Tag Archives: psychotherapy

What is always there

 

But seriously, the “project” that was once psychoanalysis, or now psychotherapy or whatever, has been disrupted by Covid-19. Telemedicine, Telehealth, Telepresence, is here to stay, according to some. This is a watershed moment, a bump or a shove into the next paradigm. No going back? Well, I won’t be the only one kicking and not quite screaming, but rather only moaning and possibly sulking. I’ve lost one or two from the caseload: people who perhaps think the virus scare is not what it’s negatively cracked up to be. Or—here’s a thought—maybe they think I’m not all I am positively cracked up to be, and therefore the crisis that’s upon us is a pretext for a separation. Neurosis aside, this situation is not what I trained for. Something’s missing, and something else has been mobilized in response. Temporally appropriate feedback. That’s a term I heard yesterday, used to explain why the phone, the latest video technology, the e-mail, and even the text message might be used for a psychotherapeutic exchange and why the fax machine never was. It wasn’t quick enough, basically. That’s what temporally appropriate feedback means, by the way. Yes, I know. Talk about unnecessary verbiage, someone’s dissertation nomenclature. Anyway, whatever’s happened overnight, it seems tailor-made for opportunists, entrepreneurs; futurist thinkers with a survivalist edge and a nose for the front of a line. I’ve thought about my peers, even some of my colleagues in all of this. Some of them belong in the jungle, I think, pulling at the bamboo, or squeezed into a tight gap beneath a fallen hut or an all-terrain jeep. They have grease on their hands, an ample toilet paper stash, and numbers dancing across their mirrored pupils, for they have versatile, fix-it aptitudes, which means they navigate well all the toys that mediate contact with the material world and which are derivatives of the childhood games they played better than anyone else.

What is always there is never noticed until it is missing, said Jose Bleger. That’s another of those psychoanalytic aphorisms that are meant to stir thought if not practical solutions. What is it that was always there? I have wondered aimlessly instead of, say, moving to use Venmo, or signing up for What’s App, or whatever, as if those were the clues. I don’t skip along a trail of newfangled ideas the way that others who…don’t use words like newfangled and therefore don’t have issues with planned obsolescence, come to think of it. I thought I had an idea, dull as it may seem, of what was and is always there: the analytic frame, manifest as the office space, with a door leading to a waiting area wherein a would-be patient sits and waits for me to open my door and beckon them towards me. It sounds more authoritarian than it is. And it seemed like it still had a few years left in it, too, as paradigmatic frameworks go. Now it isn’t there. Or, it is there but it seems like an abandoned warehouse with a faintly stale air about it. Recently, I’ve not been getting my money’s worth out of my office. It collects mail, a bit more dust than usual. I can go there once a week and make a phone call from it if I like, but it’s not the same. The nice view from the window’s not the same. There’s no collegial hum across the walls that connect to other suites. There’s nothing charming anymore about the rickety elevator that takes me to my floor, or pleasing about the sudden abundance of parking spaces in the adjoining lot. And after the first week of lockdown—not even the consolation of a few toilet rolls to steal from the bathrooms. What was always there? I haven’t figured that out yet, but like a good would-be analyst, I am thinking, still wondering.

Meanwhile, I am thinking of bigger things, philosophical, mindful ideas. Phenomenology, I think. I’m reminiscing, at least, if not deepening. Back in 2001, I thought 9-11 was a fine how-do-you-do to the 21st century. Now I think that episode less an introduction to doomsday than the residue of the last century, with all of its terrorizing, authoritarian ghosts. Not that we don’t have plenty of nutjobs these days, but you don’t beat the 20th century for tyrants and martial horror: two world wars, a couple of nuclear explosions (not counting the tests in the Pacific and the deserts of the American Southwest); Hitler, Stalin, a few other genocides, assassinations all over the place, at least one war that America lost. Seriously, a total s—tshow. But 9-ll, which made household names of Al Queda and a guy named Bin Laden, seems today like a distant memory of airport inconvenience and yesteryear jingoism: a tough deal for anyone sniffing at a military life, but for the rest of us, not the economic and civil collapse that stares at us now. Images of twin towers burning didn’t make the cut of my recent Dr. Strangelove video, with its “We’ll Meet Again” montage of zeitgeist existential threats, 2020-style. Not topical. Scenes of floods, wildfires, stranded polar bears and penguins on thinning ice were the visual accompaniment, not the cold war terror of mushroom clouds or the once Arab stereotype of airplane hijackings. Covid-19 snuck into the slide show with the odd picture of a solitary figure wearing a hospital mask amid empty landscapes, signifying for me, anyway, the ubiquity of the virus’ impact: the live presentation I was meant to give on Strangelove was canceled, after all.

The ‘live’ has always been there. Nature has always been there, and the notion that it won’t be has long felt like an abstraction, despite the slide show of evidence to the contrary. It’s trite to point out that nature is unforgiving, getting its revenge upon us now or else teaching us a lesson, perhaps in the nick of time, depending on what climate change scientists actually think and wonder. It’s further trite to distill the Bleger reverie and consider that what is always there is a warning to not ignore the signs of danger; to notice the impact of phenomena upon others, environments, even things. Indeed, it stirs shame to consider that Covid-19 has aroused more fear, more loss, or more determination than any other modern calamity simply because, unlike any other world event one might remember, this has truly impacted everyone to one degree or another. I conjure the grim-faced, somewhat unsympathetic gaze of those who have known and felt war, environmental catastrophe, unspeakable man-made atrocities or the constant slaps of racism and other oppressions. They may be quietly saying, Oh, so we’re all in this together now, are we? Maybe some of them got a head start. They’re like California, or North Korea or Singapore, or whomever else might have done this thing right. They were and are good with the things, and technology, that which mediates and distances us from nature, enables, intrudes, obstructs, complicates, and yet may save us. It helps…sort of.

 

 

 

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It’s high time

 

It’s been several centuries since the Sunni Persian poet Rumi waxed lyrical about the value of wine. Intoxication, escapism from anxiety: these were venerated effects once, before the medical or psychological problems related to drugs were apparent or widely known. Ancients bemoaned excess, thinking drunkenness shameful, but they also observed in humans the drive to change consciousness, as important perhaps as our drives towards sex and aggression. We seek freedom from oppressive thoughts, inhibitions…that problem of what others think.

I’ve long felt ambivalent about what intoxicants promise, regardless of what the medical or psychological consequences are. The tacit principles of psychotherapy extol the values of altered consciousness, but through natural means, not via the imbibing or inhalation of a foreign substance. Further, therapy implicitly encourages the exploration of anxiety or depression—the staying with pain—not so much its alleviation, or the substitution of it with pleasure-seeking. These values place my professional (or at least certain sections of it) at odds with many who are not interested in learning about their pain, and therefore addiction or dependency treatment represents a huge faction within mental health services. Implicitly, most of us in this field are wedded to sobriety, and professionally at least, suspicious of so-called altered consciousness, as induced by chemicals. Fortunately, growing knowledge about marijuana, for example, enables a different discussion: one that focuses upon pain, not consciousness. Increasingly, intelligent choices can be made about the types of pain that should be medicated, and those that shouldn’t.

Medical marijuana, or Cannabidiol (CBD), is one of a hundred plus cannabinoids that binds to cannabinoid receptors within the immune system, whereas Tetrahydrocannabinol (THC) binds to receptors only within the central nervous system. That distinction has only been known for a few years. THC has intoxicant qualities—a ‘high’—and impacts various areas of the brain, including the basal ganglia (impacting movement), the hypothalamus (hunger), the hippocampus (memory), the cerebral cortex (reality testing and perception), as well as the medulla, which mediates the experience of pain. That marijuana disaffects short-term memory should remind us that in the context of PTSD, for example, or even certain aspects of grief, we might consider that ‘forgetting’—ordinarily an aversive symptom—is a propitious, as in welcome option. CBD does not get a user ‘high’, nor does it increase appetite, and can (unlike THC) treat rather than stir anxiety or psychosis. As an anti-convulsant, it can also be effective in the treatment of epilepsy. However, it can be counterproductive with respect to eating disorders (because it doesn’t stimulate appetite), and ineffective in treating depression, because it blocks THC from producing feelings well-being.

Research indicates that marijuana, whether in configurations of THC or other cannabinoids like CBD, places teenagers, and specifically males aged 16-24, most at risk for addiction, as that is assessed via DSM criteria. Adolescence is a tender period of life, for sure. We all remember what it is (or was) to worry about what others think, especially as a teen, and perhaps males are less socialized to talk about this–that’s the chestnut theory, anyway. But this vulnerable population constitutes just less than 10% of estimated marijuana users in this country. Now that 28 states have legalized use and possession of marijuana, and that legitimate medical uses for CBD have been established, it seems time to remove non-habit forming marijuana from the federal list of Schedule 1 narcotics (for which lack of medical application, plus abuse potential, is a criteria), and to block what has long seemed a tertiary, social effect: the indirect persecution of the black community via the pretext of illegal marijuana use and possession.

As a therapist specializing in addictions treatment, I have long dodged the legalization debate, especially when speaking to clients who are externally motivated to abstain. The legality question has always been in the way, it seems. The real questions—the ones that will persist over time, are the following: what do you want to do about pain? How do you want to raise consciousness?

Graeme Daniels, MFT

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More things in heaven and earth

 

I am watching it. I am compelled, and I should not be writing of this while I know so little, while so much is unexplained. But that is my life, my “subjective” reality: the unknowing. And not knowing doesn’t stop me from writing or doing my job.

I am four episodes into The Leftovers, an HBO series adapted from a novel by Tom Perrotta which is set in the aftermath of a rapture-like event in which 2% of the world’s population has inexplicably disappeared. October 14th of 2011, is a 9/11-style shorthand for a mass “departure” that scientists can’t explain. This results in a social malaise that recalls P.D James’ Children Of Men. In that novel (also made into a film), the world’s population has become sterile for similarly mysterious reasons, and in the aftermath an aging (and therefore dying) population is variously depressed or psychotic. Cultists speculate that mankind is being punished; that its hubris, perhaps manifest as a privileging of science, is to blame.

In Leftovers, the focus is not so much on a failure of science as it is that of mainstream religion. Major denominations are nowhere to be seen. A baby Jesus replica is stolen and later desecrated by the acting out daughter of a local police chief of a grim, middle-American town. Baby Jesus is later returned, but significantly, the response is indifferent, and the police chief ultimately dumps the rejected figure on the side of a road. Meanwhile, cultists are represented by a group call the Guilty Remnant, a name reduced to the letters GR until episode two. This tidbit of withholding is typical of the series thus far, which parallels the air of unknowing by minimizing exposition, thus keeping viewers in the dark, and not just about the headline departure, but also about personal details. I am gripped, but optimally frustrated—the essence of suspense, I suppose. Four hours in, I am yet to understand the following: why do all the followers of GR smoke (an ironic play on ‘don’t waste your breath’?) Have the departed transformed into dogs or birds, creatures of either violence or passivity, as is also suggested? Why do the dreams of some enter those of others, as indicated by the profusion of nightmares featuring strangers and foreshadowed events? Why is the police chief estranged from his kids and his wife? It seems implicit that something happened, and whatever it was, it happened before the departure.

It’s just a story, after all: a good one that promises more about meaning; perhaps how religion, ostensibly exiled, has a defiant, parting comment on humanity. The stories of those who enter therapy are good stories also, and the details are likewise often obscured; divulgence of truth, not to mention meaning, is delayed. It is a feature of projective identification, a primitive defense yet more ubiquitous than most imagine, that individuals communicate in fragments: through play, language that is reduced to slang, idioms and inside jokes; by ‘acting out’ infused with terse revelations; by somatic displays that medicine can’t explain. Symbolic expression, via the articulate, coherent use of language, has broken down, though it may repair and unfold over time. Unpleasant emotion is dissociated, replaced by a standard of flatness and baffling obsession. When something has happened that is traumatic and not understood, life goes on, promise onlookers. It goes on with ritual, structure; with substitute things to do that mark time but also betray, in pieces, an epistemological drive.

The police chief of Leftovers loses his bagel in its inadequate incubator, and he’s not gonna take it lying down. He bemuses colleagues by not giving up on the search: for his bagels, for that baby Jesus. He finds the bagels also, eventually, through a semi-violent dissembling of machinery. They were stuck in back of the toaster, trapped in a secret passage, burnt. As the chief pulls them out, he sits back, moping over burnt food, dead…something. He is mildly relieved, having discharged energy from a nagging mystery. He is also depressed, aware that mysteries will keep coming, and that unfolding reality may yet be horrific. “Say it! Fuckin’ say it!” he later cries towards the wife who won’t speak, won’t explain. But she wants to leave him, she writes, giving an answer. It’s not enough. He pleads to know why. About everything.

 

Graeme Daniels, MFT

 

 

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The Adventures of Process Man

 

Rick sat on a stool adjacent to his parents’ kitchen, indulging his father’s Sunday night oratory. Tonight, it was about the latest kitchen renovation, proudly completed just in time for his adult son and his wife’s latest visit. Across the way, Rick’s mother was bending Amy’s ear about something which left Rick’s spouse glassy eyed and feigning rapt interest. Rick’s father was a more insistent speaker. To properly placate him, Rick would need to affirm every sentence with a nod, an appreciative hum, or an occasional query indicating sustained curiosity.

“See how it opens up the space and you can look out into the living room, speak to your guests if you want, carry on a conversation while you’re preparing some food.”

“Yeah, it’s great, dad. Really. I can see how it’s gonna work for you.”

“Well, you might wanna think about it for your own place. I could give you the number of my guy. He’d give you a good price, or if you like, we could help you out. Call it an early Christmas gift.”

“It’s April, dad”

“So what. It’s a very early Christmas present.” This was Rick’s mom chiming in, and releasing her daughter-in-law for a moment. Rick and Amy exchanged a furtive glance.

“Yeah, I don’t know,” Rick said with diplomatic caution. He wore the kind of placid smile that he’d been sporting with his parents since his late teens.

“What’s to know. Look, it’s up to you, but see how it opens up the whole place. I’m thinking about your kitchen. You’d be crazy not to do something like this. Look, you can…” Rick’s dad basically repeated everything he’d said three minutes earlier, only now Rick made less effort to oblige him. It was an old pattern, an old diminishing set of returns. While he hung his head, his father continued. Opposite him, his mother resumed her monologue with Amy. Rick sighed.

A flash appeared in the center of the room, accompanied by a plume of smoke but leaving in its wake a muscle-bound, toothy and earnest figure.

“Hi!” said the ephemeral, masculine image.

“Process Man! What are you doing here?” asked Rick

“Who? Who’s this?” asked Rick’s dad, dumbfounded.

Rick quickly collected himself. “It’s Process Man. He’s a legend. He helps people with communication problems—tells them what they’re saying to each other beneath their content.”

“What?”

“That’s right, Rick,” the figure affirmed. “I am Process Man and I am here to help you understand what you’re REALLY saying to one another.” He turned to face the awestruck women. “What you all are saying to one another”

“Wait a minute, what’s going on here?” protested Rick’s dad.

Process Man began his sage lesson, unperturbed. “You see, Rick, what’s being offered here is a parental gift. Your father has money and advice to give you, and will only be satisfied when you allow him to make this gift.”

“I know that, Process Man, but—”

“But what you don’t know or realize fully is that this conversation isn’t over until you give unequivocal support for the idea. That’s why your father is prepared to repeat the information, and will keep repeating it until you agree. He’s the one who decrees when the communication is over. That’s what he’s saying.”

“You know, you’re right,” Rick enthused.

“Wait. I—”

“And Dad, you probably understand that your son’s gotta consult with his good woman, who’s over there listening to your good woman, loyally absorbing the mother-in-law’s words. But what you don’t fully know is that Rick needs to make up his own mind, and the more you repeat your lessons, the less he’ll take in what you have to say.”

“The law of diminishing returns,” Rick’s dad intoned soberly.

“That’s right. You understand.”

“Thanks, Process Man,” said Rick.

“Tell a friend,” said the figure as he and the smoke disappeared.

 

 

 

 

 

 

 

 

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Personality Disorder: the other way (part two)

 

I want to blame someone. James Masterson did also, I think. He will have argued with many over what comprises a real versus a false self, or a personality disorder—whether such a thing exists with some. Were he alive today I think he’d argue with proponents of trauma model, and possibly with authors of novels like The Woman in Cabin 10. Not that these people don’t think that personality disorders exist. They simply call them something else, because mental health services, like any commodity, ultimately, is not just something to be validated by research, or—sorry—evidence-based research. It is something to be sold to the public.

For the average consumer of psychotherapy, a diagnosis of trauma, whether that trauma is episodic, chronic, the result of fatefully aberrant events or an aggregate of quaintly termed little ts that shape development (the theorized etiology of personality disorders) is simply more palatable. The word connotes victimization by an external agent, and thus a diminished responsibility for the sufferer. Treatment encourages a present identity of a survivor (very popular), with a possible future of healing. It’s a meet-them-where-they’re-at-thing. Regarding etiology, the accent is upon recent, precipitating events, with an intellectualized nod towards distant antecedents, that complex internalization of others which blurs a simplified reality.

Trauma model practitioners pay lip service to the antecedents of trauma. Prominent authors even co-opt object relations theories without crediting them, and repackage (reframe in the jargon of the field) personality disorder as something like developmental or relational trauma. A good example is featured in Barbara Steffens’ Your Sexually Addicted Spouse, whose target readership is evident by the title. In her text, Steffens describes PTSD as “something that can last a lifetime”, and that relationship trauma entails “painful coping mechanisms ingrained in personalities” Study the work of Klein, Fairbairn, Mahler, Winnicott, Masterson or Kohut and you’d hear the echo of their theories in such pop psychology literature: that psychic pain is integrated into personality over time, generating a disordered self in which such pain is habitually defended against in relationship.

But again, while trauma model educators pay lip service to old patterns, they mostly ignore it in treatment. The reasons are two-fold: A.) Treatment doesn’t last very long in this model. It’s a two week stay in a group home of some kind, or an eight-week course at your nearby hospital. B.) Discussion of problems is intellectual, academic—therapy as education. You’re given homework, even, to solidify the association with school. This is organizing, some say. Stabilizing for the unsafe person who cannot, it is presumed, manage complexity, the uncertainty of not knowing more deeply why something is happening. They are unable to weigh or contemplate their own mind alongside those of others, which are similarly complex, and implicitly dangerous. This danger is cast as objective reality, and anyone who says otherwise is “gaslighting”. Thus, treatment prioritizes affect regulation techniques and procedures, not the contemplation of self and other; it advises the practice of coping skills, self-care activities—all of which is worthy, actually, as adjuncts to growth. Meanwhile, the model’s adherents suggest that the afflicted let go of the actions, opinions, even the feelings of difficult others, while attaching labels. Fuller contemplation is put off until some ambiguously later time, when the person may be deemed ready. I think that readiness is seldom achieved. Time passes. It doesn’t so much heal as fossilize thoughts about self and other. What’s difficult to let go of are the pat understandings imparted by practitioners who recycle the same lessons in one short-term treatment episode after another.

In a longer-term therapy model, individuals inhabit their adult roles and live their lives as opposed to dropping out of society and going to school. They are challenged to do more than learn how to self-soothe or calm down, or take time-outs when mad, or to leave that bad relationship that your friends all think is wrong, only to start another one that’s similar because you haven’t learned what you got from that bad relationship. Instead, some learn (or are challenged to learn) to hang out with confusion, the grey areas of day-to-day life; to tolerate discomfort, stay with the difficult, as Masterson was once quoted as saying. Reality is learning about one’s own mind and being open to those of others, especially those that are not so easy to detach from: bosses, spouses, children; the memory of those absent but still profoundly influential.

What’s your pain today? Who or what do you want to blame, talk about instead of understand; focus on instead of yourself? Do you really know what your pain is about, what it’s backstory is—it’s underpinning? Do you think you really know the story of others? I know. It’s not what you (I’m) thinking.

 

Graeme Daniels, MFT

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Holden Caulfield would understand

 

Final day of 2016. Possibly the last time I will focus on my most recent novel, the one featuring my most cryptic of titles, Venus Looks Down On A Prairie Vole.

“What the hell is a prairie vole?”, complained one reader, who further implied that he didn’t like obscure metaphors in popular art–that is, until I pointed out that his favorite book was Catcher In The Rye, and that his favorite film was To Kill A Mockingbird, and that his second favorite was One Flew Over The Cuckoo’s Nest.

“Fine, you’ve made your point,” he conceded, only to add, “But pretty please, so I don’t have to bother Wikipedia—what the fuck is a prairie vole?”

“Fine,” I replied. Fine, I think finally: I will explain more pointedly, more comprehensively than I have before, my oh-so-obscure metaphors. I guess I’ll start with the second one: a prairie vole is a monogamous rodent. I’ve written that before and left it at that, feeling cheekily evasive. But there’s more, of course. I learned about prairie voles a couple of years ago, from the book The Compass of Pleasure, a non-fiction about addictions, whose author, David Linden, wrote with similar cheek about creatures that didn’t fit the masculine stereotype of wanton promiscuity—hence a passage about prairie voles, who not only put a ring on it and devote themselves to one partner, they behave aggressively towards other females who impinge. How romantic. What real men prairie voles are.

The latter trait doesn’t necessarily pertain to psychologist Daniel Pierce, my recently widowed and ever faithful protagonist—at least, not until he meets Lira, a former prostitute antagonist, with whom he engages with tense debate, contesting her careless feminism, which underlies her effort to expose one of Daniel’s patients, who is accused of child abuse, among other things. Because of Daniel’s resistance to her, Lira presumes his solidarity with masculine license, and is only mildly convinced by his grief-stricken diffidence, and much less by his ethical stance on privacy. Still, over the course of the story his reluctant attraction to Lira becomes evident, adding to the air of sacrifice in his character.

Which leads me to the other metaphor, the less obscure term, Venus. No one has asked me about the meaning of this one, which is disappointing on the one hand, and mildly gratifying on the other. I guess that readers get the idea. I think. Anyway, though I believe most readers are aware that Venus is Roman mythology’s answer to Aphrodite, and means goddess of beauty and love, what may not be entirely clear is the term’s relevance to the story.

Well, firstly, and most sentimentally, Venus is a reference to Mary, Daniel’s recently deceased (from cancer) wife, who is “looking down” upon her ever faithful husband, lovingly. You’d think this alone might render Daniel likable, or at least sympathetic, and thus gird him from the wrath of readers who might (like Lira) upbraid him for not later doing the right thing, from an average point of view. Because the average view is that therapists and other mandated reporters can and should, if they have the information, violate their patients’ privacy if said information might help the investigation of child abuse and thus yield the protection of children.

Daniel rejects the simplicity of this argument and therefore represents, as my hero/anti-hero, what I imagine to be one of, if not the most unpopular position that any responsible adult might take in today’s society: the protection of a possible sex offender’s privacy. I was acutely aware when I was writing Venus of how this might affect a reader’s sympathy for my central character.

And as a male writer with a male protagonist, I position center stage the opinion of women, especially. What does Venus, the symbolic everywoman, think of Daniel? Would she think him a hero? Probably not. Merely decent? Maybe. Look down on him, so to speak? Would it be enough for Daniel, to be considered decent? Is being decent enough for men? For Women? It seems to me that many in our culture are reappraising heroism: what counts as heroism—who gets to be a hero. Women seem to feature in more traditionally heroic roles in cinema these days (note the deliberate effort in the Star Wars series, for example), so a millennial, unlike a traditionalist, might chide Daniel for being cowardly, but not rely upon him, necessarily. Lira, for instance, will pursue her cause with or without Daniel’s help. She might not need men anymore, though—and here’s my truly final (not to mention obscure) spoiler—she might join them.

 

Graeme Daniels, MFT

 

 

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The old scripts

 

A man sits in a conference room, chatting collegially with a pair of co-workers, ostensibly leading a meeting. Technically, the man is in charge, but he prefers to keep things informal, not throw his weight around. Soon they will be joined by another man—everyone’s boss—who appears to not have such reservations. As a kid, he will have been a problem, this man: if not an out-and-out bully, then maybe just a nuisance; tagged as having attention deficit disorder, and needing a good dose of meds in order to follow directives, play well with others. Today, an observing psychiatrist might say he has poor audience; meaning, a blind spot keeping him from knowing where he treads. A less generous opinion would be that he doesn’t care. He walks into a room and simply expects people to drop what they’re doing and focus on him. It’s how he got to where he is, he might say. His turn to give directives, direct play. That is, if he notices.

The first man has had a different life. Until now, his once subordination to either bullies or the inattentive has been dormant. He’d worked hard, quietly achieved a certain status within the organization, and earned his graduation to civil society, mostly spared the obnoxious company of autocrats whom he’d suffered plenty enough as a younger man. When the boss walks in he begins talking louder than anyone else, instantly turning the heads of everyone present. That other collegial exchange is now relegated in importance, which immediately stirs in the first man a dreadful anger. What is this feeling? the man wonders…later. In the moment, his thoughts go blank as his adrenaline surges, followed soon by a chill sensation. Bad, implicit memories. Anxiety. The resultant compromise between states is a halting, passive, as in barely discernible complaint: “I guess we’ll postpone our talk until later.”

In models of psychoanalytic psychotherapy, espoused by the likes of James Masterson, treatment proceeds with the following assumption: that individuals develop self and other representations, based upon an accumulation of experience of ourselves in relationship with others, which in turn forms a psychological structure that is activated in times of stress. Our explicit (conscious) and implicit (unconscious) understanding of ourselves and others is an aggregate of our object relations (experience with caretakers), derived from early development, and nurtured over time. The task of therapy is to make sense of one’s own mind and that of a therapist, even though manifest content tends to eschew focus on the therapist, especially early in the process.

Self identities—meaning, strategies of being in relationship—are often fixed and rigid by the time therapy begins. They constitute a way of getting by, but not of growing, or of being happy. A kind of quantum phenomenon collapses time, disorienting the distressed patient, who experiences new stressors with an old psychological structure, and therefore people are dimly reminded of unfinished business, though presented with fresh choices. Though I am few people’s idea of an autocrat, I might tread on toes this day, and look into fleetingly bewildered, scared eyes; hear the opening strains of quickly defended selves. I wonder what they’ll say.

 

Graeme Daniels, MFT

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