The good news about this question is that the psychotherapist usually intends in it in an affirming way: “You are a good person who deserves to be treated well. Don’t settle for less!” In the psychotherapy business, I’d say that almost all of us like almost all of our clients, and grow to care about them. It’s painful sitting with these people we care about while we listen to them tell of accepting mistreatment, especially ongoing mistreatment, and most especially severe ongoing mistreatment.

If you’re a psychotherapist, maybe you’re nodding – and if you’re nodding, you’re probably thinking of clients locked into a seriously abusive relationship. This may get at the hardest part of the job: we’re vulnerable to what’s called “vicarious traumatization”, which is about the reality that if you are empathically attuned to a person, you feel that person’s pain – and the more attuned you are, the more you feel the pain. Work with enough traumatized clients, and work deeply enough, and you’re experiencing the trauma, too – a version of it, anyway.

So for reasons of self-preservation as well as concern for the client, we want to get the client out of the pain. Sometimes this desire gets to be more about the therapist’s agenda than about the client’s, particularly when the therapist has personally faced similar situations.

It can happen for opposite reasons. Consider a therapist who may currently be in an abusive relationship in her/his own private life. (I know we’re supposed to have it all together about everything, but – get ready for a shock – we don’t.) The therapist desperately wants out, but hasn’t yet gotten to the point of being able to do so. S/he may then “externalize an internal conflict.” That is, there’s a shouting match going on in the therapist’s head about his/her own life:
“You have to leave!”                     “I can’t leave!”
“You have to!”                                “I can’t!”
“Have to!”                                       “Can’t!”
And so on. When a client enters the picture with a similar abusive situation, the therapist may take the “You have to leave!” side, and push the client the way the therapist’s internal voice is trying to push the therapist. This is unfortunate, because the therapist typically loses a sense of empathy for the client, just the way his/her internal “You have to” voice has no empathy for his/her “I can’t” voice. It gets even more unfortunate when the client also has a parallel internal shouting match going, because then the therapist’s “You have to” voice gets paired with the client’s “I can’t” voice, and their internal stalemates get replicated in the counseling relationship.

Consider an opposite situation: a therapist was in an abusive relationship, struggled mightily, and finally – with great courage, because it takes great courage – left it. When this therapist now works with a client caught in a similar abusive relationship, the therapist vicariously re-experiences the feelings s/he worked so hard to overcome: helplessness, shame, terror, doubt, despair, etc. Understandably, the therapist may want to get away from those feelings as soon as possible, and may push the client to change at a pace faster than the client is able to manage. The therapist’s “You have to” voice, which, in his/her case, won the day, now gets turned on the client. Again, the therapist’s understandable desire to avoid having to re-experience these unpleasant feelings can lead to a loss of empathy for the client.

Other bad outcomes of a different sort are possible: a therapist in an abusive relationship may unconsciously give the client implicit permission (or even encouragement) to stay in the client’s abusive relationship, because it makes the therapist feel less like a failure to have company. A therapist who has escaped an abusive relationship may simply withdraw emotionally from a client who is in an abusive relationship and won’t get out soon enough for the therapist.

Of course, good outcomes are possible, and – I hope – more frequent. The most gifted therapists are often “wounded healers” who can make use of their own painful life experiences to connect at deep empathic levels with their clients. These therapists have, in addition to solid clinical skills, an ability to convey an “I’ve been where you are” message in an empowering way, while still respecting the client’s uniqueness and the differences between the therapist’s life and the client’s. (This self-disclosure is a delicate line to walk, however, and the therapists who think they’re really great at it are usually not. Look for “The Three-Second Rule” in an upcoming blog.)

But when I hear it, I worry about the “Why do you put up with that?/You shouldn’t put up with that!” message. On a pragmatic level, clients are usually hearing this message from other sources (friends, family, coworkers), and may be feeling ganged up on already – it doesn’t help the therapy for the therapist to join the gang. And as much as it reflect the therapist’s affirmation, it can be a red flag that the therapist may be losing empathy with the client. The therapist may still care – even care deeply – but lose empathy nonetheless.

To contrast care and empathy: care is wanting the best for you, while empathy is working to understanding (emotionally as well as intellectually) what you experience. Empathy is when I try to see what you see, feel what you feel, and think what you think. The best therapy combines care and empathy; losing either element causes problems.

My strong belief is that when a person is stuck in a self-defeating behavior, the most effective intervention often starts with empathic connection, in which the therapist works to understand the client’s experience in that stuckness. If the therapist is able to achieve a solid connection, this often leads to an empathic release, as though the client were to breathe a huge sigh of relief, and then say, “Now that someone truly understands why I’m clinging to this, I can at last let go of it.” If you’re familiar with Aesop’s fable of the wind and then sun, you’ll see the parallel: as long as someone is trying to blow my coat off of me, I hold onto it tighter; when I feel a safe, accepting warmth, I can finally to take it off.

No solution in psychotherapy is one-size-fits-all, including this approach. Still, it’s often worth a try. Rather than saying, “Why do you put up with that?”, a therapist might consider expressing genuine, caring curiosity about the part of the client that can’t stop putting up with it. Something like, “What makes that approach seem like the best one?” Of course, no syntax can outweigh the message of underlying tone; any question can be made to sound shaming. So the tone of genuine, caring curiosity is all-important, conveying an “I really want to understand how you experience things” message.

A client’s initial response to such a question is often embarrassment, since his/her answers don’t make sense, even to him/her. It is critical to validate those answers, because that is a way of validating the client: “You may not think these answers make any sense. Emotions aren’t logical; that’s just the way things are for everyone. Still, your emotions are powerful, and they are important. Let’s listen to them and see where they take us.”

What emerges from the client offers the therapist an opportunity to accept the client’s powerful motivations for “putting up with that”, while looking for ways to validate their origins and also reorient their meaning in the present. Perhaps a client (and physical abuse victim) who has a male partner might say, “I love him so much. He can be mean, but he’s so sorry afterward, and I know he wants to change.” It’s tempting to jump in to confront the minimization and denial, to challenge all the things that genuinely need challenging about those statements.

Those may be  appropriate interventions, eventually. But in my view the first step involves empathy. “When he means so much to you, it must feel impossible to consider leaving him. And you so want to believe he’s a good person – when you see his remorse, it touches you deeply, and makes you want to forgive him and try for a fresh start.” Clients are sometimes genuinely startled by a response like this – they are speaking from their “I can’t leave!” side, and the only response they’ve ever gotten is “You have to!” in overt or covert ways.

If the client comes to believe that you will genuinely honor his/her “I can’t leave” side, this can open the door to looking at the factors involved: a depleted sense of self, for instance, or a belief that only the abusive partner will ever love the client, or a belief that only the client understands and can “save” the abuser. The therapist’s accepting empathy helps release the client’s deep woe.

And with that released woe, the client may feel free – perhaps for the first time – to speak from his/her own true voice, something more whole, something larger than either the “You have to!” or the “I can’t!” voices. It may start softly –  “Sometimes I wonder if I really deserve all the hitting (or name-calling, betrayals, drunken rages, etc.).” This is a quiet voice, different from the outrage immediately after an abusive episode that is still part of the cycle of violence – outrage that fades predictably in response to the abuser’s apologies and promises. The therapist responds to this new voice with interest but not enthusiasm, being careful to stay at the client’s pace: “Really? I don’t know if I’ve heard you say that before. It’s like a different part of you is speaking.”

This is the voice to which the therapist throws allegiance. This “larger self” has observed the “Have to/Can’t” two-step and wants out of that dance. The therapist, who has stayed out of the dance all along, can credibly offer to be a companion; perhaps they can find a way together to enable the client to leave the abuse dance hall entirely.

Wow.

More readers, more comments, more subscriptions than in any of the previous 68 posts. Therapists read, commented, and subscribed; clients read, commented and subscribed. This is a thing. Who knew?

One reflects on such an outburst: what can it mean? Many explanations are possible; I’ll focus now on one factor that – I’m guessing – is central to the strong feelings people have about the topic: shame. When we perceive that we have failed at something, it’s a short step to make that about us rather than about what we’ve done: we can jump from “I have failed” to “I’m a failure.”

A shame summary: at its core, shame is the awful emotion we feel when confronted with perceptions of our imperfection – flaws, limitations, unattractiveness, failure, etc. It helps to contrast shame and guilt: guilt is about something we’ve done – “I broke a window and I felt guilty about it.” Shame is about our perceptions of who we are – “I’m ugly and stupid.” Guilt is situation-specific and contained, therefore amenable to repair: if I broke a window, and then fix or replace it, all is well. Shame is global and pervasive: if I think I’m ugly and stupid, I will also feel that nothing can be done about either problem. Guilt evokes remorse; shame evokes fear. With guilt, then, we are motivated to make things right; with shame, we feel helpless and simply want to hide.

Shame is a developmentally primitive emotion, that is, it is available quite early in life. Before a child can understand “right” and “wrong”, or “yes” and “no”, a child will understand bad: “Bad boy!” “Bad girl!” (Even dogs react with shame to “Bad dog!”) As a result, we feel this primitive shame deep down in our guts, and shame perceptions and feelings are typically quite resistant to new perceptions, well-reasoned arguments, and compassionate care – all of which affect us at metaphorically “higher” developmental levels (head and heart).

Shame does have a healthy side. A little shame helps us keep in mind that we do have limitations – we are not perfect, we are not gods. We all know someone who has no shame, and it’s not a pretty picture. And facing reality-based shame can turn a life around, as when a person says, “No, it’s not just that I drink too much. The truth is: I’m an alcoholic.”

But in general a little shame goes a long way, and many of us have had too much. Some families are “shame-based”, that is, shame is the currency of the system: people are motivated by shame, punished by shame, and shame permeates all interactions. In such a family, important psychological components like self-image and intimacy become profoundly distorted. Shame pushes people to attempt to give the appearance of perfection, because of the fear that any sign of imperfection will “unmask” them in all their profoundly flawed ugliness, and leave them vulnerable to criticism and contempt.

Can you hear the child’s developmentally primitive mindset in the background? A child thinks in quite limited and caricatured categories: there are beautiful princesses and handsome princes, and there are trolls and ogres. There aren’t tall people, but there are giants; there aren’t little people, but there are dwarfs. The good people are perfectly good, and the bad people are perfectly bad. These “false dichotomies” reflect the way shame works: shame says that we are perfect or we are shameful, there are no choices in between – and since we know we’re not perfect, the only real choices are about trying to hide our shame (pretending perfection) or letting it show. Since “letting it show” is incredibly excruciating and feels quite dangerous, the more inviting choice is hide-and-pretend.

Another element of the child’s mindset in shame has to do with a certain kind of developmentally appropriate self-centeredness: the child is the center of his/her universe, regarding both uniqueness and self-reference. That is, the child feels, “No one else is like me,” and “Everything is about me.” Once the amount of shame a child has ingested reaches a certain point, these messages shift: “No one else is as unlovable as I am,” and “Everything is about my shame.” When we struggle with an excess of shame, it seems as though everyone looks at us either with suspicion or full knowledge of our intolerable flaws.

Well, there’s more, but perhaps this will do for now. Let’s return to the notion of “failed therapy.

I’m guessing that when the therapy experience ends badly, both therapist and client experience shame, or else do whatever mental gymnastics are necessary to ward off that feeling. Any sort of failure typically generates a shame reaction to some extent, but with therapy, we might expect the shame to be unusually intense. For the client, shame might threaten because the client has essentially presented much of his or her whole self to the therapist, often risking a level of self-disclosure far beyond what the client has done in any other relationship. When things seem to go badly, shame could easily assert itself: “See, you really are a total loser! Even a professional therapist can’t fix you.” Or, to go another route, “See, I told you not to let the therapist know your awful secrets. You’re no better off, and now this other person knows the truth about what a loser you are!”

The therapist may experience a complementary kind of shame: “See, you really are an incompetent bungler! Your client trusted you, and you were worthless.”

(You’ll notice that I’m treating shame as though it is an entity with its own voice. Sometimes people find that disconcerting, as though I’m suggesting schizophrenia or something similar. I do not intend that. Rather, I have found this approach to be useful as a means of creating some mental “space” between the individual and the distorted perceptions shame presents. Giving shame a voice opens the door to arguing with or ignoring the voice. Shame says, “You’re a loser.” You respond, “Well, I have lost. And I have also won. There’s more to me than my losses.” Or, alternatively, you respond, “I am sick of your distortions! Shut the #$%& up!)

As I mentioned in the last post, therapy that ends badly can still have good effects. It isn’t necessarily a complete failure – or, more precisely, it’s almost never a complete failure. If you’re the client, you’ve learned things about yourself – even if mainly they’re about what you don’t like in a therapist. You made some progress, even if it was primarily about developing a more comprehensive understanding of the challenges you face. And you’re out of the therapy, which means you can find a different therapist who might be a better fit with your needs and personality.

If you’re the therapist, you have an opportunity to explore blind spots or holes in your skill set; working on these areas can improve your competence, and even simply being more aware of them can help you make better decisions about the clients you accept in the future (i.e., limiting yourself to areas of competence).

In either case, a therapy that ends badly can help you realize there are places in the psychological landscape that you’re just not ready to enter yet, feelings you’re just not ready to experience, vulnerabilities you’re just not ready to share. It seems that many therapy “failures” are like that: either therapist or client just can’t (or isn’t ready to) take the next step. The therapy may end in an explosion that the unready party causes as a way to stop things right now; it may also end in a sort of energy asphyxiation as the unready party digs in his/her heels, refusing to take the next step or explore why not.

Something we almost never say in therapy about reaching that unready stage is: “It’s okay.” But it is okay. It’s legitimate to reach a point beyond which you’re not willing to go. If the client reaches it, it behooves the therapist to acknowledge and affirm the client’s choice: “It is valid to take a break or stop entirely at any point. You always have the freedom to return to the work later, if you choose.” If the therapist is the one to reach that point, s/he can convey this in a non-shaming way to the client: “We’ve reached a point where I am unable to accompany you for the next step. You’re ready for it, and it would be an appropriate step for you to take, but I am unable to accompany you.”

Does that sound odd? Perhaps. The general belief – among both therapists and clients – seems to be that therapists ought to be able to go wherever clients want to go. It turns out, however, that humans are limited creatures, and therapists are human. We just can’t go everywhere. And I’m guessing a fair number of bad therapy outcomes occur when therapists feel they have to go somewhere with a client that they (the therapists) aren’t ready to go. This almost certainly creates shame in the therapist: “I ought to be able to do this, but in my defectiveness I can’t.” Sometimes the therapist finds courage equal to the task, and stretches his/her reach helpfully, but I’m guessing more often the therapist messes things up, and perhaps finds a way to make it the client’s fault in the process. It would be better for both parties for the therapist to acknowledge the truth. Then the therapist could offer a referral to another professional who truly could take the next step with the client.

But what about the clients? How do they cope?

Years ago, I was listening to a senior clinician grouse about all the bad therapists there were out in the world. (I’d venture the opinion that there are at least as many out there now.) His biggest complaint, he said, was that bad therapists “use up hope” – that is, a person brings all his or her hope into that initial therapy session, and when things go south, the person is likely to say, “Well, I tried therapy, and that didn’t work either.” Some portion of the person’s hope dies.

This outcome is unfortunate in many ways. Just now I’d focus on one: the client is overgeneralizing. All we can really say for sure is that this therapy experience with this particular therapist at this particular point in the client’s life didn’t work out well. And even that cautious statement may go too far, as I’ll explore in a moment.

In some ways, an unsuccessful therapy experience is easier for the client to handle if the therapist is obviously incompetent. Then the client can attribute the failure to the therapist, and may be able to hang on to some hope: “My therapist is a goofball who clearly doesn’t know what s/he is doing. Maybe if I found a better therapist, I’d have a better result.”

But even good therapists – even excellent therapists – have failures. Every therapist has a “range of competence”, that is, we work well with certain people in certain situations. A good therapist has a wide range of competence, but we still have blind spots or areas of limitation. I’m guessing a bad therapy experience is harder for the client when the therapist seems obviously competent: “My therapist sure seems to know what s/he’s doing, but I’m not getting any better – it must be me! I guess therapy just won’t work for me.”

Actually, one of the places I worry about this loss of hope most isn’t in psychotherapy, it’s in the prescription of antidepressants. Back in the 1980s when I first got into the practice of psychotherapy, many people entered therapy because of depression. Antidepressants existed then, but had bothersome side effects, weren’t marketed in the mass media, and required regular psychiatric med-checks. In short, the drugs did some good sometimes, but they were a hassle, and people were more honest about the problems. Nowadays, we find that most people who experience depression seek an antidepressant prescription – few try psychotherapy, especially at first. In spite of consistent research findings that the current generation of antidepressants are effective less than 40% of the time, and in spite of bothersome side effects (e.g., in sexual functioning), mass marketing successfully portrays antidepressants as the decisive answer. I worry about the 60% of depressed people whom the drugs don’t help: rather than saying, “These drugs are pretty useless,” (which would be true) I fear that they say, “I must be really screwed up. Even drugs can’t help me.” Now they’d be even more depressed, with even less hope.

A message to clients: Hang in there!

Here’s what you know about yourself when therapy (or an antidepressant) doesn’t help: [drum roll] nothing.

More precisely, the mere fact that the therapy (or medication) didn’t work out can mean so many things that there’s no way to know what it might mean in your particular situation. There are so many variables in therapy, including not only what you bring to the table but also what your therapist brings: his or her skill in general, as well as his or her skill in dealing with your particular issues; his or her personality, and how it meshes (or doesn’t mesh) with yours; his or her own life situation, including outside stresses that have nothing to do with you.

I’ve certainly had cases from time to time that didn’t go well. When a case ends badly, it’s a lousy feeling, and I do my best to explore what my part in the outcome was. I encourage the other psychotherapists at the Samaritan Center to do likewise, and any competent therapist will do so. It can be painful, as it may involve looking at our own inadequacies, but that sort of exploration is essential to developing competence. And painful as it may be for the therapist, it’s probably less painful than the therapy “failure” was for the client.

I put “failure” in quotes because sometimes therapy that ends badly can have ultimately good effects. Sometimes I sense that I’m part of a “chain of treatment” with a particular client, who is moving through a succession of therapists. Each of us contributes something, and the client moves on in search of more. Sometimes I’m lucky enough to be the last therapist in the chain, so that I benefit from the work others have done; sometimes I’m the first therapist, and help do the planting that won’t bear fruit until later, sometimes much later, long after the client has gotten fed up with me and moved on.

That’s where hope is so essential. For the chain of treatment to run its course, the client has to believe that there’s reason to keep going, reason to try yet again with someone else.

Actually, that gets at another way therapy has changed in my lifetime. Back in the 1980s, it was common to attribute a stalled therapy to “client resistance” – in other words, things were going badly because the client wasn’t cooperating. There were therapists back then who objected to that explanation – it is, after all, a “blaming the victim” tactic that often served primarily to protect the therapist’s ego. But many of the newer therapeutic approaches have discarded the “resistance” explanation, and want to focus instead on where the client wants to go, rather than blaming the client for not going where the therapist thinks the client should go. That’s a welcome development.

Okay, this may be too much information, but the ghosts of my old supervisors will haunt me at night if I don’t say a bit more about “client resistance.” In classic psychodynamic formulations, “resistance” had to do with the ways in which the client’s dysfunctional patterns blocked the natural unfolding of the therapeutic process. (Of course, back then we would have said “neurotic” or “characterological” rather than “dysfunctional.”) So resistance was normal and expected – it was, after all, why the client had come to therapy in the first place, whether consciously or not.

So a key therapeutic task was “interpreting the resistance” – that is, the therapist would help the client understand the unconscious aspects of his/her neurotic/dysfunctional thoughts, feelings, and actions as they showed up in the therapeutic relationship. In theory – and often in practice – bringing those unconscious elements into consciousness (“achieving insight”) freed the client from being trapped in them unawares (“the repetition compulsion”). A client might “resist” this interpretive process, for a number of reasons – including not only the client’s dysfunction, but also inaccurate or poorly timed interpretations.

Thus, a failed therapy might be seen as having to do with the client’s resistance, yet be caused primarily by the therapist’s ineffectiveness in interpreting the resistance in freeing ways. But psychotherapists have egos, and sometimes a therapist’s ego is much larger than his or her clinical competence, and in such cases it was easy to say, “My client ‘s resistance led to the therapeutic failure,” rather than, “I was unable to interpret the client’s resistance in ways that kept our work alive.”

A parallel problem has to do with therapists who more generally have a narrowly structured approach to therapy, and need clients to fit into that mold. I think of it as “car wash” therapy: every client gets sent down the same procedural track (the same mechanical wash, rinse, and buff, as it were), and if your needs don’t fit the process, oh well. I remember reading once about a therapist who created a program for helping troubled couples, and said proudly that it helped 60% of the couples who entered it. I think also of a therapist whose idea of couple therapy involved walking spouses through exercises in a workbook – if clients had concerns that didn’t come up in the discussion questions, those concerns went unaddressed.

Of course, there’s a danger at the other end of the continuum: “electric” therapy. I should note that this term comes from Dr. Samuel Gladding, about whose definitions of psychotherapy and counseling I ranted in my 6/27/2010 blog, “Winners Write History.” Here I’m in agreement with him, though: Dr. Gladding talks about undereducated counselors (those who are merely users of various techniques without understanding the underlying theoretical framework behind the technique). He points out that they may describe their approach as ”eclectic”, when in fact they are “electric” – trying any and all methods that “turn them on”, without any sort of comprehensive understanding of what they are doing or why.

Actually, most research says that good outcomes have more to do with the therapy relationship than with the particular approach the therapist uses. One of the best measures of good therapy, for instance, is whether the client feels that the therapist cares authentically and has accurate empathy. So if your therapist doesn’t seem to care or doesn’t seem to get you, please (for both your sakes’) let the therapist know. If the therapist responds in ways that take your concern seriously, and things get better, great. If the therapist responds defensively, or indifferently, or somehow seems to make it your fault, it’s okay to leave the car wash – you don’t owe it to anyone to go all the way to the end of the line.

And in any event, if the therapy experience doesn’t work out, keep hoping. Things can get better.

Clients often seek help because of a crisis of one sort or another: “My teenager just got a DUI – what do I do?” “My boss says I have to get counseling or I’m fired because of my attitude, and I have no idea what s/he means – what do I do?” “I found a hundred texts on my spouse’s cell phone from a former lover – what do I do?” “I’m having panic attacks every day – what do I do?” “My loved one died over a year ago and I just can’t get back on track – what do I do?”

Such a client is often in the throes of panic. S/he may eventually feel some depression, once the shock wears off, but this client isn’t coming to see me so that I can address either emotion. The client wants advice (or, really, direction): “Please tell me what to do!”

Does the distinction I’m making make sense? I’m trained to offer treatment, but what people often seek is direction. “Tell me how to navigate this overwhelming situation!” I know about how to help people work toward personal change that will help with psychological symptoms, but what people often want is to be given a way to get through a crisis while staying the same.

I was more of a purist when I was new to the field. I’d say things like, “Here’s what I can help you with, and here’s what I can’t help you with.” It was a matter of professional ethics that I wouldn’t pretend I could run someone’s life better than they could – who was I to presume that wisdom, that privilege?

Over the years, though, my sharp edges have been worn down by thousands of pleas for the kind of help I wasn’t trained to offer. I still have scruples – at least I tell myself so – but I’ve come to look for ways to help people think things through without telling them what to do. My goal isn’t to direct them toward a particular decision, but rather to help them make the best decisions they can. For instance, in my first example (the person wondering about whether to move out in compliance with the divorce-seeking spouse’s request), I might ask if the client wants a divorce. The client says no, of course. Then I’d ask why the client would cooperate in making it easier for the other spouse to divorce, when the client wants them to stay together.

You might say that I’m indirectly directing – that’s a fair point. At the same time, I’m asking an honest question: perhaps the client has a valid reason for wanting to cooperate – valid to the client, whether I like it or not. Usually, though, the client blinks as though a bright light just came on, and says something like, “I guess that would be kind of silly, wouldn’t it?” And that would accomplish my therapeutic goal: to break the person out of “panic mode” so that s/he can start reasoning things out again more calmly. Once reason is restored, I’d happily respect his/her ultimate decision, whatever it is.

It also seems legitimate for the therapist to offer information that might be useful to a client’s decision. For example, the same client might say, in response to my question, “Well, if I cooperate by moving out, maybe my spouse will appreciate this and it will bring us back together.” I might offer: “I suppose it could work that way – I’ve barely met you and I have never met your spouse – but in my experience of working with people in this situation, I’d say that moving out usually doesn’t lead to reconciliation. If anything, it generally encourages the spouse to take you for granted even more and value you even less.” Again, you might say that I’m indirectly directing, but the information I’m providing is based on decades of clinical experience, and I leave the client free to decide what (if anything) to do with it. I’m continuing with the same treatment goal of moving the client from panicked impulse to calm reason.

Decision-making is best when the individual has multiple valid options. Often when people seek counseling, they feel that they have only two choices – and much of the time, neither one seems palatable. “My 20-something child has moved back home after getting fired for stealing on the job, and now my child is stealing from me. Do I throw my beloved child out, or do I let my child keep stealing from me?” This may seem like a no-brainer to the counselor, but the client is unable to make either choice. At that point, a legitimate therapeutic goal would be to help the client develop other options: something in between the unpalatable extremes, or something “outside the box.” Still, the psychotherapist cannot appropriately argue for one choice over the others. “You just have to get tough and throw your child out!” is direction, not treatment.

This treatment/direction distinction seems lost among many people in mental health. I shudder at times to hear the stories clients tell about their previous therapists: in these stories, the therapist comes across as setting him- or herself up as the expert who knows exactly what decisions the client should make in any number of non-therapeutic contexts. (Of course, I also shudder to imagine the stories certain of my clients will tell about me to their next therapists, but that’s another conversation.)

This part of doing psychotherapy is difficult, even painful. I almost always come to care about my clients, and it is hard to watch some of them make self-defeating choice after self-defeating choice. I can point out the pattern – “Gee, the last four times you moved in with a guy a day after meeting him online, you weren’t happy with the results. Do you see some reason to expect a better outcome this time?” Okay, that’s an exaggeration, but perhaps it makes the point. It is painful watching clients make decisions I’m pretty sure they’ll regret. I can point out what I see, and then I must respect their autonomy.

The alternative is untenable. The moment I take charge of a client’s decisions, I cease to be his or her psychotherapist. I become a boss, or parent, or case manager, or something else – not that those roles are bad, but those roles aren’t what I’m trained or licensed to do.

This therapeutic dilemma is often clearest when an individual comes with a primary concern about marital problems. The client will describe all the ways the absent spouse is unfair, or indifferent, or hostile, or whatever, and then ask, “What should I do?” It is crucial for psychotherapists to keep in mind that we are getting the particular version of reality that the client has chosen to tell us – a specific narrative, leaving out more than is included. We must not assume the narrative is objective or comprehensive. This awareness helps us maintain critical objectivity. We can feel empathy for the client’s experience, as the client understands it, while still staying open to the reality that there is more to the story.

I have the hunch that the therapists who don’t maintain this distinction are the same therapists who feel comfortable taking charge of their clients’ lives. This is a particular risk when the client’s issues resonate with the therapist’s own experience. A male therapist who listens to a male client vent about his wife’s infidelity  – where the therapist’s own wife had an affair – can easily fall into commiseration: “Women are faithless, aren’t they?” While such a comment may provide immediate gratification for both parties, it is terrible therapy, and it’s only a short step from there to saying, “Here’s what you do…” and then describing the actions he (the therapist) took in his own marriage.

When individual clients come with couple issues, the psychotherapist faces a daunting challenge in trying to help the client work through those issues while stopping short of giving direction. Actually, some theorists say it can’t be done – the therapist’s opinions inevitably emerge, even if unconsciously. From these theorists’ point of view, it is better for the therapist to be upfront immediately: “All things being equal, I will encourage you to stay in your relationship rather than leave it,” or “All things being equal, I advise clients to get out of troubled relationships.” Then the client can make an informed choice about whether to continue with that therapist.

I dislike the “upfront” approach, because all things are never equal when it comes to human relationships. I also think that such statements are as likely to shame a client into silence as they are to help a client make a mature choice.

Even more to the point, I disagree with the underlying assumption, which seems to be that because it’s hard to accomplish a certain task, we shouldn’t even bother to try. When it comes to “Please tell me what to do”, I think we psychotherapists have an important responsibility to stay psychotherapists to the best of our ability, and give clients the best of what we have to offer: our skills and training, not our opinions about how they should live their lives.

As I noted in that blog, his situation raises both a general question (How do you try to change people who are happy the way they are?) and a specific question (What would you say to a happy-as-they-are couple about their casual sex partners?). I spoke about the general question last time; this time I’ll tackle the specific.

Given the pastor’s situation, I’ll limit myself to comments that might make sense to his couples. I won’t make moral arguments (defining morality as authority-based – i.e., what my God tells me I ought to do), and will stick with rationality-based considerations (what my reasoning leads me to see as most convincing). It could be argued that we’re just talking about two kinds of authority – religion and rationality – but that’s another discussion [See my blog entry from 6/5/2011: “Faith and Rationality: The Impasse, and Beyond”].

So if the pastor moves “beyond morality”, what can he say to the couples about an ongoing practice of casual sex with people outside marriage, where spouses and partners agree there is no emotional involvement in these outside relationships? The couples, said the pastor, believe that intimacy and commitment should be limited to the marriage, but see sex as a no-strings-attached and separate practice. They see plenty of support for this belief in their peer group and in the entertainment media. (I’m assuming here that he would like to convince them to give up this practice in favor of conventional monogamy – “fidelity in marriage”, to use the traditional phrase. Okay, it’s not an assumption – he said that’s what he wants to do.)

First, he might say, “Sit down. Have a cup of coffee. Relax. This may take a while.” I’m not aware of any catch-phrases or sound bites that would be convincing to even moderately functional adults.

Second, just for starters, he might ask about the nature of these “friends with benefits” arrangements. Are we talking about a series of one-night stands, or does each spouse develop a “steady” sex partner? For the moment, let’s assume the latter. In this case, our pastor might laugh at the notion that one can have ongoing sex with someone without emotional involvement. It would be like saying that you could get into a swimming pool with someone without either of you getting wet. You both may try to minimize or suppress the emotional involvement, but there would be emotional involvement nonetheless. This is a simple psychological reality.

More to the point, attachments would form. The spouses would, over time, form emotional attachments to their “casual” sex partners. Think of two trees growing side by side: they might make every effort to keep their branches separate, but over time, their roots would comingle. The physical intimacy inevitably creates emotional intimacy of one sort or another. Attachments complicate things: inevitably one participant would begin to want a little more from these “non-intimate” relationships.

What if the couples say their extramarital sex is only with “anonymous” partners in one-night stands? Our pastor might respond first that they have an inadequate understanding of human nature: such “free” sex is not psychologically free. There is a dehumanizing element to using another person sexually, even where the use is consensual. One must abandon one’s higher self (one’s capacity for empathy and compassion, for instance) in order to participate, and each such experience reduces that higher self. I’ll return to this toward the end.

Third – well, many approaches are possible. Just now I’d suggest talking about the work of a research psychologist named Haidt. I’d mention that Haidt is a scientist and an atheist, just to make it clear that this wasn’t a backdoor move of some sort toward religious authority.

Some years ago Haidt embarked on research in a field you might call the “evolution of emotion.” He was interested in the origins of emotions in the dawn of humanity – what purpose did they originally serve, and how did they evolve from their original forms? Anger, for instance, appears to have evolved as a response to threat: the emotion helps organize how the brain prepares the body to fight.

He got interested in the emotion of disgust, of all things. No particular research had been done on that emotion (which isn’t hard to imagine), so he had the topic all to himself. After exhaustive work, he developed a convincing case for the notion that disgust has its origin in the instinctive human spitting-out reaction to tasting something rotten. Yecchhh! I’m guessing it broadened out fairly quickly: we’ve all been exposed not only to “disgusting” tastes, but also to disgusting smells, sights, and sounds – if you’re drawing a blank here, check with anyone who is a parent to teenage boys.

Haidt’s research shows, however, that disgust evolved into even broader use: it now seems to include our natural reaction to anything that evokes our animal nature. You might recall, for instance, the sights, sounds, and smells of your last bowel movement – an “animal nature” experience and an exercise in disgust par excellence. In one article, Haidt shared a bit of writing from a renowned minister in early Colonial days: traveling alone through the Northeast wilderness, the minister stopped to urinate. As he did so, a dog paused to urinate with him. The minister was struck by his kinship with this beast (and the dog, no doubt, was grinning); he described being filled with disgust about his “animal nature”, seeing it as a sign of his sinful defectiveness.

Sexuality has the potential to be “disgusting” in this sense, when it is reduced to our basest desires and impulses: simple lust. Of course, attitudes toward “animal sexuality“ vary in this society: some find it disgusting, while others embrace it, revel in it. Pornography, for instance, is attractive to one person and disgusting to another person (or both attractive and disgusting to the same person) for the same reason: it reduces us to our lustful animal nature.

Haidt’s scientific curiosity, however, took him to an interesting question: what emotion is the opposite of disgust? The available literature offered no information, so he coined a term: elevation. If disgust is our emotional response to “lowering” ourselves (or the threat of being lowered) to our animal nature, then elevation is our emotional response to lifting ourselves (or the promise of being lifted) toward… what? Haidt, a scientist and atheist, puzzled over this at length, and his research took him to this answer: toward divinity. This led him around the world to explore ways in which people experience elevation. He has come to believe that human beings exist on a “vertical dimension” of disgust and elevation, animal nature and divinity, and now he preaches (if that’s the right word) to psychologists about how essential the disgust-elevation dimension is to understanding human beings.

Again, Haidt is an atheist. His “divinity” is not necessarily a being, and certainly not any particular being (the Christian or Jewish God, or any God at all). It is one end of a dimension: as we lift ourselves above our animal nature, we move up the dimension toward divinity. (You’re thinking, of course, that this sounds suspiciously Neoplatonic. Once more, that’s another discussion. Haidt is a psychologist, not a philosopher or theologian. He’s going where the data take him.)

Perhaps it wouldn’t stretch his meaning too much to say that, with regard to sexuality, this dimension is about lust and love. Lust would be on one end with its “animal intimacy”; love would be on the other end – particularly if we define love as a deep emotional commitment to the other person’s best interests, along with a mature desire to develop a “divine intimacy”, with emotional, intellectual, and spiritual components.

It’s worth pointing out that our “beyond morality” approach doesn’t label animal nature as bad and divinity as good. Both are what they are, with benefits and consequences. We are, after all, animals (vertebrates, mammals, homo sapiens), a fact which we ignore at our peril. Haidt might point out that the foolishness comes when we deny either our animal nature or our divinity, rather than acknowledging both.

A rationale approach to sexuality, then, would ask what kind of life – what approach to this dimension – makes the most sense, offers the greatest fulfillment, promises the best outcomes.

Of course, the couples might see Haidt’s findings a complete validation of their practices: they are neatly separating animal sexuality and divine intimacy, and creating a place for both in their lives. I’m reminded of a recent Psychotherapy Networker article on affairs, written by a South American couple therapist, who criticized the general North American couple therapy approach of seeing sexual infidelity as bad: she wrote that this is cultural bias, not good science. She pointed out that many South American, Central American, and European cultures accept and even expect marital infidelity as a healthy practice.

Still, I’d propose that the best life is also the most mature life, the most actualized life, and – this is key – the most integrated life. Maturity and actualization offer the greatest opportunities for fulfillment. A core feature of human maturity/actualization is the integration of our many-sided humanity into a coherent whole. Applying this belief to sexuality, we could say that the best available approach integrates the animal and the divine. In other words, at our best, we bring lust and love into organized harmony.

This integration would contrast, I suppose, with segregation, in which a person acts one way in this situation, and an entirely different way in another – being “two-faced”, as it were. We revile public figures whose two-facedness is suddenly put on display, especially with regard to sexuality: those who claim to be strong and righteous adherents of “divine” marital fidelity, but then are discovered to be involved in all sorts of, well, “disgusting” behaviors – that is, behaviors that would be disgusting to the people who had supported these people in their claims of divine living. And the rest of us are disgusted as well, but for a different reason: the self-righteous hypocrisy. Several politicians and religious figures come to mind.

In a different way, many are disgusted by people who are consistent in claiming only their animal nature. To return again to pornography: producers of these materials are not two-faced (except where they represent themselves as somehow “artistic”). Perhaps we could say that they are “half-faced”: they live out of only the animal half of their humanity, ignoring the divine – straining the love out of sexuality so that only pure lust remains.

I suppose there’s an equal but opposite problem: here people would live in denial of their animal nature, straining the lust out of sexuality so that it becomes saccharine and passionless. As with “pure lust” practices, nobody much complains about this if people are private in this practice – but it can be offensive in its own right when people promote saccharine sex as best, or as reflecting divine intention.

Perhaps as a summary of a more integrated approach, we could say that love elevates lust (that is, love lifts sex out of being merely a “disgusting” animal practice), and lust animates love (that is, lust generates passion through physical sensuality, so that love can be experienced in its full intensity).

To return, for a moment, to the one-night-stand couples: perhaps it is apparent now that the more complete anonymity and detachment of this practice has a steep price. The participant reduces him- or herself to a loveless, half-faced, animal state. Perhaps the participant believes that it is possible to easily “bounce back” to a more integrated or divine place, but in practice it doesn’t seem to work that way. Visit a place enough, and it becomes home.

Going back now to our pastor’s dilemma: he could explain to these couples that they are living out a segregated rather than integrated lifestyle. In the terms I’ve proposed, they want to have a “divine” relationship of committed love and also a separate “animal” relationship of unfettered lust, and they believe both can coexist in happy, healthy ways. Our pastor could say, “There’s something better than that. Life has something better to offer than the segregation of an emotional partner and one or more sexual partners. Greater maturity and self-actualization are available in the integration of animating lust and elevating love in a single relationship. This approach makes the most sense, offers the greatest fulfillment, and promises the best outcomes.”

*           *           *           *           *

A postscript: not everyone is ready for this integration in relationship. You might not think so, but the vulnerability and intensity of this mature intimacy is more than many can tolerate. Some can’t stand the lust; others can’t stand the love, and still others can handle either separately, but not both together. A half-faced or two-faced approach to sexuality may be all they can manage.

If that’s where you are, that’s where you are. Just be honest: segregated practice reflects limitation, not virtue. And realize that there is something more. Don’t give up too quickly on the possibility that you might be able to find your way to the integration of animating lust and elevating love. It’s worth the journey, worth the effort.

A few qualifiers and disclaimers: it’s not realistic to expect perfection anywhere in human experience, and especially not “perfect” perfection (i.e., the constant achievement of perfection). The integrated experience I describe is something toward which to strive, rather than something that one can completely master – intimacy is an ephemeral experience. Enjoy it when it emerges.

And my perspective here is one among many. Some would argue vehemently, for instance, with my “segregation reflects limitation” notion: they would say instead that segregation reflects preference, and as such is no better or worse than integration. My response would be that each has its valid place on a developmental spectrum. It is simply descriptive to describe the location of two perspectives relative to each other on that spectrum. A preschooler’s perspective on Santa Claus isn’t better or worse than a high schooler’s – each has its place. Depending on the two children, we might even feel the preschooler is closer to the truth. But we could say that the high schooler’s perspective is more developed than the preschooler’s, which would be the more limited.

The first few years of these workshops, I did a lot of lecturing, but then things got better for all concerned when I switched to a discussion format. Interesting questions emerge, like this one from a young pastor who has a ministry to young adults: “I’m meeting more and more couples who believe that it’s fine for each person to have outside sex partners. They believe the couple relationship is for emotional intimacy and commitment, but see no problem in having casual sex with others. What do I say to them?”

He was obviously pained about this. He saw these couples as good people who were living out roles that were accepted among their peers, and for which they found support in the larger culture. They weren’t coming to him in distress; he was the uncomfortable one. He wanted to tell them they were wrong, but he knew they didn’t see it that way.

Several pastors responded quickly and confidently: “The Bible clearly requires fidelity in marriage.” “Christian teaching has always stated that we ought to maintain sex within marriage only.”

[This could be an interesting discussion all by itself. As Barnard University Bible scholar Alan Segal puts it: in the Bible, marriage is an arrangement between “one man and as many women as he could pay for.” But that’s another discussion for another time.]

The pained look on the young pastor’s face spoke volumes. He already knew all what the pastors were telling him. (Duh…) He didn’t exactly say this, but his response suggested that this was his situation: the couples about whom he was telling us weren’t going to do something just because the Bible said to do it – there would also have to be an explanation would that would make sense to them. They were happy the way they were, and they’d need serious convincing before they’d even consider changing. If he came at them with “shoulds” and “oughts”, they’d be gone. He didn’t want to lose them, but he felt he should say something. But what?

Some of the pastors just didn’t seem to get this. “Explain what the Scriptures say!” They were getting frustrated: the answer was obvious – what’s the problem here?

By this point, I could see that the young pastor was sorry he’d asked the question in the first place. He tried to explain again that these young couples just don’t see centuries-old writings from some desert people halfway around the world as requiring their unquestioning obedience. He didn’t say it that way, of course, for fear of causing major coronary events in the crowd.

Another pastor spoke up, hoping to defuse the tension. “People find authority in different places. Some people aren’t willing to accept Scripture as the final authority. They might place their faith instead in science, for instance.” This comment seemed to slow the crowd down a bit.

There’s an upside to being the only person in the room with a microphone, and I decided to make use of it. I started by telling them Aesop’s fable about the Wind and the Sun. [Wind and Sun have an argument about who’s strongest. They see a man walking below them, and agree that the one who can get the man to take his coat off wins. Wind goes first, blowing up a gale – but the man just clenches the coat tighter around him. Sun goes next, and simply glows radiantly – and the man has no need of a coat, and takes it off. Sun wins.] I said that the young pastor was looking for a way to be the Sun with these young couples, and the suggestions he was getting felt more like Wind to him.

This seem to calm the crowd a bit more, but the young pastor pressed his luck and asked what a Sun response would look like. This, of course, is the downside of having the microphone: when a tough question is asked, everyone looks your way.

I agreed that the “should/ought” approach generally doesn’t help much in talking with people who are happy the way they are. I suggested instead that he might think about how he could invite them to something better than what they had now.

Some of you may be thinking: “Wait – what could be better than having a casual sex partner, where nobody gets hurt, and you still have a loving, intimate, ongoing relationship?” The young couples would likely have that response.

An interesting situation, no? It raises both a general question (how do you try to change people who are happy the way they are) and a specific question (what would you say to a happy-as-they-are couple about casual sex partners).

[A side note: sometimes people claim to want to change, but underneath are committed to staying the same, even though they seem to be quite miserable and spend a lot of time seeking help. I wrote about this in my 6/2/2010 entry: “If People Don’t Want to Change, You Can’t Stop Them.” Today, though, I’m focusing on people who are happy as they are rather than seeming miserable about it.]

The General Question: How Do You Try to Change People Who Are Happy the Way They Are?
There is interesting overlap here between a particular strain of psychotherapy and a particular strain of theology. Let me talk about each.

On the psychotherapeutic side, Prochaska and DiClemente researched a wide number of theories about why and how people change. They developed a Transtheoretical “Stages of Change” Model looking at different stages of openness to change, all the way from “I’m not even remotely interested in changing” (precontemplative) to “I’m changing. Watch me change right now!” (action). They recommend that we match out interventions to the person’s stage, and they point out that nothing good happens when we don’t. Most commonly, we run into trouble by treating people in a way that would be effective if they were ready to change, but just alienates them if they’re precontemplative. (This seemed to be the young pastor’s dilemma.)

So how do you intervene with precontemplative people? The Stages of Change model recommends that we don’t talk with them about what they need to do differently; instead, we talk with them about what they’re doing right now: is it working for them? What are the consequences? We offer information that helps them see the problems in what they’re doing – and then we stop talking. We don’t say, “And so here’s how you should change…” They aren’t ready to talk about changing, and we alienate them if we get ahead of them.

On the religious side, various Christian authors (like Dominic Crossan) talk about Jesus’ use of parables along similar lines. They note that Jesus appears to have invented the parable – no evidence exists of prior similar use of the parable as a literary device (at least, that was true back in the dark ages when I went to seminary). A parable doesn’t contain should/ought language, and doesn’t tell people to change. Instead, it uses a metaphor or a story either to explain something about how things are, or about the consequences for current choices and behavior in light of the current situation. “Because this is how things are”, the parable says, “this is what happens to people who make this choice.” Or sometimes different characters in a story make different choices, and we’re invited to consider which one made the better decision.

The closest we get to the should/ought approach comes in parables that show characters making wise or foolish choices, and then we’re invited to decide which one we wish to emulate. Emulating the wise character would involve making a big change, but the wisdom of the change is tied to current realities rather than tradition or authority. The listener’s only decision is whether or not to accept the parable-teller’s version of “what is” – if that version of reality is accepted, then the resulting decision is obvious.

So the Transtheoretical counselor might say to an alcoholic, “You seem to be counting on your liver to manage all the alcohol in which you’re drowning it. Were you aware that people with your level of alcohol consumption tend to die from liver failure at just about your current age?” Or Jesus might say to a group of self-satisfied seminary professors (our age’s Pharisees), “You seem to believe that your erudition and eloquence will pass for authentic faith. Were you aware that God prefers the earnest prayers of a developmentally challenged meth addict to your polished pronouncements? (It seems that Jesus likes alliteration. Who knew?)

I’d suggest that both psychotherapeutic and theological approaches have these things in common: they accept people where they are, and don’t try to coerce them into changing through use of shoulds and oughts (i.e., use of shame or guilt). Instead, these approaches enter the person’s world on its own terms, and then blow it up from the inside – that is, these approaches show limitations, flaws and dangers that make the world uninhabitable.

Notice my shift to talking about world rather than behavior or choices. Imagine that you’re sitting comfortably in your home, reading this blog. Someone comes up to you, and says one of these three things: 1) “You ought to stop reading and go outside. It’s what a healthy person should do.” 2) “You ought to stop reading that blog and start reading the Bible. It’s what a good Christian should do.” 3) “The house is on fire. Keep reading or not – it’s up to you.”

With regard to the “general question”, then, new information about the world, and about our current behaviors in that world, is generally more compelling than opinions about the shoulds and oughts of things.

I’ll speak to the “specific question” next time.

All good questions, but what I want to look at just now is the spectrum of untruth. Psychotherapists, good-hearted people that we are, often get taken in by untruth, because we want to see the best in people – why else would we be in such a low-paying, high-frustration profession? Since we don’t tell untruths (or at least don’t see ourselves as doing so), it’s easy to overlook the possibility that our clients might tell untruths to us.

Of course, there are many exceptions, even among psychotherapists. Those who are involved in court referrals – child custody cases, legal matters around drug/alcohol abuse, and so on – are quite used to hearing untruth, and may have come to the point where they assume the client is lying until truthfulness is proven. But for the clientele of a Samaritan Center, for instance, we can generally assume honesty.

Maybe you’re wondering why I don’t just say “lie”: after all, Liars: A Field Guide would have been a snappier title. I considered this, but to lie is to choose to say something untruthful, and I want to look at the more general category, looking at both unintentional and semi-intentional as well as intentional untruth-telling. Some of the most convincing untruth-tellers are convincing precisely because they’re not consciously aware (or only partially aware) of the untrue nature of their communication. Of course, there’s another philosophical question here: if I tell you something that is false, but which I firmly believe is true, am I telling truth (it’s truth to me) or untruth (the more objective – or at least consensual – reality)? Again, a question beyond the scope of this blog.

I thought it might be of interest to lay out the variety of untruth-tellers we encounter, along with a word about detection and response. I can’t claim that this is a comprehensive and highly researched listing – that would also be beyond the scope of this blog – but I hope it will still be of use.

Deficit-based Untruth: the things we say because we just don’t know any better [Unintentional]
A person may tell untruths because of limited awareness (of self, of other, of the world). For example, a husband may say with utter confidence, “I understand my wife completely,” where his wife (and any even marginally impartial observer) would beg to differ. Similarly, a person who is embedded in a culture of prejudice may make racist statements that seem obvious and self-explanatory within that highly limited worldview. Or an individual, raised in a home where both parents lied continually, may  have no understanding of the difference between what is true and what you want the other person to believe is true.

Primitive Defensive Untruth: denial and its companions [Semi-intentional]
Consider the situation in which a parent catches a small child in the act of taking cookies from the cookie jar. When confronted (“You are taking cookies from the cookie jar!”), a child might give reasons or excuses (“I’m so hungry and cookies taste so good”) or lie (“I dropped my toy in here and I’m just trying to get it out”). At a certain age, however, the child – with the hand still in the jar – may give the parent a most innocent look and respond, “No, I’m not.” The child is “in denial,” that is, the child’s mind is employing a primitive defense in which the mind simply “makes true” what the child wants to be true. What makes denial unique is that the in-denial person, in a kind of psychic juggling act, both knows and doesn’t know the real truth. A person can move “into denial” – an alternate state of consciousness in which truth is highly malleable – and then come back “out of denial”, able to see what is real. An intoxicated man both knows and doesn’t know he’s alcoholic – and may come at you with that child’s denial-based pseudo-sincerity: “I haven’t been drinking – why would you even think such a thing?”

Mature Defensive Untruth: the things we say because of unconscious limitations [Unintentional]
Here we walk down a psychodynamic road, with its propositions about how the mind works: unconscious defenses (repression, projection, displacement, etc.) put the person in a position of saying things he or she believes, but which are nonetheless untrue. Consider this common therapeutic exchange:

Therapist: “So when your friend insulted you, what did you feel?
Client: “Well, I certainly wasn’t angry.”

The client is telling what we might call the “conscious truth” – that is, speaking with integrity about his/her conscious experience – but there might be indications that the deeper truth is quite different. “Hmm,” a therapist might wonder, “why did anger come immediately to the client’s mind, and why did the client need to make a point of disclaiming it?” Of course, this involves accepting the notion of “deeper truth”, and making a clinical interpretation about this truth. Making assertions about another person’s unconscious mind requires caution and humility.

Or another example: “My boss hates me.” This may be true; it may also be that the deeper reality is that the speaker hates the boss, but can’t tolerate the conscious experience of hating (“I’m not that kind of person”), so unconsciously projects that hatred onto the boss and then tells everyone about it. The person would have no conscious awareness of the projection, and would swear to the truth of the statement – yet it is nonetheless an untruth

Pathology-based distortions: the things we say because we’re ill [Unintentional]
Many psychopathologies lead people to tell untruths, because the pathology distorts perception in ways that make the untruth seem true – thus the person is sincerely reporting a distortion as though it were the truth, without any awareness that it is a distortion. Mood disorders come to mind: a person who’s been clinically depressed for six months may say the depression has been present for six years; a person in a manic phase may genuinely believe he or she has come up with the total solution for economic prosperity, and expect the President to meet with him/her to hear it. Persons with eating disorders may tell you they are obese when in fact they are underweight; persons with paranoia may say that a power outage during a storm was created by a top-secret government organization in order to install listening devices in the walls. Again, there is no intent or awareness in the untruth-telling.

A grayer area in this vein involves people who aren’t obviously mentally ill, but have a view of reality that is sufficiently idiosyncratic that it significantly limits their functioning – even though they may not see any problem in themselves. For example, a person might have such an inflated self-image as to feel above the law and entitled to special treatment from everyone; while in most cases this is simply an annoying personality trait, in extreme cases it is considered pathological. At this extreme, the person’s communications are filled with grandiose untruths. The ambiguity has to do with deciding where to draw the line between annoyance and psychopathology. Wherever the line gets drawn, however, one can expect unintentional untruths in various degrees of extremity.

Ego-based untruth: “true lies” [Intentional]
Sometimes people just plain lie: they know the truth and consciously choose to lie. This may grow out of good motives – the “white lies” we tell, or the lies a CIA operative might tell as part of espionage. Others tell lies for reasons of self-interest: to protect an infidelity, for instance, or to hide a crime. Still others find gratification in lying: either they delight in the power twisting the truth creates for manipulation and control (a number of politicians come to mind here), or they delight in the pain it allows them to cause others (perpetrators of abuse come to mind) – or both (e.g., career criminals).

Detection
There have been a number of news items and TV law enforcement dramas that claim we now have the ability to tell when people aren’t being truthful. I suppose sometimes these approaches can work, particularly when we’re dealing with “true lies”, and the liar is unsophisticated or unintelligent. Gamblers make (and, more often, lose) fortunes trying to read “tells” – the unconscious behaviors we exhibit that convey information about our feelings. Neither science nor craft offer perfect results.

As we get to know the limits of a person’s life experiences and perspectives, we can better evaluate what they say. With deficit, defense, and distortion, accurate “untruth detection” becomes more likely as we see clear patterns of behavior. When a person is “never angry”, for instance, we might become curious about all the many “angry people” who plague that person. When a person regularly asserts that which is obviously untrue (claiming sobriety while intoxicated, for instance), we might assume denial.

When it comes to “true lies”, especially those told to gain control or cause pain, we can look for a cluster of approaches. Persons who take this approach commonly try to dominate, define, and disorient the listener. With domination, the untruth-teller attempts to use emotional intensity (often accompanied by a hypnotic or piercing gaze) to force the listener to accept the untruth: “I’m telling the truth! You have to believe me!” With definition, the untruth-teller attempts to recast reality in ways that support the untruth-teller’s agenda: “What do you mean I’m selfish? You are the selfish one for not giving me what I want!” With disorientation, the untruth-teller attempts to get the listener to doubt his or her own perceptions, memories, and basic grasp of reality: “That’s what you think I did at your friend’s house? How could I have done such a thing – I was never there! You’re really losing it.”

Response
It seems reasonable to open any relationship with a moderate level of trust, neither open-hearted gullibility nor close-minded paranoia. We can assume that people are telling the truth – but we also keep track of how well their words match their actions. As words and actions match, we may increase our trust, while we might become less trusting when there is a disconnect between the two.

The more we sense that a person is communicating with us untruthfully, the more important it becomes to take a protective stance. The person’s untruth-telling may grow out of deficits or defensiveness (i.e., unintentional or semi-intentional), but we are still wise to evaluate their words and their agenda carefully. Unintentional harm is still harm, and their lack of awareness that they are causing it does not create any obligation for us to tolerate it.

Where there appears to be conscious intent – “true lies” – it becomes even more important for us to hold on to the realities we perceive, and to consult with others for support – especially if we start to feel dominated, defined, or disoriented. With such relationships, it is usually advisable to look for a speedy exit.

Catastrophizing is one of several styles of thinking that people may engage in without even realizing that’s what they’re doing. Once these thought patterns have been identified, the therapist teaches the client new perspectives and behaviors that support healthier thinking. The theory is that healthier thinking will diminish or eliminate unhealthy emotions.

Research supports this approach, health insurers love it, and I use it myself when it seems appropriate. Generally, though, I also explore the hydraulic possibilities. By this I mean to suggest the metaphor of a U-shaped pipe. Whatever’s in the pipe, the more you push down on one side of the U, the more whatever’s on the other side rises. I want to suggest that we have U-shaped pipes with anger on one side and anxiety on the other.

I think of a client decades ago who suffered from panic attacks. They hit her out of nowhere; medicine and previous therapy just hadn’t been helpful. She was on leave from work, and was afraid to leave her home – or, at times, her bedroom – for fear of having an attack in front of others.

It was only by chance that one of our discussions turned up an interesting connection: she realized her attacks usually came within a few hours of receiving a phone call from her mother. She loved her mother, but also feared her mother’s ongoing criticisms, demands, and complaints. As I listened, it struck me that she was receiving a lot of angry communication, but wasn’t aware of feeling any anger in return. We explored this, and to her the notion that she could be angry with her mother seemed ridiculous, impossible – it would only make things worse. Besides, she didn’t feel even a tiny bit angry at mother, she was completely scared of her.

Well, the mind doesn’t really work that way. That is, when someone gets angry at us, it generates anger in us in return. That’s the natural flow of things. When we receive anger and can’t feel our own anger in response, most of the time that means our internal defense mechanisms have done something with the anger – repressed it, projected it, sublimated it, whatever. Sometimes this is just the right reaction: if a bear growls at you, running is a wiser course than trying to argue. But then afterward (assuming you get away), you might recover your anger: what was with that crazy bear?

So back to our U-shaped pipe: the more we push down on the anger (suppressing or repressing it), the more the complementary anxiety rises, and with this client it rose to the level of clammy-skinned, dread-filled, heart-stopping panic.

When I initially proposed that she might possibly have anger toward her mother, the client was insistent that she did not. The very possibility, as we might imagine, increased the anxiety she was feeling. But she was sick of the panic-limited life she was leading, and she was, deep down, really quite brave. So she allowed herself to entertain the possibility that she might be angry at her mother. Eventually she began to experience it – actually to feel her own anger. It was an awakening, an incredible turning point!

Two major things happened rather quickly after that. First, she began setting limits on her mother’s ability to call her. This is often a benefit of recovering one’s anger: we need it, in measured doses, to defend ourselves from harm. When our anger is completely suppressed, all we can do is freeze or run; if the person (or bear) catches us, we’re completely vulnerable to whatever they want to do to us. Anger enables us to say a firm, authentic “No!” In this case, the client realized she could decide when to take her mother’s calls, how long to talk, and when to end the call. Always before, only her mother made those decisions.

Second, her panic attacks lessened in frequency and severity. They didn’t just stop, and once in a while they were difficult to manage. But as she reclaimed the strength of her anger, she grew confident in her ability to deal with the panic when it emerged. Rather than panicking about her panic attack, she took a more practical view: this will be an unpleasant 10 minutes, and then it will be over.

Over time, the panic attacks occupied a smaller and smaller part of her life. She returned to work, and restructured her relationship with her mother – and, while she was at it, with several other people who had been taking advantage of her. It is important to note that getting in touch with her anger did not turn her into an out-of-control, rageful maniac. Sometimes people fear going from one extreme to another, but it rarely turns out that way. Rather, anger became a resource she could call upon for healthy self-affirmation, limit-setting, and assertiveness.

Well, that’s a peek at a hydraulic approach to emotion. I can hear any number of cognitive-behavioral practitioners responding with irritation: they might point out that their approach would have achieved the same results – or better. To which I’d respond: I’m glad to see that you’re in touch with your anger.

Here’s the basic idea: it’s healthy and appropriate for a child to develop an attachment to a stuffed animal, and insist on having it for bedtime (and perhaps for other stressful situations, like travel). This attachment is a landmark, a time to celebrate, just as much as the child’s first step or the first word: the child has taken the first step toward internalizing a relationship!

To understand that, you must understand this: a child at earlier stages of development does not have what psychologists call “object permanence”- in other words, from the child’s point of view,  “out of sight” means “out of existence.” If a child at that stage is playing with a toy, and you cover the toy with a cloth, the child loses interest: for the child, the toy no longer exists! Similarly, when the child’s primary caregiver walks out of the room, the caregiver no longer exists. The child screams the scream of a terrified, abandoned orphan: “I have no one! I am alone in the universe!”

When the caregiver returns, of course, the damage can be repaired and the relationship resumed – providing there such absences aren’t too often, or too prolonged, but that’s another story. For now, let’s just look at a healthy situation.

If you’ve cared for an infant, you know how intense and stressful these regularly occurring experiences of “subjective orphanhood” can be for the child. You may be able to recall similar experiences in your own life – even as an adult – where you felt that same alone-in-the-universe panic and dread. There’s nothing like it.

So enter the Teddy bear to save the day. When the time is right, the child develops an attachment to an object (bear, blanket, whatever) – the object comes to matter to the child. The child creates a relationship with the object, completely out of imagination. In this relationship, the child projects onto the object a parent’s love and care, and then experiences the object as caring for, loving, and comforting the child. With this new object relationship, the child can now tolerate aloneness – because it’s not truly aloneness anymore: the child is alone in the presence of the Teddy bear.

We take this experience for granted, but it’s really a marvelous – perhaps miraculous – transformation. A child – all on his or her own – finds a way out of excruciating feelings of total abandonment and complete isolation. The child takes parental love and makes it portable, by transferring it to the object. “Me and my Teddy bear” can handle anything.

Well, almost anything. If the child is alone long enough, the child will have a new feeling: loneliness. This is different from the terror and dread of “I’m alone in the universe”; it is a more manageable “Me and my Teddy wish Mommy were here.” This involves pangs of sadness – sometimes deep pangs – but stops short of panic. The child is able to miss someone important, while still feeling more or less okay.

With time, nurturing relationships, and a safe environment, the child’s internalization process continues. Eventually the Teddy bear gets “retired” – another milestone, signifying that the child has completed that stage of development. The child can now do “self-soothing.” This still draws on the child’s experiences of being cared for, loved, and comforted – but now the resources are all within the child’s mind. The Teddy bear is like a set of bicycle training wheels: once the ability to ride the bike is learned (internalized), the wheels are no longer needed.

When all goes well, the child emerges into latency (grade school years) with a sense of calm confidence. The child has internalized a world in which she or his is safe and cared for. The child is open in relationships, and calm and comfortable in solitude (because the child feels alone-in-the-presence rather than alone or lonely). Of course, the child will have preferences somewhere on the scale of introversion and extroversion, but the child will be comfortable with both relationship and solitude.

So what is a good internalization feel like? Paul Simon’s “Loves Me Like a Rock” captures the spirit:

She loves me like a rock
She rocks me like the rock of ages
And loves me.

As you know, though, all does not always go well. A child’s transitional object can only be as caring and soothing as the real-life care and soothing that the child has received. Too many children receive problematic primary care: inconsistent, unempathic, neglectful, abusive, etc. Parents don’t have to be perfect – in fact, some developmental psychologists say “perfect parenting” would not be in a child’s best interests. Instead, a child needs “good-enough” parenting: enough for the child to thrive and grow, but with enough occasional mild flaws that the child has to develop coping skills.

Parenting that doesn’t reach the good-enough level creates a challenge for the child’s internalization processes. Whatever parenting the child receives is the only parenting the child knows – it defines the child’s reality. If a child feels more judged than loved, or more neglected than attended to, or more unsafe than safe, then that’s how the child internalizes relationships. Now the Teddy bear is a mean or neglectful companion – not much help in developing self-soothing capacities for the child. Or, in extreme cases, the parenting is so awful that the child can’t risk hooking up with a similarly awful Teddy bear – better to be alone, dreadful as that is.

These unfortunate children grow up with highly ambivalent internal attachments. When someone in the child’s current life isn’t present and caring, the child is thrown back on internalizations that may be of no help – or even make things worse. Imagine being such a child: the schoolyard bully is telling you that you’re a loser, and your internalized Teddy bear – instead of soothing, affirming, and encouraging you – couldn’t agree more. (See my previous blog on the “Inner Conversation.”)

Perhaps some of you have seen my next comment coming. If you’ve ever fallen in love, or had certain kinds of religious experience, you have undergone what we might call Transitional Object Replacement Therapy (TORT, and of course I’m making up this term). When we fall in love, it is as though our loved one becomes our new transitional object – well, not the loved one as she or he is, including all the failings and limitations to which the flesh is heir. Instead, our minds create an idealized version of this loved one, and immediately boot out any and all other Teddy bears. For a while, then, we walk on air, wrapped in a psychologically invulnerable shell of protection provided by this TORT: while my wonderful lover loves me; I can do anything!

As high as we fly during this falling-in-love experience, we usually hit an equally extreme low on the other side. When something shatters the spell (whether the reality of the lover’s limitations hits us in the face, or whether the relationship ends abruptly), this idealized transitional object is yanked out of the picture, and there is nothing to replace it. We vacillate between despair (aloneness) and desperation (loneliness). In time we can recover previous internal resources and build new ones, but there’s just no skipping that awful shattering when the idealized version of your loved one stops being your transitional object. You feel, quite literally, like “a motherless child, a long, long way from [your] home.”

And by now you’re probably ahead of me regarding religious experience. Some kinds of religious experience operate also in the realm of the idealized transitional object. I’m most familiar with it in a Christian context, where Jesus is presented in this role: the constant companion who “walks with me and talks with me and tells me I am his own.” Worship and prayer in this context often revolve around evoking the presence of Jesus as the Divine Teddy Bear: an internal presence who enlivens, comforts, and encourages those who find their way to that experience.

This approach to faith can do tremendous good, and has sustained people of faith through incredible ordeals, and has challenged people of faith to be the best they know how to be. As with other love affairs, though, there are the inevitable crashes – but in this case, the damage may be more insidious because the shattered individual may see it as a sign of having a weak faith, and thus feel deeply ashamed. Congregations typically don’t make room for this possibility (this inevitability), so the individual going through the “motherless child” experience may see it as a sign of profound failure, and thus feel isolated and alienated. Rarely would anyone suggest that perhaps the training wheels are no longer necessary.

My experience with clients over the years suggests that a typical worship service includes many people who are singing and praying and listening, but who have “lost that loving feeling” – they can’t find the attachment to their idealized transitional object – and sit in lonely sadness and secret shame.

Psychotherapy certainly doesn’t have all the answers in such situations, either. At the same time, a psychotherapy process that is effective (and mid- to long-term) usually has a TORT element to it, whether or not either party sees it that way. The client gradually internalizes the therapeutic relationship: feeling accepted at a deep level, feeling supported and affirmed, feeling challenged to grow. The competent psychotherapist can help the client modulate any idealization so that the relationship ends with a soft landing, allowing the client to move on with a sense of calm, realistic self-acceptance. Or perhaps we might say that it doesn’t ever quite end, in that the client continues an inner dialogue with an internalized version of the psychotherapist, drawing on the acceptance, finding motivation in the challenge.

This little story illustrates a psychological process called internalization, by which we take external voices and incorporate them into our internal experience. I spoke my parents’ “No!” out loud, but in short order it was “inside” me – I didn’t have to say it to hear it. The impulse to grab the curtain would trigger an internal “No!”, and I would leave the curtain alone.

By the time we reach our teens, we have internalized all sorts of communication. Ideally, we have internalized enough reality-based “dos” and “don’ts” to form the basis for both good decision-making as well as a healthy conscience – with a minimal amount of shaming and a healthy dose of affirmation. The words and tones we internalize tell us not only what to do, but also who we are: valid and valued, for example, or worthless and useless.

Notice that internalization begins when we’re much too young to be able to evaluate the validity or accuracy of what we’re hearing. We simply take it in without question, for better and for worse. The words – and voice tones, and facial expressions, and body language – simply get inside us, as is. These internalizations form “inner conversations” that, in turn, form the basis for our experience of reality.

Many of the people with whom I’ve worked over the years as psychotherapy clients suffer from their inner conversations. For some, their inner experience is like having a balcony just above them filled with people who hoot and jeer at their every move. For others, it is a courtroom scenario: the client is the defendant, the prosecuting attorney is ruthless, the judge inevitably gives guilty verdicts, and the defense attorney is mute – or absent entirely. Every mistake the client/defendant has ever made is exhumed for extensive review of the damning evidence, and the judge again delivers the same verdict.

The effect of this inner conversation can range from “occasional nuisance” to “crippling.” Usually, people are so used to this conversation that they don’t realize its impact – they more feel it (usually as guilt or shame) than hear it. It can be eye-opening to spend an afternoon recording the conversation:

“God, what an idiot you are!”
“I can’t believe you did the same thing again!”
“You are a failure and will always be a failure.”
“Look at their faces. Or better, don’t look at their faces, so you don’t see the scorn and contempt.”
“You are a loser. L-O-S-E-R!”

Now you might ask, “If a person has such an inner conversation, does that mean that the person heard exactly those words in childhood and then internalized them?” Well, sadly, sometimes yes. But sometimes a person’s balcony just gets more creative (if that’s the right word) over time, increasing the viciousness of the commentary. However it came to be, though, it has the same impact.

Actually, often the diatribe is first-person: “God, what an idiot I am!”, and so forth. The person isn’t aware of repeating internalizations; instead, it feels like personal belief: “I am a loser. This is what I think about myself.” This is sometimes called incorporation, and represents a deeper taking-in of the internalized material: I no longer hear someone saying this to me; I’m saying it to myself. This creates an even deeper sense of isolation and hopelessness.

So what can be done about a toxic inner conversation? Various schools of psychotherapy offer different approaches. Here are my favorites:

Increase awareness of the “inner diatribe”. Spend a day (although sometimes an afternoon – or even an hour – is enough) writing down every negative or self-critical comment you hear in your head. Read the list back to yourself. Amazing, isn’t it? Consider: this is what is running through your head every waking moment! How does that awareness make you feel?

Discredit the inner diatribe. This is tough work, but also crucial work. Consider that the inner diatribe feels true and isn’t true.

Consider the balcony: has this “chorus” ever been pleased with anything you’ve done? Has it ever appreciated, accepted, or affirmed you? For most people, the answer is no. You could invent a cure for cancer, and the balcony would respond, “All this is going to do is give you a big head.” What credibility can such a balcony have? How seriously does it deserve to be taken?

In the courtroom scenario, consider the judge: has this judge ever rendered a verdict of “innocent”? For most people, this simply doesn’t happen. If you won the Nobel prize, the prosecutor would shout that you should have won it years ago, and how come you only have one? “Guilty!” responds the judge. What credibility can such a judge have? How seriously does such a judge deserve to be taken?

The goal here isn’t just an intellectual awareness (though that can be quite a task), it’s also coming to an internal experience of liberation. “This diatribe isn’t true. I do not have to accept it as determining my reality and my identity!”

Bring in other resources. If you have a balcony full of critics who hound you at every turn, consider this: it’s your balcony! If you were going to decide who gets to be in your balcony, whom would you choose? Imagine selecting people who accept and care about you. What would it be like to have that balcony with you throughout the day?

Or, in the courtroom, consider: don’t you deserve a better judge? Again, it’s your courtroom! Can you think of a person you would select to replace the judge? I’d suggest someone who wouldn’t necessarily go to the opposite extreme and always affirm you, but instead would help you maintain a healthy balance in your life.

Ignore the parrot. If you have incorporated the toxic dialog (that is, if the internal conversation is “I’m a loser” rather than “You’re a loser”), imagine this: there’s a parrot on your shoulder. I picture a big, colorful one, as in Long John Silver illustrations. Imagine giving the parrot the toxic diatribe: instead of saying inside yourself, “I’m a loser”, imagine now that the parrot points its beak toward you and says, “You’re a loser. Awwwk!” Now: ignore the parrot. (Some people have success telling the parrot to be quiet. After all, it’s your parrot.) Turn your attention instead toward things that are important to you, things that matter. Let the parrot squawk; that’s what parrots do. You’ve got a life to live. (If you find yourself sliding back into the dialog, give it to the parrot as soon as you realize what’s happening, and then ignore the parrot again.)

This may seem silly, but sometimes it can be quite helpful. And it’s legitimate: parrots say what they’ve heard. They are internalizers and incorporators par excellence. So let them squawk – imagine their squawking as exaggerated and ludicrous. Then turn your attention toward what matters to you.

Evaluate your relationships. When you’ve written down your internal diatribe, think about your current relationships. Are there people who treat you badly, who reinforce the false “truth” of the internal diatribe? Look for ways to renegotiate the relationship (or limit their access to you) so that you protect yourself from that external negative input.

If the inner conversation hinders you, take action. Again, you’ve got a life to live.