  Listening is important, and something that comes easily to me in this setting, but I damn well better be doing more that just listening.  It is a very active listening, one in which I am both emotionally engaged with my client and reflecting that engagement, while also a part of me is stepped back and observing, contemplating the meanings, implications and nuances, making connections with what else I know about my client.  Then, there is a response of some kind required, allowing the right words to come forth which might help them toward greater self-awareness, self-acceptance, insight and motivation to move beyond their current situation and habitual modes of responding.    Sometimes, just bearing witness in a compassionate and non-judgmental way to someone's experience is all that is necessary, at least until I feel more sure about what the helpful thing to do or say actually is.  But my style is fairly interactive and pro-active, not just reflective.

Best advice I ever got from a supervisor:  When you are not sure what to say, don't say anything.


"It must be draining/stressful/difficult to hear so much pain."

The answer:  Yes, sometimes it really is.  Rape, assault, emotional abuse, sexual abuse during childhood, addiction, death, grief, loneliness, self-loathing, betrayal, dreams deferred, utter and abject hopelessness, intense suicidal thoughts and feelings...yes, some days are harder that others.  I try to make sure that I meet my needs for socializing, exercising, rest, fun, meditation etc. so that I have energy reserves and balance.  The more experienced I have become, the easier it has gotten (usually) to keep boundaries in place and to know my job is not to be the savior.  And embracing the idea that pain is a part of life, but suffering need not be so, helps too.  Pain is not mine to take away, and it is in the suffering I can be helpful, but ultimately the degree to which someone profits from what I am able to do is not in my power either.

But I know I carry it sometimes.  When I get a deep tissue massage, I can tell that my back and shoulders are the physical repository for whatever I haven't let flow through me, professionally and personally.  I was surprised the first time I cried on the massage table; now when it happens, I understand why.


"How do you know what to do?"

The answer: Like all professions, mine has its techniques and its knowledge base to apply. God knows all that time spent in school and on practicum and internship better have taught me something.  And like all other sciences, it has empirical validation.  Like all healing practices, it has various interventions.  Like all relationships, it is based on shared humanity. And like all creative arts, the psychotherapeutic interaction is something alive and emerging in the present moment.  Each moment is unique, and when I am most genuine, responsive and attuned, experience and intuition guide me as to how to best respond.

However, it should go without saying that sometimes I don't know what the hell to do.  Occasionally in a session with someone I am distracted and off-kilter and I feel like I should refund their copayment.    Sometimes I totally put my foot in it and I will say or suggest something that is way off the mark from where my patient actually is.  Luckily, most people are forgiving of this and will simply correct me so that I can get back on track with them.

And sometimes I feel like I am not being helpful at all, because I am not seeing evidence of what I think  should constitute improvement, or change, or diminishing symptoms.  That is when a collegial consultation comes in handy.  Other times, I simply must remind myself that I never see the full picture from an hour in my office, and that some things take a lot of time.  And finally, sometimes things simply not getting worse is actual improvement.


The bottom line is, it is often hard for anyone to imagine doing someone else's job.  Mine is not especially heroic or unusual.  I can't fathom being an ER surgeon or  a soldier, but neither can I really imagine being an accountant or an architect.  If we are lucky, that is because we are doing exactly what we feel we are meant to be doing, and simply can't imagine it any other way.   So what seems impossible or boring or frightening to the outside observer does not feel that way to the person doing it.


I do feel lucky.  I love being a psychotherapist.  I feel honored and humbled to be trusted to walk with someone for a part of their path; at best, this allows me to be an agent of healing.   At worst,  I am simply present with someone, perhaps planting a seed that will blossom later.  


What is not to love?

Summer School (Fireflies) next version...

Here is the same poem from my previous post,  me tightening up the meter/syllable counts per line.   Sometimes I think it is structurally better to have everything evened out, other times I like the ragged edges for the flow of the meaning.

If anyone has an opinion regarding the two versions, would love to hear it!

Summer School

I remember lightning bugs:

first time I saw them,

a golden buzz blinking

in black of the night.

My cousins with a Bell jar,

holes punched in metal

for catching the laggards

and twisting lid tight.

I felt myself mesmerized;

that belly on fire

twinkling, one moment here

then one moment done

Ah, the thrill of the capture!

Delicate creature!

But once I encased it,

I wanted it gone

released to the nighttime sky,

back to the starshine;

because in the glass was

a prison and death.

I ached when I saw her there,

glow slowly fading,

wings searching for freedom,

she struggled for breath.

For here was a lesson learned

early in childhood,

though I had not words for

this wisdom I'd learned:

In the act of possessing

you kill what you love.

In taking the fire of

another, you burn.

Summer School

Summer School

I remember lightning bugs
and the first time I saw them
a golden buzz blinking
in the black of the night

My cousins with a Bell jar
holes punched in the metal
catching the laggards
twisting lid tight

I felt myself mesmerized
by the fire in their belly
the twinkling one moment here
one moment done

Ah, the thrill of the capture
this delicate creature
but once I encased it
I wanted it gone

released to the nighttime sky
back to the starshine
because in the glass
was a prison and death

I ached when I saw her there
glow slowly fading
wings searching for freedom
as she struggled for breath

For here was a lesson learned
early in childhood
though I had not words for
this wisdom I'd learned:

In the act of possessing
you kill what you love
and in taking the fire
of another you burn

But my no-self still needs sleep...

So as to what I was reading from the night before that may have spurred some insomnia.   I just had started reading a book on Buddhism on the Kindle that my husband so thoughtfully just got for me.  I love the feel of books and so resisted the whole e-book thing, but I find that I like it.  It is kind of like holding a book, and it has a groovy little night light.

Anyway, the chapter was about awakening to the true nature of mind and no-self.  I will do my best to explain what I was reading as far as my still limited understanding goes, and if anyone reading this post can correct or further enlighten me (pun intended) I would love your feedback and dialogue.

Buddhist psychology looks at mind in its pure state as a process, not a thing, and as a result there is not really a self that exists independent of others, no static entity, but rather, no-self.  That is, the concept of a fixed identity is an illusion of sorts, an artifact that we construct out of our beliefs about the nature of reality, particularly dualities such as there being a world "out there" and then a separate world inside my head, what I consider "me."

And when I am caught in the concept of "me" there is always something to defend, to cling to, to avoid, to fear--all in an attempt to preserve an idea of a "me" that exists only because I have constructed it.  You, I, all of us are more like drops of water in a larger stream; we do not exist independent of the stream, we are the stream and the stream is us.

Now I find this to be a wonderful, limitless, peaceful point of view; when I can inhabit that idea and I really feel into it during meditation, the experience is beyond words.    It is the flip side to my existential dread, that fear of non-being, the loss of "me" upon death.  Buddhist philosophy is that my suffering because of those thoughts and fears is unnecessary, because there is no actual individual, isolated self to lose.

Okay, so if these kind of ideas are new to you, this might sound like gibberish, and when I am too caught up in my ego, this perspective can spin me out a bit.  But truly, in combination with other aspects of Buddhist values and practices, I find these ideas to be absolutely transformative, and (a word only a recovering Catholic Buddhist would use), redemptive.

This kind of inquiry into the nature of reality, the questioning of perceptions and assumptions, and moving past limitations I have placed on myself and others is vital to me right now.

But it I think at bedtime it may be a little intense.  

Better to read or ponder some other aspect of Buddhism like loving-kindness, something soothing to lead to slumber, and leave the mind-morphing stuff to a fully rested brain, planting the seed in the morning light, then meditating, to see what fruit it bears.

Or maybe at night I should just switch to one of the other books Curtis loaded on my Kindle.

Hmmm, Fifty Shades of Grey...

Insomnia

I want to be sleeping, but it is almost midnight and here I am writing.  Sometimes I am purposefully and happily up late writing, when I am feeling inspired, or just can't step away until whatever I am working on feels finished.

Not tonight.  Really, I just want to sleep.  And of course, sleep is one thing you can not will yourself to do, it has to happen.  The more vexed you feel by not sleeping, the more impossible it becomes.  So rather than toss and turn, here I am at the computer.

Insomnia is one of the most ubiquitous of human complaints, although I wonder if non-Western societies are as plagued.

And there are so many reasons and factors.

I never had any issue with sleeping until having a baby; most women will tell you they never quite rest as well again once sleep is so massively interrupted by the discomfort of the third trimester and then the arrival of the bundle of  up-all-night joy.  Yes, shitty diapers makes for shitty sleep, and my sleep has been generally a bit lighter since that time in my life, as though I could never entirely turn off that vigilance for things that go "wah" in the night.

And then of course there is perimenopause.  My friend Rita said she was surprised I did not include insomnia in my post the other day.  I guess I wasn't really making the association, but now that I think about it, my insomnia does seem more frequent lately.  Hormones affect everything...

Then there is the factor of poor sleep hygiene, as it is called.  Most of us have some bad habits that get in the way of a good night's sleep, like leaving the TV on.  Or sometimes we do things in bed we shouldn't, like pay the bills.  The first rule of good sleep hygiene is that the bed is only for sex and sleep. Since sometimes I try to help my clients with insomnia, I know all the things that you are supposed to do and not do, and of course I do not always follow my own good advice (like right now, engaging in the stimulating activity or writing!)  But even when I do everything the right way, sometimes it just is what it is.  I can not sleep.

Many people are up at night because they are worried or stressed and can't turn off the chatter in their brain.  I tend not to worry too much, but occasionally my brain gets to buzzing about something or the other.   And tonight, as many times, it is also that my body that feels restless, despite the fact I am really tired.  It is not a lack of exercise; I spent an hour at the gym this morning, and one after work.

Well, it just is what it is.  I will go lay back down, focus on breath, and sooner or later I will shift into non-consciousness.

Ah, it just occurred to me!  I was reading right before I tried to go to sleep, and I think it stirred me up a bit.  I will tell you about what I was reading on my next post, or else I really shall be up for half the night.

See you in my dreams...

Monday, Monday...

Just a quick post as the strains of The Mamas and The Papas float through my head.  Just like the lyrics of the song, I think many of us have an ambivalent reaction to this day of the week.  Are we energized and purposeful for the coming week?  If so, then "Cool, it's  Monday!"  Was the weekend not long enough for us, and are we ignoring the fact that we are in a rut of some kind, or dreading the coming week?  Then it's "Crap, it's Monday."

I rather like Mondays though.  Usually.  Sometimes I feel a little tired as I look at a very full schedule of clients for the coming week, or if I am feeling rueful about that report I really should have sat down to do on Sunday.  But  I start and end Monday at the gym, in the morning with  rigorous weight training, which makes me feel healthy and strong,  and then with dancing in the evening, which makes me exuberant and joyful.  What's not to like about those feelings?

So to all my friends, I wish for you on this day the energy and capacity to open wide to all you desire for the coming week.  Shape it to your liking where you can, choose a helpful attitude when you can't, pay it forward to a stranger, spend time with someone you love,  and embrace the present moment.

Namaste.

Ridin' the Harley

Yesterday my husband and I took a ride to Eagle Rock to visit a funky burger/sandwich joint called The Oinkster.  It was the first I had been on the bike in a while; I think the last time was late last summer, maybe early autumn.

Being on the back of a Harley, hurtling down the freeway at 70 miles per hour, the roar of the wind in my ears --you would think that would be an entirely present-moment experience.  So it was interesting to me to notice that I had to keep pulling myself out of my head to focus on sensation and perception.  At first, the reason was... well... anxiety and fear.

Curtis is an experienced biker, sure handed and safe and not afraid to kick up the speed.  I can count on both hands and maybe one foot the number of times I have been on a motorcycle, and I am still getting used to it.

It is an exhilarating experience, but it is very raw and exposed as well, and as much as I like to think of myself as a risk-taker, I know that in very many ways I am not.  So it is a small step of courage to ride with nothing but a bitchin' helmet to protect me.   Although holding on to the sturdy frame of my husband helps, I still find myself closing my eyes as the bike tips towards the ground in the bend of the curve, and I remind myself to relax and let the lean happen.  By the time we are on our way home, I am getting used to that curious sensation once again.

But even after I have let go of the tension, still I notice my mind wandering away from the beauty of the landscape and sky through which we are traveling.  Sometimes a random rumination, sometimes just the running commentary that tends to fill my head all the time as if I am writing a script.  As I keep bringing my attention back --to the green hues of the crops, or the scrubby hillside, or the wind and the sun on my skin--I begin to find just the barest beginning brief moments of pure awareness, the gap between thoughts that comes so much more easily when sitting in the dark and quiet of my morning meditation.

I guess I need more riding practice.  Letting go of automatic reactions, trusting the moment, leaning in to the scary places.  I like this metaphor as it is unfolding for me right now as I write this.  This is how I want to live, this mindful and purposeful practice of fully inhabiting the present moment.  Whether I am on the bike, washing the dishes, talking with a friend, doing therapy, walking to lunch; I want to be in the now in all its fullness, neither grasping nor avoiding, fully engaged and authentically expressive.

It is the practice of a lifetime.  But I have a handsome guy with a Harley to help me along.

And Happy Father's Day to my favorite biker dude.