From the Shrink in the Cheap Seats:

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!