24 year old Delia shared with me the following story about her on-and-off boyfriend, Noam, who treated her miserably, sadistically, but from whom she could somehow not find a way to detach.

“… so I haven’t heard from him for a while, so I text him, asking him if he wants to hang out and he says, ‘If you want’, and so I go over there and he’s nonchalant, like he doesn’t care if we’re together or not, and we’re sitting and talking outside and trying to figure things out, and he says, ‘Why don’t we go inside and talk without our clothes on?’

“And I surprise him, I go, ‘Sure, why not?’ and I love how confused he looks, just for a moment, and so we go inside and take our clothes off and soon he’s got his head on my lap, and then we’re making out, and then we’re doing all kinds of things, and then we’re done and I say,’ So do you wanna get some cigarettes?’ because that’s what we usually do afterwards, and he’s okay with that, but I can tell he’s already had it. So we go get cigarettes but he’s done with me, I know it, and yet that’s what grabs me. He’s done with me and that’s exactly why I’ll go back to him. That’s exactly what turns me on, that look in his eye!

“And so I leave, it’s like 4 in the morning, he doesn’t even walk me out to my car, I go home and the next day I’m talking to my mother and I fill her in, and of course she’s pleading with me, ‘Delia, isn’t it time for you to be with a nice guy? Isn’t it time for you to be with a guy who treats you well, who loves you for who you are not just what you do for him?’

“And I want to say, ‘Mom, my vagina chooses who my vagina is going to choose, and I don’t want to be in a loveless, sexless marriage like you are in,’ but I can’t say that because it’s mean. I can’t say that to her because she means well.

“But, look, this is not the time for fucking sitcom advice, this is not the time for me to hear everyone say, ‘Stay away from him, Delia, he’s bad news, stay away from him, Delia, you can do better, stay away from him, Delia, just stay away.”

She is silent for a long while, staring at her feet. “Say something,” she finally demands.

I reply, “It’s quite an achievement on your part to have become aware that the worse Noam treats you, the more you are drawn to him. That is an impressive piece of self-knowledge. I do find myself wondering about it — its origins, what it’s like for you, how it might work to your disadvantage — but I do have to commend you for being able to recognize and articulate it.”

At which point Delia’s eyes brim and she begins to sob.

What does Delia need from me in this moment of revelation? In one sense, she made it easy for me by emphasizing what she did not need—in her (slightly comic) words, what was neither requested nor required was “sitcom advice”, the self-evident admonition against pursuing a man who was more interested in using her than in loving her. She knew enough to know that there was no use for, and that this was not the time for, such senseless guidance.

But perhaps what she did need was support in disinterring the genesis of her vulnerability, the locales in her psychological terrain where she was losing sight of, and track of, her power. Her capacity to begin to understand that what she sought from Noam was exactly what was persecuting her is the basis for eventually putting an end to that persecution.

Beginning to understand that she was in love not with Noam, but with being subjugated to Noam, is, from my perspective, where she will begin to find her power. She was bound to him as Gulliver was bound in the land of Lilliput. Noam was clearly her tormenter, and sometimes, for unknown reasons, we become convinced that the only way to end our torment is to turn our power over to our tormenter — which of course only fuels the torment, further inflaming it.

It is better, instead, to attempt to locate the hidden source of the need for torment, for persecution, for subjugation, which is what Delia may have been needing from me most.

All therapists want to empower their patients and all patients want to feel empowered. But empowerment doesn’t generally result from sound advice, robust pep talks and inspirational sermons, well-intended as these may be. It is in allowing and encouraging our patients to lead us into their shadows, accompanying them through the darkness and joining them in being temporarily carried away by it, that the patient’s power, and the therapist’s power, are more reliably discovered.

The post Plumbing the Depths of Power appeared first on Behavior Online.

One of the challenges to establishing sufficient parent-child empathy, however, is that the process requires the parent to embark on a reverberating journey back in time, and that journey is influenced and distorted by the inevitable feelings of nostalgia that arise when we consider our childhood. The etymological origin of nostalgia, in fact, is a compound of two Greek words—one for “homecoming” and one for “ache”.

Whether we recall our growing up as existing in a rich, tranquil utopia, in a lethal, brutal dystopia, or in some province in between, the reality is that, as adults, we will always miss and treasure our childhood to some extent. Roland Barthes speculates that this is because childhood exists outside of time—it’s an age not in the chronological sense but in the mythic sense.

What gently limns our childhood in roseate light is that we intuitively understand and recall that it was the time in our lives when we were able to feel without our feelings being screened, edited or tempered by thought, words, or language. It was when we were, in certain ways, most awake, most alive, most sensual, when we were most present to the world and its beauty. It was when we were naturally finding meaning and joy in every endeavor that we undertook, in every encounter that we experienced. We may not want to go back to being the child that we were, but we all, to some extent, long to return to the native land of childhood that we once inhabited.

Difficulties ensue, however, when a parent’s tendency to romanticize that Edenic time interferes with his/her capacity to connect with his/her child, to become better acquainted with and understand the rough perplexity of a son’s or daughter’s growing up. I frequently hear these sanitized commentaries from parents when their child’s struggles threaten to disrupt the tender glow of memory that they would prefer to perpetually bathe themselves within:

I don’t know why you’re so unhappy, I wish I was your age again.

These are the best years of your life, why aren’t you enjoying them?

Life is never going to be this good again—if only I could turn back the clock.

The parent’s nostalgia serves a purpose, of course — it helps to soften the grief associated with aging, with the growing contemplation of mortality, with the burgeoning awareness that our children are here for one reason — to replace us. Time is not at all on a parent’s (or any person’s) side — it passes and surpasses us, ruins us and ultimately destroys us. Nostalgia helps to cushion the blow, serving as a psychological barrier that protects us from the anguish that we know, at some level, still retains the power to wound and demolish us should we re-visit it, or should we allow it to re-visit us.

Yet all children yearn to annihilate those parental barriers so that they are better able to become the beneficiaries of the natural empathy that all parents want to embody.

As clinicians, we can’t deprive our parental patients of the necessary nostalgia that helps them to survive, that allows them to safely reside in the region of adulthood without being buffeted and upended by the unruly forces of childhood. But we do want to help them to gradually penetrate this nostalgia so that some essence of the unsolvable pain of their childhood flows outward, and allows them to bear empathic witness to whatever unsolvable pain is being borne by the child whom they are raising.

The post The Pull of Nostalgia & Empathy appeared first on Behavior Online.

Stories breathe, and the storytelling process keeps us alive and psychologically oxygenated. The patient’s tales convey to us everything that we need to know about who they are and what they need. Human beings naturally follow the river of narrative impulse and when the therapist bravely joins them in navigating these currents, treatment is inaugurated.

I find myself most worried about the patients of mine who can no longer tell their story — whether their story is rich or impoverished, elegant or clumsy — or worse, those patients who appear to have lost interest in their story. Our most sacred and potent mission is to help them to recover or re-discover their story, and to re-animate their passion for telling it.

Something crucial is invariably lost when unconscious thoughts and ideas are dragged, sometimes kicking and screaming, into consciousness. There is an unavoidable collapse of one’s personal lexicon at the moment of attempted articulation. But more is gained than lost when the story is told, and the therapist’s primary function is to be the midwife who supports the labor that ushers their epic into the waiting world.

And labor it is, because there is a deep-seated fear that all of us experience when thought and feeling are funneled into language. Telling one’s story means acknowledging the mountainous iceberg of experience that lies beneath that story, an iceberg that mutely lurks underneath enduring and fathomless depths.

So I am interested in the patient’s story, but I become just as interested in what the patient leaves out of the story — which, of course, is its own story. I am tuning in to both what the conscious mind allows to be spoken, and what it has disallowed, what remains, for whatever reasons, unspeakable. As noted above, we are all driven by the narrative impulse, but we are simultaneously driven by the fear of that impulse, the terror of the anarchic shadow story that, like a dream, resists comfortable formats and inevitably illuminates the darkened shadows of the troubling unconscious. So our work entails listening to what is said, and listening for the unsaid that lies outside of or on the margins of the story, the “anti-story” that simultaneously conceals and reveals itself in the language of plangent silence.

Meaningful therapy depends upon a careful exploration of the patient’s determined effort to deploy certain words while eschewing others, to articulate certain phrases while muting others, to recount certain tales while silencing others. This complex calculation results in the series of linguistic choices that govern the nature and texture of the therapeutic conversation.

In that context, the meaning of the patient’s told and untold story and the meaning of the patient’s lived and unlived life are terminally bound up with each other and cannot and should not be disentangled.

There is a transcendent wisdom to the patient’s language that, when recognized, is unsurpassed when it comes to finding ways to be more fully human, to once again feel whole. The most important request a small child makes is, “Tell me a story.” When we make the same request of our patients, the story of their healing is summoned and finally allowed to begin.

The post Tell Me a Story: The Power of Storytelling appeared first on Behavior Online.

Wikipedia notes that one possible derivation of the word is from the French sabot, a wooden shoe or clog. Sabot became the French name for the brake on a wagon, as a shoe was pressed against the outer rim to halt its progress. Another etymological hypothesis is that sabotage derived from the Netherlands in the 15th Century, when workers would throw their sabots (shoes) into the wooden gears of textile looms to break the cogs, fearing the automated machines would render human workers obsolete. Sabotage is often advocated by labor unions as a means of self-defense, and as a protest against unfair, de-humanizing working conditions.

As clinicians, we often take note of patient’s “self-sabotage”, observing the many ways in which individuals ingeniously preclude or disrupt their growth, assemble and deploy roadblocks that impede their path forward, maneuver themselves into situations that completely prevent the possibility of success. And with this in mind, our initial clinical efforts are often directed at attempting to disarm the saboteur, since s/he appears to be working against his/her own best interests.

Sabotage, however, even when directed against oneself, may serve important functions, so we should not necessarily endeavor to too quickly deprive our patients of this strategem. As noted above, the act of sabotage has its origins in potentially useful, even necessary, personal and inter-personal functions such as braking, self-defense, self-preservation, and protest.

For example, adolescents are often trying to slow down their development when they feel that they’re being ushered towards the cliff of departure too hastily. In this respect, self-sabotaging behavior is the braking force that can retard the process, and make it clear to whoever is too forcefully propelling them forward—family, school, community—that separation and individuation cannot and should not be rushed.

Other adolescents engage in self-sabotage as a protest against conditions that have not been favorable to their development. Numerous teens have confided in me that they refuse to blossom as young adults as a way of making it insistently clear to their parents that are unhappy with the ways in which they were raised. They will steadfastly refuse to supply their family with the relief, pride and feeling of liberation that growing self-reliance would stimulate until there is some recognition on the part of the family’s leadership that mistakes were made, and until parents display a willingness to convey regret and remorse to their recalcitrant offspring.

And then there are adolescents who try to disrupt the machinery of their own lives because they are afraid that, like the Dutch textile workers described above, they, themselves, are becoming obsolete or irrelevant as they continue to stolidly march along through childhood and adolescent rites of passage. Self-sabotage becomes the most honest and authentic way they have of trying to maintain a hold on the childhood identity that they are most familiar with as the windswept adult world that they are entering attempts to tear their juvenile selfhood away from them.

Psychological treatment of adolescents becomes even more complicated than it already is because teens will inevitably direct sabotaging powers at the treatment enterprise itself. These are the cases I find most compelling, adolescents showing up in my office with boiling fury, with sullen silence, with hostile indifference. The clear message from them to me (and to everyone else) is: “I don’t want what you want for me. Your belief that you know what is best for me has nothing to do with what I believe is best for me. I will fight you off with all of the courage, perseverance and cleverness that I can muster.” Well-meaning adults, including the clinician, are not perceived as caring, supportive advocates (despite our efforts to appear and behave that way), but as occupying entities who, in the adolescent’s eyes, wield illegitimate power and must be neutralized or annihilated so that s/he can survive.

In that sense, the toughest adolescent patient can be understood not as “resistant”, but as a fierce resistance fighter, a brave and lonely young adult who is doing whatever he or she must to fight off, repudiate or rebuff those who pose a threat to his/her very existence.

When we examine adolescent self-sabotage from this perspective, we may find that troubled and troubling teens begin to appear a little less annoying, a little less obnoxious, a little less stubborn—we may, in fact, even begin to grow fond of them. And as they trust that we are not interested in depriving them of, or forcefully confiscating, their precious self-sabotaging efforts, they are more likely to allow us to help them examine its role in their lives, and better able to thoughtfully consider whether or not the role of saboteur is one that is worth maintaining. When that happens, their motivation for self-sabotage may naturally and gradually dissolve, and, as a result, they may even become a little more fond of themselves.

The post The Adolescent Saboteur appeared first on Behavior Online.

From my perspective, for example, adolescence is essentially a time of loss. Teens must close the door on their childhood in order to open the door into adulthood, and parents of teens must close the door on the stage of life during which they are most essential and most relevant—that of raising children—and prepare to enter a twilight that can certainly be meaningful and enriching, but that is nevertheless less significant than when they were intimately involved with caring for their young.

The necessary closing of these developmental doors on the part of both generations cannot be completed without considerable feelings of grief and loss. “The tomb becomes the womb” is one of the ways in which I attempt to capture, for teens and their families, the necessary grief that is the handmaiden to growth, to the resolution of one chapter of life in preparation for authoring the next one.

That is why countless adolescents have plaintively admitted to me that, “I am a loser.” What they appear to be saying, at least on the surface, is that they are losing at the game of life, not experiencing success in the realm that holds most significance for them, which might be anything from having a girlfriend to making the soccer team to being admitted to the college of their choice. But while they may be talking about losing-as-opposed-to-winning, what I am hearing them struggle with is losing-in-the-sense-of-loss—they are unwittingly acknowledging with their words the loss of their childhood, and all that childhood has been, for better or worse, associated with.

For the same reason, countless parents of adolescents in my office have offered phrases like, “I’m tired of him giving me grief” or “I am at a loss as to how to handle her.” “Giving grief” is exactly what teenagers do—as they blossom into the springtime of their lives, they nudge parents further towards the margins of life, reminding them of their vulnerability, their susceptibility, and, ultimately, their mortality. Intentionally or unintentionally—and it is usually a combination of both—they insist that their parents mourn.

And in the same context, the phrase “at a loss” also defines, with exquisite precision, the emotional phase that adolescents thrust their caregivers into—a time of loss when they must come to terms with the unmet dreams and unfulfilled promises that unavoidably litter the landscape of middle-age.

As clinicians, we understand that grieving is, ultimately, a liberating process—it frees us to let go of the past and evolve successfully into the future. When we don’t grieve we inevitably wind up developmentally marooned, unable to gain traction and successfully adapt to life’s changing circumstances, its unrelenting volley of slings and arrows. Unfortunately though, from my perspective, our culture does not do a particularly good job of speaking the language of grief—we instead choose to emphasize endeavors such as achievement, entertainment, and acquisition, none of which, in and of themselves, emancipate us in any enduring way.

We do our patients a tremendous service by attending carefully to their words, and helping to illuminate for them the healthy, developmental grief that is a crucial component of their successful adaptation to the crises and challenges that life bequeaths to us. Our clinical voices—what we say and how we say it—will hold forth their most profound healing powers when we allow ourselves to listen carefully to our patients’ plaintive voices, and enable them to hear their own melodies of loss and longing, the melodies that all of us must learn to sing.

Teenager image available from Shutterstock.

The post Songs in the Key of Grief: Loss & Longing During Adolescence appeared first on Behavior Online.