Macbeth: How does your patient, doctor? Doctor: Not so sick, my lord, as she is troubled with thick-coming fancies that keep her from rest. Macbeth: Cure her of that! Canst thou not minister to a mind diseased, pluck from the memory a rooted sorrow, raze out the written troubles of the brain, and with some sweet oblivious antidote cleanse the stuffed bosom of that perilous stuff which weighs upon her heart. Doctor: Therein the patient must minister to himself.
The fact that political ideologies are tangible realities is not a proof of their vitally necessary character. The bubonic plague was an extraordinarily powerful social reality, but no one would have regarded it as vitally necessary.
To make matters worse, everyone she talks to has a different opinion about the nature of his problem and what she should do about it. Her clergyperson may tell her, “Love heals all difficulties. Give him your heart fully, and he will find the spirit of God.” Her therapist speaks a different language, saying, “He triggers strong reactions in you because he reminds you of your father, and you set things off in him because of his relationship with his mother. You each need to work on not pushing each other’s buttons.” A recovering alcoholic friend tells her, “He’s a rage addict. He controls you because he is terrified of his own fears. You need to get him into a twelve-step program.” Her brother may say to her, “He’s a good guy. I know he loses his temper with you sometimes—he does have a short fuse—but you’re no prize yourself with that mouth of yours. You two need to work it out, for the good of the children.” And then, to crown her increasing confusion, she may hear from her mother, or her child’s schoolteacher, or her best friend: “He’s mean and crazy, and he’ll never change. All he wants is to hurt you. Leave him now before he does something even worse.” All of these people are trying to help, and they are all talking about the same abuser. But he looks different from each angle of view.
The most effective weapon a parent has to control a child is the withdrawal of love or its threat. A young child between the ages of three and six is too dependent on parental love and approval to resist this pressure. Robert's mother, as we saw earlier, controlled him by "cutting him out." Margaret's mother beat her into submission, but it was the loss of her father's love that devastated her. Whatever the means parents use, the result is that the child is forced to give up his instinctual longing, to suppress his sexual desires for one parent and his hostility toward the other. In their place he will develop feelings of guilt about his sexuality and fear of authority figures. This surrender constitutes an acceptance of parental power and authority and a submission to the parents' values and demands. The child becomes "good", which means that he gives up his sexual orientation in favor of one directed toward achievement. Parental authority is introjected in the form of a superego, ensuring that the child will follow his parents' wishes in the acculturation process. In effect, the child now identifies with the threatening parent. Freud says, "The whole process, on the one hand, preserves the genital organ wards off the danger of losing it; on the other hand, it paralyzes it, takes its function away from it.
The manic relief that comes from the fantasy that we can with one savage slash cut the chains of the past and rise like a phoenix, free of all history, is generally a tipping point into insanity, akin to believing that we can escape the endless constraints of gravity, and fly off a tall building. “I’m freeeee… SPLAT!”.
Underlying the attack on psychotherapy, I believe, is a recognition of the potential power of any relationship of witnessing. The consulting room is a privileged space dedicated to memory. Within that space, survivors gain the freedom to know and tell their stories. Even the most private and confidential disclosure of past abuses increases the likelihood of eventual public disclosure. And public disclosure is something that perpetrators are determined to prevent. As in the case of more overtly political crimes, perpetrators will fight tenaciously to ensure that their abuses remain unseen, unacknowledged, and consigned to oblivion.
The dialectic of trauma is playing itself out once again. It is worth remembering that this is not the first time in history that those who have listened closely to trauma survivors have been subject to challenge. Nor will it be the last. In the past few years, many clinicians have had to learn to deal with the same tactics of harassment and intimidation that grassroots advocates for women, children and other oppressed groups have long endured. We, the bystanders, have had to look within ourselves to find some small portion of the courage that victims of violence must muster every day.
Some attacks have been downright silly; many have been quite ugly. Though frightening, these attacks are an implicit tribute to the power of the healing relationship. They remind us that creating a protected space where survivors can speak their truth is an act of liberation. They remind us that bearing witness, even within the confines of that sanctuary, is an act of solidarity. They remind us also that moral neutrality in the conflict between victim and perpetrator is not an option. Like all other bystanders, therapists are sometimes forced to take sides. Those who stand with the victim will inevitably have to face the perpetrator's unmasked fury. For many of us, there can be no greater honor. p.246 - 247 Judith Lewis Herman, M.D. February, 1997
As Louis Cozolino Ph. D., observes, a consistent theme of adult psychotherapy clients is that they had parents who were not curious about who they were but, instead, told them who they should be. What Cozolino explains, is that the child creates a "persona" for her parents but doesn't learn to know herself. What happens is that "the authentic self"--the part of us open to feelings, experinces, and intimicy--remains underdeveloped.
Good therapy, gently but firmly, moves people out of denial and compartmentalization. It helps clients to develop richer inner lives and greater self-knowledge. It teaches clients to live harmoniously with others and it enhances Existential consciousness, and allows people to take responsibility for their effects on the world at large. For me , happiness is about appreciating what one has. Practically speaking,this means lowering expectations about what is fair, possible and likely. It means,finding pleasure in the ordinary.
There were nights when I left the sessions physically and emotionally drained after hearing the anguish pour out like blood from a gaping wound. Don’t let anyone ever tell you different – psychotherapy is one of the most taxing endeavors known to mankind; I’ve done all sorts of work, from picking carrots in the scorching sun to sitting on national committees in paneled board rooms, and there’s nothing that compares to confronting human misery hour after hour and bearing the responsibility for easing that misery using only one’s mind and mouth. At its best it’s tremendously uplifting as you watch the patient open up, breathe, let go of the pain. At its worst is like surfing in a cesspool struggling for balance while being slapped with wave after putrid wave.
What daily life is like for a multiple Imagine that you have periods of lost time. You may find writings or drawings which you must have done, but do not remember producing. Perhaps you find child-sized clothing or toys in your home but have no children. You might also hear voices or babies crying in your head. Imagine that you can never predict when you will be able to have certain knowledge or social skills, and your emotions and your energy level seem to change at the drop of a hat, and for no apparent reason. You cannot understand why you feel what you feel, and, if you are in therapy, you cannot explore those feelings when asked. Your life feels disjointed and often confusing. It is a frightening experience. It feels out of control, and you probably think you are going crazy. That is what it is like to be multiple, and all of it is experienced by the ANPs. A multiple may also experience very concrete problems, even life-threatening ones.
For example, in order to identify these schemas or clarify faulty relational expectations, therapists working from an object relations, attachment, or cognitive behavioral framework often ask themselves (and their clients) questions like these: 1. What does the client tend to want from me or others? (For example, clients who repeatedly were ignored, dismissed, or even rejected might wish to be responded to emotionally, reached out to when they have a problem, or to be taken seriously when they express a concern.) 2. What does the client usually expect from others? (Different clients might expect others to diminish or compete with them, to take advantage and try to exploit them, or to admire and idealize them as special.) 3. What is the client’s experience of self in relationship to others? (For example, they might think of themselves as being unimportant or unwanted, burdensome to others, or responsible for handling everything.) 4. What are the emotional reactions that keep recurring? (In relationships, the client may repeatedly find himself feeling insecure or worried, self-conscious or ashamed, or—for those who have enjoyed better developmental experiences—perhaps confident and appreciated.) 5. As a result of these core beliefs, what are the client’s interpersonal strategies for coping with his relational problems? (Common strategies include seeking approval or trying to please others, complying and going along with what others want them to do, emotionally disengaging or physically withdrawing from others, or trying to dominate others through intimidation or control others via criticism and disapproval.) 6. Finally, what kind of reactions do these interpersonal styles tend to elicit from the therapist and others? (For example, when interacting together, others often may feel boredom, disinterest, or irritation; a press to rescue or take care of them in some way; or a helpless feeling that no matter how hard we try, whatever we do to help disappoints them and fails to meet their need.)
Those who are aware of their condition and experience themselves as "multiple" might refer to themselves as "we" rather than "I." I shall use the term "multiple" at times, in respect for their internal experience. It is important to point out, however, that I recognize that someone who is multiple is actually a single fragmented person rather than many people. On the outside, a multiple is probably not visibly different from anyone else. But that image is only an imitation: people who are multiple cannot think like the rest of us, and we cannot think like them. (In fact, since it is difficult for the multiple to understand how singletons think, some of them might think that is is you who are strange). Just as a singleton cannot become a multiple at will, a multiple cannot become a singleton until and unless the barriers between the parts of the self are removed. Those barriers were put up to enable the child to tolerate, and so survive, unavoidable abuse. p20 [Multiple: a person with dissociative identity disorder (DID) or DDNOS. Singleton: a person without DID or DDNOS, i.e with a single, unified personality]
I recently consulted to a therapist who felt he had accomplished something by getting his dissociative client to remain in her ANP throughout her sessions with him. His view reflects the fundamental mistake that untrained therapists tend to make with DID and DDNOS. Although his client was properly diagnosed, he assumed that the ANP should be encouraged to take charge of the other parts at all times. He also expected her to speak for them—in other words, to do their therapy. This denied the other parts the opportunity to reveal their secrets, heal their pain, or correct their childhood-based beliefs about the world. If you were doing family therapy, would it be a good idea to only meet with the father, especially if he had not talked with his children or his spouse in years? Would the other family members feel as if their experiences and feelings mattered? Would they be able to improve their relationships? You must work with the parts who are inside of the system. Directly.
The freedom of an unscheduled afternoon brought confusion rather than joy. Julius had always been focused. When he was not seeing patients, other important projects and activities-writing, teaching, tennis, research-clamored for his attention. But today nothing seemed important. He suspected that nothing had ever been important, that his mind had arbitrarily imbued projects with importance and then cunningly covered its traces. Today he saw through the ruse of a lifetime. Today there was nothing important to do, and he ambled aimlessly down Union Street.
The shame, embarrassment, feeling of low self-worth, and scores of "labels" we give ourselves are not fitting. I am beginning to see how I had no control over the situation. He was a big man, I was a little boy.
Tempting as it may be to draw one conclusion or another from my story and universalize it to apply to another's experience, it is not my intention for my book to be seen as some sort of cookie-cutter approach and explanation of mental illness, It is not ab advocacy of any particular form of therapy over another. Nor is it meant to take sides in the legitimate and necessary debate within the mental health profession if which treatments are most effective for this or any other mental illness. What it is, I hope, is a way for readers to get a true feel for what it's like to be in the grips of mental illness and what it's like to strive for recovery.
When emotions turn and stay sour, when thoughts become cynical and judgmental, good and compassionate treatment is on the line. Helpers who become sour and cynical tend to begrudge their high need clients for their neediness. There is a risk that helpers become too well-practiced at taking a bleak view of those they have avowed to assist. There is a temptation to begin to blame clients for their failure to improve. If treatment ends pre-maturely, with either a client never returning to treatment or a helper 'firing' them out of frustration, there is a tendency for the client to take the fall. Of course what we are talking about here are signs of burnout.
Therapy when practiced well is a fine but delicately balanced intervention in another person’s life. It requires a devotion to truth and a merciless pursuit of right living. Expertise in bringing people out of the darkness of a disappointed or bitter life into the light of a new vitality is hard earned. It is a privilege and a pleasure when it works well. But that level of engagement with clients is also extremely demanding and it can never be achieved by trotting out stereotyped tricks from approved textbooks.
For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.
Even you, the professional helper, often mistaken for the enlightened Guru or Staretz, can become lost in your thoughts that you must be competent without fault. You may become enthralled with your identity as a professional, even the pressures of the culture of mastery that expects you to heal your clients without fail. Never mind all of the variables over which you have no control, it is up to you, according to the canons of mastery, to control the health and well-being of those for whom you provide professional care. This potentiates a furthering alienation between you and your clients. You are at risk to become, if you have not already, the one who does to your clients; to be the one the active subject acting upon the passive and receptive objects, your clients; to be the one in possession of special knowledge, technique and mastery. All of this conspires to coax or coerce you into treating your client as reduced, a mere case. Unawareness to these influences gives you little chance to consider their influence on your practice in the clinical setting, much less give attentive efforts to resist or change them.
It wasn't a sign of weakness to tell what happened to me. I feel guilt no longer, only regret. The other emotions are coming around too. How much further do I need to go? I'm not sure, but there is comfort in the fact that I am in the hands of expert guides, both in the doctor's office and at home with Sue.
The "apparently normal personality" - the alter you view as "the client" You should not assume that the adult who function in the world, or who presents to you, week after week, is the "real" person, and the other personalities are less real. The client who comes to therapy is not "the" person; there are other personalities to meet and work with. When DID was still officially called MPD, the "person" who lived life on the outside was known as the "host" personality, and the other parts were known as alters. These terms, unfortunately, implied that all the parts other than the host were guests, and therefore of less importance than the host. They were somehow secondary. The currently favored theory of structural dissociation (Nijenhuis & Den Boer, 2009; van der Hart, Nijenhuis, & Steele, 2006), which more accurately describes the way personality systems operate, instead distinguishes between two kinds of states: the apparently normal personality, or ANP, and the emotional personality, or EP, both of which could include a number of parts. p21
Somehow the disorder hooks into all kinds of fears and insecurities in many clinicians. The flamboyance of the multiple, her intelligence and ability to conceptualize the disorder, coupled with suicidal impulses of various orders of seriousness, all seem to mask for many therapists the underlying pain, dependency, and need that are very much part of the process. In many ways, a professional dealing with a multiple in crisis is in the same position as a parent dealing with a two-year-old or with an adolescent's acting-out behavior. (236)
Although the client-centered approach had its origin purely within the limits of the psychological clinic, it is proving to have implications, often of a startling nature, for very diverse fields of effort.
Bit by bit, Dr. Driscoll helped me to peel away the layers of protection I had built up over the years. The process was not that unlike the peeling of an onion, which also makes us cry. It has been a painful journey, and I don't now when it will end, when I can say, OK, it's over. Maybe never. Maybe sooner than I know. I recently told Dr. Driscoll that I feel the beginnings of feeling OK, that this is the right path.
Psychotherapy works for the treatment of depression, and the benefits are substantial. In head-to-head comparisons, in which the short-term effects of psychotherapy and antidepressants are pitted against each other, psychotherapy works as well as medication. This is true regardless of how depressed the person is to begin with. Psychotherapy looks even better when its long-term effectiveness is assessed. Formerly depressed patients are far more likely to relapse and become depressed again after treatment with antidepressants than they are after psychotherapy. As a result, psychotherapy is significantly more effective than medication when measured some time after treatment has ended, and the more time that has passed since the end of treatment, the larger the difference between drugs and psychotherapy.
This was truly to be a radical milestone: the world’s first-ever marathon nude psychotherapy session for criminal psychopaths. Elliott’s raw, naked, LSD-fueled sessions lasted for epic eleven day stretches. The psychopaths spent every waking moment journeying to their darkest corners in an attempt to get better. There were no distractions—no television, no clothes, no clocks, no calendars, only a perpetual discussion (at least one hundred hours every week) of their feelings. When they got hungry, they sucked food through straws that protruded through the walls. As during Paul Bindrim’s own nude psychotherapy sessions, the patients were encouraged to go to their rawest emotional places by screaming and clawing at the walls and confessing fantasies of forbidden sexual longing for one another...
First, psychotherapy is an art. It is not a science (the human-beings-are-laboratory-rats mentality of the behaviorist notwithstanding). A friend of mine, a philosopher of esthetics, defines art as: anything that people treat as art. So it is with psychotherapy. Any mad school that springs up and gets people to call it "psychotherapy" then becomes a "psychotherapy." But is it good psychotherapy or just mad?
Our society’s love affair with mechanical devices that respond at a button-touch ill prepares us to deal with the unruly organic mind that dwells within. Anything that does not comply must be broken or poorly designed, people now suppose, including their hearts.
Why Cults Terrorize and Kill Children – LLOYD DEMAUSE The Journal of Psychohistory 21 (4) 1994 "Extending these local figures to a national estimate would easily mean tens of thousands of cult victims per year reporting, plus undoubtedly more who do not report.(2) This needn’t mean, of course, that actual Cult abuse is increasing, only that-as with the increase in all child abuse reports-we have become more open to hearing them. But it seemed unlikely that the surge of cult memories could all be made up by patients or implanted by therapists. Therapists are a timid group at best, and the notion that they suddenly begin implanting false memories in tens of thousands of their clients for no apparent reason strained credulity. Certainly no one has presented a shred of evidence for massive false memory implantations.
Fui acusado de ser um utópico, de querer eliminar o desprazer do mundo e defender apenas o prazer. Contudo, tenho declarado claramente que a educação tradicional torna as pessoas incapazes para o prazer encouraçando-as contra o desprazer. Prazer e alegria de viver são inconcebíveis sem luta, experiências dolorosas e embates desagradáveis consigo mesmo. A saúde psíquica não se caracteriza pela teoria do nirvana dos iogues e dos budistas, nem pela hedonismo dos epicuristas, nem pela renúncia monástica; caracteriza-se, isso sim, pela alternância entre a luta desprazerosa e a felicidade, o erro e a verdade, o desvio e a correção da rota, a raiva racional e o amor racional; em suma, estar plenamente vivo em todas as situações da vida. A capacidade de suportar o desprazer e a dor sem se tornar amargurado e sem se refugiar na rigidez, anda de mãos dadas com a capacidade de aceitar a felicidade e dar amor.
The mind-body clash has disguised the truth that psychotherapy is physiology. When a person starts therapy, he isn't beginning a pale conversation; he is stepping into a somatic state of relatedness. (168)