Thursday, June 2, 2011

What I Did in Psychotherapy Today

Today's therapy session was outstanding, all the more because I couldn't make it in and we talked over the phone.  But with the trust built on a dozen years of work, and my understanding that a good session begins with no agenda, I started blind.  What we very quickly got into was the sorting out of two of my most important relationships: how they originate from the same place and yet are so entirely different.  In one I must not be who I am if I am to have any relationship with this woman at all.  I must listen very carefully to her, respond at every turn to her moods, her needs, her desires, her wishes, and give her the empathy she needs at that exact moment regardless of my mood, need, desire, or wish.  This is a great deal of work for me...as much work as if I were in my chair marked "Therapist" in my consulting room.  The sad reality is that she believes that she is doing all that for me also but in reality she is not hearing a word I am saying, even when I am empathizing with her.  She is carrying on in her own world, and there I am attempting to carry on with her, being so little noticed as to not be there at all.  Within that relationship, I am not.  Or, in the luminous words of Martin Buber, there is no I-THOU relationship between this woman and me. 


The above is sad.  What follows is the devastation.  For the past forty years of my life, I have believed exactly the opposite of what is reality.  I have believed that she and I were in it together; that she was tracking with me as I was tracking with her; in short, that we had a relationship in which I was being my genuine self.  None of it is true.


About that other terribly important relationship in my life: it has been tumultuous since the day I was born.  Full of love and hate and envy and adoration and loathing and camaraderie and eroticism and every-flavor feeling.  Now, through the adversities of  these past 3 years of life, we two characters have found a new rejoinder to each other: a deep and abiding respect.  At a level approximating that at which plate tectonics function, we intuit that throughout our lives each of those emotions, and the accompanying behaviors, has been blatantly honest, forthright to the bone.  Each of us, for our own reasons, has journeyed toward enlightenment and we have lately caught sight of each other on parallel paths.  We have become steadfast friends who can, and only do, tell each other the truth in all things; we rely on each other when we can and wait patiently for each other until we can.  We have a relationship in which I can be, in short, my genuine self.


All that was discussed in my session today.  Also discussed was that without [my dear] Dr. H. none of that could have been discussed.  Such was the trust held over a tenuous telephone  connection in this other inimitable I-THOU relationship which holds and strengthens me to shed light on the truths of my life, the greatest of which is that I do not and can not ever take for granted that I will trust myself as being seen in any given relationship.  I must remember, with every person with whom I converse, to remember myself.
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My post script is odd but necessary.  It is written to a remark made by Rush Limbaugh years ago.  He commented on his radio show that psychotherapy is a forum in which people can blame all their problems on their parents.  Rush Limbaugh's total ignorance in 1988 still makes me sad and angry--perhaps because I have so little reason to think he has had impetus to improve his insight into this most serious of the healing sciences and, thus, has continued to misinform his legions.

Tuesday, February 15, 2011

Are We America?

Harken back to the heady days of the 1760's and 1770's, when the streets of Philadelphia and Boston and New York were ablaze with the pamphlets of Tom Payne and the letters home from Ben Franklin and the ideas of Tom Jefferson, and Alexander Hammilton getting ready to go his next round with James Madison over Federalism v. Populism.  And all the while these men are anxiously awaiting the next round of communiques from France, Germany, and Spain with their grandiloquent ideas as to how to next decide the questions of the day, lest the Mighty Methodists gain too much power over the Secular Unitarians, or the Fighting Federalists founder Madison's Mamas.

Not so much.

Yet as Egyptians teemed with the overthow of the exact same kind of autocracy in the last few weeks, American and other world leaders imperialistically worried over the future of Egypt's government as if the people of Egypt were too stupid or too gullible or too mindless of their religious fanatics to do so for themselves.

But note an article in today's New York "Times" Blog which recounts the history of an enclave of a section of Cairo, Imbaba, long thought to be held by the Muslim Brotherhood, where young people are standing up one by one to discount the influence of this religious conservative faction and voice their hopes for a secular government that will deliver jobs, economic security, and a modern way of life to this and all areas of Egypt. 

These are voices not unlike those in our once proud, honorable society, clashing with a true oppressor.  Not the voices of right wing conservatives who by their very nature must take the stance of victims of whatever form of government exists, and extend their logic to the degree of paranoia if necessary to make their point, as is happening in this country.

It is a given that Glen Beck and his Tea Partiers rail at the United States government "as if" it had taken freedoms from them commensurate with the freedoms the autocracies of the Middle East have long usurped from their peoples.  Had our government in fact acted in this manner, we would not have heard from the Tea Party except on carefullly guarded Facebook pages.  [But that obvious irony of the woeful moaning Tea Victims is best left for another discussion.]  The point here is that, while leaving our own citizens in relative perfect freedom, the United States government has played fast and loose with the citizens of the world's nations, while fostering and maintaining autocrats and powermongers and outright theives as national leaders, forcing entire nations into slavery, all in the name of national security for decades upon decades.

This two-faced take on democracy is not the ultimate responsibility of "Our Government".  It is "Ours, The People's".  If we want to organize a meaningful Tea Party, let us wrest this control over the people of the world back from our Executive Branch and its innumerable slippery fingers, such as the CIA and the Justice Department; the Congress, with its impossibly many secret budgets and its first loyalty to coporate lobby money; and let us make our uncompromising will made perfectly known to the Supreme Court by standing on its steps, as the Egypians stood in Tahrir Sqare for as long as it took.

Yes, the proud and insular people of these United States have much to learn about humility and purpose from the citizenry of the Middle East. 

And yes, our American Tea Party has much to teach us about how to organize.  It is unfortunate that so far, the Tea Party's goals are no more far-sighted than the end of their tax forms. 

There is much for us, as American citizens, to share with the world about the true benefits we have lived with for 235 years under democracy.  If the time comes that we find our true collective moral compus, perhaps we will join together in our true collective moral purpose, despite the quagmire that deigns to call itself our federal government, to assist in whatever way possible peoples like those of Egypt who truly could utilize assistance in moving toward a peaceful democracy.

We are a people who have lived for over two centuries, in relative peace, with free elections, a non-police state, actual freedom of speech, and the myriad other benefits of a democratic society.  Who better to share with those struggling people than "We, the People" of the United States of America?

Thursday, February 3, 2011

Status Report

The treatment team met this morning re: blog immediately below.  I will summarize reports from each of the participants:
  • Nursing staff report the patient has been cooperative with all orders, taken meds with no trouble.  She has been eating fairly well, ~70% of her trays, no snacks.  She has remained quite aloof in the milieu but responsive, polite, occasionally even humorous to specific questioning.  Appears to sleep comfortably through the nights.
  • Psychologist reports that patient has participated actively and very thoughtfully in thrice weekly therapy.  Is in psychoanalytically oriented work as this approach is successfully uncovering underlying conflicts to which the patient is responding with new material and appropriately intense and varied affect.  Work will continue at this level though admission and after.
  • Occupational Therapy is seeing the results of intense therapy in the broad range of emotion and affect patient both presents and applies to her work.  Also sees frequent confusional states which patient is able to work through with Irving, to whom she has formed an attachment.  On occasion patient requires extended time away from the other patients in order to collect herself; is then able to return to the group.
  • Group Therapy-Pt follows the context of the group; occasionally offers a powerful insight, but for the most part is unable to maintain a consistent presence in the group.  Has developed an empathic interest from several patients rather than having built up a level of hostility from the group because of her low level of participation, which is seen as a hopeful therapeutic sign.
  • Psychiatrist: have increased antidepressant to full therapeutic dose.  Patient requires low dose antipsychotic to alleviate massive anxiety caused by childhood PTSD.  Will continue working with her to work on social skills on the unit.
Overall prognosis continues to slowly improve, remains guarded.

Wednesday, January 19, 2011

Where to Hide...

This entry is written to somebody specific--I don't know whom--but they will know. It is a love letter to a person who thinks he/she is crazy. But I know he/she isn't, just as I know I am not crazy. I also know that I have been deeply (almost mortally) psychically wounded in my life. I know that I began at about the age of one year to develop ways to handle the psychic trauma I endured. Although I am now in my seventh decade, sometimes when I sustain wounds that are reminiscent of psychic wounds I received as a child, I respond now in the ways I did then.

My characteristic response to danger of any kind is to retreat. Specifically, when I begin to trust that a person has come into my life and is available to me, responsive to me, and honest with me, and then I come to doubt whether any of that is true, I become confused regarding whether the person has turned on me or whether I have misread the myriad clues about that person's true nature. It is in that state of utter confusion--confusion about the external (the trustworthiness of the person) and confusion about the internal (my ability to trust)--that I retreat.

You could look at me and not know I have gone away. Actually you'd have a hard time looking at me when I am in this state because I stay inside my house, very often not dressing for days on end, very often not leaving my bed.

My away place is a psychic place that is as real as a transparent column. It exists parallel to my real life, but the person who occupies it is not my real self. It is a physical person who does not feel physical. She feels as if she has no body. She is not connected to anything of this earth. The inside of her head feels hollow and just on the edge of vertigo. She looks at her arms and legs and does not recognize them as belonging to her. She can use her eyes to read and her ears to hear, but her hands do not want to respond to a ringing telephone. Her legs do not want to respond to the call of a full bladder. Walking is a risky proposition for her, even to go to the bathroom 10 feet from her bed. Even removing the blankets and exposing her extremities to the air seems too harsh for her to endure.

She has lost all sense of time. It could be Sunday morning; it could be Wednesday afternoon. It doesn't matter.

Nothing matters. She is safe here, in this place where she does not have to explain anything to anybody. She doesn't have to ask for anything. She has no future and no past. She is time out of mind. She is not connected to anything or anyone, and nobody remembers her.

Her store of food diminuishes; she eats whatever she finds in the cupboard whenever she feels stomach pangs. She falls into and out of blessed sleep, round the clock. She is far, far away, numb...

...until!...Reality inevitably forces itself into her private space. Damn Reality...That force that causes the blood to start moving again through her body. Such pain!...the pain of feeling coming back into her legs, her arms, her mind.

Pain of lonliness, pain of betrayal, pain of abandonment, pain of hatred, pain of feeling the physical and mental shell that contain the emptiness.

Her dearest and most loyal friend (who also knows all this for himself), her brother, comes to her and transports her to her only safe person on the planet, her psychiatrist. She can tell him everything about how she can't feel, doesn't want to feel. Inside those four walls she knows from experience that she can say all of it and not be judged. Better yet, she is taken seriously, accepted totally, and in no danger of reprisals. This man is a full partner in her life. He wants to work it through with her, help her feel, help her heal.
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Damn that excuse for a human being who told her for four months that he loved her, was fascinated by her, was going to be close to her for a very long time. Damn him for calling her every day, sharing his secrets, laughing at her jokes. Damn him for living 1500 miles away, writing those hundred emails over the months. Damn him for coming to within 60 miles of
her and just dissapearing from her life.Damn him for breaking his proomise. Damn him for saying it was her fault. Damn him to Hell. He can find her in Purgatory on his way down.

She will come back to life at some point. Not quite yet. Soon maybe. For now the parallel existence is a safe enough place. In case he decides to call he won't be able to find her in her hiding place. But her brother knows where she is; he has a key to the transparent door.