The Task of the Modern Psychotherapist

What would Freud say if he overheard me offering medical advice to a client for a toenail infection? He might be horrified because he’d want to probe for the deeper meaning of the topic. Imagining this

conversation with the great psychoanalyst inspired me to address some changes in the practice of psychotherapy and psychoanalysis since Freud’s time.

Of course like Freud, the psychotherapist aspires to the motto that  “Nothing human is alien to me.” Ideally, we’re not shocked by any confession, and we’re sworn to honor a client’s privacy, except in situations of potential suicide or homicide.

Freud believed that the mind is a blank slate or tabula rasa in Latin. The question then becomes to what extent does heredity, opposed to the environment, impact the tabula rasa of the developing brain. A simple answer today is that our perceptions of the mind change in accordance with discoveries in neuroscience.

For example, disorders like autism and attention deficit disorder, recognized and treated early in a person’s life, portend a more favorable prognosis. This observation connects and supports the hereditary nature of both conditions, and the environmental factors (involved in timing) of treatment. In other words, early intervention has a greater impact on the developing brain, and implies that windows of opportunity close rapidly.

Today psychotherapy is not restricted to an exploration of the unconscious, nor to the wealthy, elite, artistic, or intellectual.  The variety of psychotherapeutic techniques has broadened, and the psychotherapist hopes to meet the client’s challenges rather than adhering to a theory.

Freud’s outlook was decidedly more deterministic than today’s open-ended approach. Diagnosis doesn’t necessarily determine prognosis. We know we don’t have all the answers and expect the unexpected regarding possibilities and potential. Like the stock market, the outcome of psychotherapy is unpredictable: Past performance doesn’t predict or guarantee future results.

For example, a patient of mine, whom I refer to as Mr. Z., began psychotherapy following an affair. He questioned whether he should leave his wife. As therapy progressed, he was surprised to realize that he, himself, was the problem, not his spouse. He could barely tolerate his own company. He simply didn’t like himself. His outlook changed: Instead of focusing on what his life lacked, he began to appreciate his partner and home life.

For Freud, an objective of treatment was to convert neurotic suffering to the universal suffering of humankind. Today, the psychotherapist is more likely to focus on the positive aspects of life, like transformation and appreciation.

We live longer and recognize the capacity and human potential to change: We have the chance to engage in multiple careers, relationships, hobbies, interests, and travel. The psychotherapist supports change and maintains an open mind regarding the ability of a client to transform his life.  Our objective is to help the client become aware of how, when, and why he may get in the way of his goals (for example, fears of change, success, failure).

Regardless of a therapist’s orientation ­­­­––interactive, relational, psychodynamic, behavioral, cognitive––the “good-enough” psychotherapist conveys a belief in his client, and supports his efforts to improve his life and become the best, authentic person possible. (The term “good-enough” originates from the psychoanalyst, D.W. Winnicott, who applied the term to mothering).

Conclusion: The “good-enough” psychotherapist adapts theories to relate and collaborate with clients to support their growth and help examine obstacles that interfere with their constructive goals.

Dear Reader, I welcome your thoughts. jsimon145@gmail.com

Money, Power, and Your Health

A recent AARP conference (ideas@50+ ) featured Arianna Huffington, president and editor-in-chief at The Huffington Post. In her presentation “Thriving After 50,” she spoke about retirement and the fact that people are not saving enough to “thrive” in their future. According to the Employee Benefit Research Institute, about 36 percent of American workers have less tan $1,000 in retirement savings. Sixty percent have under $25,000 and 58 percent have debt problems.

There is little doubt that lack of sufficient money constitutes a major stress and contributes to bodily ills.  Our attitudes toward money undergird much of our lives,  impacting our lifestyle and sense of well-being. Yet many of us ignore the task of managing our finances, often with dire consequences.

Taking stock of your money with an eye on your financial future is a good idea. Here are some examples.

Do I think money:

1. is meant to spend on myself? Some of us feel deprived and believe material possessions will erase the suffering. For example, Mr. G. purchased multiples of shoes, sweaters, etc. filling his apartment with stuff he could never use.  Ultimately he had to declare bankruptcy.

2. can lift me out of the doldrums? Often a depressed person attempts to lift his mood by buying something new. Mr. B. realized the glitter of the new item quickly faded, and he wasn’t dealing with the real problem, but covering it over, like painting a rotting floor board.

3. is meant to spend on my children, because I’m generous,  want the best for them? Mr. V. wanted to save his children from accumulating  college debt and paid all their expenses. However, he neglected to save for himself and had to postpone retirement.

4.  is for others to handle?

Ms. W. knew in her “heart and mind” that she shouldn’t go into business with her husband.  But she did not listen to herself. When the business failed, she had to ask her son to help. He took over her finances, and she found herself in the humiliating situation of having to ask him for money.

5. requires too much discipline?

  At age 70, Ms. Q. still expected someone to bail her out as her mother did when she was a child. “Mom would open the cash register in her beauty salon whenever I asked for money.”

6. doesn’t have to be protected?

Mr. M. gave up his health insurance, betting on the odds that he wouldn’t get sick. When he became ill, his wife divorced him so she didn’t have to cover his medical bills.

7. is too frightening a matter to face?

  Mr. O. was often in a panic about his finances because he was too frightened to figure out how much he really needed to retire.

Once we recognize the psychological snafus, we can appreciate that 

the principles of money management are relatively simple.

1. Purchase what you really need.

2. Spend as little as possible to get the most.

 A woman doesn’t have to go beyond her budget to find attractive clothes. Similar styles are sold in Macy’s and Bergdorf’s.

3.Save as much as possible. No one can predict if or when an emergency will arise, and most of us want to have the option to retire.

4. Pay down debt as soon as possible.

Conclusion: Taking care of our money is an important aspect of taking care of ourselves--our health and sense of well-being. Investing time and effort in managing our money pays off in more ways than dollars.

P. S. Here is a haiku that is relevant to money management:

To finally know

the plum, use the whole heart too,

and your own nose.

  

   Onitsura (1660-1738)

It inspired me to write my own:

To counterbalance

the gross substance of lucre

seek the plump rose

 Dear Reader, I welcome your responses. Jsimon145@gmail.com

Permission & Prohibition

As humans we are dependent on obtaining permission from someone, sometimes for almost anything we do!

Permission applies to behaviors whether they relate to our bodies, our minds, our feelings or our socio-cultural behaviors.

Let’s begin with our bodies. The baby naturally puts his fingers and toes in his mouth. Understandably, he eventually learns not to.  Sucking one’s thumb is certainly not permissible after a certain age. We all learn that many bodily functions belong out of public view.

But lack of permission regarding our body can be detrimental. In his fifth decade, Mr. K. thought he was becoming deaf.  The doctor found mounds of wax were occluding his auditory canal. When his ears were cleaned, he heard very well.  He realized he had never cleaned them because his mother told him not to put anything in his ears.

Most of us learn that our feet are dirty and require no attention beyond washing. But Ms. W. suffered from foot pain and the podiatrist gave her exercises that decreased inflammation and prevented contractures of the toes. We’ve learned to diminish and regard feet as “inferior,” but they are most essential in supporting and balancing our entire skeleton and aligning our bodies.

When we fail to have permission and go against our parents, we may suffer dire consequences. On my recent vacation to Hallstatt, Austria, I learned about Saint Barbara, patron saint to the miners since the seventh century. On the mountainside many visit her prominent shrine. Barbara, a beautiful 29-year-old woman, was beheaded by her father for converting to Christianity! (Fortunately, disobeying a parent doesn’t often lead to this extreme!)

Undoubtedly, we grow up without permission to accept our feelings. We often hear a parent say to a child, “Don’t be sad. Don’t cry.” Rarely does time or opportunity allow an exploration of why the young person should or shouldn’t be sad.

In psychotherapy the client gains permission to experience all feelings and thoughts, to understand them and to figure out what to do with them. Obviously not all thoughts and feelings are appropriate to express or act upon.

A big lesson in life is having permission to make mistakes. Years of schooling teaches us that mistakes lower our grades. But in the real world, we learn a lot from making mistakes. A classic example is the experience of Dr. Alexander Fleming, who discovered the earth-altering antibiotic penicillin, when his Petri dish became accidentally contaminated by a mold.

Regarding permission and socio-cultural practices, examples are almost endless.  Mr. R. grew up in a country where the fish head was considered the most tasty part of the anatomy. In the U.S. he met people who wouldn’t eat this food unless it was thoroughly cleaned.

Conclusion: Re-examining our behaviors regarding permission and prohibitions in the realm of body, mind (belief systems), feelings and socio-cultural practices can be beneficial to our health and well-being.

Dear Reader, I welcome your comments. Jsimon145@gmail.com.

Attachments & Connections to Ourselves & Our World

The nature of the early attachment to our parents or primary caretakers influences (to a major degree) our relationships for the rest of our lives.

John Bowlby (1907-1990), the first attachment theorist, concluded that these early emotional bonds affect us from “the cradle to the grave.” He observed that the cries of an infant when separated from a parent or caretaker is an adaptive response to assure his survival.  The child feels loved when a parent (or caretaker) is accessible, attentive and reliable, and this in turn, leads to feelings of security and confidence that allow him to explore his environment. Failure to receive good-enough physical or emotional nurturing leads to (feelings of) anxiety, or in more extreme cases, despair and depression.

As we mature, we form bonds outside the family. Ideally the circle of connections increases to include teachers, peers, girl or boy scout troops and/or fellow team mates.

The adage, “don’t put all your eggs in one basket” is a useful metaphor to keep in mind. Often, people with affiliations (beyond attachments to fellow humans) to include a discipline, like arts or sciences, fare better than those who rely exclusively on interpersonal relationships. Outside interests render us less vulnerable to our less-than-perfect fellow humans who at times fall short of our expectations.

Mr. D. failed to receive good-enough nurturing early in life and never felt loved or accepted by his wife or children. When his dog died, he experienced a severe depression and had to be hospitalized.

By contrast, Ms. W. was able to transform her feelings of abuse (at work) to an interest in studying law. Desire to learn the legal aspects of work place behavior connected her to the library and to other people in similar situations.

Jonathan Lear’s classic 1990 book Love and its Place in Nature, a philosophical interpretation of Freudian analysis, expands Freud’s libido theory to positive connections beyond intimate relationships. Love, a basic force in nature, underlies the (infinite possible) positive affiliations to our world.

 

Our connections to the world are in a state of flux throughout our lifetime. We attach and detach to people, places and things as we evolve.

Mr. I. married twice and lost his wives to illness. In middle age, he decided he preferred a variety of friends to forming another marital bond.

Flexibility of our attachments and connections leads to physical and emotional health. By contrast, rigidity leaves us vulnerable.

When forced to retire early, Mr. F. became very depressed.  He hadn’t realized the extent to which he had relied on his job to fill his life.

Today many of us bond with technology. Witness the ubiquitous presence of the laptop and iPad. How this reliance alters the nature of our relationships to each other and our world is complex, and at present, to a large degree, unanswered.

Conclusion: Attachments and connections change throughout our lives. The quality of flexibility helps us adjust to our evolving selves and the world.

Dear Reader, I look forward to your response. jsimon145@gmail.com.

Please check for the next post on September 1. 

Conundrums of Our Complex Minds and World

Our human minds often complicate simple matters and  simplify complex ones.  Take the example of the stock market. It goes up until it goes down. But when it is rising, most of us (naïve) investors assume the trend will continue; when it is sinking (especially at a rapid pace) most of us don’t believe or trust that it will ever rise again. “The investing masses expect the most when prospects are worst, and vice versa,” William Baldwin said in the June issue of Forbes Magazine,

For socioeconomic, religious and psychological reasons, we may complicate a clear matter like nutrition. (Please refer to my blog post of May 12, Maintenance and the Body Self).   Simply stated, we consume calories (to provide energy) in the form of a balanced diet of proteins, carbohydrates and fats. We often overlook the simple equation that too many calories equals a gain in weight.

 

Happiness and sadness, gains and losses alternate like day and night, yet the human mind frequently becomes stuck in one position, like a car locked in gear. Quite often, we need to experience a few cycles before we perceive, and hopefully, accept them.

On the other hand, our minds simplify complex matters. We tend to turn a conflict into a matter of black and white (like the situation in the Middle East). Often the truth lies somewhere in the middle, with a broad swatch of gray in which both sides bear responsibility to resolve the conflict.

A developed mind is required to perceive and sort out the complexity of our human condition. In her work with children, the psychoanalyst Melanie Klein observed the psychological defense mechanism  she coined “splitting” to explain the phenomenon of black-and-white thinking.

Raised in a supportive and nurturing environment, the child’s mind develops the capacity to juxtapose opposing points of view and to perceive the complexity or gray zone of a person and/or situation. (Maurice Sendak’s classic 1963 children’s story, Where the Wild Things Are, is a delightful portrayal of how this process is played out. In the story, little Max misbehaves. He’s sent to his room where he fantasizes about a kingdom with wild beasts. Psychologically speaking, these creatures represent the (unconscious) projection of his rage.  He tames the wild animals, and this feat enables him to integrate opposing views of the world in which his parents nurture and reward him, as well as reprimand him.

This discussion relates to psychotherapy in significant ways. The “good-enough” therapist attempts to dislodge the client from the world perceived as all black or all white-to help the client integrate diverse points of view and the complexity of relationships.

Because an individual has spent years perceiving the world in binary terms, the process is neither quick nor simple.  Years may be required to accomplish the paradigmatic shift in a world view.

Oddly enough, the ability to integrate diverse points of view isn’t related to intelligence or educational level. Mr. O, very intelligent man who graduated Phi Beta Kappa from college, wasn’t able to grasp this concept and, as a result, his personal relationships suffered.  Presumably, his traumatic early environment created the need to maintain the rigid defense mechanism of splitting.

Nor does psychotherapy guarantee the ability to integrate the polarities. More important is an individual’s recognition that the process is possible and productive.

Meditation (time alone with our thoughts) and a desire to understand and resolve conflict help us live in our complex world.

Conclusion: A conundrum of the human condition is our tendency to simplify complex issues and complicate simple issues. Recognizing that tendency helps resolve the polarities in ourselves and our world.

Dear Reader, I welcome your response. Jsimon145@gmail.com.

In Pursuit of Persistence

Nature is persistent I think as I observe the plantlets pushing their fragile stems and leaves between stones and bricks embedded in the ground surrounding a New York City tree.

Persistence is the pursuit of a goal in spite of obstacles and is a key element to success.  But if persistence is so important, why doesn’t it come more naturally?-- like breathing for example.

Observe the infant:  He instinctively struggles to sit up and walk and talk.  But beyond early life, many of us loose our natural forward thrust or have trouble maintaining it.

Curiosity and motivation help us persist, but to this day these attributes-- how to nurture and who possesses them—for the most part, remain mostly mysterious.

What factors influence our drive to persist?  Perhaps instead of encouragement along the way, we’re exposed to criticism that inhibits our progress. By contrast, an appreciative audience can spur us on like a favorable tail wind.

For example, Ms. S. was raised by a critical mother and a praising father. The contradictory messages led to confusion and doubt and interfered with her goal to become a singer. Before she persisted, she had to become aware of her thoughts and conflicted self-perception that blocked her progress.

Obstacles include fears of many kinds. For example, fear of failure as well as of success. Either case portends change which humans in general shun.

Staying with negative, uncomfortable emotions—whatever these may be-- from doubt to fear of isolation- plays a role in persistence. Leonard Bernstein, one of the great orchestra conductors of the 20^th century and a composer of celebrated musicals like West Side Story, struggled with his fear of isolation. Spending time alone, a necessity in the creative process, was agony for him. He struggled with the question of whether he should devote his energy to composing or to conducting. In a letter to a college roommate, he wrote, “You may remember my chief weakness-my love for people. I need them all the time—every moment....I cannot spend one day alone without becoming ...depressed” (The Leonard Bernstein Letters edited by Nigel Simeone). Composing was so “lonely” for him, and yet he occasionally sacrificed companionship and persisted  in his craft, and in doing so, left a lasting imprint on the American psyche.

 

Conclusion: Persistence includes enduring discomfort and facing our negative feelings.

Dear Reader, I welcome your thoughts. jsimon145@gmail.com.

Time, Vacations, and Routine (A Brief Meditation)

With the arrival of summer, many of us are thinking about our vacations. We change our location and our activities, but no matter where we go, we take time with us. In other words, although we do take a vacation from routine, we can’t take a vacation from time.

The good news is that we can do a better job of feeling like we're on vacation even when we're not, simply by altering our perception of time. The matter boils down to living in the present. 

Diverse practitioners of meditation emphasize that we do best to experience  “the moment” as fully as possible. But this is a difficult goal to attain. Our minds often rush into the future or, on the contrary, hurl us back into the past.

Almost from the beginning of our lives--except for infancy, if we’re lucky enough to be born to parents/caretakers attuned to our basic needs-- we grow up adjusting to the schedules of our families, the school day, and ultimately, the workweek.

We certainly don’t learn to be in our own moment—in sync with our minds and bodies. Although this accomplishment sounds self-evident or basic, to be with one’s inner or true self is complex. It involves breaking out of everyday routine to master a lesson that extends beyond the common curriculum.

Even more worrisome is the fact that we may not be aware that we’re missing something; that is, a sense of serenity, feeling all is well within us and our world.

Dogs help us live in the present. My dog, Woolf, baulks and plops down on the pavement when I urge him to pick up the pace so we can circle the block according to my schedule. Then he glances up at me as if to say, “What’s the matter with you? Why the hurry? We’ll do better if we slow down.”

Young children also naturally live in the moment and may resist our efforts to pry them from it. If we enter this child’s world paradoxically, by extension, he may help us experience the present.

Dwelling in the past and future can work against us. For example, a person may deprive himself of a pet because he has experienced the loss of one in the past. Imagining the inevitable demise of another pet can deprive him of an animal’s company in the present.

In the practice of meditation we learn that the process of breathing grounds us in the body. Although our minds tend to disorder and disobedience, our breath follows the pattern of inhalation and exhalation. Focusing on the “in” and “out” reminds us to slow down. (If I can’t focus on slow breathing, I employ the rapid in’s and out’s of belly breathing, a pattern that resembles the panting of an over-heated dog.)

 

Conclusion: Focusing on breathing helps us live in the moment, and can seem like a mini-vacation from the routine.  

Dear Reader, I welcome your comments, jsimon145@gmail.com. 

P.S. I ask your indulgence as I post this blog with less regularity in the future. However, please check once a month for new topics. Thank you for your loyalty and understanding.