Archive for October, 2011

#6 — On Loving Yourself: It’s not what you think.

October 29, 2011 Leave a comment

One of my favorite things is irony.  I see it a lot in my work.  I see people unwittingly working against achieving what they claim to want the most.  I see people inadvertently alienating those they care about the most.  And I see people trying to conceal what they believe to be their own unattractive traits, only to make those traits all the more visible.  Yet of all the ironies I encounter in my practice, by far the most common, and also the saddest, is the irony of people desperately struggling to get someone to love them. 

Many of these are forlorn and lonely people, who have somehow come to believe that if they behave in just the right ways and do just the right things, they actually can make someone love them.  Some even couple this belief with another, that while they might not be healthy and happy as individuals, they will be fine once they “get into a relationship.”  The ironies here are obvious.  In the first case, you cannot make someone love you, you can only let someone do that.  In the second, being healthy as an individual is not a result of a healthy relationship; it is a requisite for one.  You cannot take two unhealthy people and add them up to make one healthy relationship.  The math simply won’t work! 

Yet the misguided beliefs persist.  And often the people who are the most adamant are those who have just finished some sort of self-help book and who have just read something like, “You can’t expect someone else to love you unless you love yourself.”  So, adopting the belief that all will be well once they learn to love themselves, many come into my office reciting that mantra and expecting me to show them how to make it happen.  The ensuing conversations always go the same way.  I point out that, while “love yourself” makes a great sound bite, it is really devoid of any practical guidance.  Next, I suggest a hypothetical scenario:  Imagine going home at the end of the day and then sitting down and saying to yourself, “Now I’m going to love myself.”  Exactly what would you do?  What would it look like?  No one has yet been able to give me a definitive answer. 

For those who are able to set platitudes aside and consider reality, the discussion finally shifts to something more substantial.  In the best of circumstances, children are raised by parents who love them unconditionally, without reservation or judgment, making the children feel uniquely valued simply for themselves — just for being who they are.  The clinical result of this parental acceptance is that the children develop what is called a healthy attachment with the parents, which ultimately enables them to become accepting of themselves just as they have been accepted by their parents.  This self-acceptance subsequently allows the children to grow into generally healthy adults who don’t feel the need to please others just to be accepted.  And, of course, since these self-accepting adults are not dependent on others to validate them, they have a much greater likelihood of having healthy relationships.  The irony here, then, is that the more able we are to be alone, the less likely we are to be that way.

So, it’s worth considering, instead of a vague “love yourself” sort of dictum, wouldn’t “accept yourself” be more practical?  For fun, I sometimes use the movie character “Dirty Harry,” created by Clint Eastwood, to illustrate.  In the second movie of this series, Magnum Force, Harry’s memorable line is, “A man’s got to know his limitations.”  The point here is that acknowledging limitations relieves you from having to worry about what you don’t have or what you can’t do.  Instead, you are free to take what you do have and what you can do and make the most of them.  Imagine being able to look at yourself in the mirror, honestly see what’s there, and then say to yourself, “Maybe it’s not everything I’d like to have, but it’s mine; so I’ll take it out and see what it will do, and if other people don’t care for it, that’s their problem.”  This single measure of self-acceptance effectively makes you immune to other people’s judgments and criticisms because you have essentially rendered them irrelevant. 

Surprisingly, framing the situation in this way often meets with considerable resistance.  A lot of people who come to see me already have a deeply held dislike, in some cases even loathing, for themselves.  Surely I couldn’t be suggesting that they start accepting someone who has so clearly been deemed unacceptable!  Surely no one with such faults and inadequacies could be accepted without reservation!  Surely no one so unredeemable could be accepted without some kind of transformation at the hands of the guru-therapist.  Sadly, many have family histories that seem to confirm these misguided beliefs. 

Once again, I remember sitting in the cheap seats at Fenway, easily taking in the interactions of an entire team on the field.  What was abundantly clear from up there was that each position on the team has its own specific requirements.  A successful team cannot be made up of nine pitchers or nine catchers or nine shortstops no matter how talented these players might be.  The person playing each position must bring some special, even unique, strengths or talent to that position.  And so it is in life’s ballpark.  Each of us brings some unique strengths or talents or other characteristics without which the whole team is incomplete.  The challenge for each of us is in learning just what our particular strengths or talents are so we can develop them.  Added to this challenge, of course, is that some strengths are obvious in people while others are not.  The variation from person to person is significant.  And for people who are predisposed to view themselves negatively, who are constantly preoccupied with all the things they have been told that are wrong with them, the prospect of recognizing and appreciating their own strengths is often dubious at best. 

And so a final irony emerges.  By being preoccupied with negative aspects of ourselves, we lose the ability to see anything else.  Our knowledge of ourselves and who we truly are is, therefore, incomplete.  And this begs the question, how can we accept someone we don’t really know?  Self knowledge must precede self-acceptance or “self love.”  In this, I think we can all benefit from following Dirty Harry’s advice — turning on our interest and imagination as we look at ourselves and our experiences, without expectations or assumptions, and being open and willing to learn.  If we can remain interested and seek to understand rather than judge, we can free ourselves from the burdens of our limitations and allow our strengths and talents to emerge.  With more complete self-knowledge, we can truly start to be self accepting.  And with real self-acceptance, we can finally learn to love ourselves.


#5 — On Being a Counter-Culture Operative: “But I thought you were . . “

October 22, 2011 1 comment

Along with my regular therapy practice, I also teach and provide clinical supervision for young therapists seeking licensure.  This is a part of my work that I especially enjoy, because it allows me to introduce the next generation of therapists to the actual practice of psychotherapy in the real world and not simply in a classroom or laboratory.  An esteemed colleague of mine refers to psychotherapy as a “counter-culture operation.”  After all, it is the job of the therapist to challenge people and get them to ask themselves the very questions that they have long been conditioned not to ask.  What is it like to interact with people?  How do you respond?  What results do you get?  What do you believe about yourself?  About others?  What is the basis for those beliefs?  In a very real sense I think this does make the therapist a kind of emotional revolutionary, intent on challenging and helping to undo the patterns of conformity and control that society relentlessly seeks to impose.

 The instructions I give my students and supervisees are both easy to understand and difficult to do.  I tell them to learn all they can about disorders, theories, and therapeutic techniques, and then, as they approach the therapy room, leave it all outside.  Once inside the room, they are to do only the following: be present and assume nothing! 

 Being present is something that most people assume they are doing when they are not.  In today’s sound-bite world, where there is a television in every room, a telephone in every pocket, and people are expected to be wired to a dozen or more locations other than where they actually are, being present is often problematic at best.  Most of us are conditioned to deal with life in terms of there-and-then rather than here-and-now.  Conversations typically address experiences had elsewhere at other times or with other people, while the immediate experiences of people in the conversations are avoided.  There is, of course, a certain element of ego protection in speaking about people and events other than those with whom we are directly engaged.  There are also risks. 

 First, the experience of the present moment between two people is lost and with it some important truths which, if honestly acknowledged, could help validate and deepen the substance of the relationship.  Second, the shifting of attention away from the present causes us to divest ourselves of our personal power.  Since we shape our lives through the choices we make, if our attention is drawn away from the present, our choices are made by habit — essentially repeating choices we have already been conditioned to make.  If our attention is in the present, our choices can be made deliberately to serve us and, more importantly, to make change possible.  The very first job of the therapist, then, is to bring people back into this present, where life is actually going on. 

 Still, as difficult as it is to remain fully present while engaged with someone, it is all the more difficult to avoid making assumptions.  After all, assumptions have a certain utility value; they are necessary aspects of daily living that we all rely on and don’t even notice until one of them turns out not to be true.  Consider how each of us gets up in the morning unconsciously assuming that the world and our lives in it are continuing pretty much as we left them the night before.  Most of the time this turns out to be true.  Yet imagine what life would be like if we could not make this assumption.  To say life would be chaotic would very likely be understating the case.

 Problems arise, of course, when our assumptions extend to the interpersonal — the ways we see ourselves and others.  We make assumptions about people we deal with and then we proceed as if our assumptions are true, often without being aware of them, and certainly without questioning them.  This means we are no longer dealing with real people but with some concocted ideas of people or what we think they represent.  All this tends to create distance between us and people who, if we could see them more as they are, might add richness and value to our relationships and our lives. 

 During my recent stay in the hospital, I had occasion to be on the receiving end of some of these assumptions.  Almost immediately upon waking in the ICU following my surgery, I had a bad reaction to some of the pain-suppressing drugs I had been given.  This reaction lasted for a couple of days.  I found it difficult to focus, to concentrate, or even to engage in simple conversation.  Despite my wife’s protests, she was repeatedly told, “This is normal for older men.”  To her everlasting credit, my wife refused to accept this pronouncement, insisting that, while the condition might be normal for many men, “It’s not normal for him!”  The original drugs were stopped, and I was switched to a milder OTC medicine instead.  The problem cleared up almost immediately. 

 Later, surrounded by energetic young clinicians eager to check my vital signs and tell me how I was doing, I was often advised, “You know, when you get to a certain age . . .”  My sense was that upon seeing me, they assumed I was just a doddering old codger with nothing to look forward to but his next meal, who might start drooling on his shirt at any minute.  I stayed present and made clear that their assumptions about me were largely false.  Most of them were genuinely shocked to learn that, not only was I not retired, but I was actually a mental health professional with a very active practice. 

 Of course, there is always reason for me to question my own assumptions too.  In Mary Pipher’s classic book about aging, Another Country, she describes the two stages of elder life as young-old and old-old.  While I have always appreciated the construct and used it often in my work, I have never managed to apply it to myself.  For years, I have simply thought of myself as old-young.  However, this recent experience involving my health has caused me to reflect.  It seems one of life’s great ironies to find that, like your car, your body is running out of warranty, with replacement parts harder to come by, and all of this happening just when your brain has started to catch on to things.

 And so, I think we owe it to ourselves and our lives to continue our own individual counter-culture efforts.  The more we can be present, be fully engaged with the people and experiences in our lives, the richer and more satisfying our relationships and our lives are likely to be.  The more we can be aware of and question the assumptions we and others are making, the more we can free ourselves and our relationships from the sterile compartmentalizing that assumptions tend to produce.  It is certainly not easy to be present and assume nothing.  But the good news is that none of this requires us to be perfect, only to work at getting a little bit better!

#4 — On Turning Things Inside-Out: Who am I? Who decides?

October 15, 2011 3 comments

Too often I find people in my office who are living with the emotional pain imposed by their own sense of inadequacy and failure.  There are single men and women feeling pressure to be married and raising a family “by a certain age,” or others wanting to be in a “committed relationship,” and both in a quiet panic over what they perceive as a lack of progress and of prospects.  There are married men and women, some with families, who are nevertheless feeling trapped and miserable.  There are the many who are divorced and struggling to restart their lives amid the emotional wreckage of a failed marriage.  And then there are all those who endlessly pursue relationships one after another, somehow unable or unwilling to tolerate being alone. 

Many of these people arrive in my office with other complaints, secondary issues that are often more the result of their situations than the cause of their miseries.  A lot of them have already been informed they have a mood disorder or an anxiety disorder or something more exotic.  Many are already taking antidepressant or anti-anxiety medications or both.  In general, these people expect therapy to “fix the problem” so they can simply resume the lives in which they have been so miserable.  When I suggest to them that perhaps their clinical problem might be related to something larger, they often look nonplussed.  Aren’t they living life the way they are supposed to live it?   Isn’t this just another misfortune that has befallen them?  Why should taking care of it require anything more than medicine and a few therapy visits?  When I explain further that their clinical disorder is not something they just caught, like a cold or the flu, and that it is part of their body’s reaction to the wear and tear of the ways they’ve been living, I get a variety of reactions.  Many respond with disbelief, some with anger, others with a mixture of the two.  And a few — the fortunate few — get curious.

When each of us arrives on the planet, we are aware of very little except, ideally, the warm and comforting and reassuring presence of our primary caregiver.  Ignorant of almost everything — who we are, where we are, or what anything means — we depend on this caregiver and those who gradually join in our upbringing.  During the time spent with this cadre, we start to develop a sense of who we are, what the world is like generally, and what it means to live in it as a “good” girl or boy.  Later, as we get older, our society takes over.  It is our institutions — educational, commercial, governmental, religious, and even our popular culture — that complete the picture.  They tell us who we are supposed to be and what it means to be successful as people, irrespective of our individual tendencies or preferences.  The effect of all these influences is that from birth we are defined as individuals from the outside-in.  And during every passage through life we are thus predisposed to view our experience in terms of who our family, our friends, and our institutions expect us to be and to do what they expect us to do.  This is how we are formed, and this is how we are ultimately controlled.  If we deviate from those expectations, the implied message is, “You are failing as a person!” 

Human development is a chancy process at best.  Under ideal circumstances, we receive support and encouragement to reverse this definitional process during our later formative years.  Under ideal circumstances, we are encouraged to develop our own personal sense of self, with its attendant values, and to assess our experiences through the filter of these values.  And under ideal circumstances, as we enter adulthood we have generally managed to develop a level of emotional autonomy, to become our own persons, and to reverse this process of self definition.  But as it happens, a lot of us grow up under less than ideal circumstances.

In my case, I entered adulthood during a time when young men were expected to conquer.  Despite the growing preoccupation with the unfolding tragedy in southeast Asia, this was also the time of the “aero-space boom,” a time when young men who did not opt to enter a classic profession were expected to conquer the world of business and technology.  Hollywood notwithstanding, the accepted model was much more John Wayne than Jimmy Stewart.  And so I began living the button-down, pinstriped life that young men at the time were expected to live, projecting an air of false confidence, often feeling as if I was being judged as a person based on whether I was seen as having a “successful” career.  More and more it became important, even in personal relationships, to “keep up appearances,” while part of me wanted to scream at the world, “This is not who I am!”  Yet I too succumbed to the relentless pressure to be what the world expected me to be.  I worked diligently to keep my insecurities, my sense of inadequacy, and my ongoing misery hidden from that world.  I tried to impress people with my knowledge and skills and personal presentation in order to be accepted.  And I constantly worried about making some public error and being judged as “not good enough.”  All this because I was allowing others to define me.  History eventually rescued me (see Blog #2), but not without my share of strife.  

Today, while people’s circumstances have changed, the challenge of how we are defined remains.  As a result, I see too many clients caught in the same old trap — people desperately seeking to be loved and approved of, because they believe that is the only way they can establish their own self-worth.  They cannot simply approve of themselves; they must be approved of by others.  These are often people willing to adopt any persona, perform almost any service in hopes that it will bring them “love.”  Then, having seemingly gained this mercurial sort of love, they must continue a desperate struggle day by day just to keep it.  Many respond with dismay when I point out that love is not a matter for barter and that if it is not freely given, it is not really love. 

This is the point where many people leave therapy, loath to undertake the serious work that lies ahead or not yet dissuaded from the notion of learning some secret or some simple technique that can quickly and painlessly resolve all their troubles.  And I always let them go without protest, because I know that, in the words of The Borg, “Resistance is futile!”  For the few who remain, however — those curious few — this is the point at which therapy can really start.  This is where they can finally begin to reverse the process of self definition from outside-in to inside-out.  This is where they can finally begin the quest to learn who they really are so that they can finally be who they really are.  And this is where they can truly begin to understand that if they are to be loved, it must be for who they are, not for who they are supposed to be.

#3 — On Life, Experience, and Change: Free baseball!

October 8, 2011 Leave a comment

It’s called “open-heart surgery,” and somehow the term doesn’t do justice to the experience.  There are many ways to describe spending 4-5 hours having your chest cut open, your heart stopped, and one of your giblets taken apart.  What comes to mind for me is memorable.  In my case, my defective aortic valve was removed and replaced with donor tissue described as “porcine.”  My doctor said later that he had installed a “large valve.”  That makes the porcine citizen probably male, and my intuitive sense sees him as British and going by the name Barnaby.  Even now, I find myself developing an interest in tea in the late afternoons. 

Naturally, the impact of such an experience is profound and not to be taken in all at once.  Yet what is most memorable to me is not the occasion itself but many of the details involved.  What struck me first was how routinely I was greeted at the hospital.  There was a group of us, all scheduled for surgery early that morning.  We were all cordially yet unceremoniously greeted and then ushered into a series of preparation rooms.  Then there were questions, followed by a lot of poking, sticking, and “prepping,” followed by more of the same questions.  I was struck by the contradictory nature of this experience, a bizarre mixture of the monumental and the mundane.  So much was treated as simply routine that it was difficult to connect it all with the idea that I was about to face my own mortality, with my life and future quite literally in my surgeon’s hands.  But then another voice from the back of my mind chided, “What did you expect — a brass band, fanfare, some kind of ceremony?”  I recognized this as the part of me that seeks to keep me grounded and that lets me know if I start to take myself too seriously.  I have come to value this part of myself very much.  After all, the only thing I really needed to know was that I was about to go through a major transition — change. 

So much of how we deal with change is determined by how we view experience, whether we see it as happening to us or from us.  Do we have active control of our lives, or are we merely victims of them?  This is, of course, a classic yin-yang debate: subjective or objective, proactive or reactive, right brain or left brain.  There is benefit in understanding and appreciating both sides of this debate, yet there is great danger in actually choosing a side.  The reason is that we are not truly faced with an either-or question.  The answer, ultimately, is both.  Just as we seek to change our experience, our experience changes us; that’s what it is supposed to do!  That is the way life works!  There are many important lessons we all must learn that only experience can teach us, which means that being an active participant in life is not an option but a requirement.  You can’t learn about love or pain or inebriation, for example, from books or in a classroom.  Sure, you can get an intellectual grasp of what those things are like, but until you’ve actually experienced them for yourself, you can’t really know. 

 If we make the mistake of choosing a side in this yin-yang debate, say opting for objective over subjective, we first experience a gradual devaluing of the other side, the other point of view, and an inevitable loss of perspective.  I remember working with a couple years ago who always ran into conflict in making joint decisions.  He would start by asserting they should choose A because it “made sense.”  She would respond that A didn’t “feel right” and B did.  He would then accuse her of being “illogical and emotional.”  She would respond that he was “insensitive.”  I would point out that they had both painted themselves into a corner by insisting on seeing and interpreting all their experience from just one point of view.  Such decisions cannot be made in the corners; they must be made in the middle.

 An even greater danger, however, in adopting a fixed viewpoint is that it makes you vulnerable to that dreaded bugaboo, expectation.  There is much wisdom in the saying: The man who has no expectations cannot be disappointed.  Yet having no expectations is a tall order.  Despite all our practices of mindfulness, presence, acceptance, and so on, we still inevitably develop expectations even without knowing it.  And expectations love to play off ego.  Without even being aware of it, we can easily become wedded to those expectations and start to feel entitled.  Then, when an expectation isn’t met, we’re not just left disappointed, we become resentful.

 My recent major surgery was not my first.  Having gone through coronary bypass surgery nine years ago, I looked forward to this latest experience with the confident air of a veteran.  I knew the territory.  I knew what to expect.  I knew how to handle it.  I was ready.  And, of course, what I expected is not what happened.  I awoke in the ICU, not with focused attention or relaxed acceptance, but in a kind of anesthetic never-never land.  Rather than the quiet calm and constant attention I had received previously, I was surrounded by chaos and cacophony and a caring but harried nurse who had to deal with me and three other people.  To make matters worse, I suffered a bad reaction to a pain-suppressing drug I had been given, which took several days to identify and eliminate.  In all, my arrival on the other side of this surgery defied all my expectations and left me feeling somewhat chagrinned.  Nevertheless, while I didn’t exactly breeze through the way I had expected, I did get through.

 And there is a bright side.  Before and after both my surgeries a lot of people made a point to discuss post-operative depression with me and how it is prevalent among “older men.”  I am forced to confess that of all the aspects of this surgery with which people struggle, this is the one I relate to the least.  I still vividly remember what it was like being in those cheap seats at Fenway, when the game would end tied and then have to go into extra innings.  Every pitch, every hit, every play became a potential game winner for one side or the other.  The players, coaches, umpires, and fans were never more engaged, and all this was after we had already completed nine innings.  The game was still going, and being there was never more fun.  We used to call it free baseball.  For me, this is what it was like waking up after surgery.  Once I became oriented and understood where I was and that the surgery was past, I realized that the game was still going.  I could still be engaged and make every part of every moment of every day count.  Rather that post-operative depression, I experienced post-operative euphoria.

 I think there are two things to take from all this.  First, if you’re having surgery, leave your modesty at home and take your sense of humor with you.  Second, in approaching experience, it’s importance to seek a balance.  Life is rarely all one thing or all another; rather it is an ambiguous mixed bag in which we get to choose some things but not others.  And sometimes life makes choices for us, even when we prefer that it wouldn’t.  Nevertheless, if we can resist choosing the yin or the yang, if we can keep seeking our own balance, accepting its personal and elusive nature, then we can be truly free to engage fully in life’s ballpark.  We can keep the game going and enjoy personal enrichment.  Free baseball!

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