How do I…?

How do I…?

  A question that emerges after the story has been told, the problem outlined. A man doesn’t trust himself: he has a plan to stop doing what he’s been doing for a long time, perhaps his entire life. He’s determined; the stakes are higher than they have ever been before, which usually means that others will be affected. Guilt will be key. The guilt stems from the prospect of failure, a background of it, and the implicit knowledge that there is something inside that demands expression.

 How do I…?

 As a therapist, I attend to the question on its own terms, responding with an outline’s semblance. First I mimic the crowd, who also knows the story, the history of the problem, and the stakes. Those stakes are reiterated. Regular reminders about the consequences of problem behavior: the impacts upon self and especially others; the damage to health, career, family. To hear some, you’d think that nothing more than such interventions are called for in the prevention of self destruction. I think that therapy supplies the subtext: people care; the man, despite himself, and despite the observations of some, cares also Further, reality can be cruel. Fate is indifferent.

 Implicit is the call for fellowship. The man in question has been isolating, not talking to others, getting lost in himself. Where is the accountability? I ask. I’m quick to explain: I don’t mean he should answer to me, or that he owes anything to anyone. At an early stage of therapy, I avoid stepping into dynamic roles wherein lines of authority are unconsciously laid. I mean something subtler; having something like structure, containment—that there is someone to speak to, to be honest to, when mania has run its course.

 How do I…?

 Continuity. How do you keep it up, your motivation? A woman changes her mind, doesn’t want what she wanted last month, has forgotten what drove her in another mood; what seemed different. The next twisting, turning switch must be explained while the past is denied. A therapist is memory—an aspect of containment. Something changed. Why? The question doesn’t compel answers as much as it does thinking, the protraction of curiosity, and slowing down. Very little has to happen “right now”.

 How do 1…?

Needs. A subset of the why question: why do people do what they do, especially if what they do generates guilt? Why doesn’t guilt itself motivate change? Why doesn’t remorse always do what courtrooms think it should? People do what they do in spite of guilt, in spite of shame, guilt’s less confident twin. Truth—that something within—hurts; it hurts self and others, and it always will. It needs out. It needs to be released, titrated in the spirit of compromise, for if it can be discharged without anyone knowing, then no one gets hurt.

 How do I…?

 Hope. When continuity has broken down; when the relapse once cast as a mere change of mind has returned the individual back to square one, a knowledge of pain lingers. The day after is another appointment. The fellowship, in all likelihood, is still there. People still care. The questions are still worthwhile. Curiosity is resilient. The therapist is in his office, waiting.

Graeme Daniels, MFT




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