Story about Integrating Self-Parts

My patient is a powerful and charismatic person who was terribly abused as a child. We journeyed in his mind to the little boy who was beaten for squirming in his chair and left alone in the back room of the church. The boy in his mind embodied him today and wailed, "Why do they beat me?!" to himself, to his parents, to God, and to the reverberating aether. The depth of this access swelled my heart with tears.

I told him to ask that little boy if he could hold him. He hugged him, rocked him and whispered loving words to him: "You did nothing wrong. It's not right what they did to you. You didn't deserve it. It's over. I love you. Come with me. You can grow up now." He wept and wept, and rocked and rocked, until the pain was slowly held and slowly healed.

As he gained access to this wounded child, he also began to see other parts of himself that he had developed to protect himself: a smart man, a fierce man, a charming man. They each had different names based on when they emerged in his life and reflected the actual variations of the names he went by at that time--names like Little Timmy, Tom, Alexander (his strong middle name), and Thomas.

We began to appreciate that each of these self-parts was vital for his survival ,and he began to embrace them all. His smart part helped him gain recognition and praise. His fierce part helped him become powerful, realize his dreams and prevent others from taking advantage of him. His charming part made sure that others liked him and would follow him. He realized that he used to think that this last part was his true self, but he slowly realized that this part was the most duplicitous of them all, for it would never show vulnerability, only obsequious catering and manipulative insincerity.

Awake to and accepting of all of these parts, he began starting his day by gathering his self-parts together for a pep talk. "Timmy (who had now grown to be a strapping young man), keep me joyful and playful. Tom, I need you to figure things out. Alexander, watch my back and get me through the tough times. And, Thomas, take care of other people with true heart. Thank you all for being with me. Stand beside me but not in front of me. I love you all. Now, let's go!"


My patient's anecdote of how therapy helped her

I’m always struggling with how to describe how the way I work works—especially that last post about living the question that was titled How to fix everything wrong with you. What does it mean to live the question?!

Well, this one amazing person I had the pleasure of working with shared this anecdote about how she lives the questions.

“So yesterday I was having a conversation with my husband, and I kept interrupting him. I tend to do that a lot, especially in conversations that I am very distressed or passionate about. He got very annoyed with me at one point and showed it clearly.

I noticed a terribly uncomfortable feeling and the urge to react. Either to defend myself or to flip the tables on him and get angry at him back. But I didn't give into that urge right away. Somehow I had been able to slow down my observation of what was happening inside of me, so I was able to have that space between the uncomfortable feeling and the urge to react. That space gave me the fortitude not to act on my urge. Instead I just observed the uncomfortable feeling and tried to notice what it was.

I recognized it as shame. I never tuned into shame on quite this level. I knew it is wrong for me to interrupt him so much, and the shame that came with it was so big that I have always felt the need to repress it or hurt the other person who is shaming me. Because its too unbearable.

So in that space of observation, I asked myself why it was so unbearable. And I realized it was because in my mind and psyche, doing something bad/wrong/stupid denies me the right to even exist. My body and mind think that I am only worthy of existing if I never do anything wrong. I then was able to gently tell myself that I can make mistakes, even ones that get other people upset, and still be worthy of existing. It was so incredible to be able to hold both possibilities side by side.

It was the notion that I cannot exist if I do something wrong that made the shame unbearable. When I recognize that I do not have to be perfect to exist, I can suddenly be okay with the shame. It isn't unbearable. It just is and I can handle it.”

Pulsing Poignancy

In great therapy moments,
my body becomes a hollow body guitar primed
to resonate harmoniously
with another person's guitar.

Each string a different layer of self:
thoughts, emotions, intentions, identity and purpose.
Presence only full
when strings are tuned
through my own work,
my own healing.

Then, my guitar can coax another
to tune,
to heal,
to sing
soaring sonorously.

..."While my guitar gently weeps" - The Beatles

My patient's description of therapy in her own words

My patient wrote this very lovely and wonderful reflection on how therapy with me is helping her, even though she chides me for not knowing a thing about eating disorders. I asked her if I could share it with the world so that others may know what therapy can be like, sometimes:

Bulimia is one of my dirtiest and one of my best kept secrets. It leads to feelings of shame, disgust, and, what’s worst for me, isolation and crushing loneliness. My eating disorder tells me, “people won’t like the whole you especially once they really know you (who could like someone so gross)!” It tells me, “Maybe they only like the silly, smiley person you put out for the world.” So I play the role of someone who doesn’t have their own issues and someone who can be there for others and hold their pain, heartbreak, and anxiety without asking anything in return.

I’ve been in therapy for years with so many therapists, but recently therapy has begun to take on a new meaning. My therapist doesn’t get all the credit, but he deserves a lot of it. I began this new round of therapy to actually address my insomnia and debilitating panic …and oh my eating disorder, duh!

I had suspected, and with my therapist’s help, finally learned that so many of these symptoms were trauma. Therapy has helped me begin to see that my eating disorder’s voice doesn’t exist in a vacuum. Instead, it is the voice of multiple traumas manifested as bulimia, my eating disorder trying to protect me from uncomfortable feelings or people that will hurt me. However, it left me with an inability to face those things that hurt me in the past and an immediate and reflexive repulsion to doing or thinking about anything that might make me uncomfortable me today. But, I’m slowly learning that avoiding pain and relationships actually leaves me in even more pain …and even lonelier.

The other night after a session I began to really think about all of this. I was able to see that I am in fact likable and I do have friends. I make my therapist laugh, sometimes at the ridiculous things that come out of my mouth, but sometimes because maybe I am genuinely funny (maybe).

I also learned that the ways I cope don’t make me a bad person, a weak person, a gross person, or an unlovable person. What is truly healing about therapy and my therapist is that I am allowed to be sad, happy, angry, silly, narcissistic, petulant, avoidant, and lonely without judgement and even acceptance. Sometimes I do deserve an eye roll or two. He definitely gives me much needed feedback and reality checks, but I can be myself with the eating disorder or without it. All parts are welcome.

We need people in our life whether that be parents, siblings, friends, mentors, or partners. When we don’t have these relationships or when they hurt us, we feel insignificant, unlovable, and alone. To help me heal and begin to trust again, my therapist takes on many of these different roles at different times. This begins to make me whole, and at the end of the day, all we need is for people to see us and acknowledge us (even our most shameful parts).

I feel grateful that I have a space where my fragmented self (my eating disorder included) can be laid out and talked about. I want to remember therapy and my therapist as a person whom I trusted and finally opened up to, who didn’t reject me, and most importantly who kept a space in their heart for me. It feels scary and good at the same time.

I show up every week because I don’t want to be alone, I like being authentic, and I appreciate that he in turn shows up for me and bears witness. In a way I believe us showing up is how we honor each other’s existence and importance as humans. Therapy will be the place where I was accepted and began to accept myself. The hope then becomes that I can take these feelings and begin to experience that with others.

Sitting on the Balcony Overlooking a Fog of Fun House Mirrors

Today, my dear patient came in angry and confused by our last session. She couldn’t remember the mantra that she was supposed to take away and left feeling even more confused and agitated. Over the week, she eventually realized that what she felt at his core was a shame that had been building subtly and inexplicably over the past many weeks. Maybe it started after she had forsaken her abusive father, now apologetic, but enfeebled in his advanced age. But, this explanation didn’t quite settle her.

So, we reconstructed our conversation in the minutiae.
Then, we recalled a repulsion to whining and neediness,
fended off with barks of nastiness and meanness,
which, sure, sounded like her father,
but also sounded
very much like
herself…

In this swirling vortex of shame,
she in turn assumed that
others were mean and nasty back
—her fear of always being one disappointment away
from rejection taking purchase again, like a tightening claw around her throat.

She didn’t want anything to do with anybody
and was reprimanded
for being
impatient,
rude
and condescending.
She dreamt of being trapped in a tiny room with me,
wishing she could shove me out!

She cried out in confusion, panic and redoubled shame
at the return of such depressive agitation.
She begged me
to tell her what to do
, but knew she would resent me if I answered.

Instead, I beckoned her to sit on the balcony overlooking her shame.
I showed her how
the inside mirrored the outside, and
the outside rattled the inside.

I showed her how
her divided
self
apparated like swirling reflections
in a haunted
house of mirrors,
at times, projecting the whiny self
while embodying the resenting self,
at other times, projecting the critical self,
while filling herself with shame.

Out of the blue, she declared
with streaming tears and quivering lip,
“Sometimes, I think I was bad
because
I was hoping that my father
would notice.”

And, I can’t help but let slip, “…beautiful!” as I look over the dawning light dissipating the fog.

I tell her that the mantra to remember is this:
and I put my arms up as if
holding my baby
patting his bottom,
saying, “there, there…
It’s ok.
It’s ok.
”

New Journal Article on the Importance of Relationships in Trauma Therapy

As you have probably guessed based on my blog, I have a beef with the misrepresentation of effective trauma therapy as being narrowly evidence-based, which often leads people to conclude that the best therapies are the most studied, which often defaults to cognitive-behavioral therapies. But, what the general public less frequently hears about is the vast evidence-based, research literature showing that the therapeutic relationship is the most important ingredient in effective trauma therapy (and therapy for lots of other disorders for that matter). Here’s a really cool new article that supports this fact.

Norcross, J. C., & Wampold, B. E. (2019). Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline. Psychotherapy, 56(3), 391-399.

http://dx.doi.org/10.1037/pst0000228

Abstract

The therapeutic relationship and responsiveness/treatment adaptations rightfully occupy a prominent, evidence-based place in any guidelines for the psychological treatment of trauma. In this light, we critique the misguided efforts of the American Psychological Association’s (APA, 2017) Clinical Practice Guideline on Posttraumatic Stress Disorder in Adults to advance a biomedical model for psychotherapy and thus focus almost exclusively on treatment methods for particular disorders. Instead, the research evidence, clinical expertise, and patient preferences and culture (the necessary triumvirate of evidence-based practice) should converge on distinctive psychological guidelines that emphasize the therapy relationship, treatment adaptations, and individual therapist effects, all of which independently account for patient improvement more than the particular treatment method. Meta-analytic findings and several trauma-specific studies illustrate the thesis. Efforts to promulgate guidelines without including the relationship and responsiveness are seriously incomplete and potentially misleading. The net result is an APA Guideline that proves empirically dubious, clinically suspect, and marginally useful; moreover, it squanders a vital opportunity to identify what actually heals the scourge of trauma. We conclude with recommendations for moving forward with future APA practice guidelines. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

The Center of the World

A set of parents took a step back to ask if our discrete trauma treatment for their children was taking into account the impact of the horrible event on them, a question their couple’s therapist had asked them to ask. Without fully understanding what was meant, I shared the itch gnawing my intuition: I didn’t know the husband yet and his presence often disappeared from the room. The wife agreed that her husband wasn’t “therapized" like she was. He defended by saying that he’s been in plenty of years of therapy.

But, she’s been in therapy for years and years, and therapy revealed to her that she had been living in the world as is, but there was a floor beneath the world—one filled with nuance, complexity and layered meaning. Over the years, she realized that the floor was actually just a hallway to floors upon floors until you reach the center of the world, and she loved living in that world, exploring its ever changing and revealing landscape. Her husband only visited a few floors from time to time.

I actually freaked out for a second. How did she know about this world?! Who showed her?! I felt both validated and banal and needed to know the name of her therapist.

Afterwards, the nature of our trauma work plunged into the gravity of Kairos.

*shared with permission

Transforming the Ember of Rage

I met a man who experienced unbearable, unspeakable
and unspoken horrors at the hands of his
parents. He observed
that when they died he
grieved for just a moment, before
moving to the comfort of anger,

anger at the fact that they
would never be
able to restore his childhood
so violently wrenched. Then,
for the next ten minutes, he lost himself
in this rage against the world.

When he spoke of this grieving rage, I imagined
sifting through the ashes of a dying fire
discovering a weak ember of life.

But, as his rage engulfed, this ember
turned into a blaze of Pyrrhic victory burning
everyone.

I hurriedly gathered that ember
gingerly nursing it without igniting it,
to light a torch illuminating
the path to what he is truly fighting for.

I told him that he should fight
to reclaim his childhood—to be
surrounded by the safety
of love, so he can finally
play.

*shared with permission

Fighting for Love

A beautiful autumnal woman dragged her handsome winter boyfriend in
for one last desperate attempt to make this miracle work.
Her history of abandonment triggered by his enacted history of neglect.
He yearns for her, like tiny arms reaching for the mother
who left him stranded on a front yard
at an age too young
to understand in any other way than
he’s not worth taking.

He’s slipped past therapy his whole life,
a lesson in never letting anyone get close enough to hurt him or see his un-worth.
Christmases in the Caribbean, avoiding all reminders of love and family.

But, for her,
anything.

So she lashes him with wet tears,
angry when he turns away,
scared that this will push him away,
guilt-ridden knowing his history, but blinded by her own pain
and her own needs.

I help her see
herself as fighting,
fighting for love, fighting.
Fighting for “I deserve better.”
“We deserve better.”

He shrinks in self-absorbed self-flagellation, reliving
his unworthiness in every
cell. A prisoner
of his pain.

Now, I get angry.
I refuse to let him disappear.
I yell, “Do not leave her!
And, do not leave yourself on that front yard again.
Fight for her! Fight for yourself!
Open your heart and embrace her pain.
The greatest challenge and the greatest reward
left undone in your life is
to feel
to hurt
to love
to hold
and never, ever, let go again.

*shared with permission

The Wisdom of Negative Emotions

Part of the work with one patient revolves around this question: What is the value of sitting in uncomfortable emotions?

My patient tells me that his teen-age cousin from out of town is visiting him over the holidays. This is a cousin whom he wishes he could know better and support more. They and some other family members are having a holiday meal. My patient asks the teen what gift she is giving her mother for Christmas and the teen says, "Nothing, I hate her." My patient understands that the teen and her mother are struggling quite a bit, but he doesn't like the negativity displayed so publicly during a holiday meal. Over the course of the meal, my patient grows more and more annoyed by the teen's endless chatter about nothing and can't wait for the evening to end. He ends up feeling guilty for harboring such negative feelings towards his dear cousin and thinks maybe he's just not very patient with teenagers and is a bad older cousin.

After receiving his permission to offer some advice, I tell him that he can't dismiss his annoyance because it holds wisdom and insight about what he really cares about. His annoyance is telling him that he is frustrated in his desire to have a meaningful moment with her so that he can really get to know her as a person, a longing he himself expressed earlier in the session when he said so beautifully,

"I don't really know if my father ever thinks about me when I'm not in front of him."

Secondly, his annoyance is telling him that he really cares about feeling gratitude for the moment that they are able to share together with other family members during that meal.

At the same time, I remember how deeply he appreciates his mother's love for him. I visualize one of the earliest memories he has shared with me--sitting on her lap while reading a book--overlaid onto an image of the same energy holding him over the phone while she listens to him speak as an adult. I don't mention this explicitly, but feel it settling into my heart and coloring my experience of the moment.

Next, I imagine how he might be guided by what he cares about. I tell him I imagine him whispering to his cousin, "I wish we had more time to really talk and
get to know each other."
Like a hug.


Then, I imagine his cousin's energy settling and easing
out of her anxious wanting to be seen while being afraid of being judged,
manifest as the endless babble about nothing.

And in that same moment,
my patient's energy is settling,
his self consolidating, as
he sees himself more
compassionately
and imagines himself more
powerful and effective
in the world, achieving
the knowing he wishes for his cousin
and for himself.

*shared with permission

My Therapist's Journey: Play Therapy

The second biggest pillar of my early training was play therapy. I probably did more play therapy than anything else during grad school because I had a part time job placed in an elementary school treating about 15 children per week.

Children taught me a lot about how to bring spontaneity and playfulness into my work. Children will not put up with a neutral, distant person and will tell you whether you are doing right by them, whether you like it or not. If you listen, they will teach you how to be the therapist they need, but you still need to play and experiment for them to know "yes, more" or "no."

When I was thrown into play therapy, I never really received any clear instruction on how to be therapeutic. I even took a semester-long class on child therapy but didn't learn a thing about technique, just a bunch of theory. Now, it is true that some of the developmental and dynamic theories were informative and I found that children's imaginative play often paralleled real-life themes. For example, one five-year-old only watched Lion King up to the point of the father's death and then rewound the tape over and over again. Other children play out generalized themes of powerlessness, fear, family stress, social stress, anger or sadness. But, this work was plodding and it was often difficult to know how to make this play helpful in the real world. Furthermore, many young children quickly grow out of pretend play beginning around age 7 and move into board games and other rule bound games.

It was through hours of playing Uno and Sorry and Trouble that I began to understand that children at this stage were practicing a variety of skills: turn-taking, following the rules, reciprocity, fairness, impulse control, controlled aggression, good sportsmanship, decision making, frustration tolerance, planning, etc. I really began to understand moment to moment activities in terms of what skills or neuro-cognitive functions were being expressed and exercised.

I also had the amazing fortune of learning Ross Greene's Collaborative Problem Solving Approach early on and co-led parenting groups with him in an outcome study comparing his approach to Russell Barkeley's Defiant Child approach, which is a classic behavior management approach. I was beginning to see behavior as being the shaped by external reinforcements (as highlighted in behavior management), neurocognitive drives and deficits (Ross Greene), and internal psychic and relational drives (psychodynamic).

I was becoming more and more interested in diving deep into the moment-to-moment world of play and overlaying these paradigms onto the immediate behaviors and experiences. I started to care more about how things are being said and done versus what was being said or done. In fact, I rarely ever asked children how they were doing or bothered with helping them "open up." Instead, I just played as hard as I could. I tried to really imagine all of the imaginary actions happening between characters. I competed in board games with gusto. I began to figure out what the issues were as they emerged in moment to moment play and tried to figure out ways to correct them without leaving the play.

This obsession with the moment to moment process has carried with me throughout my work and remains a core aspect of how I work and what makes me effective. I listen and observe on so many levels at once: what's being said or done, how, when, why now, how it's connected to history or to other relationships, what's the deficit or the struggle, what's the yearning or aspiration, what's the hurt and pain?

In future posts, I'll give a nod to cognitive-behavioral approaches and then spend a lot more time on modern relational approaches as applied to individual and family work.

The Truth about Trauma Work

I was working with a couple terrorized by demons of severe trauma experienced as children, re-inflicted on each other. They lashed out at each other trying to cause as much pain on the other as they felt themselves. 

And I dove in head first with barely a safety line in tow. 

Utterly uncertain that I would be effective or helpful. 
In a zone. Half unconscious. 
Trying desperately, 
using everything I've learned, making stuff up along the way. 
Tracking them to see what worked; 
stabbed with pangs of regret and doubt when it didn't. 
Moving in and out of panic and beautiful poignancy. 

The session focused on de-escalating the husband, he with a history of violence, while
monitoring the fear and the fury in her eyes who suffered the violence. 
Trying to stay empathic to his pain, while
not forsaking the pained by pushing him
to acknowledge the pain he has caused. 
He moved between ferocious disappointment that everyone let him down and his unbearable shame that he in turn disappointed others in ways nigh unforgivable. 

My heart ached for him. 
Holding both his suffering and his crime was unbelievably difficult
and only possible for me because of the painful work
of accepting my own crimes and broken parts. 
It triggered in me a deep sense of sadness, shame, acceptance, and  compassion. 
Then tenderness, for both of us. 

I stayed with him, 
brushing aside the hurtful parts, mining for the hurt. 
Digging barehanded for shrapnel lodged in his heart, without anesthesia. 
Phantom pain from my own shrapneled heart burning in resonance. 

When something did work, it didn't feel like I could take credit. I'm so aware of how often the very same acts fail with someone else or in some other moment. The only conclusion I come back to again and again leaves me with a deep gratitude for the angel of therapeutic healing that blessed us that day and for the courage of my patients who grace us to co-create these magical moments greater than anything we could imagine or will alone. 

*shared with permission

two brothers learn to feel and heal

Yesterday i met with two young school-age brothers, whose mom brought them in so they can learn to get along better and stop fighting. I’ve met with them separately and the older one says he likes to hurt and tease his little brother because the little brother is annoying and makes up lies to get the older one in trouble. The younger one wishes that they would get along better but he feels like the older brother doesn’t like him and hurts him so he has to get revenge to make him stop and to hurt him back. 

The boys come in a little silly and aggressive with each other. They are huge, burly young boys dripping with testosterone. Last session, the younger made up this joke: whenever we said something that made him feel proud, he said, “I can feel my chest hairs growing!” I imagine them as bear cubs wrestling in the wild. The mother does a great job of keeping their energy in check and to my surprise these boys have always been able to sit through entire therapy sessions and stay engaged in conversation, a feat that I rarely see from school age children. 

We review that the purpose of today's session is to help them learn to get along better. Mom brings up an example from last weekend: the younger one had a baseball bat. The older one chimes in and says that the younger one was swinging the bat. The younger one denies swinging it; he was just holding it. The older one gets frustrated with the lying and they start going back and forth. 

We try to move past this by continuing with the story. The older one continues, saying that he was holding a large stuffed animal as a shield. The younger one interrupts, “It wasn’t that large." The older one gets agitated again, so we try to hurry on, knowing that this won’t get us anywhere. 

The older one says that the younger one then hit him in the knuckle and showed me the bruise. He’s getting really agitated and accuses the younger one of doing it on purpose. The younger one vehemently denies it and goes back to saying that he didn’t swing the bat. This makes the older one even more livid and the moment is escalating. 

I stop them from going back and forth about what exactly happened and ask the younger one what he is feeling. He takes this seriously and reflects for a while, which is so amazingly adorable because it shows how mature and willing he is to think about his emotions and it shows how much good parenting he must have received to want to access these feelings. The older one is capable of this too, by the way. 

Nevertheless, he can’t come up with anything. I ask if I can offer some ideas. He nods. 

I ask, “Do you feel bad?” 

“Yes”

“Why? Because you hurt your brother?”

“Yes”

“What should you do when you feel bad about hurting your brother?”

“…say I’m sorry?”

“Yeah!”

“But, I already did!”

The older brother cries out, “No, you didn’t! You never said you were sorry and you never feel bad!” 

Mom tries to jump in saying that she thinks she heard the younger one apologize, but she wasn’t in the room to hear it actually. 

I’m trying desperately to figure out how to move away from this back and forth quibbling, which all people get mired in.

I recenter back into what’s happening now and try to figure out why the older is mad right now. I say to him, “You know what I think is going on?” He gives me his attention. Another adorable hallmark of attachment security and willingness to de-escalate. “I think that just thinking about what happened and seeing your bruised knuckle is making you feel hurt again.” 

He tells me that that’s partly true but that more than anything he’s mad because his brother is lying! I love that he rebutted and clarified, because it’s such a sign of autonomy and agency, and engagement with the self-exploration. 

Then, I try to help him see that his younger brother is feeling defensive and bad so he’s trying to minimize what happened. He doesn’t care. I admit to myself that that strategy didn't work. He doesn’t want to acknowledge his brother’s experience when he’s hurt. 

So, I turn to the younger and repeat that his brother is mad and hurt right now, so what can he do to help his brother feel better. He starts by saying that his older brother needs to learn to tell the truth. His older brother gets angry and says, “He asked what YOU should do!” I nod in agreement. 

The younger one says, “Say I’m sorry?” 

The older one, whose head was down, snaps to and glares at his brother. The younger one smiles back nervously, I think. This part happened really fast, and I was in the middle of saying something like, “And that you didn’t mean it?”

The younger one says, “Yeah, that’s what I was trying to say," referring to his “lying” about not swinging the bat. 

The older one is not having it. 

I realize that I missed something and ask what just happened and why the older looked at his brother. 

The older says that the younger is lying. I disagree saying that if the older had looked at his brother while he was apologizing he would have seen that his brother was being sincere. The mother nods in agreement. 

The older continues, “But I’m getting this weird feeling on my side and I only get that feeling when I know that someone is lying to me about feeling sorry.” This is reminiscent of a breakthrough moment earlier in our work when we talked about how missing his mother when he is hurt is just something that his body naturally feels. He really liked that his body had a form of wisdom that made it okay for him to feel certain ways. 

The younger brother goes and sits on his mother’s lap. I can see that he’s upset because he opened up to be vulnerable and he was rejected. 

I realize that I was also quibbling and finally notice that the older boy has his head down. His face is reddened, and he looks sad. I ask him what he’s feeling. He doesn’t know. The younger brother chimes in, “Disappointed.” This is such a lovely acknowledgment that his apology wasn’t enough. But, the older brother lashes out, “No it’s not!"

Realizing that nothing we could say would feel good enough for this little boy, I suggest to him that he’s turning into the Hulk, which I’ve described to him in the past. I say that he’s so hurt that his Hulk is coming out to protect him and it’s making him want to be mad instead of hurt. I say, “It feels so much better to be mad than sad." 

He lightens up and agrees, “Yeah, being mad is fun! I like to hurt my brother!” 

And I think i can sense in the corner of my eye that the younger one is steeling himself for more cycles of useless vendettas, which is a realization that dawned on him last session and inspired him to want to work things out with his brother.

I interrupt the process and say, “Oh now I get it. You’re too upset to accept your brother’s apology!” 

He agrees and mumbles to himself, “I need to get the anger out.” He starts breathing deeply, clenching his fist and trying to figure out what he can punch, which is all quite adorable too because he’s acknowledging that his anger is limiting him right now and he’s taking responsibility for reducing it. 

However, I think he can do better. I tell him, “You know, I don’t think you need to get the anger out. I think you need to learn to stay in the hurt and get the hurt out.” He looks at me with a look of repulsion. 

I press on, "How can you do that?”

He says he has no idea. 

I say, “Well, you see what your brother does when he gets upset?”

“Yeah, he lies about me.”

“No, not that. He goes to sit in your mom’s lap.” She’s still holding the younger one lovingly in her lap. 

He looks up with another look of repulsion, like he’s too grown to run to his “mommy." His mother reacts playfully by extending her arms out to him, suggesting she can hold both of them, but also exaggerating the gesture to acknowledge his repulsion. 

I fold an insight based on this into the next thing I say: “I think it’s tough to be the older brother. Because once your brother came around, he got all the attention and you thought you had to take care of yourself, even though that’s not true.” 

As I’m hoping would happen, his mom jumps, “Yeah that’s right. I want you to know that you can always come to me. Like remember that time you came to me and said, ‘Mom, I need some alone time with you,' and we did. We had some really special time together?” 

The boy lightens up and I can tell that he’s okay and we have run out of time. The younger one holds up his hand and the older one mirrors it. It’s hard to tell whether this is a request for a high five or a threat. They stay like this and are smiling. They resume playing, trying to work out whether they trust each other enough to close the loop of intimacy they just created. 

Running out of time, I turn to the mom to debrief about what happened and she wants to bring the boys back to do this again. As we are looking at our schedules, the older one yelps. They were still playing this strange game of brinksmanship, and the younger one had slapped the older one’s hand. The rough play that got them into this place of hurt over the weekend is happening again, but this time it doesn’t escalate into such personal pain. They move on. The mother very quickly tells them both to stop but we are both rushing to warp up. They barely register her and just move on to enjoying more rough and tumble play, wild cubs again who are not harboring resentment as they balance the limits of playful aggression and connection. 

 

*shared with permission

My Therapist's Journey Part 1: Insight.

I've learned so many different types of therapies over the past 20 years and continue to take from everything I’ve ever learned. In a series of posts, I'm going to share what I've personally learned about therapy and becoming a therapist. I hope these posts help future therapists embrace their own journeys and help patients feel more informed and empowered to seek good and smart therapists rather than good and smart therapies that fit their needs in their current moment. 

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Ode to A Depressed Person

I know someone who always feels like ending her life. I told her that I admired the way she lived, which is a ridiculous thing to say. Why would anyone admire someone who is always at baseline suicidal? I tried to unpack what I meant by it and this is what came out:

You, who bears this unrelenting weight of depression,
wake every morning and ask, "Why not today
finally Rest?" 

I know for you
life drags on
despite your protestations,

but I believe that you
more than anyone else has
this remarkable opportunity
, or maybe undesired obligation,
to choose life
every
moment.

See, for you, life
is not a given, 
like the certainty of sunrise.

Every morning, you must choose,
stay or go? 
Every morning, you ask yourself, why stay?
How do I make
today
at least bearable
and possibly worthwhile? 

Then,
to see you be kind and generous and loving,
I am left concluding,
that love alone fulfills life's purpose. 

And, I am reminded that for me love is the source from
which all worthwhile things must spring
(I worry so much about how much hate drives our politics these days)

Then, I feel
reaffirmed, revitalized,
and grateful, for you, who bears this weight, 
reminding me to love and
act in all ways from love.