One of our chief modes of death denial is a belief in personal specialness, a conviction that we are exempt from biological necessity and that life will not deal with us in the same harsh way it deals with everyone else.
Erik Erikson, in his study of the life cycle, described this late-life stage as generativity, a post-narcissism era when attention turns from expansion of oneself toward care and concern for succeeding generations.
Existential psychotherapy is a dynamic therapeutic approach that focuses on concerns rooted in existence.
I use ‘dynamic’ in its technical sense, which retains the idea of force but is rooted in Freud’s model of mental functioning, positing that forces in conflict within the individual generate the individual’s thought, emotion, and behavior. Furthermore – and this is a crucial point – these conflicting forces exist at varying levels of awareness; indeed some are entirely unconscious.
Therapy should not be theory-driven but relationship-driven.
My therapy goals with these patients are ambitious: in addition to symptom removal and alleviation of pain, I strive to facilitate personal growth and basic character change
Karen Horney’s Neurosis and Human Growth. And the single most useful concept in that book was the notion that the human being has an inbuilt propensity toward self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree.
When I was finding my way as a young psychotherapy student, the most useful book I read was Karen Horney’s Neurosis and Human Growth. And the single most useful concept in that book was the notion that the human being has an inbuilt propensity toward self-realization. If obstacles are removed, Horney believed, the individual will develop into a mature, fully realized adult, just as an acorn will develop into an oak tree.
‘Just as an acorn develops into an oak . . .’ What a wonderfully liberating and clarifying image! It forever changed my approach to psychotherapy by offering me a new vision of my work: My task was to remove obstacles blocking my patient’s path. I did not have to do the entire job; I did not have to inspirit the patient with the desire to grow, with curiosity, will, zest for life, caring, loyalty, or any of the myriad of characteristics that make us fully human. No, what I had to do was to identify and remove obstacles. The rest would follow automatically, fueled by the self-actualizing forces within the patient.
And what therapist has not been struck by how much easier it is to make a DSM-IV diagnosis following the first interview than much later, let us say, after the tenth session, when we know a great deal more about the individual? Is this not a strange kind of science?
Everyone – and that includes therapists as well as patients – is destined to experience not only the exhilaration of life, but also its inevitable darkness: disillusionment, aging, illness, isolation, loss, meaninglessness, painful choices, and death.
We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence.
During my training I was often exposed to the idea of the fully analyzed therapist, but as I have progressed through life, formed intimate relationships with a good many of my therapist colleagues, met the senior figures in the field, been called upon to render help to my former therapists and teachers, and myself become a teacher and an elder, I have come to realize the mythic nature of this idea. We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence.
Hence, nothing takes precedence over the care and maintenance of my relationship to the patient, and I attend carefully to every nuance of how we regard each other. Does the patient seem distant today? Competitive? Inattentive to my comments? Does he make use of what I say in private but refuse to acknowledge my help openly? Is she overly respectful? Obsequious? Too rarely voicing any objection or disagreements? Detached or suspicious? Do I enter his dreams or daydreams? What are the words of imaginary conversations with me? All these things I want to know, and more.
What do patients recall when they look back, years later, on their experience in therapy? Answer: Not insight, not the therapist’s interpretations. More often than not, they remember the positive supportive statements of their therapist.
If patients make an important and courageous therapeutic step, compliment them on it.
If a patient obsesses about physical unattractiveness I believe the human thing to do is to comment (if one feels this way) that you consider him/her to be attractive and to wonder about the origins of the myth of his/her unattractiveness.
effectiveness of empathy. Therapy is enhanced if the therapist enters accurately into the patient’s world. Patients profit enormously simply from the experience of being fully seen and fully understood. Hence, it is important for us to appreciate how our patient experiences the past, present, and future.
Therapy is enhanced if the therapist enters accurately into the patient’s world. Patients profit enormously simply from the experience of being fully seen and fully understood. Hence, it is important for us to appreciate how our patient experiences the past, present, and future.
When teaching students about empathy, Erich Fromm often cited Terence’s statement from two thousand years ago – ‘I am human and let nothing human be alien to me’ – and urged us to be open to that part of ourselves that corresponds to any deed or fantasy offered by patients, no matter how heinous, violent, lustful, masochistic, or sadistic. If we didn’t, he suggested we investigate why we have chosen to close that part of ourselves.
I believe that the here-and-now offers therapists a powerful way to help patients develop empathy. The strategy is straightforward: Help patients experience empathy with you, and they will automatically make the necessary-extrapolations to other important figures in their lives. It is quite common for therapists to ask patients how a certain statement or action of theirs might affect others. I suggest simply that the therapist include himself in that question.
This is, of course, simple social-skills training: I urge the patient to address or question me directly, and I endeavor to answer in a manner that is direct and helpful.
I urge you to let your patients matter to you, to let them enter your mind, influence you, change you – and not to conceal this from them.
I opened the following session by acknowledging my immature behavior, and then we proceeded to have one of our most productive sessions, in which she revealed several important secrets she had long withheld. Therapist disclosure begets patient disclosure.
(Many years ago I read an article by Sándor Ferenczi, a gifted analyst, in which he reported saying to a patient, ‘Perhaps you can help me locate some of my own blind spots.’ This is another one of those phrases that have taken up lodging in my mind and that I often make use of in my clinical work.)
If you make a mistake, admit it. Any attempt at cover-up will ultimately backfire. At some level the patient will sense you are acting in bad faith, and therapy will suffer.
At its very core, the flow of therapy should be spontaneous, forever following unanticipated riverbeds; it is grotesquely distorted by being packaged into a formula that enables inexperienced, inadequately trained therapists (or computers) to deliver a uniform course of therapy. One of the true abominations spawned by the managed-care movement is the ever greater reliance on protocol therapy in which therapists are required to adhere to a prescribed sequence, a schedule of topics and exercises to be followed each week.
the therapist must strive to create a new therapy for each patient.
every course of therapy consists of small and large spontaneously generated responses or techniques that are impossible to program in advance.
Take advantage of opportunities to learn from patients. Make a point of inquiring often into the patient’s view of what is helpful about the therapy process.
Another patient, who had been convinced that I would ultimately abandon her because of her chronic rage, told me at the end of therapy that my single most helpful intervention was my making a rule to schedule an extra session automatically whenever she had angry outbursts toward me.
Checking in by phone to a highly distressed or suicidal patient takes little time and is highly meaningful to the patient. One patient, a compulsive shoplifter who had already served jail time, told me that the most important gesture in a long course of therapy was a supportive phone call I made when I was out of town during the Christmas shopping season – a time when she was often out of control.
A colleague told me that he had once treated a dancer who told him at the end of therapy that the most meaningful act of therapy was his attending one of her dance recitals.
To my mind, personal psychotherapy is, by far, the most important part of psychotherapy training. Question: What is the therapist’s most valuable instrument? Answer (and no one misses this one): the therapist’s own self.
Therapists must be familiar with their own dark side and be able to empathize with all human wishes and impulses.
It is important for the young therapist to avoid sectarianism and to gain an appreciation of the strengths of all the varying therapeutic approaches. Though students may have to sacrifice the certainty that accompanies orthodoxy, they obtain something quite precious – a greater appreciation of the complexity and uncertainty underlying the therapeutic enterprise.
I believe there is no better way to learn about a psychotherapy approach than to enter into it as a patient.
The patient has only one therapist while the therapist has many patients.
Another aid I have often used is to refer to my personal experience as a psychotherapy patient by saying something like: ‘I know it feels unfair and unequal for you to be thinking of me more than I of you, for you to be carrying on long conversations with me between sessions, knowing that I do not similarly speak in fantasy to you. But that’s simply the nature of the process. I had exactly the same experience during my own time in therapy, when I sat in the patient’s chair and yearned to have my therapist think more about me.’
The rationale for using the here-and-now rests upon a couple of basic assumptions: (1) the importance of interpersonal relationships and (2) the idea of therapy as a social microcosm.
Our self-image is formulated to a large degree upon the reflected appraisals we perceive in the eyes of the important figures in our life.
the interpersonal problems of the patient will manifest themselves in the here-and-now of the therapy relationship. If, in his or her life, the patient is demanding or fearful or arrogant or self-effacing or seductive or controlling or judgmental or maladaptive interpersonally in any other way, then these traits will enter into the patient’s relationship with the therapist.
You must develop here-and-now rabbit ears. The everyday events of each therapy hour are rich with data: consider how patients greet you, take a seat, inspect or fail to inspect their surroundings, begin and end the session, recount their history, relate to you.
we learn best about ourselves and our behavior through personal participation in interaction combined with observation and analysis of that interaction.
One of our major tasks in therapy is to pay attention to our immediate feelings – they represent precious data. If in the session you feel bored or irritated, confused, sexually aroused, or shut out by your patient, then regard that as valuable information.
boredom in the therapy hour, then we may confidently assume that he is boring to others in other settings.
if it is the patient who evokes your boredom in the therapy hour, then we may confidently assume that he is boring to others in other settings.
Everything – especially episodes containing heightened emotion – is grist for the mill.
In the case histories in Studies in Hysteria Freud entered personally and boldly into the lives of his patients. He made strong suggestions to them, he intervened on their behalf with family members, he contrived to attend social functions to see his patients in other settings, he instructed a patient to visit the cemetery and meditate upon the tombstone of a dead sibling.
The psychotherapy outcome literature heavily supports the view that therapist disclosure begets client disclosure.
Preparation for individual psychotherapy is also essential. Though individuals are likely to have had experience with intense relationships, it is highly unlikely that they have been in a relationship requiring them to trust fully, to reveal all, to hold nothing back, to examine all nuances of their feelings to another, and to receive nonjudgmental acceptance. In initial interviews I cover important ground rules, including confidentiality, the necessity for full disclosure, the importance of dreams, the need for patience.
To engage in a genuine relationship with one’s patient, it is essential to disclose your feelings toward the patient in the immediate present. But here-and-now disclosure should not be indiscriminate; transparency should not be pursued for its own sake. All comments must pass one test: Is this disclosure in the best interests of the patient? Over and again in this text I shall emphasize that your most valuable source of data is your own feelings. If during an hour you feel that the patient is distant, shy, flirtatious, scornful, fearful, challenging, childlike, or exhibiting any of a myriad of behaviors one person can with another, then that is data, valuable data, and you must seek a way to turn that information to therapeutic advantage, as shown in examples of my revealing that I felt shut out by a patient, or closer and more involved, or irritated at repetitive apologies for moving a Kleenex box.
Big, unconcealable secrets are inimical to the therapeutic process.
The self-disclosure of similar thoughts by other group members is wonderfully comforting and provides a ‘welcome to the human race’ experience.
One of Nietzsche’s aphorisms expresses an opposing view: ‘Some cannot loosen their own chains yet can nonetheless redeem their friends.’
Note carefully the wording in these responses. In each I stick to my observations of the behavior I see and how that behavior makes me feel. I take care to avoid guesses about what the patient is attempting to do – that is, I do not comment that the patient is attempting to avoid me by not looking at me, or control me by the written agendas, or entertain me by the long stories. If I focus upon my own feelings, then I am far less likely to evoke defensiveness – after all, they are my feelings and cannot be challenged. In each instance I also introduce the idea that it is my wish to be closer to these patients and to know them better, that the behavior in question distances me and may distance others as well.
The fear of death always percolates beneath the surface. It haunts us throughout life and we erect defenses – many based on denial – to help cope with the awareness of death. But we cannot keep it out of mind. It spills over into our fantasies and dreams. It bursts loose in every nightmare. When we were children we were preoccupied with death and one of our major developmental tasks has been to cope with the fear of obliteration.
Psychotherapists cannot afford to ignore the many great thinkers who have concluded that learning to live well is to learn to die well.
Though the physicality of death destroys us, the idea of death may save us. In the years I worked with terminally ill patients, I saw a great many patients who, facing death, underwent significant and positive personal change. Patients felt they had grown wise; they re-prioritized their values and began to trivialize the trivia in their lives. It was as though cancer cured neurosis – phobias and crippling interpersonal concerns seemed to melt away.
concerns about death often masquerade in sexual garb. Sex is the great death-neutralizer, the absolute vital antithesis of death.
(There are TAT [Thematic Appreciation Tests] studies documenting increased sexual content in cancer patients.)
A patient with a malignant abdominal cancer once consulted me because she had become infatuated with her surgeon to the extent that sexual fantasies about him replaced her fears about death. When, for example, she was scheduled for an important MRI, at which he would be present, the decision of which clothes to wear so consumed her that she lost sight of the fact that her life hung in the balance.
Schopenhauer said that willing itself is never fulfilled – as soon as one wish is satisfied, another appears.
‘we are condemned to freedom.’
Reality is not at all as we imagined in childhood – we do not enter into (and ultimately leave) a well-structured world. Instead, we play the central role in constituting that world – and we constitute it as though it appears to have an independent existence.
And the relevance of freedom’s dark side to anxiety and to clinical work? One answer can be found by looking down. If we are primal world constituters, then where is the solid ground beneath us? What is beneath us? Nothingness, Das Nichts, as the German existential philosophers put it. The chasm, the abyss of freedom. And with the realization of the nothingness at the heart of being comes deep anxiety.
But if we hope for more significant therapeutic change, we must encourage our patients to assume responsibility – that is, to apprehend how they themselves contribute to their distress.
Responsibility assumption is an essential first step in the therapeutic process. Once individuals recognize their role in creating their own life predicament, they also realize that they, and only they, have the power to change that situation.
Sometimes I simply remind patients that sooner or later they will have to relinquish the goal of having a better past.
Sometimes I’ve galvanized patients caught in a decisional dilemma by citing a line from Camus’s The Fall that has always affected me deeply: ‘Believe me, the hardest thing for a man to give up is that which he really doesn’t want, after all.’
Hearing herself described from a distance in third-person voice may permit her to gain more objectivity upon her situation.
therapy works best if it approximates a continuous session.
I am rarely the one who begins the session. Like most therapists, I prefer instead to wait for the patient. I want to know his or her ‘point of urgency’ (as Melanie Klein referred to it).
Because weeping often signifies the entry into deeper chambers of emotion, the therapist’s task is not to be polite and help the patient stop weeping. Quite the contrary – you may wish to encourage your patients to plunge even deeper. You may simply urge them to share their thoughts: ‘Don’t try to leave that space. Stay with it. Please keep talking to me; try to put your feelings into words.’ Or you may ask a question I often use: ‘If your tears had a voice, what would they be saying?‘
Psychotherapy may be thought of as an alternating sequence of affect expression and affect analysis. In other words, you encourage acts of emotional expression but you always follow with reflection upon the emotions expressed.
I’m too tactful and delicate
In an experiment I described earlier, in which a patient and I each recorded our views of each therapy session, I learned that we remembered and valued very different aspects of the process. I valued my intellectual interpretations whereas these made little impact on the patient, who valued instead the small personal acts relevant to our relationship. Most published firsthand accounts of psychotherapy point to the same discrepancy: Therapists place a far higher value than patients on interpretation and insight.
Nietzsche said, ‘We even invent the expression on the face of the other with whom we converse to coincide with the brilliant thought we think we have uttered.’
Nietzsche put it, ‘Truth is an illusion without which a certain species could not survive.’
We crave the comfort of absolute truth because we cannot bear the desolation of a purely capricious existence. As Nietzsche put it, ‘Truth is an illusion without which a certain species could not survive.’
bear in mind Nietzsche’s dictum: ‘There is no truth, there is only interpretation.’ Hence, even if we do offer some elegantly packaged insight of extraordinary we must realize it is a construct, an explanation, not the explanation.
One often hears of patients (in either group therapy or individual therapy) who are excellent patients or group members, yet remain essentially unchanged in their external lives. They may relate well to the individual therapist or may be key members of groups – self-disclosing, working hard, catalyzing interaction – and yet do not apply what they have learned to their outside situation. In other words, they use therapy as a substitute rather than a rehearsal for life. This distinction may prove useful in termination decisions. Behavior change in the therapy situation is obviously not enough: patients must transfer their change into their life environment. In the late stages of therapy, I am energetic in ensuring transfer of learning. If I deem it necessary, I begin to coach actively, to press the patient to experiment with new behaviors in work, social, and family settings.
When I turned my gaze back to her, I had a moment, only a moment, of shock at how she had suddenly aged, but I quickly reconnected with the essence of the lovely person I knew and entertained a fantasy of running my fingers through her wisps of hair. When she asked about my feelings, I shared the fantasy. Her eyes flooded with tears and she reached for the Kleenex. I decided to push further. ‘Shall we try it?’ I asked. ‘That would be a wonderful thing,’ she replied, and so I moved next to her and stroked her hair and scalp. Though the experience lasted for only a few moments, it remained indelible in both of our minds. She survived her cancer and, years later, when she returned because of another issue, she remarked that my touching her scalp had been an epiphany, an immensely affirming action that radically changed her negative image of herself.
Therapists who have a history of feeling unattractive to women may be exhilarated and destabilized when avidly sought after by female patients. Keep in mind that the feelings arising in the therapy situation generally belong more to the role than the person: Do not mistake the transferential adoration as a sign of your irresistible personal attractiveness or charm.
I want to tell them, and often do, to find some way of fulfilling their sexual needs with one of the billions of potential partners in the world: anyone except their patients. That is simply not a professional or moral option. If, in the final analysis, the therapist can find no solution to unruly sexual impulses and is unable or unwilling to get help from personal therapy, then I believe he should not be practicing psychotherapy.
If a patient is weighted down with anxiety and asks or pleads for relief, I generally find it useful to ask, ‘Tell me, what would be the perfect thing for me to say? What exactly could I say that would lead to your feeling better.’ I am, of course, not speaking to the patient’s rational mind, but instead addressing the child part of the patient and asking for uncensored free associations.
I do not like to work with patients who are in love. Perhaps it is because of envy – I too crave enchantment. Perhaps it is because love and psychotherapy are fundamentally incompatible. The good therapist fights darkness and seeks illumination, while romantic love is sustained by mystery and crumbles upon inspection. I hate to be love’s executioner.
There is one true property of romantic love: it never stays – evanescence is a part of the nature of an infatuated love state. But be careful trying to rush its demise. Don’t try to joust with love any more than you would with powerful religious beliefs – those are duels you cannot win (and there are similarities between being in love and experiencing religious ecstasy: One patient referred to his ‘Sistine Chapel state,’ another described his love as his celestial, imperishable condition). Be patient – leave it for the client to discover and express feelings about the irrationality of his feelings or disillusionment in the beloved.
Nietzsche’s phrase ‘One loves one’s desire, not the desired’ has often proved invaluable to me in my work with love-tormented patients.
Nor is the dissolution a steady process. Setbacks occur – and nothing is more likely to bring about a setback than another encounter with the beloved. Patients offer many rationalizations for such new contact: they insist that they are over it now and that a cordial talk, a coffee, or lunch with the former beloved will help to clarify things, help them to understand what went wrong, help them establish a lasting adult friendship, or even permit them to say good-bye like a mature person. None of these things is likely to come to pass. Generally the individual’s recovery is set back, much as a slip sets back a recovering alcoholic.
Despite my reliance on an intuitive mode of collecting data, there is one particularly productive inquiry I always make in the first or second session: ‘Please give me a detailed account of your typical day.’ I make sure everything is discussed, including eating and sleeping habits, dreaming, recreation, periods of discomfort and of joy, precise tasks at work, the use of alcohol and drugs, even reading, film, and TV preferences. If this inquiry is sufficiently detailed, therapists can learn a great deal, uncovering information that is often missed in other history-taking systems.
When I hear patients describe their significant others, I create some mental image of the other person, often forgetting that my information is highly skewed because it has been filtered through the patient’s imperfect and biased eyes.
I attempt to normalize my patients’ darker impulses in any way I can. I reassure, I imitate Olive Smith in using we, I point out the ubiquity of certain feelings or impulses, I refer patients to appropriate reading material (for example, for sexual feelings I suggest the Kinsey, Masters and Johnson, or Hite reports).
Not only did Freud single-handedly invent the field of psychotherapy but he did it in one fell swoop. In 1895 (in Studies in Hysteria, co-authored with Josef Breuer) he wrote an amazingly prescient chapter on psychotherapy that prefigures many of the major developments that were to occur over the next one hundred years. There Freud posits the fundamentals of our field: the value of insight and deep self-exploration and expression; the existence of resistance, transference, repressed trauma; the use of dreams and fantasies, role playing, free association; the need to address characterological problems as well as symptoms; and the absolute necessity of a trusting therapeutic relationship.
In my teaching, I concentrate particularly on the first texts, Studies in Hysteria, selected sections of The Interpretation of Dreams, and Three Essays on the Theory of Sexuality, and sketch out his historical context – that is, the psychological zeitgeist of the late nineteenth century – which permits the student to realize how truly revolutionary were his insights.
Incidentally, it is not unusual for a follow-up dream the same night to express the same issue but in different image language. (Freud referred to such dreams as companion dreams.)
I inquire about the relevant events of the day preceding the dream (the ‘day residue’). I have always found quite useful Freud’s formulation that the dream borrows building blocks from the day residue, but that for images to be important enough to become incorporated into it, they must be reinforced by older, meaningful, affect-laden concerns.
Sometimes it is useful to consider all the figures in the dream to be aspects of the dreamer. The gestalt therapist Fritz Perls, who devised a number of powerful dream work techniques, considered everything in the dream to represent some aspect of the dreamer, and he would ask the dreamer to speak for each object in the dream. I remember watching him work effectively with a man who dreamed of his car being unable to start because of a bad spark plug. He asked the dreamer to play various parts – the car, the spark plug, the passengers – and to speak for each of them. The intervention threw light upon his procrastination and his crippling ambivalence; he did not want to go further with his life as he had defined it, and instead Perls helped him explore other paths not taken and another, unheeded, life calling.
amnesic for much of his childhood and curiously
I’ve always considered psychotherapy as more of a calling than a profession. If accumulating wealth, rather than being of service, is one’s primary motivation, then the life of a psychotherapist is not a good career choice.
We are intellectually challenged. We become explorers immersed in the grandest and most complex of pursuits – the development and maintenance of the human mind.
Not only does our work provide us the opportunity to transcend ourselves, to evolve and to grow, and to be blessed by a clarity of vision into the true and tragic knowledge of the human condition, but we are offered even more. We are intellectually challenged. We become explorers immersed in the grandest and most complex of pursuits – the development and maintenance of the human mind.
In general, the field of therapy focuses far too much on the past – on parental figures, long-ago events, and trauma – and too often neglects the future – our mortality, the fact that we, like all living creatures, wish to persist in our own being and yet are aware of inevitable death.
The anxiety that bedevils us issues not only from our biological genetic substrate (a psycho-pharmacologic model), not only from our struggle with suppressed instinctual strivings (a Freudian position), not only from our internalized significant adults who may be uncaring, unloving, neurotic (an object relations position), not only from disordered forms of thinking (a cognitive-behavioral position), not only from shards of forgotten traumatic memories (a trauma-developmental model), nor from current life crises involving one’s career and relationship with significant others, but also – but also – from a confrontation with our existence.
To borrow, again, from Staring at the Sun: The anxiety that bedevils us issues not only from our biological genetic substrate (a psycho-pharmacologic model), not only from our struggle with suppressed instinctual strivings (a Freudian position), not only from our internalized significant adults who may be uncaring, unloving, neurotic (an object relations position), not only from disordered forms of thinking (a cognitive-behavioral position), not only from shards of forgotten traumatic memories (a trauma-developmental model), nor from current life crises involving one’s career and relationship with significant others, but also – but also – from a confrontation with our existence.
The basic sense of epigenetics is conveyed by its frequent use of such phrases as ‘switching genes on and off,’ ‘gene packaging,’ ‘gene clothing.’ In other words, it is not only the molecular structure of the gene that is important but also the factors that influence gene expression, for example, the biochemical environment and all the factors influencing that environment.
it is now clear that our environment alters our biochemistry, which, in turn, controls the switching on and off of gene activity. The rate at which genes are expressed is greatly influenced by environmental events that occur during development, such as rearing practices, psychological and physical trauma, chronic life stressors – loss, grief, and early attachment experiences in both animals and humans. Rat pups who receive more licking and grooming from their mothers are physiologically more resilient to stress throughout their subsequent lives than those who do not benefit from such maternal support. Conversely, women who suffer sexual abuse as children are destined to secrete more stress hormones in response to stressors throughout their lives.
Memories are more powerful and more deeply encoded if they are associated with a strong emotion. Who among us does not remember the details of their day when they first learned about 9/11 or the Kennedy assassination? Neuroscience refers to this as a ‘flashbulb memory.’ This is why traumatic memories are so persistent and essentially impossible to extinguish; it is also why the ‘learning’ associated with a therapeutic explanation will be more powerful and meaningful for a patient if it is also accompanied by emotion – for example, the emotion evoked in the crucible of a powerful and caring therapeutic relationship. This supports the thesis I advanced decades ago that effective therapy is an alternating sequence of affect (emotion) evocation and affect analysis.
Don’t fall into the error of early psychoanalysts who felt interpretations and insight were all that mattered! It’s never the specific content that cures: remember that ancient archaic frameworks (alchemical, magical, shamanistic, theological, libidinal, phrenological, astrological) used to do the trick too! Any cogent explanation (that is, an explanation attuned to the personal-cultural-historical context of the individual) offers relief through making sense of previously inexplicable feelings. Naming and understanding lead to a sense of control particularly when they are matched to the patient’s educational, cultural, and intellectual background.
There is benefit in feeling that one understands. There is a sense of greater mastery if one can name the problem. What the new neuroscience adds is the concept of brain plasticity. Many patients feel relieved and empowered by the evidence that brains can be changed. Neuroscience research has shown us that not only does the wiring of the brain influence the way we think, but our learning experiences can influence the wiring of the brain.
EEG studies have shown that there is coordinated firing of motor area neurons prior to our awareness of having willed our hand to move. In other words the unconscious is no longer so fuzzy, no longer a figment of our imagination.
Over three hundred and fifty years ago Baruch Spinoza pondered some of the same questions we therapists face on a daily basis. Why do we act against our best interests? Why are we in bondage to our passions? How can we liberate ourselves from such bondage and live a life of rationality, harmony, and virtue? Spinoza ultimately arrived at a formulation highly relevant to everyday therapy. He concluded that reason is no match for passion. Emotions can be conquered only by another stronger emotion. Knowledge will work for us only if it itself is imbued with emotion. (And, as I pointed out in the preceding section, current neuroscience evidence supports this idea.)
Vladimir Nabokov, the Russian novelist, who says in Speak Memory, ‘life is but a brief crack of light between two eternities of darkness.’
Rippling is the phenomenon of creating concentric circles of influence that may affect others for years, generations, interminably. Without our conscious intent or knowledge, we leave behind something from our life experience, some trait, some piece of wisdom, act of virtue, guidance, or comfort that passes on to others much as the ripples caused by a pebble tossed into a pond go on and on until they are no longer visible but continue at a nano level. The idea of transmitting something of ourselves, even beyond our knowledge of it, offers a potent answer to those who claim that meaninglessness and terror inevitably flow from one’s finiteness.