Patient: All I'm asking is that you take the pain away.
Me: I wish I could do that.
Patient: What does that mean?
Me: As far as I can tell, pain is part of life.
Patient: So what am I doing here?
Me: Learning to manage it. . . .
Patient: I hoped you'd get rid of it.
Me: You wanted a cure.
Patient: That's what doctors do -- they make it go away!
At these moments I find I'm the bearer of bad news. Pain is part of life, and there's no way around it. The best we can do is learn how to manage it. That's the only way to stay healthy despite it.
All the same, it's second nature to try to avoid it. And it's amazing how clever we can be when it comes to it. We abuse drugs, we abuse alcohol, we abuse sex, we overwork, we under eat, we overeat, we overexercise, we oversleep, we pull our hair, we pick our skin, we obsess, we check the locks, we count words, we get into fights, we cut ourselves, we kill ourselves -- just to find a way around feeling the pain.
Unfortunately, these strategies tend not to work. Or at least not to work on a permanent basis. Otherwise, why would we ever give them up?
Often our strategies fall apart in a crisis. We get sick. We get fired. Our relationship crumbles. That's when we're forced to take a look at ourselves. It's when they're overloaded that our defenses tend to crack.And that's when those old, painful feelings leak out. And what a toxic stream that looks to be! Rage toward a father who had an affair. Fury toward a mother who demanded perfection. Helplessness before an uncle who sexually abused us. Humiliation at the hand of a sadistic older brother. They are old. They are raw. They are untouched by time. Unlike a good wine, they don't mellow with age.
Which is why it's important to let these feelings see light. To sit with them. To get to know them. To think about why they're there. To bring the wisdom of experience to bear on their meaning. To make sure they don't secretly distort our perception.
That's what it means to deal skillfully with our pain. Therapy can't get rid of it but it can help us to manage it. So we finally have a chance to move out of the past. So we finally have a chance to move into the present.
8 comments:
I started therapy because my parents thought it was a good idea (I had been dating someone that did not treat me well) and at first it seemend fine bt somehow now if I think about therapy adn what we talked about I cant cope and I cut my arm. No one can see it but I don't know how to stop and to deal with it "skillfully". I dont want the therapist to be angry because I haven't told her but I want her to help me. I can't tell her but I was thinking of just showing her but I feel like she is going to think I am blaming her since it started after therapy. As a therapist would you drop your patient if you found that out.
If I were your therapist, I'd want to know that you're cutting. That you're doing this isn't surprising to me. Someone in your situation might choose to cut themselves in order to feel control in the face of difficult feelings that have begun to surface in the course of therapy. Cutting can be a completely absorbing experience. It disracts from the emotional pain inflicted on us by others with physical pain that we inflict on ourselves. This is why it can bring relief -- better to be the agent of our own pain than to feel helpless through the agency of others. Unfortunately, this solution is also a problem. And it is preferable to process our feelings of helplessness rather than to defend against them by causing ourselves harm. This is where effective therapy comes into play. And why it's a great idea to share your cutting with your therapist.
I told my therapist....took a few tries but was ok. I can't totally stop but she did not make me feel like a total freak.....thanks for the advice
My pleasure!
As a therapist what do you do when those feelings see light and your patient has a strong reaction? I ask because in therapy the other day we touched on a difficult subject and I started crying for the first time after a year in therapy and my therapist just sat there and watched me. It was awful I felt so alone...he did not offer me a tissue, or sit by me,or offer a pat on the shoulder or hug.......Is that normal?...That made me never want to react in therapy again and it certainly did not help me to sit with those feelings....
It takes a great deal of courage to express emotional pain in therapy. Courage because we allow ourselves to be seen as we are. Courage to be vulnerable before our therapist and ourself.
Ideally, our therapist will be supportive and empathic. Will let us know that he respects our willingness to be seen. Will telegraph his compassion for the anguish we're feeling.
How our therapist does this is a matter of style. I do this through language, posture, and expression. Other therapists have their own particular approaches. The key here is not how the therapist shows up. But that he shows up in these agonizing moments.
I can't say for sure what your therapist was feeling, but I can say from your description that you felt exposed. I would encourage you to bring this up with your therapist, let him know how you felt, and let him know what you hoped for.
Sometimes it's in expressing our disappointment in others that we're able to begin to get what we need. And even if this isn't what comes of the exchange, expressing your feelings, especially when they're difficult, is wonderful practice for a healthy relationship -- even when the relationship is between your therapist and yourself.
I was reading the comments on your blog (a blog that I wish was still active it is very impressive) and I notice this comment. I have been reading a good deal on touch in therapy and how it can be very useful though there is still a taboo about it. Do you ever employ touch? I have been in therapy with a couple of different people and have found that a simple hand on the shoulder can make a huge difference. It is almost as if that small connection is much stronger than anything else that can be offered. At the same time it seems there is a line where even if appropriate a hug might be too much,. I was just curios as to what you found in your practice since you seem to be focused on being in tune with your patients and with showing up for them.
One of the biggest challenges I encounter as a therapist is mindfully to maintain the boundaries of the therapy. One of the boundaries I adhere to is that of no touch -- apart from a handshake with the occasional patient. This is because the emotional intimacy of the treatment can lead the best intentioned touch to be misconstrued, especially in moments of great vulnerability.
I don't mean to suggest that touch can't be powerful, nor to suggest that it cannot help to heal. But I do mean to say that for me as a therapist I prefer to use other ways to communicate, as frustrating and limiting as this parameter might be.
In the long run I hope that my patients will value the predictable safety that such restraint implies. A safety that allows them to share their deepest feelings with me. A safety that allows them to share such feelings with themselves.
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