The Ladder Herald

Memory and Therapy

What happens each week in my Group Dynamics class?

We meet for three hours, the twelve of us. We talk the entire time—there is rarely silence and often it feels like you have to really assert yourself to get your words in. People feel strong feelings, confront each other, make themselves vulnerable—all powerful activities. And most of the time I feel like everyone is being authentic and present—there is not too much acting out, in my opinion. Even from me.

And yet, I am often asked by friends, at school, at parties, what it's really like—group dynamics class. They ask me how school is and I say a few things about how I love it, how I feel energized by learning so much. I mention Group Dynamics and people are often intruigued, "isn't it insufferable?", "isn't it boring to listen to other people's feelings?". And then when I try to get more specific about this class—one I feel moved and disturbed by, I fail. I can't quite remember what literally goes on during our class time. This is also weird because in addition to confidentiality issues, my lack of content effects my writing here for Ladder Herald. it is sometimes really hard for me to write about "training to be a therapist"—the actual tag line for my blog.

Why do I walk around thinking it's good, even amazing? Why is it charged? Why do I look forward to it and dread it like I have a crush or a secret?

Mulling it over I realize that this also happens to me in individual therapy—there is an amnesia I am unsure about that happens each week. Is the amnesia ok? Is it a problem? I simply forget what we talked about. There is almost a clean slate when I start, though I often recall echoes of past conversations once I get started. A vague uneasy feeling can come over me that I have talked about this same thing before. I have been in therapy off-and-on for about ten years, and I think that most times when I start I have no idea what I am going to talk about. I think this is part of the agreement of being a patient.

But I also hope to be a therapist—I am training to be one. I wonder if a therapist should start each session with a blank slate? Should I not have a few ideas about what the patient and I are doing together? Should I think about my patients or try to figure things out about them when I am not with them? What if I don't do that? Hmmm.

I have a sensory memory of an excitement/anxiety/riled-up feeling in my body related to being in Group Dynamics. And I often leave class with a strong sense that I have learned something powerful. But what?

Here is one idea: I am learning how to be present, and with everybody's help, I am being present. And therefore my memory is not that active. I am not doing too overly-much analyzing.

Of course, this makes reflection tricky.

And, of course, again, this is a self-preserving theory, but it's my best idea so far so I will explore it for a second.

Can I have strong memories of times when I am in-the-moment and present? Yes. Then why am I not now? I think it is more than just the fact of being present, I think I also have anxiety about taking in so much in the class—feelings and risking and the real presence of others. I think that once I finish class, my mind and body move in to protect me by saying something like, "Hey, that was great! Let's check out for a while and rest." I picture a trainer moving in to throw a robe over a boxer's shoulders.

If this is true, I think it is OK. But as I get better trained, and maybe more able to handle things, perhaps my capacity for remembering/reflecting/learning actively will increase. I would like that.

Nice Description of Why Therapists Are Awesome

From the Sunday New York Times, by Lois Brady Smith

"Susan Holgate and Robert Barron sought counseling when they could no longer talk gently or calmly about money. Even discussing the phone bill led to long, loud fights.

“There was so much strain around who’s making the money, who’s paying the bills,” Ms. Holgate said. “It was a control issue. Like, who’s got the reins?”

“Every couple has their big topic,” her husband added. “Ours was finance.”

Things became even more strained when Ms. Holgate’s career as the vice president for institutional brokerage at E*Trade Financial, the online brokerage house in New York, took off, making her the primary earner.

“Counseling helped me go from resentment to appreciation to thinking, Aren’t I lucky that she’s so lucky and successful,” said Mr. Barron, who was then a business development executive at the Nielsen Company in New York.

That shift in thinking took some time: they saw Dr. Johnson in his West Side office every Wednesday evening for six years.

“If you don’t have a third party acting as a referee, things get so heated you don’t even want to bring them up,” said Mr. Barron, who added: “People go to a tennis pro to improve their tennis game. They go to a ski instructor for their skiing. Why not go to a marriage pro?” "

Full article: Lois Smith Brady article NYT 3/30/08

A New Approach to Psychotherapy

Such an amazing article by David Kohn from the New York Times, about training laypeople to work with people in Third World countries who are depressed, anxious, dealing with alcoholism, etc. A survey by one doctor working at a community clinic there found that as many as one in three patients arrived with symptoms of depression. And that may be an underrepresentation.

Psychotherapy for All (NYTimes)

A quote:

"The clinic is at the forefront of a program that has the potential to transform mental health treatment in the developing world. Instead of doctors, the program trains laypeople to identify and treat depression and anxiety and sends them to six community health clinics in Goa, in western India.

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year."

And another:

"After completing training, [Doctor Patel] spent two years in Zimbabwe as a researcher. He hoped to prove that Western concepts of mental illness did not apply in the developing world. Instead, he came to the opposite conclusion, that the ailments were in fact just as common and just as treatable as in the West.

[...]

At government clinics like the one here, overworked doctors lack time and inclination to ask patients about mental health. Even clinicians who look for depression may miss it. For reasons that no one fully understands, depressed patients in the developing world often complain of physical symptoms like fatigue, headache and insomnia rather than emotional problems like sadness or regret."

Wrote Too Soon

I guess the Galway poem didn't help. (How is it possible??) I got sick again! Just hours after the strep throat/ear infection seemed to go. These last few days have been hell, as Gabriel's been sick too. We are weak and indigent. I have not done my poetry lines, or taken photos, or school essays/homework, or written here seriously in at least two weeks, maybe more. I feel so disconnected from being an independent adult. It is all just snot rags, advil, throat coat tea, and begging each other for naps while the other one groggily 'plays' with the kids.

I swear I will get back to my real life!

I want to write about an exercise we did last week in Gestalt class, because it was really interesting.

This exercise was about "projection", that is, the ways we project our inner feelings and stories onto others. We do this positively as well as negatively. This is something I am really interested in, because I know I do it chronically. Fritz Perls (the Founder of Gestalt) says it may be that up to 90% of what we experience is projection. It's strange to contemplate the world from this lens.

So, for this exercise you chose someone you did not know and then you sat down and for ten minutes said everything you could think of that you were projecting onto them. The other person says nothing. Then you switch. So weird!

I was paired with a man and I started in first, "You're a vegetarian; you're hetero; you're from the country, not the city; you're into yoga; you're a writer; you're an athlete; you ride your bike to school." And then, after a few minutes, it got hard, and you had to start risking a little more, "You have older sisters; you wish you didn't have to live in the city; you're dating several women; you're very careful about what you eat; you're from the Bay Area; you're for Obama; you're close with your parents."

It turns out I was right about a lot of it! But, some of the things I laid on him mystified me: he was in a serious relationship, living together in fact (why did I see him dating multiple people?); he was from the East Coast, not here (I'm from EC too, why didn't I pick up on that?); he had one brother and no sisters (I was pretty sure he had feminist sisters and had been close to women growing up).

He guessed some things about me correctly, that I want to be an artist (poet); that I am a mother; that I am not married but am partnered; that I live in San Francisco. He said something really perceptive about how he thinks I must be struggling hard to be a mother, be a serious student, and be a writer. This made me feel really recognized. Then some other things he got wrong: I'm not from the Midwest; I'm not the youngest in my family; I'm not into theatre. I noticed that I felt happy when he guessed correctly about me, and sort of ashamed when he did not.

Later, when we debriefed in the larger circle, some other people said the opposite, "I can't believe she guessed I was from Connecticut! What makes me seem like I'm from Connecticut?? I thought I had gotten all that out of me!"

I guess the opposite of projection is, in a way, asking questions and reserving judgment. This sounds easier than it really is. In fact it is an explicit rule in my Group Dynamics class; that each person is the authority on their own feelings. But this is hard to really allow inside of me. In my own half fucked-up, half-experienced way I feel like I can sometimes know what another person is feeling. (Gabriel would say I am wrong about this.) But anyway, it is hard for me to turn off my sense of what I "see" going on in another person. And this happens in Group Dynamics, sometimes. I think I "see" that another person is upset, though they say they are not. I don't know what to do with this.

As I write this, it seems absurd to follow the rule that you have to accept whatever the other person says about themselves at face value. In fact, I feel like I have had breakthroughs and success as a client and as a listener using that sense to say, "You seem angry," or "You seem hurt". I have denied it, and so have others, even when it is true. And the outside perspective has sometimes been a help "I seem hurt? Well, maybe I am..."

First Day of Group Dynamics Class

The teacher, an imposing woman, greets us and says, "the feedback you give really says more about you than about the person you are responding to."

She also says that if something comes up in the group--conflict, feelings, reactions--we cannot process it outside of the group. We have to wait and bring it back next time. "You need to live with the tension," is how she puts it.

Without any further instruction, she stops talking, and there is silence in a room of twelve people. This is how it will be: no facilitation, no theory, no direction, no topics, no help. Just silence, and waiting for someone to speak: the beginning of three hours of class.

People risked, and spoke, and others responded. There was a lot to say, and a lot going on. I loved it! And it gave me a headache.

Therapy and Understanding

Thinking about therapy because I am about to start school again after winter break. How does it work? What is it for? Do people ever get better? How do people really change?

"That psychoanalysis has lost its once formidable influence is undisputed. The question remains whether its insights have been surpassed or merely repressed." — Ellen Willis

I love this quote. And Ellen Willis, RIP.

Scanning around the web for resources when I was in finals, I noticed that the American Psychoanalytic Association's website has a feature called, "Ask a Psychoanalyst". I think it is so amusing, especially given Freud's way of working so uniquely and deeply with each of his patients (from what I have read and understood). There is no possible way he could answer the questions that appear there, such as: "Can you tell me something about commitment phobia? Including the causes and possibility of being cured?" The only thing he could and would say in good conscience is something like, "Please tell me more." I think that that should actually be the answer under each of the questions submitted.

The website also looks as if someone's cousin "just getting started" in web design created it. The graphics alone are worth a chuckle—in the main heading, a group of stoned-looking corporate drones stare out at the reader from around a table. How does this represent "psychoanalysis"? Weird.

Maybe I am jealous and just partly wishing that I had this job—to answer psychoanalytic questions. I guess that is why I am training to therapize people. I had this silly idea that I didn't do at Burning Man, which was to put a sign on my bike that said, "Psychological Problems Diagnosed with Poetry." I planned to have a little library card-file of poems with headings like, "broken heart" "hate father" "kids are fuck ups" "miserable over affair" "lost stupid job" etc. Then I could pull out a poem for the speaker based on what was told to me. Hopefully it would offer some comfort or insight...

Maybe I will do this next time. Or you can.

The Dead.

The New York Times Magazine's December 30th issue has an amazing feature "The Lives They Lived". I think they do this each year but I've really been appreciating 2007. In particular I loved Daphne Merkin's piece on Allen Wheelis, Lauren Slater on Marian Radke-Yarrow, and Rosemary Mahoney on Lady Jeanne Campbell. A few of them are complete headscratchers ("Joybubbles" b. 1949 — invented the prank phonecall? Sort of unclear.)

NYT Mag  (free, but you have to register)

Anyway, Merkin calls Wheelis "A neurotic's neurotic" and writes about how he "put himself—and psychoanalysis—on the couch." He was also a San Francisco local since 1954: my shrink knew him.

I love his darkness, and his poetry: "Life is unmanageable," he wrote, "escapes reason."

Here's the last thing I'll quote from the piece: "He never really became part of the orthodox psychoanalytic establishment—largely, it would seem, by choice. He trafficked in existential despair, unceasingly questioning the purposes and limitations of putting people on the couch — in "a room of listening, of longing" — even as he continued working in his chosen field. "I have not found in psychoanalysis the meaning I sought. I function as guide to the lost, but do not myself know the way.""

He wrote quite a lot. I've ordered a bunch of his books, including "How People Change". I would really like to know.

Last Psychodynamics Class

Mildred Dubitsky, the professor, always insisted it should be called Psyche-dynamics class, after Psyche herself, who was, Mildred felt, pissed off about "losing her vowel".

The last day of class, Mildred told us about the free lectures for students offered at the Psychoanalytic Institute and encouraged us to go; and then she said (I am wildly paraphrasing): "I'd like to leave you with a question, or what I think is the central problem, in psychoanalysis today, and it concerns how Freud understood suffering and being human, and how his critics saw the same problems. Is the goal—the goal of therapy, the goal of life—to love the self, to "discover" it, to "find" it, to "nurture" it, to "accept" it, as Freud's critics maintain, and as most therapies in the U.S. today prescribe, or is the goal to "forget" the self? To expand those experiences of living and working and loving where the "self" recedes and is neglected."

I love this question, and wrestling with these two ideas. I feel like, the more I consider them both, the more I am drawn into relating to them both and really not knowing which is right.

Forgetting the self: writing poetry, listening to someone else, playing with kids/some mothering...

"Loving" or "accepting" the self: publishing the poetry I write, achieving anything or setting goals for myself, figuring out what I feel or think about something...

Or maybe these ideas aren't in the right categories. Or maybe they are.

"Condition Branding"

I didn't know what "Big Pharma" spends annually on marketing until I read this article—it's $25 billion. From Frederick Crews' "Talking Back to Prozac" in the December 6, 2007 New York Review of Books:

"During the summer of 2002, The Oprah Winfrey Show was graced by a visit from Ricky Williams, the Heisman Trophy holder and running back extraordinaire of the Miami Dolphins. Williams was there to confess that he suffered from painful and chronic shyness. [...]

Williams had an incentive—the usual one in our republic, money—for overmastering his bashfulness on that occasion. The pharmaceutical corporation Glaxo-SmithKline (GSK), through its public relations firm, Cohn & Wolfe, was paying him a still undisclosed sum, not to tout its antidepressant Paxil but simply to declare, to both Oprah and the press, "I've always been a shy person." [...]

(If drug makers don't find lucrative new applications for their drugs) through experimentation or serendipity, they can be conjured by means of "condition branding"—that is, coaching the masses to believe that one of their usual if stressful states actually partakes of a disorder requiring medication."

Working with Challenging Clients

Have to write something for my Therapeutic Communication class about "the most valuable thing I've learned this semester" and I have something hard in mind. I'm not sure how to write about this well without sounding self-justifying or defensive. What I really want to write about (this is actually a lot more of what I thought this blog would be about, and maybe it will be as I do more and more counseling) is the last session I did—it was really challenging.

(All specifics have been changed around.)

The client began by talking about a sort of surface-level story about being "annoyed" with someone in his family. Listening and questions seemed to take us nowhere but stuck in "annoyed" and a strong disinclination to say anything self-reflective. I asked about states of feeling he had referred to in his story, but he declined to go into them. I offered simple observations about his body language which he ignored. I tried more quiet listening, he seemed insecure and embarrassed without my active participation. And yet, most of the gentle things I said, he disagreed with (which is fine to do, but he seemed pretty judgmental about it). At one point I asked him what it felt like to be "hurt" and  he flatly denied being hurt. When I explained that I was referring to his own words a little earlier, he seemed a little nonplussed, but still annoyed with me. In fact, the "annoyance" he was expressing at someone else seemed instead to be directed at me. He said no. On and on like this.

At several points during the session, I said, "It feels hard to connect." or "It seems like you don't want to be talking about this—is there something else you'd like to talk about?" etc. But nothing I thought of really broke through. I was confused, but luckily, I was managing to stay present and not get my feelings hurt. I felt aware of how hard the session was, but up for the challenge.

We tried a few minutes of silent meditation together at my suggestion, I tried offering him a role-playing session which he declined, I tried many many things I've been taught this semester and they all failed. Our session was dead, uncomfortable and shallow.

When our class sessions end, we have to review how it went with one another. I said, "I feel like it was hard for us to make a connection, and I feel curious about that. Towards the beginning I was trying a bunch of things, just kind of experimenting with what might be good. And I liked doing that—I didn't feel bad when things didn't work—I just felt focused on you. I don't totally understand why we didn't connect but in a way it was an interesting session anyway."

That's when he told me that he didn't trust me because of something judgmental he'd heard me say at the beginning of the semester. He said that that's why he didn't feel safe with me. He also said that he'd known he felt this way when I asked him to counsel and it had made him reluctant to work with me. He did not explain why he did not tell me what was really going on.

Everything started to make sense, and I felt a lot of relief that it was not just my terrible counseling that was making it so bad between us, but instead something I had done. I was non-defensive (an observer confirmed this, and confirmed to me what a difficult session it had been.) The client said he felt better for having told me, and I said I felt curious about what the session would have been like if he'd told me at the beginning. I thought it might have been hard but juicy and good.

Now, a few days later, I'm feeling a little manipulated. I also feel judgmental towards my client, like, "this is how a therapist in training behaves??" And yet, I also have this funny (for me) feeling of ok-ness. I am not super-anxious. I find myself wanting to talk and think about it, to understand what was going on. But I actually think I did a pretty good job, despite how challenging it was.

So I'm feeling what it's like to work hard and fail, but to know I did strong work.

A Few Recent Ideas from Psychodynamics Class

Some things I want to remember:

"What all pathologies have in common is secrets from the self."

"There is a kind of pleasure in and attachment to symptoms. There is a gain from the symptom to the patient."

Ask: "What comes to the surface when you relax?"

"Freud counseled therapists not to count on our love or our pity to help a patient. He advised us to be more humble than that. And he warns against the idea of 'curing' a patient. He insists that the craving to 'be of help' that therapists will feel blinds us to the constructive, positive suffering that people must do to grow and mature."

Freud's Invention

From Leston Havens' A Safe Place: Laying the Groundwork of Psychotherapy:

"Freud invented, in the silences of psychoanalysis, a method of correcting a particular human problem so specific and effective as to defy any substitution or even alteration. A great invention is like a piece of great wit: it seems in retrospect the only answer. Recall G.K. Chesterton's reply to the question, What book would you most like with you on a desert island? "Huntingon's Guide to Practical Shipbuilding." Freud's invention is like that."

Feeling Blue

A few days of feeling low. Maybe from after-birthday let down, or after-holiday sadness. Everything was delightful, though it's not as if depression is rational. Maybe hormones, as Rye seems to be nursing less and I am making less milk. (And I feel sad about that too.) Maybe the grey sky, or the cold in our apartment.

But then, a good talk with my therapist today. And, somehow, just the simple perspective that I am "having a hard day or two" instead of seeing everything through the dingy lens of depressed feelings, helps. (That and playing with Orion Gabriel on the floor all day. His dazzling smile cuts through all anhedonia.)

When I am in a bad place I do not yet know how to tell myself, "look out! you are sad/crabby/depressed" and instead I think I am seeing clearly. I suck, my life is messed up, I am unrecognized, victimized, etc etc...

It is so nice to have someone help me with my perspective-taking. I should lay low, take care, and not make decisions or start fights. Too late for this time but maybe next time. (Sorry, everyone in my family!)

Love on the Rocks

According to the New York Times, the U.S. divorce rate is just over 40%.

Here's a quote from a book I'm reading for Human Development:

"[In this study] More women got a psychological divorce than a legal divorce. This finding highlights a broader issue: some people deal with an oppressive situation (in marriage, job, career, religion, community, or whatever) by leaving or making a drastic change. A larger number who are in the same situation resign themselves to it and go into a psychological retirement—doing a minimum, giving little of themselves, and obtaining little in return. The incidence of legal divorce is thus not an accurate indicator of the extent of marital conflict or distress in a population. The divorce rate underestimates the degree and depth of the actual severity of marital problems, just as the number of patients receiving psychological and psychiatric treatment underestimates the extent of severe emotional distress."
Daniel J. Levinson, The Seasons of a Woman's Life, Ballantine Press, 1996

This makes it seem like the instances of good marriage must be under 10%, no?

Quotes from M. Greenspan on the "Dark Emotions"

Miriam Greenspan: "Healing Through the Dark Emotions: The Wisdom of Grief, Fear and Despair" Just reviewing this book...it has been important to me for so long:

"In my view, there are no negative emotions, just unskillful ways of coping with emotions we can't bear."

"There is no life without loss and therefore no life without fear."

"Without a listener, the healing process is aborted."

"We are socialized to condemn ourselves for our feelings, and therefore we often abort emotional energy and don't reap the benefits of our emotional sensitivity."

School for Shrinks

I start classes at the California Institute of Integral Studies next week: Human Development, Psychodynamics, and Therapeutic Communication. This blog is for thinking and writing about my training to become a therapist. It may also contain writing about hetero relationships, mothering boys (I have two!), family, friendship, San Francisco and Mission neighborhood city life, and poetry and other things I'm reading. Welcome!

"Between human caution, stubbornness, and our beloved theories, it is surprising we know anyone." — Leston Havens, Reflections on the Art of Psychotherapy.

I have a brilliant therapist, and my time with her has made me really interested in the way that intimacy can heal people. I think it's done that for me. Intimacy in other relationships has healed me too, from the parenting I received to the man I love. Allowing yourself to be seen and known, or seeing and trying to know another—it has some kind of transformative magic to it. Here is something my shrink wrote when she was running a school to train "master listeners" (I was in this school and it didn't survive, but more on this some other time):

"In this program we ask: How might we draw closer in our listening to the idiosyncratic individual who comes to speak with us? How can we be still, attentive, watchful enough, sufficiently unburdened by ourselves to catch that fleeting uniqueness before it enters our particular organizing system?"

I love how this highlights the grapsing after a person's "uniqueness" as one of the important goals of therapy. I have several friends who completed the program at CIIS and it made me hopeful that perhaps it might have a similar approach to training shrinks.

But I knew for sure I wanted to go to CIIS during the group interview. It was really fun!

With very little explanation we were each given an index card with a statement we were to read to the person next to us. The task was to respond to the statement you are read by saying how it makes you feel. The facilitator explained that much of our work at CIIS would be in groups, and this was a way of seeing how we reacted and worked in a group situation.

My card read, "I don't believe what you are saying and I don't trust you." I turned to the man beside me and read it aloud. He froze and was silent for several agonizing minutes. I resisted the strong urge to ask him questions to draw him out. Finally, he said, "this does not hurt my feelings, because I know this is only an exercise." It was just too hard for him in that moment to say what he was feeling. It seemed understandable, but it was also fascinating. Was he too nervous? Was the situation too false and pressured? Did he have absolutely no idea what he felt? Was he ashamed of what he felt and could not say?

The facilitator let him off the hook and he read aloud his card to the woman beside him, "I am attracted to you and I hope something can happen between us."

"Ok, uh, that makes me feel...curious. And, I want to know more about you..." She seemed to be feeling her feelings as if he were declaring his real attraction. Again, so interesting. Was the sentiment too overpowering to think about calmly—that someone would be attratcted to her and say so directly? (I think it would have been for me and was glad I hadn't had this one). Was it threatening? Was it true—was she picking up on how this guy really felt in those few minutes?

Then she read her card to me, "I am jealous of the power you have in this group." I was lucky to go third. I had had time to prepare and think about feelings, but it was easy for me to blurt out what occurred to me, "that makes me feel worried—like there will be retaliation against me for having power and causing jealousy. And it makes me feel pleased, because I sometimes like to be a leader in groups."

So strange, in a way, to be going to school to learn such ordinary things: how to know what I am feeling, how to be able to say what I'm feeling, how to listen with care, how to think about other people, how to watch for brilliance, uniqueness, and originality. A good society would have no need of this as a specialty, maybe. Maybe if we do it right, people will someday be capable of making a good society.