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Larger than Life

Marianne Walters Was Family Therapy's Foremost Feminist

by Mary Sykes Wylie

Family therapist Marianne Walters, who died on February 21, 2006, at the age of 76, didn't invent a brilliant new therapeutic paradigm, publish a large and magisterial body of research, or establish her own unique school of clinical practice. Her name never had quite the instant brand recognition associated with some of the founders of the field--Nathan Ackerman, Salvador Minuchin, Murray Bowen, Virginia Satir, and the other immortals. A housewife and mother (who dutifully followed her economist husband around from one academic posting to another for years), she didn't even become a family therapist until she was nearly 40.

Yet, Walters probably had as great an impacto the overall clinical zeitgeist of family therapy, in her own way, as any of the master theory-builders and gurus. Along with her three comrades in arms--Betty Carter, Peggy Papp, and Olga Silverstein--she formed The Women's Project in Family Therapy in 1977, what family therapist Carol Anderson called "the first, biggest, longest-running feminist road show." It was a combination feminist think tank and SWAT team, which, in public workshops all over the country, challenged the underlying sexism in some of the most basic notions of family therapy. Largely at Walters's continued prodding, the four went on to write The Invisible Web, the first book to focus on women's relationships in the family and, more important, on how to bring feminist insights into daily clinical practice.

In these days, when no therapist would admit to not supporting feminist principles, it's almost impossible to resurrect the mix of excitement and outrage Walters engendered, as much because of her truly formidable personality as her unflinching challenge to the male hierarchy. A woman of great personal e[Serbian DJE]lan, fearless temperament, and iron will, she wasn't cowed by authority, to say the least. "She was funny, political, very radical, and wasn't going to soften her position for anyone," remembers psychologist Michele Bograd, who herself has written about feminist issues in family therapy. "She didn't care about her image--she was simply not afraid. Marianne was a warrior-hero to many of us. It was as if she and the Women's Project broke a path through deep, crusted snow that the rest of us could follow."

In all the attention Walters commanded as de facto ringleader of the Women's Project, it was sometimes forgotten that she was also a brilliant clinician, to whom doing therapy seemed to come as naturally as breathing. She had an almost uncanny talent for instantly connecting with clients as if she'd known them forever and somehow startling them out of their funk into a radically new, far more creative and helpful, view of their own dilemmas. Not remotely interested in therapeutic neutrality, she was always fully herself--to be so was part of her working credo. "I'm Jewish," she said, describing one consultation, "so I say 'mazel tov' to this client, instead of 'congratulations'--it's a way of identifying myself and establishing a relationship with the person I'm talking to."

 

 

As a teacher, Walters was unforgettable, an ineradicable neon memory, burned into the neural synapses of every student she ever taught. She could be very tough--more than a few students limped out of her supervision sessions feeling scorched by her blunt assessment of their missteps in the consulting room. But she also had a gift for encouraging inexperienced young therapists to think independently of the systems they'd been taught. At a time when family therapists were still deeply in thrall to abstract, formulaic constructions--circularity, complementarity, triangulation, homeostasis, differentiation, enmeshment, not to mention the diagrams and genograms schematically demonstrating these concepts--she challenged students to do therapy less by the book and more from the gut.

For a student or trainee, getting the Walters treatment could be both terrifying and freeing. Larry Levner, director of the Washington, D.C.-based Family Therapy Practice Center, founded by Walters in 1980, describes how disorienting it was for him, as one of Walters's students, to give up his dependence on the neat, predefined sequence of clinical steps that provided a guaranteed road map through any session. "The great thing about the systemic or structural ways of working was that from the minute you entered the therapy room, you knew what you were going to do," Levner says. "When Marianne began challenging family therapy constructs like complementarity, my feeling was, 'I can't do this work if I don't have my formula.' And yet, I remember this period as a defining and empowering time for me as a therapist, when I finally began to understand that therapy wasn't just what you do, but how you think. "

A short woman--only about five feet tall--zaftig of build, with unruly dark hair, a vast smile, and charisma to burn, Walters had undeniable star power and a grand presence that belied her physical stature. "She was divaesque, bigger than life," says Jay Lappin, who was a young faculty member at the Philadelphia Child Guidance Clinic when Walters was there as a family therapist and director of training. "When you were with her, you felt you were with somebody special, and that something important was just about to happen."

 

The Making of a Radical

Marianne Lichtenstein Walters was a lifelong political activist, who came by her left-wing politics naturally--she was the quintessential "red-diaper baby." Her mother emigrated from Russia to the United States at the turn of the 20th century, speaking only Yiddish, and met Walters's father in New York at a meeting of the Young Person's Socialist League. The couple settled in Washington, where Mr. Lichtenstein got a doctorate in foreign-service studies at Georgetown University.

Finding that Jews weren't welcome at the State of Department, he went into business instead. But while economically comfortable themselves, the family remained steeped in the progressive, prolabor, antiracist political causes of the time. "We were raised in the time of Hitler and grew up understanding what fascism was," says Barbara Bick, Walters's older sister. Her mother was an activist on behalf of civil rights for blacks, and helped to incorporate a cooperative bookstore that included on its board of directors several black professors from Howard University--a radical practice for a white business of the era.

Walters seems to have identified herself as a socialist early on and, as a young woman, even briefly joined the Communist Party. At 17 or 18, she was a delegate to an international youth and student congress held in Prague, where Paul Robeson was one of the speakers. In the heady, earnest spirit of solidarity with the "workers of the world" that informed such occasions, she joined a youth brigade to do volunteer labor on a railroad in either Czechoslovakia or Yugoslavia (accounts differ). But she disliked the work so much that she was grateful when she broke her leg, giving her an unimpeachable excuse to stop--although she did receive some sort of official medal for her efforts.

At the University of California at Berkeley, Walters met and married a left-leaning economist and political activist, Joseph Hart Walters. According to Peggy Papp, Walters liked to tell the fanciful story that her 1950 wedding was a very nice Jewish affair, after which everybody was arrested and taken off to jail for various "un-American" activities. But for all Walters's lifelong commitment to social justice and left-wing sympathies, she was, says her daughter Suzanna, "much too idiosyncratic and independent for any group mentality; too much a free-thinking iconoclast to become mired in orthodoxy."

 

During a trip to Cuba with other American therapists for an international conference a couple of years ago, she was in a large group of visitors listening to a government functionary talk up the achievements of the Cuban revolution, including free health care and universal literacy. Walters then raised her hand. "Excuse me," she said sweetly. "Have those 79 dissidents and journalists arrested and jailed in 2003 been freed yet, or are they still in prison?" There was a moment of aghast silence before the speaker managed to mumble something to the effect that they hadn't been jailed for their political beliefs but for "other" reasons. The talk resumed. A few minutes later, Walters's hand was in the air again. "I was just wondering," she said, "if you're still rounding up homosexuals and keeping them in special units!"

In 1954, Walters got her M.S.W. degree and took a job as a clinical social worker at the Philadelphia Child Guidance Clinic (PCGC), while it was still under the influence of psychoanalyst Otto Rank. Walters took some satisfaction from the fact that she preceeded by 10 years Salvador Minuchin to the clinic that would become almost synonymous with his name and his pioneering family therapy techniques. She left PCGC in around 1963 to become chief social worker on a Howard University project in Washington, D.C., training community mental health aides. After that, she spent time in Warsaw, Poland (her husband was there on a grant), where her third daughter was born.

In 1968, Walters and her family returned to Philadelphia, where her husband joined the faculty of the University of Pennsylvania and she again joined PCGC. By this time, the organization had been completely reborn as a family therapy center, and was one of the most exciting places to be if you were a social activist, had a rebellious streak, and wanted be in the vanguard of a radical new therapy movement. Walters fit right in.

Not formally trained in family therapy, Walters took to it immediately and quickly became a luminary in her own right. Lappin recalls that when she did supervision, it was if she were "holding court, and people felt lucky to be there." Walters loved the dynamic, politically charged atmosphere of the clinic. "The therapeutic approach seemed so progressive and Sal's politics appealed to me a lot," she recalled. "We'd practically close down the place to go on peace marches. I also liked it that he was always interested in the cultural and social context of people's lives--how poverty affected families. I loved his energy, his intellectual excitement, his commitment and engagement and presence when he was doing therapy." The cozy, teamlike atmosphere of PCGC extended after hours. Walters and Minuchin were neighbors, and their families visited in each other's homes. She, Minuchin and Jay Haley--an early hire of Minuchin's--played poker together for nickel and dime bets.

 

But, as might be expected in a circle that included a number of leading lights in the family therapy field--generally not shy, self-effacing personalities--there was a certain amount of jostling and maneuvering for position. Often the principal contenders were Minuchin and Walters, who was, by the mid-'70s, executive director of training at PCGC and a star in her own right. One younger staff member recalled how tough the Monday-morning faculty meetings could be, when senior members would stake out positions on different issues, then put junior faculty on the spot by lobbying them to take sides. Typically, Minuchin might say to a junior member of the team something like, "So, what do you think of this idea of Marianne's?" The atmosphere at the clinic was often intensely politicized, and the politics could be intensely personal.

 

The Making of a Feminist

For Walters, the bloom began to leave the PCGC rose in the mid-1970s, when it began to dawn on her that, however "radical" family therapy seemed, the field was, in her words, "primitive" when it came to women. Gradually, as feminist thinking suffused the cultural atmosphere, she realized how few women were in executive-leadership positions at the clinic, that almost all the major figures in the field were men, and that many women therapists had a hard time confronting men in therapy, much less in their clinics and agencies. Most damning, it seemed to her that the vaunted interventions of family therapy existed in a social vacuum, completely ignoring the real circumstances of women's lives.

According to a well-known story, in 1978, Walters asked her friend Peggy Papp to co-lead a workshop about women and therapy. As far as Walters was concerned, the field had grown so in thrall to its own abstract architectonics of structures and systems that it was losing its anchor in the real, earth-bound world of families, and virtually ignoring the daily reality of women in those families. Papp, in turn, recruited two smart colleagues and former students, Betty Carter and Olga Silverstein. The first workshop, held at PCGC, drew nearly 100 participants, who began to explore what family and couples therapy that included women's experience and consciousness might look like.

One person who hadn't been informed of the workshop was clinic director Minuchin, who discovered the insurrection under his own roof only by accident. "I was always a very intrusive director," he says (he was famous for walking into other clinicians' sessions or offices, unannounced and unapologetic). "I opened the door to the conference room and saw all these women and, at the front of the room, I saw Marianne, Peggy, Olga, and Betty." Taken aback, Minuchin asked what was up. "This is a meeting for women," Walters declared. "But how was it that I didn't know this was going to take place?" Minuchin asked. "You're a man," she said flatly.

"She evicted me," recalls Minuchin, still sounding incredulous nearly 30 years later. "I had the feeling of being pushed out, and I didn't like it. I felt betrayed." Thus began a period of confrontation, Minuchin says, "when I was singled out as the embodiment of male obtuseness and discrimination. The truth is, I really didn't like it at all."

 

Over the long run, Minuchin says, Walters had an important effect on his own thinking, however. He began to understand that he, too, was the unconscious product of culture--in this case, a patriarchal, hierarchical, macho-infused Argentine family, in which the male was supposed to be top dog. "What I saw as simply the 'natural' way things were, she made me realize, was quite a narrow vision of the world--she opened my eyes."

A few months after the PCGC meeting, at the annual meeting of the American Orthopsychiatric Association conference, Walters, Papp, Silverstein, and Carter decided to hold an impromptu gathering on women's issues and therapy. "We put up a little handwritten sign announcing the meeting, then went to lunch and almost forgot about it--we didn't think anybody would come," Olga Silverstein remembers. When they went to the room scheduled for the event, they found it jammed with nearly 400 people. "We weren't prepared," adds Silverstein, "but we went ahead and did something, and it seemed to go very pretty well." Soon after that, The Women's Project in Family Therapy was born, which kick-started a national movement that ultimately transformed the field.

At some point, the friendship between the four collaborators became as important as the work. After Walters moved to Washington, D.C., and started the Family Therapy Practice Center, one of the first free-standing family-training programs to be run by a woman (Betty Carter's was the first), they continued to meet in Olga Silverstein's New York City apartment. The four would spend the first day updating one another on their personal lives--marriages, divorces, kids. "As we talked, we saw the connection between what we did as parents and wives and friends, and what we did as therapists," Silverstein remarked in a 1997 Networker article about the Women's Project. "We saw that all those roles weren't something that interfered with your professionalism. They made you more of an expert on families."

All four women had their individual identities, backgrounds, ways of working, even physiques. "We were two little women and two tall ones, two Jews and two Wasps--one Catholic and one Mormon," said Silverstein recently. "Our models were all totally different. Peggy and I came from Ackerman, Betty was a Bowenite, and Marianne came from Minuchin's school." By common agreement, Walters was the leader of the pack. "We were four self-motivated, bossy, strong women, but she led us just the same. She kept us together." In fact, when the four began writing their book, it was Walters--often thought of as a confrontationist--who had a gift for soothing jangled nerves, cooling off tempers, and raising spirits when arguments, hurt feelings, misunderstandings, and disappointments threatened progress.

 

Once the book was published, it became a kind of lodestar to women therapists because it went beyond critiquing sexist assumptions and patterns in family therapy and outlined systematic strategies for making interventions more woman-friendly. The four acquired as much renown as any of the "old masters" of the field. But in certain circles, they became the target of brutal attacks. One major figure circulated a paper that sneeringly used the acronym MAW to describe the group. It pointedly suggested that the four were aggressive, mean-tempered, power-hungry old women who were sacrificing the good name of family therapy to their own selfish yearning for glory.

In retrospect, what adversaries seem to have found most infuriating wasn't that the Women's Project dared to challenge some of family therapy's pet concepts, but the bold, unapologetic, very public and in-your-face way they went about it. And the one who seemed to be the most brazen, most outspoken, least fearful of offending the powers that be was Walters. Not only did she become the de facto lightning rod of the Women's Project, she seemed to take on the job with real gusto.

Putting Families First

While Walters was sometimes regarded by people who didn't know her as an unbending ideologue, she insisted that, for her, feminism wasn't a war against men, but against the monolithic male dominance in the way our culture thinks about and defines human reality. She wanted to include women's experience, women's thoughts, women's perspectives in the way we envision family and society. As committed as she was to the cause, however, she was never doctrinaire. She was too earthy, too rooted in life and aware of its messy ambiguities, too fascinated by people and their individual foibles ever to pigeonhole entire populations into preexisting political categories.

In fact, for somebody with the reputation of a radical, Walters was actually a funny kind of traditionalist, even a moralist, regarding the family--an unreconstructed believer in the necessity of mutually loving and respecting family connections. More than anything, she was a critic of the cult of individualism in American society, which seemed, paradoxically and weirdly in her eyes, to have been adopted by the family therapy establishment. She simply couldn't fathom the vast attraction in family therapy circles to concepts like "differentiation," "separation," and "individuation," nor the zeal of therapists for various strategies aimed at helping "enmeshed" families kick reluctant, postadolescent fledglings out of the nest, nor the cult for "leaving home"--the title of Jay Haley's famous book about getting kids to grow up and get out. "Being a Jewish woman, I just cannot understand separation and boundaries and so on, but I completely understand enmeshment," she said, typically exaggerating for effect. "In our field, you're supposed to grow up in a family and then separate from them, and they're supposed to let you go. But why would you want to let go of your family? Why would you 'let go' of someone you love?" she wondered.

 

Once, in response to an anxiety-ridden, young, single mother, who was afraid her young son would grow up to be too dependent on her, earning the dreaded label of "mama's boy," Walters dismissed the whole concern with a careless wave of the hand and the immortal remark, "Oedipal, Schmedipal--as long as he loves his mother." In her view, maturity is a process of continually renegotiating the terms of your connection with your family of origin and continually forming new families--with friends, mates, work colleagues, whoever you really care about, who cares about you. "Let a hundred families bloom" might have been her motto.

True, her ideas about "home" and "family" were far more inclusive than the standard-issue, married heterosexual couple with 2.5 children living in a freestanding suburban house. To her, a true family wasn't an institution, but a state of mind and heart--a feeling of being at home with certain chosen others; not a ritualized, privatized legal contract, but the natural unfolding of affiliation between people--whoever they were, whatever their biological connection, whether or not they were formally sanctioned by law and custom. "A home is a place of intimacy and familiarity that holds people who love you and whom you love; a place where you feel taken care of, where you feel comfortable and can talk about things that are important to you," she said

Although she was celebrated as a woman who could dish out challenges to the worldviews of others, her family taught her to readjust her own notions of the correct world order. When, at 16, her youngest daughter, Suzanna, announced to her mother that she was gay, "my mother, typically thinking that she knew it all, without missing a beat, said 'no, you're not!'" recalls Suzanna. Walters herself remembered the occasion with more characteristic hyperbole and self-mocking dramatics. "I said to her, 'That's completely stupid, honey, completely ridiculous. Cut it out! You're always saying something dumb like that. You aren't gay." However, Walters not only came to "accept" her daughter's sexual orientation, but to throw herself into the fight for gay rights with as much joy, enthusiasm, and determination as she had for any of the other causes she'd championed, later thanking her daughter for opening up yet another opportunity for fighting the good fight.

In a profession often known for its avoidance of conflict, Walters will be remembered as an indefatigable fighter who'd go toe-to-toe with anybody on behalf of what she thought was a fundamentally important principle or idea. As Jay Lappin puts it, "That's why I was so shocked when I heard she'd died. I just couldn't imagine Marianne losing a fight to anyone or anything."

Mary Sykes Wylie, Ph.D., is the senior editor of the Psychotherapy Networker . Letters to the Editor about this article may be e-mailed to letters@psychnetworker.org.

 

Can a Course in Positive Psychology Change Your Life?

by Richard Handler

If Thomas Jefferson were a psychology graduate student today, he'd probably think of himself as a positive psychologist. It was Jefferson, after all, who began the Declaration of Independence with the statement that human beings aren't only created equal but "endowed by their Creator with certain unalienable Rights, [and] that among these are Life, Liberty and the pursuit of Happiness." Happiness was the word he chose, not pursuit of power or economic gain.

Jefferson didn't formally study happiness. He wanted each man to find his own. Judging by his writings, he wasn't always happy himself, especially if you define happiness as a smiley-faced succession of positive feelings. Nor was he a particularly religious man. He didn't think that a happy human life was a reward for obeying a Supreme Being or a set of rules laid down in a holy book. He was a lover of the Greek classics, a believer in progress, a deist, and a man of the Enlightenment. His faith lay in the notion that philosophic inquiry, reason, and study of the natural world could lead one to what Aristotle called "the good life." That was the bedrock of Jefferson's secular faith--a view that many positive psychologists share today.

That faith led Jefferson to a full and productive life, replete with the factors that today's positive psychologists say are crucial to the whole-grained, solid, muscular happiness they promote. Jefferson had many friends (recent demographic research finds that the happiest people have huge social networks). He didn't agonize about his faults, but rather exercised his creative talents as a writer, politician, and thinker (positive psychologists urge people to maximize strengths rather than correct weaknesses, and to turn their work into a moral calling). He was a man of complex identities: not only a lawyer and slaveowner, but a farmer, Southerner, architect of Monticello, letter-writer, father, gracious host, bon vivant, and lover of women and wine, of oysters and sonatas. Such complex identities, positive psychologists say, are a crucial ingredient in that elusive, nebulous, eternally-sought-after state we call happiness

Today, Positive Psychology, as popularized by former American Psychological Association president and bestselling author Martin Seligman, is taking folk wisdom and Greek philosophy, mixing them with solid contemporary research on joy, optimism, satisfaction, contentment, forgiveness, and gratitude, and popularizing the result as scientifically validated fact. The result, they hope, will be a new take on psychology, at once Victorian and scientific.

 

They're doing so in a country Jefferson wouldn't recognize. Even as Americans spend $76 billion a year on antidepressants and additional millions on talk therapy for depression; even as they overwork relentlessly in pursuit of the "good life" defined in material terms; even as they grope their way through crises in divorced and blended families stripped of the aunties and grandmothers who once stabilized extended families, positive psychologists are administering happiness questionnaires, writing happiness books, and giving radio interviews on how to be happy.

Much of what they say is as old-fashioned as Jefferson's viewpoint and cuts hard against the modern grain: their studies, for instance, suggest that within certain constraints, money doesn't buy happiness (Brazilians, according to demographic data, are almost as satisfied with their lives as Americans, despite having only 23 percent of the purchasing power). Positive psychologists say that most folks are as happy as they make up their minds to be. Like Victorian moralists, they argue that almost Stoic moral and emotional practices--lowering your expectations, looking on the bright side, counting your blessings, volunteering, forgiving others, expressing gratitude--can make you much happier than going shopping or excavating childhood hurts in therapy.

This list may make some therapists cringe (and make positive psychologists sound like nuns), but its proponents include many of the most creative and influential psychological researchers alive in America today. Seligman, for instance, is the original elucidator of "learned helplessness." He's Fox Leadership Professor of Psychology at the University of Pennsylvania, and attracts grant money the way a magnet attracts iron filings. George Vaillant of Harvard Medical School is the chief architect of a respected, 60-year longitudinal study of the lives of Harvard graduates and blue-collar Boston men. Social scientist Mikhail Csikszentmihalyi is a noted business professor at Claremont College and author of the bestseller Flow, the famous study of work satisfaction.

In the seven short years since Seligman convened Positive Psychology's first organizational summit in a resort in Mexico, the surge to popularize this new discipline--and challenge clinical psychology's 60-year preoccupation with mental pain and illness--has spilled far beyond academic backwaters. Positive psychologists have set up courses in at least 20 universities in North America, leavening syllabuses previously heavy on abnormal psychology and DSM criteria with courses discussing "signature strengths," learned optimism, faith, and contentment. While the National Institute of Mental Health gives millions of dollars each year to study schizophrenia, panic, depression, and other mental illnesses, the Templeton, Mellon, Annenberg, and Pew foundations are now funding research into the happiness-producing potential of civic engagement, gratitude lists, forgiveness, hope, and altruism.

 

Last January, Time magazine devoted 40 pages to "The Science of Happiness," and similar cover stories have appeared in O: The Oprah Magazine, Psychology Today, Scientific American, and Tricycle: The Buddhist Review. Books on the subject range from Seligman's 2002 bestseller Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment to British economist Sir Richard Layard's Happiness: Lessons From a New Science to Richard Nettle's Happiness: The Science Behind Your Smile and the Dalai Lama's The Art of Happiness. Google "science of happiness" and you'll get close to 70,000 hits.

Seligman and his colleagues are trying to forge a new cultural role for psychology. This isn't psychology as practiced for the past half-century plus--as a diagnostic system for the many ways human beings go horribly wrong, dedicated to changing pathological misery into ordinary unhappiness, one damaged client at a time. Nor is it psychology as a research profession so focused on administering shocks to rats or measuring eye-blink rates that it forgets about overarching questions of life satisfaction, social contribution, effectiveness, and connection. And despite their emphasis on nebulous concepts like joy, compassion, virtue, character, and what goes right in life, positive psychologists vigorously differentiate themselves from their forerunners like Carl Rogers and Abraham Maslow in the Human Potential Movement, dismissing that earlier work as short on hard-boiled research and long on therapeutic intuition and quests for radical, almost effortless, personal transformation. Theirs is a new vision of psychology as a muscular, morally prescriptive, socially influential, positively focused, and thoroughly researched discipline. It's psychology as a way of life.

Beyond Helplessness

The Positive Psychology movement is a sunny place for people whose lives have been lived at least partly in shadow. And it's impossible to fully understand it without understanding the less-than-rosy early life of its leading popularizer, Martin Seligman.

Seligman has called himself "a dyed-in-the-wool pessimist." His five home-schooled children have called him a grouch. His parents were civil servants who wanted to see him get into a good college, and so they saved from their modest salaries and, when he was 13, took him out of the local public school and enrolled him in a private military academy full of rich kids. There Seligman felt isolated and rejected. He calls the experience the "first crisis of my life," and adapted by becoming something of an amateur psychiatrist, like Luci, for pretty girls who wouldn't otherwise have looked at him.

 

One morning while he was still in military school and spending the night at a friend's house, he felt something was terribly wrong and ran home in a panic. There he watched his father, who'd recently been acting strangely and prone to weeping, being carried out in a stretcher, immobile. Three more strokes followed. His father, once a vital man who hoped to run for public office, was left permanently paralyzed, alternating between bouts of euphoria and sadness, as Seligman writes in his 1990 book, Learned Optimism. "This was my introduction to the suffering that helplessness engenders. Seeing my father in this state, as I did again and again until his death years later, set the direction of my quest. His desperation fueled my vigor."

For the next two decades, Seligman committed himself to the study of helplessness, while making double-sure that he wasn't helpless himself. A high achiever, he graduated from Princeton and went on to graduate studies in psychology at the University of Pennsylvania. In 1964, when he was 21, he watched a group of lab dogs in their electrified wire cages there, acting as despairing as his own dad. They were slumped with their heads on their paws, whimpering, and doing nothing to avoid the shocks being administered to them. In a previous experiment, they'd been unable to escape being shocked. Now, even though the experimental parameters had changed and they could leap to safety on the other side of the cage, they didn't. They simply endured.

Seligman concluded that the dogs were no longer learning sets of discrete behaviors through reward and punishment, as the Skinnerian behaviorism of the time maintained they would. They'd come to an overarching conclusion: that "nothing they did mattered," which perpetuated its own reality even when circumstances changed. Seligman's observation was heretical--animals weren't supposed to adopt abstract, generalized attitudes like helplessness.

Fascinated, Seligman (in loose concert with Aaron Beck, the father of cognitive psychology, the rationalist Albert Ellis, and others) began studying the effect of helplessness. Such thinking styles, they hypothesized, generated depressed moods. They then dissected the thinking styles of pessimists and noted that they globalized their failures like the dogs had ("I'm no good with people" or "Nothing I do makes any difference") and minimized their successes ("I was just lucky"). Not surprisingly, the pessimists' moods measured consistently low. In the face of adversity, they often gave up. Optimists, by contrast, were consistently cheerier and more effective. They drew global conclusions about their successes ("I'm an excellent athlete") and considered their failures and disappointments to be momentary flukes that weren't their responsibility ("She must have been in a bad mood"). The optimists had huge advantages. They got depressed at half the rate of pessimistic people. Even though they were less realistic, their thoughts helped them create their own sunnier universes: their good moods helped them get along better with others, and they performed better on tests of creativity, efficacy, and intelligence.

 

Seligman figured that if depressed people had somehow learned to be helpless, they could also unlearn it, but as he moved from animal research into clinical psychology, he didn't just want to undo negative thinking, he wanted to foster good feelings. He had a hunch that people who consistently celebrated and exercised their strengths would be buffered against inevitable bad times when they struck. This had worked for Seligman himself: he'd learned to focus on his strengths, becoming a prolific researcher and a popular writer. He also successfully used cognitive therapy techniques on himself, learning to dispute "negative self-talk" and to marshal reality-based data that supported looking on the bright side. People, he contended, could argue themselves out of their black moods if they took action. They just had to stick to it, dispute their knee-jerk negative globalizations and catastrophizing, engage in "positive self-talk," and do their homework in journals and exercise books.

Seligman's career progressed and his grants and awards piled up throughout the 1970s and 1980s, but he was after bigger fish. He didn't want to simply bump unhappy people a few steps up the misery scale. He wanted to expand human happiness, and he wanted to do it in a much larger theater. Having morphed from researcher to clinical psychologist, he now morphed again--to social scientist and small-pond politician.

Seligman didn't like the direction his own profession was taking. For more than two decades (as private insurance reimbursements for treating DSM -defined disorders and NIMH grants for the study of mental illnesses mushroomed) he'd watched clinical psychologists who weren't interested in research-based psychology come to dominate the American Psychological Association (APA). Many of these clinicians, Seligman thought, accentuated the negative and used treatments that weren't proving effective. He liked active, evidence-based, cognitive and behavioral therapies, not those that encouraged clients to talk about their pain. He believed that many therapists were promoting a therapeutic ethos preoccupied with childhood woundedness, consumeristic entitlement, passivity, and self-centeredness. That approach, he thought, unrealistically raised expectations and set people up for disappointment and social isolation, which, in turn, contributed to the skyrocketing rates of depression.

In 1997, after campaigning vigorously, he was voted president of the APA by the widest margin in the association's history. As a researcher in an association now numerically dominated by clinicians, he was an unusual choice. His theme for his three-year term was an equally unusual choice: he'd push for a change in the focus of psychology, he announced, away from the study of some of the worst things in life to the study of what makes life worth living.

 

For years, Seligman had been assembling contacts and shaping his vision. On New Year's Day 1998, at a resort in Akumal, Mexico, he got together with fellow researcher Czikszentmihalyi and Ray Fowler, then the Executive Director of the APA, to brainstorm a taxonomy for a new field of Positive Psychology. They decided their new field would have three main pillars: the study of positive emotion, positive character, and positive institutions. They'd also recruit psychology's best and brightest to do longitudinal, demographic, and outcome studies--all unimpeachably rigorous and scientific--of everything from civic engagement to forgiveness.

Within a year, the Templeton Foundation (which specializes in the interface of science and religion) had approached Seligman to fund more research. In 1999, Seligman began to teach a Positive Psychology class at the University of Pennsylvania, assigning homework that included performing altruistic acts, writing autobiographies that showcased strengths, and making gratitude lists. The movement was on its way.

Growth of a Movement

In the seven years since the founding of Positive Psychology in Akumal, its adherents have done their best to lay claim to a large, sprawling, and only partially mapped field of inquiry, which they've framed as the study of happiness. The twists and turns of Seligman's exploration have been distilled into a simple and elegant theory of the three features that constitute happiness: the pleasant life, the good life, and the meaningful life.

He defines the "pleasant life" as characterized by fleeting positive moods and immediate experiences of comfort and pleasure. At its best, the pleasant life can be defined as the Epicureans did: the simple satisfaction of a mind and body at peace. It can be amplified by learning to savor good moments and to lighten up habitual patterns of thought. But in Seligman's scheme, the "pleasant life" is the least important aspect of happiness, because it depends heavily on an inherited positive temperament and on good fortune: luck and genes. Simply enjoying the pleasant life doesn't build character or resilience. It's perilously close to shallow hedonism, and when pursued too hard, it leads to a grasping "hedonic treadmill."

 

Seligman, who loves to work himself, is much more enthusiastic about the next tier of the pyramid: "the good life"--what Thomas Jefferson meant by happiness. This part of happiness is anchored in building a full life that goes well. It comes from exercising our talents and virtues--what Seligman calls our "signature strengths"--and it depends heavily on the ability to lose oneself in the earned pleasures of sustained effort, absorbing work, conversation, accomplishment, contemplation, or what Csikszentmihalyi calls "flow." To many people's surprise, studies in which people record their mood states in daily diaries have revealed that most people feel happy far more often at work than at home.

The third aspect of Seligman's happiness is the "meaningful life," defined as the dedication of one's life to something larger than yourself--something beyond family and personal or intellectual achievement. Although Seligman rarely uses these words, the meaningful life includes altruism and love. His definition harkens back to the Victorian moralists and to Enlightenment figures like Jefferson, who once said "Happiness is the aim of life, but virtue is the foundation of happiness." Meaningfulness is encouraged, Seligman says, by "positive institutions" that support the virtues--thriving schools, churches, community groups, and democracies--and is weakened by the splintered, consumeristic society that surrounds us. In a secular society barraged by advertising celebrating the individualistic and consumer-driven life, this approach to happiness is a tough sell.

Positive Psychology's massive public relations successes may have encouraged millions to take a fresh look at their attitudes and to think, at least fleetingly, about what really brings them satisfaction. But what happens when the movement moves from the realm of ideas to the realm of experience, and people try to carry out the snappy exhortations they read in a Time magazine article? Can descriptive research be made prescriptive? Can Positive Psychology materially change the lives of ordinary people?

Practicing Positive Psychology

In the fall of 2004, I had a chance to find out when I joined a Telecourse called "Authentic Happiness Coaching," presided over by Seligman from his office in Philadelphia. Every Thursday at 1:00 p.m. for 20 weeks, I sat at the telephone in my home in Toronto, Canada, linked not only to Seligman in Philadelphia, but to 190 fellow students. We came together to listen to lectures by Positive Psychology's leading lights, and to absorb research. We were also expected to try out practices distilled from grandma's wisdom and the sayings of the ancient Greeks and 19th-century moralists, all scientifically researched and packaged for a new secular century.

 

Some might consider me a hard case for this kind of stuff. For starters, there's my occupation: I'm neither a coach nor a therapist, but a producer for the Canadian Broadcasting System. As a journalist, I've tried through the years to hone my natural skills in critical thinking, which makes me wary. On top of that, my disposition is reflective, rueful, at times downright melancholy. I'm a former New Yorker descended from Jewish immigrants and refugees who fled Europe and the Holocaust. I grew up, like Woody Allen and many other Jews, with thoughts of historic catastrophe and personal discontent, each feeding the other. My family is a case study in how to live with a long list of cognitive distortions, from assuming the worst will happen to thinking it should, because either they deserved it or other people thought they did. Personally, when it came to rah-rah notions like "thinking positive," I remained decidedly ambivalent; I'd try them, and then curse myself for failing.

Four years ago, my doctors discovered a large, dangerous, benign brain tumor in my cerebellum. I survived three difficult brain surgeries (the last one should have killed me, said one doctor). I still work part-time, walk with a cane, and suffer from physical imbalance and fatigue. At times, it was hard to put a positive spin on all that, although knowing others who'd succumbed, I felt downright lucky. So I bucked myself up through four months in the hospital and a long recuperation. I'm rightly proud of my staying power and my sheer doggedness, which helped me during the many low points and reversals. Perhaps my pride in triumphing over odds--including my own temperament--explains why I'm a secret fan of self-help literature.

All told, I was delighted to take the Telecourse, thinking it might do me some good; but, yes, I did drag the rest of my character into the enterprise, too. Seligman--he had us call him "Marty"--has the silky baritone of an accomplished lecturer and was a delight to behold by telephone. Early on, he told us a story that he's told and retold in many interviews, about the experience that led him to come up with his version of Positive Psychology. In 1998, he was in the garden with his daughter Nikki, who was throwing weeds into the air and fooling around while Seligman was toiling away. Getting exasperated, he yelled at her for not taking her gardening more seriously. Nikki, who was only 5 at the time, looked straight at him and told him that, on her fifth birthday, she'd decided not be a whiner. She said it was the hardest thing that she'd ever done. "If I can stop whining, Daddy, you can stop being a grouch." This encounter, Seligman told us, forced him to further examine questions like: Why, after 30 years of inner work, was he still a grouch? Why have psychologists ignored positive emotion and well-being? How can we flourish as human beings?

The meat of the Telecourse was the weekly lecture, which deftly packaged Seligman's findings, collected from 30 years of research (by him and others). He ended the lectures with a homework assignment, which we'd discuss in our weekly "pods" or telephone tutorials, comprised of about 15 students. Our pod leaders assigned us different partners with whom to talk about our experiences of doing the exercises. A couple of weeks into the course, Marty gave us an exercise he called the Three Blessings. At the end of every day, we were to write down three good things that had happened to us, and why we found them beneficial. It seemed like a feel-good cliche--like "Count your blessings," the advice of grandmas everywhere.

I did the assignment like a good little student. And I was a bit dumfounded by what happened. For years, I'd kept diaries filled with ruminations--to blow off steam and to practice writing. They bored me when I wrote them, and only succeeded in tying me in knots. They read something like a transcript of the obsessions of Woody Allen's unfunny younger brother, stripped of any redeeming humor. Over the years, writing these morbid documents only made me feel worse.

 

Then, some years ago, I was assigned to criss-cross Canada producing documentaries on the environment. Before I left, I thought, if I were killed in a plane crash, I didn't want anybody to find my journals --they weren't what I wanted to be remember by. So I gathered them up, piles and piles of them, and tossed them out in the garbage. Even now, I imagine my notebooks depressing the trash that surrounds them in some landfill north of Toronto.

But Marty's assignment of diligently writing down three daily blessings asked me to pay attention to the good stuff, not the sores. As the Buddhists say, scratch the good dog, not the bad one. In years of writing drivel, I'd never done that before. It'd never even occurred to me to write out of a sense of pleasure.

I loved it.

I soon found that I had far more than three blessings to write about: conversations with friends and good, simple things, like walks and yoga sessions and exercise. By eleven or noon, I'd find myself stopping to check for what had gone well already. And lots of little things had! I began to mark little events in my mind, so I could include them in my notebook later that night. Reviewing my notebook, I discovered I often wrote about what I ate and drank (though I often experience great difficulty eating and drinking because of my surgeries). I relished small victories. It was simple stuff, but it worked in making me feel good.

Positive Psychology research, meanwhile, reassured me that writing my gratitude list wouldn't turn me into a softie, incapable of dealing with life's glancing blows. Strange as it seemed, being grateful might even better equip me. In a 2003 two-month experimental comparison conducted by psychologists Robert Emmons of the University of California at Davis and Michael McCullough of the University of Miami, volunteer subjects who kept gratitude journals on a weekly basis exercised more regularly, reported fewer physical symptoms, felt better about their lives, and were more optimistic about the upcoming week than subjects who recorded neutral life events or hassles, as I'd done for years.

 

Over time, cultivating gratitude helped me experience everyday events as gifts--part of the basic bounty of life. "For the grateful man," a Turkish proverb says. "the gnats make music." I kept the assignment up long past the due date, but eventually I stopped. Why, I don't know. Was I addicted to negativity? Lazy? Didn't know what was good for me?

The second most important exercise for me was the one that followed: we had to express gratitude to another human being. We were to pick a person important to us whom we'd never thanked, and then write him or her a letter describing what we valued in the relationship, and how it affected our lives. Marty told us that this was one of the most powerful exercises. It would make us happier, and make those who got the letters happier, too.

I picked a dear friend of mine, an 82-year-old Anglican priest I'd known for more than 25 years, who now lives in a retirement home. I love this man. When I was in my mid-thirties, I used to visit him in the country, where he had a rural parish. We had serious talks about God and philosophy. He loved to cook and garden, and had a grand appreciation for the natural world. I loved his eye for the wonders of creation, a gift from his God. But he isn't an overly pious man. He also shares my absurdist sense of humor. I'm his Jewish media friend, very different from the old ladies who used to lavish attention on him and bring him pot roast dinners. He isn't a father figure to me because he's hardly stern and has never given me personal advice. Jung has a better term for what he is to me: a warm, embracing "male mother."

So I sat down and wrote a letter detailing what he means to me. Then, following Marty's instruction, I called him up and told him I wanted to read him something . I arrived at his retirement home, cane in hand. Entering his small apartment, I embraced him, sat down in his new La-Z-Boy chair, and read him my gratitude letter. He smiled, looking a little puzzled. Then he folded the letter up and told me, "I'm not the sort who gets depressed, but if I ever do, I'll take this out and read it."

 

Struggling for Happiness

During our telephone lecture a few days later, Marty called on some students to describe their gratitude visits. All their stories seemed much better than mine. Their visits were life affirming, full of positive emotion. One fellow had given a letter to his wife as a birthday present. Another had taken the train to another city to read a letter to an old friend, who welcomed it as if it were a gift from God. I felt a little cheated. My visit was so matter of fact, so incidental--a hiccup in a long friendship, followed by a spot of tea.

Another exercise Marty had us do was to "design a good day." Since I wasn't working much at the time, I seemed always to be designing a nice day (as my wife kept telling me). So I began writing out lists of what I was going to do to have a good day, only to discover that I was just writing the simple chores that I'd do anyway. My messages to myself (about exercise and yoga and reading this book or that) created much amusement in my house. Lists are supposed to be for what you think you'll forget. My life was already an endless self-improvement exercise, without the benefit of great good health. But this assignment gave my leisure the dignity of a homework assignment.

There was much more, of course, to our curriculum in happiness. We took pen-and-pencil tests to identify our "signature strengths" (like perseverance, critical thinking, love of learning, social intelligence, spirituality, bravery, and zest). We were encouraged to try using them to turn a mundane task into one with "flow." We were sent out to savor routine events, like a meals or a walk in the park. We were even taught how to lower our expectations when we went shopping. Guest lecturer Barry Schwartz of Swarthmore College, the author of The Paradox of Choice, talked to us about the research showing that all the choice in our wealthy, consumer-driven world, could make you dither yourself into a state of unhappiness. For the first time in human history, huge numbers of people may become mental from all the choice in front of them. (Have you seen how many colors of beige there are?) All the choice can make people anxious about making mistakes--not getting the perfect "one." Schwartz sent us out shopping with this simple message: lower your expectations, and settle on something "good enough." This he calls "satisfysing," shorthand for not driving yourself crazy.

I went searching for a pair of winter boots way too late in the season. There was choice, but not many boots left. After trying different footware, I settled on a pair in a size that usually doesn't fit (it was shorter but wider), but that's all there was. When I got home, I completely panicked thinking I'd made a mistake. I worried that, because I bought the boots at a small store, I couldn't get my money back. So I went to other stores and tried on other pairs, just to see if I'd made the right choice. All in all, I spent more time looking for these $150 boots than I did buying the biggest investment in my life, my house. Schwartz was right: choice can make you plain neurotic, especially if you're neurotic to begin with.

I never told people this story: everybody in my pod was just too sane or on their best Positive Psychology behavior. Or perhaps they were more accomplished shoppers than I was, and didn't have my traces of OCD. This was more the stuff of Seinfeld than Authentic Happiness. I don't think that George was somebody Marty would approve of.

 

Listening to the Inner Cynic

But Seinfeld may have a point that Positive Psychology should consider. This show--famously devoted to "nothing"--is so popular precisely because it speaks to something elemental in ourselves. However much we may aspire to be solid citizens and publicly embody the classic virtues, the makers of Seinfeld captured our secret: we're filled with internal quirks, psychic peccadilloes, and unaccountable likes and dislikes, including many "negative" traits and predilections. Altogether, they're what make us distinctive, identifiable to ourselves as ourselves. Imagine Jerry Seinfeld without his characteristic sense of irony, or George or Elaine without their whining, which certainly wouldn't rank high on the Positive Psychology Scale of Approval.

At my worst moments in the course, I feared that positive psychologists were in danger of sandblasting the rough edges of individual personality and character to produce a shiny idealization of virtue. I wasn't at all sure that they appreciate how much the search for the "positive" can interfere with the natural rhythms of life; how necessary it is to include all the ups and downs, all the bumps and fissures that make us complete human beings.

During the course, I learned some truly valuable lessons about appreciation, gratitude, optimism, and the often underestimated role of conscious will and perseverance in the pursuit of happiness. And yet, as the weeks went by, I became gradually more aware that something about this experience just wasn't going deep enough; no new, positive roots were being planted. Was it simply the curmudgeon within me, my long-standing "bah-humbug" that kept me from getting with the program? Perhaps. But as our class continued marching relentlessly toward positiveness, I became aware of my own growing sense of difference. In short, I felt lonely.

I felt it when others raved about their epiphanies following the gratitude exercise. By contrast, all I could come up with was a pleasant, but low-key, anticlimax. I couldn't even bring myself to tell my boot-buying story! And I felt this same sense of loneliness during an exercise called "One Door Closes and Another Opens." Here, people talked about seemingly dreadful things that'd worked out well. One person didn't get the job he wanted, but got a better job instead. Another was fired, which prompted her to go into business for herself, forcing her to finally do what she always wanted to do, while making more money. I dared not say what I wanted to say: that even to the present day, behind some of the doors I've closed lay the lingering stench of regret.

 

So, instead of revelling in a connection with 200 souls in exploring the true meaning of life, I often found myself retreating into my own solitary consciousness. I knew what was required of me as a good student: that I be upbeat and cooperative in our discussion groups between classes--our pods. But it seemed that the conversations lacked openness and candor, and had little spontaneity. Our happiness lessons and tasks dominated the agenda; ordinary human vulnerability and undue attention to tragedy, failure, disappointment, and loss weren't permitted, except as asides. Once I talked about "the inevitability of suffering," and ended up feeling like a jerk. Nice, positive people don't think, much less talk, about such things. Or if they do, they have to "move on" quickly. Negative emotion is only acceptable if it's in the past.

After the stilted atmosphere of the discussion groups, however, I was always a little surprised to discover that whenever a homework assignment gave me an opportunity to talk one-on-one with my fellow pod members, they were bright, alive, and interesting, and I felt a real, authentic connection. But however simpatico I might feel, even with the most sympathetic partner, there was one topic I never brought up: how much shame I found myself feeling as the course dragged on.

What was I ashamed of? How could a course on Positive Psychology shame a smart, cynical person like me? I was ashamed of my loneliness, sure (though I knew the course wasn't therapy). But I was also ashamed that I didn't seem to "get it." As the course, and the brutal Canadian winter unfolded, I often felt in the pods that I was a small, nasty person who knew he'd best keep all of his doubts and inadequacies well hidden. I simply couldn't be as positive as Seligman or his instructors wanted me to be. And like the George character on Seinfeld, I felt ridiculous. But, unfortunately, I didn't have Jerry and the gang to kvetch to over lunch.

To be sure, Seligman wisely includes community--and the devotion to a cause larger than the lonely, isolated self--as one of the keys to a "meaningful life." Yet the actual experience of the course seemed to ignore the deep human hunger for real community. If our culture's infatuation with the "maximal self," as Seligman describes our inbred individualism, is one of the major causes of unhappiness in our time, then surely a course in Positive Psychology ought to make genuine human connection a central element, at least in the small community of the pods. But the structure of the course and its implicit pressure to "be positive," whatever the cost, undermined the experience of this critical source of human satisfaction. True, we only had 20 weeks. And true, our last homework assignment was to go out and join an organization. But it was as if we were being told, "Okay, folks, commit to something larger than ourselves. But you're on your own, from here on in." I know Seligman was trying to condense a lifetime's work into a few short weeks, but just because you're a great lecturer doesn't mean the message gets embedded in people's lives: that's what the real work of human culture is about.

 

Oddly enough, while we were never supposed to give in to negativity and depression, they both shadowed the whole course; they were the unacknowledged elephants lurking in the corner. It sometimes felt that the strategies of Positive Psychology--shopping trips, savoring tips, play days, counting blessings, and gratitude exercises--were being used as amulets to ward off life's inevitable miseries. If you suffered from these miseries, Seligman eventually advised that you see a REAL therapist, quickly. But if you weren't "clinically depressed," the full range of human mood seemed to be something to be engineered out of your soul. He told us to dispute our bad moods in the theater of our minds, like the lawyerly cognitive therapists we should all learn to be--as if negativity were just a kind of superstitious taboo. In the end, I thought, Positive Psychology shares with that very unscientific cousin, positive thinking, this one thing: if you don't have the right optimistic temperament, you need to regularly apply heavy doses of intentionality and embrace the positive with an iron will. In this, there's an odd parallel between Freud and the positive psychologists: repression, said Freud, is at the heart of civilization. And it's at the heart of Positive Psychology.

Seligman himself spoke about depression during almost every session, and admitted freely to being temperamentally pessimistic, though he never called himself a depressive, recovering or not. But when he did point out his negative quirks, it was as if to remind us (and himself, perhaps) that they'd been resolutely banished to his past life. My pod leader admitted to being a reformed hysteric--a catastrophist who'd learned to soothe herself when little details of her life went awry. It had required work for her to get past these feelings, but it wasn't that hard to do: you just had to use a few cue words and internal exercises. As with Seligman's depressive tendencies, it felt as though she was telling us to throw our negative feelings into the dirty laundry basket.

The point of these admissions by Seligman and others was to renounce "the dark side" as castoffs from an old personality--primitive throwbacks to an earlier, less evolved self we in the class should learning to transcend. To improve ourselves in this way, we should all be vigorously programming ourselves by doing the exercises and tests, "disputing ourselves" out of our negativity when it showed its atavistic head.

Seligman says he's interested in restoring old-time character to its rightful place--a worthy goal for our self-indulgent time. But does that mean that we must return to the rigid Victorian rule that you keep all your darkness under wraps; let the world see your Dr. Jeykll and keep your Mr. Hyde to yourself? One of the great advances made by the much maligned therapeutic culture is that it actually allows people to look compassionately at their own pain and gives them the vocabulary to describe it. Therapy helps them eliminate the necessity of suffering in silent shame. For all the powerful insights of Positive Psychology, it won't advance the cause of human happiness if it too enthusiastically endorses the antiquated ethic of the stiff upper lip.

 

Certainly Seligman and his colleagues can claim credit for turning the fuzzy, mushy concept of happiness--always before the exclusive purview of poets and philosophers--into a truly objective, empirically backed science. They've systemically defined particular habits of thought, will, intention, and feeling that are correlated with the good life. And these pioneers have even gone further; for that we should be thankful. They're constructing from this new science a set of principles, a practical discipline, a program of concrete procedures and exercises whereby those of us not naturally blessed with the gift of happiness can learn how to acquire it. Is this the culmination of America's revolutionary promise--the pursuit of happiness--or what?

But a basic question still nags at me. Whatever science might discover about the constitution of happiness and optimism, is it possible for science to teach us how to get them? Can you teach human beings the proper principles of living by displaying your evidence and drawing from it a series of rules that people can learn in 20 weeks? Is it really possible to devise a system, a curriculum of happiness that we can really weave into the fabric of our daily lives? Can this system become as much a part of our neural makeup as, say, the ability to read or ride a bicycle? No doubt we can all learn better habits of mind that'll relieve suffering and reduce our tendency to fly toward misery rather than away from it--after all, that's the basis of cognitive therapy. But learning how to be happy, wise, and virtuous still seems far too difficult and elusive a quest to be fulfilled by taking a didactic course, no matter how scientific its pedigree.

Seligman has undoubtedly done the field of psychology an enormous service by demonstrating that, for any science purporting to understand human nature, the study of what makes people happy, optimistic, and wise is just as important as the study of what makes them anxious, depressed, and crazy. If this work did no more than remind a therapy-soaked population that grandma's old values--gratitude, forgiveness, generosity, selflessness, dedication to something larger than oneself--have never been surpassed as the map to a life well lived, it would be worthwhile. Reminding us what's valuable in our lost traditions is no small thing. And yet, I still am left wondering if the spark that fires the flame of happiness, the will to try for the optimistic life, must come from something deeper, more mysterious, less definable than anything science can devise. After all, the question of what makes for a happy, meaningful, worthwhile life has preoccupied philosophers, mystics, and masters of ancient wisdom traditions since the beginning of human history. Will we finally be able to resolve this primeval riddle with a neat, scientifically based set of cognitive procedures and prescriptions? Allow me this last bit of negativity--I have my doubts.

Richard Handler is a radio producer with the Canadian Broadcasting Corporation in Toronto, Canada. Contact: rhandler@sympatico.ca. Letters to the Editor about this department may be e-mailed to letters@psychnetworker.org.

 

 

Rediscovering the Myth

For John O'Donohue, Therapy Is a Journey into the Unknown Self

by Mary Sykes Wylie

Psychotherapy's preoccupation with personal troubles can seem like a self-indulgent luxury in the harsh Irish countryside near Conamara, where poet, philosopher, and former priest John O'Donohue makes his home. According to a commonly told local story, one day during World War II, two German fighter planes circled overhead. One pilot radioed the other asking, "Should we bomb it?" Looking down, the other pilot radioed back, "I think it's been bombed already." As O'Donohue, a tall, rangy man with amused eyes and a sudden, piercing laugh, puts it, "This landscape absolutely minimizes any kind of supposed significance of human words or thought; your pet ideas unravel very fast. It can be so desolating that it makes you feel how nomadic and transient you are--all this was here hundreds of millions of years before humans-come-lately arrived. It makes you aware of our own arrogance, human orphans as we are, who think the whole of existence is all about us."

His Irish upbringing among rural, traditionally reserved people, has enabled O'Donohue to bring an outsider's perspective to our therapy-obsessed culture's insistence on revealing all the intimate details of our own lives and uncovering those of other people. "Americans have a sweet and touching need to personalize everything," he remarks with affectionate irony. "I found that, in America, if I put too much sincerity into the question, 'How are you?' I could unleash an entire biography. In my village, you wouldn't ask a full-frontal question to anybody--you'd read the signs in the person, take stock of him or her, keep your distance, and then, maybe, you might get a glimpse of what was going on inside." For good measure, he adds, quoting poet Rainer Maria Rilke, "I won't go to a psychologist because I'm afraid that if my demons leave, my angels will as well."

Nevertheless O'Donohue has begun to build up a small but devoted following in the therapy world, a following that mushroomed dramatically at last spring's Networker Symposium in Washington, D.C., where, in spite of the fact that few people had ever heard of him initially, his appearances became the talk the meeting. His poetry reading on the meeting's opening day in particular became such a word-of-mouth sensation that it later sparked a run on the conference taping service. When O'Donohue's new fans discovered that the reading hadn't been taped, the occasion itself became something of an instant legend: afterward, stories about it passed along from those who'd been there to those unfortunates who hadn't been so lucky, leaving the latter feeling they'd missed the biggest event at the conference. Fortunately, Symposium attendees will have another chance to hear John O'Donohue, who'll be a keynoter at the 2006 conference.

This said, the reasons behind O'Donohue's impact are a bit mysterious. He spoke about beauty, creativity, poetry, the divine. He delivered exuberant lyrical riffs--"blasts" he calls them--on the meaning of true identity; the holy power of language; the divine gift of imagination; the dialectic between visible and invisible, presence and absence, longing and belonging; the fundamental mystery of the self. He laced his almost incantatory flow of words with his own luminous poems, though the line between his poetry and everything else he said wasn't easy to draw. It wasn't even always entirely clear afterward what O'Donohue had been talking about--these were less logical discourses than extravagant wordfests. So how did he so deeply move an audience usually impressed far more by practical clinical tools than rhapsodic flights of the imagination?

 

Therapists in the audience had less to say about the information O'Donohue conveyed than about how he managed to open their inner beings to an entirely new way of perceiving the world. "He said such astonishing things, like 'When we move away from our houses, do our houses miss us?'And the shift he created, literally, smacked you in the face, demanded that you go somewhere in your mind you hadn't been before," says Richard Goldberg, a clinical social worker in Bethesda, Maryland. "It's as if he's come from some different, remote place, and he somehow touches you in that same remote place that you'd forgotten you had inside yourself," said Virginia psychologist Charles Cerutti. Lisa Tillman, a therapist in Baltimore, Maryland, thought that "something happens in people's brains when they hear language so precisely tuned into the soul. He has the ability to make that happen." Of course," she added, echoing several other people, "it didn't hurt that he also had an Irish brogue."

O'Donohue seemed to tap into a yearning in his audience not often addressed in today's therapeutic culture. At a time when the pressure is on to do ever briefer, more technical, symptom-focused, "evidence-based," standardized therapies, to make ever greater use of psychopharmacological agents, to slavishly follow DSM diagnostic categories, and to rationalize every moment of a clinical encounter, he reminded his listeners what a noble, even sacred, calling therapy can be. Quoting Plato's Symposium, he said that "one of the greatest privileges of the human being is to become a midwife to the birth of the soul in another person." This is what therapy is about, he added--"helping people retrieve what has been lost to them; wakening and bringing home their fundamental wholesomeness." Therapists are like poets or priests, he noted: they draw on the power of words in the profoundly creative work of bringing people fully alive to themselves, awakening in them the human capacity for divine imagination that "dreams our completion."

But perhaps most of all, O'Donohue reawakened his listeners to the fundamental mystery that surrounds our existence. "In focusing on how people work, we've lost a sense of reverence for the deep mystery of who they are. We have lost sight of the mystery in the primal fact of human presence--that we are here at all." He suggested that the most important dimensions of human experience are those we can't see and grasp and measure, which demands the most reverent attention from a therapist. "I'd love a return to that old way of considering human identity not just as biographical drama, but as sacred mystery."

A scholar, bestselling author, internationally known speaker, and corporate consultant, O'Donohue is clearly both successful and comfortable in the 21st century. And yet he also seems to be something of an historical throwback--like a 19th-century nature poet or 13th-century mystic, living in an 18th-century cottage, surrounded by 1st-century Celtic ghosts. Although he resists our modern tendency to reduce personal identity to the mere external facts of biography, we can't help but wonder how this interesting human anomaly came to be.

 

The Making of a Poet

O'Donohue grew up in a premodern world of rural peasantry that would be almost unrecognizable to most Americans or Western Europeans today. The oldest of four children, he was born on a farm in Conamara--his father was a farmer and stonemason--surrounded by animals, in a community that probably hadn't changed much in hundreds of years. His family had no electricity until he was nearly 10, and, in the evening, the oil lamps and candles created a small island of softly flickering light encircled by a penumbra of shadow fading off into deep, mysterious darkness. "It seemed to me, as a child, that the area of light was really an abbreviation of the dark presence of the house, and that there was a huge interim world between where light ended and true darkness began."

Outside the house where O'Donohue's family lived, nature was a constant, living presence, both intimate and vast, in which it must have been easy to imagine the existence of whole colonies of primal, wayward spirits, not at all submissive to human schemes and intentions. Although O'Donohue's family wasn't overtly "religious" in any rigidly doctrinaire way, he says, there was a great sense of spirituality in the house, along with a family ethic of nonjudgmental kindness. His mother was humorous and often irreverent, "with a wild kind of mind, very sharp, very bright," while his father seems to have been something of a mystic himself. "My father was the holiest man I ever knew; more in the presence of God than anyone I've ever met," recalls O'Donohue. "He could be great fun, and was very attentive, but his spirit was tuned into the divine, his mind and heart lingering there. If he was working in a field alone in the mountain, or on one of the open gardens we had, when you brought him up a tea or that, you'd often hear him praying before you'd see him. Being with him, you knew he had it--his presence was like a doorway opening to the divine. He also had a great sense of the transience of things, and a wariness of getting entangled in the world, which I guess kind of came over me, too. 'Life is like a mist on the hillside,' he used to say, 'look, and it's there. Look again, and it's gone.' "

O'Donohue went away to a boarding school at 12, and then, at 18, to St. Patrick's College Maynooth, Ireland's national seminary--one of the largest and most celebrated learning centers in Europe--where he began training for the priesthood. Why the priesthood? Certainly, it wasn't something his family had pressured him to do. "The idea of making money never appealed to me," he explains. "Ever since I was very young, like my father, I had the same informing intuition of transience--that everything is passing--and I wanted to do something that would make things eternal in some way. I considered medicine, but then thought that if I didn't have a go at the priesthood, I'd always be kind of restless about it; it would always follow me."

But O'Donohue almost gave this path up during the first year of seminary, when he faced "six months of complete aridity," as he calls it. "I was there studying to be a priest because I wanted to participate in the huge, infinite intimacy with the divine, but I fell into a state of feeling complete, terrifying nothingness. I began to doubt that there was any divine at all--there was just nothing there. I began to believe I'd been duped." He now remembers this terrible trial as one of his first great lessons in the tough struggle of true spiritual growth, which isn't necessarily a feel-good course in personal uplift. "I learned that there's a huge difference between feeling and presence  in the world of the mystical," he says. "When you feel absolutely nothing, or only absence, that can be actually the most refined form of presence. While I was going through it, I just knew it was a desert, but revisiting it, I begin to see it as a huge pruning of the spirit--like a false skin of protectiveness falling away."

 

While O'Donohue was never exactly a docile parish priest, he never thundered his rebellion against what he disliked. Instead, he staged a quiet, determined, persistent campaign in opposition to what he felt were some of the church's most egregious failings, including its rigid hierarchy, its fear of the feminine, and its hostility to sexuality. "I thought that sexual morality was people's own business, not the church's, and never believed in the demonization of the body," he says. "The most honest thing in human presence is the body--more honest than the mind, which is often twisted. I spoke in sermons about the lyrical beauty and innocence of the body, and tried to help people get away from the idea that sexuality was sinful, arguing instead that, for all the ambivalence we feel about sexuality, it was a creative, beautiful, and good thing in life."

Four years after he was ordained a priest, he went off to Germany to get a Ph.D. from the University of Tübingen, where he wrote a dissertation in German on the notoriously difficult philosopher Friedrich Hegel. "Through the grace of ignorance, I had no idea when I began just how difficult it was going to get," he recalls. "It was pure work, total work, work and work and work. That we don't know the future is our greatest protection. If I'd seen the amount and depth of the work I'd have to do, both learning the language and writing about Hegel, I don't think I could have done it." Nonetheless, after four years inside what he calls "the white monastery of Hegel's thought," he completed the dissertation and saw it published in 1993 and favorably reviewed by a slew of German, French, Spanish, and English critics.

In 1990, he took up the more quotidian concerns of leading a parish in County Clare. He also threw himself into a 10-year, ultimately successful, struggle to save Mullaghmore, a beautiful, unspoiled mountain in the Burren area from development as a major tourist site. At the same time that he was working to protect this ancient, natural place, he was also rediscovering another ancient birthright--Celtic culture and mythology--which, itself, was echoed and reflected in the Gaelic language, and even in the stories, anecdotes, references, and expressions used by his family and neighbors. Many people in this part of Ireland (including O'Donohue) still speak Gaelic, a language freighted with historical and social significance. Even regulation English, when spoken by the local people, reflects, says O'Donohue, "the colorful ghost of our real language, which was stolen from us by our colonizers." Furthermore, the souls of these Celtic forebears, their descendants still living in the villages, working in the fields, all somehow belonged to and seemed to have emerged from--even merged with--the palpably living, breathing, perhaps conscious and watchful, landscape itself.

During the 1990s, O'Donohue began putting this vision of Conamara's people and landscape to words, publishing his first book of poetry, Echoes of Memory, in 1994, and a second, Conamara Blues, in 2000. In both books, human love, longing, grief, memory, and faith are witnessed through the prism of, and haunted by, the brooding, timeless presence of nature. O'Donohue had begun writing poetry at about 18 or 19 on an impulse, he says, "stirred by experience too rich for normal words." It seems fair to say that, for him, language itself is in some sense holy. He cites the famous passage from the gospel according to John--"In the beginning was the Word, and the Word was with God, and the Word was God"--adding that he feels that poetry is as close to divinely inspired utterance as human beings can produce.

 

O'Donohue describes his own fraught encounters with the ungovernable muse of poetry as something like wrestling with angels. "I have a great terror of the white page. I hate going to my desk in the morning, because it's all or nothing when you sit down. When you submit yourself to this kind of rigor, of finding the form for something, what absolutely begins to emerge is something you'd never anticipate, something you can't control-- it knows it needs to come through. In some sense, everything you've ever experienced knows more about itself than you ever will. When I'm touched by a certain experience and start trying to go after it by writing it down, I often find it goes off in another direction completely, and, frequently, I find another experience is concealed there behind the first, but only now just showing itself. There's wildness, passion, spontaneity, and freedom in it. Poems are the most sublime individualities, living actualities. They aren't about anything, they are the thing itself--they just are ."

By 1995, O'Donohue began what he calls the "long journey to resignation from the priesthood." He now says that the best decision he ever made was to become a priest, and the second best decision was to resign from the priesthood. The priesthood refined and directed his inherent sense of reverence and spirituality, opened new intellectual worlds, made him lifelong friends, and introduced him to the work of thinkers and mystics that would help shape the contours of his mind. But by the mid-'90s, he was finding it ever harder to openly and honestly represent church positions he found increasingly untenable. He also crossed swords with a new bishop, who, O'Donohue says delicately, "wasn't overburdened with hospitality toward the kind of vision I had." Specifically, he insisted on assigning O'Donohue to full-time duties as a parish priest, which wouldn't allow him any time to write, and there was no possibility of compromise.

Even though O'Donohue could see no other path but to leave, it was a wrenching break. "I made the decision very slowly, over a long time--and it was a very lonesome time. What I loved most was celebrating the Eucharist. That's where the action is--the place where divine and human meet in ultimate togetherness. Sacrificing that was, for me, the loneliest, most forsaken thing."

But shortly after taking this portentous step, he was freed to write, and write he did. His book Anam Cara, about Celtic spirituality and its relevance for the postmodern era, was published in 1997. It became an international bestseller and has been translated into 20 languages. Another book, Eternal Echoes, was published in 1998, and it, too, became a bestseller in Europe, Australia, and America. In his most recent book, Beauty: The Invisible Embrace, published in 2004, O'Donohue explores the physical, emotional, and spiritual experience of beauty and protests the commonplace notion that beauty is an extraneous luxury, which "practical" people can do without.

 

An Unlikely Friendship

O'Donohue's introduction to the therapy field came through his unlikely friendship with neuropsychiatrist Daniel Siegel, known for his book  The Developing Mind and his pathbreaking efforts to help therapists develop an understanding of how the brain develops and changes in response to human relationships. As Siegel was working on his book, an intricately constructed synthesis of evolutionary biology, neuroscience, and developmental psychology, with forays into attachment research, cognitive science, the study of emotion, and complexity theory, he came across O'Donohue's poetry. Recalls Siegel, "It seemed to me that he described, in a beautifully poetic way, the human mind in a state of inner coherence or neural integration--which is my subject--and how both solitude and relationship can act in tandem to bring a sense of mental and emotional wholeness."

Siegel cited Anam Cara in his own book and tried to contact Donohue directly, without success. Several years later, he saw a poster for a 10-day retreat O'Donohue was giving in Ireland and, as a birthday present, sent his wife--who's of Irish descent--to the retreat. She came back exhilarated, saying that it had changed her life. A few months later, she returned the favor and sent Siegel to a week-long conference led by O'Donohue, this time, on the coast of Oregon. Between O'Donohue's talks, the poetry jam sessions, the meditations and long walks together on the beach, O'Donohue and Siegel got to know each other. Each seems to feel he's found in the other a true "soul friend"--the meaning of the Gaelic words Anam Cara --a teacher, affectionate companion, and spiritual guide who completes the other's unfinished self in some way.

As the two men talked, they discovered a common interest in "poetry and the brain, poetry  in the brain, poetry of the brain"--the details of which weren't entirely clear. It was clear, however, that Siegel's insights about interpersonal neurobiology dovetailed with O'Donohue's lyrical and mystical sensibility, and that both recognized intuitively the connection between the hard facts of neurobiology and the more illusive reality of emotion, imagination, creativity, and spirituality. For Siegel, O'Donohue is "living poetry," the walking incarnation of profound neural integration of the "logical, linear, literal left brain and the somatic, visual, emotional, ambiguity-loving right. Listening to him evokes a profound state of integration in us."

For his part, O'Donohue has been amazed to discover from Siegel just how inherently mystical and poetic the physical brain actually is. "In my ignorance, I presumed that the brain was a fixed, closed object of control, execution, and measurement--a kind of central headquarters for thought and so forth," he says. "But, actually, I learned from Dan that your experience shapes the kind of brain you have, and the brain you have shapes your experience. There's this amazingly intimate and subversive mutuality between your mind and brain. All the mirroring you do of the world--your gathering of information and communications, your sense of yourself--all occurs within this huge poetic, organic matrix. The brain is actually a poetic reservoir that loves possibility and makes connections we normally think would never be made. It's a lattice of subtle meshing that holds the fragile dust of spirit together to make the 'whoness' of who we are."

 

Both partners in this unusual pairing of brain scientist and poet-mystic share a disenchantment with the usual rigid dualism assumed to exist between the hard, objective logic of science and the soft, subjective imaginings of spirituality and art. They've begun to take their joint show on the road, giving workshops together, each spinning curlicued improvisations off the thoughts and insights of the other. For Siegel, speaking as a therapist and scientist with his own lyrical sensibility, the essence of good therapy is to establish with clients a deeply attuned, responsive relationship that helps a brain state of neural cacophony become a harmonious polyphonic choir, which is "flexible, adaptable, coherent, energized, and stable." For O'Donohue, the therapist, like the poet or priest, doesn't "fix" people, or "manage" them, or make them more "functional," but inspires and guides them on journeys only they can undertake into the deep territory of their unknown selves.

"The idea isn't to give people answers, or lead their bark of longing into a safe, dull, protected harbor," says O'Donohue, "but to make them aware of the depths of possibility in their hearts and lives; help them remove the barriers that keep them from being the people they were meant to be. In therapy, people tend to ask the 'how' questions-- how do you express anger, how do you deal with others, how do you show your personality, how have you become who you are. What's more interesting is the question of who. HASH(0xcafa0f8) Who are you really? The essence of who you are is ultimately mysterious, ungraspable and numinous--completely different from every other structure of matter. When people get into therapy, or when they need healing, their real hope is that they'll come to the secret frontier in themselves, some unknown source of energy and healing in themselves, where the divinity of 'whoness' is protected. This is a spiritual quest." O'Donohue clearly yearns for an era that seems to have just about vanished from the Western world--except perhaps in the Irish equivalent of Brigadoon where he hangs out. "I was born in a rural, peasant community and grew up in the midst of a folk consciousness, rooted in the land, which had taken hundreds of years to emerge and was much more subtle and mysterious than anything in Freud's Introductory Lectures. If you live in a community like this, people don't show themselves to you directly, but only in an oblique, suggestive way." He feels that the lack of respect in American culture for true privacy, for the fundamental ineffability of the deep self, has spawned an obsession with surface appearances that feeds our ravenous celebrity worship. Says O'Donohue. "I think that the pervasive loneliness of our times is related to this obsessive adoration of ever-changing surfaces--the computer screen is a good metaphor--and an addiction to keeping up a bright facade. People look so good on the surface that you'd never suspect how lost they are underneath."

Remembering the mysterious shadowy space between light and dark in his childhood home, he wonders if the momentous shift to electrical lighting, with its severe, glaring, unshadowed light, has transformed the way modern people actually view the world and each other. This "neon consciousness," as he calls it, can't tolerate ambiguity, darkness, mystery. But trying to shine a glaring, blinding flashlight into the deep center of a person's being will not, in the end, reveal anything worth seeing. "Severity of light banishes all shadows. In terms of human interiority, if you bring an electric neon band of light to shine on the inner world of thought and imagination, you'll never write a poem or compose a piece of music or paint a picture or make a sculpture. If you try to see through to the bottom of a person's being, all you'll find is a false bottom, an ersatz kind of depth, with no nourishment in it, no fecund darkness; the real depths won't show up. The excitement of creativity is something that emerges from the darkness quite mysteriously. If you completely wipe out the darkness, nothing can come forth."

In fact, it's at the threshold between knowing and not knowing, between complete mystery and full disclosure, between invisibility and visibility, at the boundary between dark unconscious and the light of awareness, O'Donohue suggests, that imagination has its fullest play. He describes a mountain near his home, with fog hiding its summit. "You know it's there, but you cannot see it with the eye. This is a wonderful living metaphor for the imagination. Around every life are these adjacencies--these huge, invisible presences that you can't pick up with the human eye, but that you can connect to viscerally and affectively through the power of imagination. This is the threshold where polarities can enter into conversation with each other, and take us to new levels of complexity, differentiation, and integration."

 

The Old Becomes New

Essentially, all John O'Donohue is doing is asking us to reflect on some of the same old questions mystics and spiritual guides have asked throughout the ages: Who are we? Where have we come from? Why are we here? What do we truly want? These are the grand, old chestnuts of philosophy and spirituality. We may still even vaguely remember them, like faint echoes from an earlier, more archaic time. And yet, somehow, through his astonishing way with language and incandescent presence, O'Donohue makes these old echoes ring again; makes the questions seem urgent, critically important, not only to our happiness, but to our very existence. Listening to him, we feel something stirring inside, something quickening, as if some buried yearning were being awakened. "There are certain rhythms and sounds of language that have their own atmosphere," he says. "What affects you is the atmospherics of language. The weather of language gets inside you. It's something intangible and illusive, but intimate and transforming." Lightly, even gaily, with what seems like no effort whatsoever, he creates a kind of climate change within every person whose heart and mind isn't terminally climate controlled.

How does he do this? The short answer is that John O'Donohue is an artist and this, to the extent of their talent, is what artists do. As an artist, he spins straw words into golden language, delivers them with all the brio of a born performer, enables us to experience the archaic world in a new, thrilling way. Perhaps one key to his appeal to therapists is that he does them the honor of suggesting that, at their best, they, too, have the power to be artists, midwives of the imagination, guides to the lost beauty their clients can no longer see in themselves. The other key may be that in a field increasingly focused on solutions and influenced by positive psychology, O'Donohue expresses an unflinching belief, deeply embedded in all the great spiritual traditions, that suffering isn't only inevitable in human life, but may also be a great opening to transcendence. He quotes again from Plato, "'All thought begins with the recognition that something is out of place,'" and adds, "Arriving into conception, into the womb, and then into birth is a primal act of rupture and disturbance, and all through human experience, that fracture doesn't let us be completely ourselves." If this is true, then the inherently human state of being "out of place" in the universe is the source of all our suffering, but also of the human imagination--born of the need to repair or transcend the primal rupture.

At the heart of O'Donohue's appeal is his ability to evoke the astonishing mystery of the human presence on earth--our peculiar, difficult place between earth and heaven. "We humans are the strangest creatures," he says. "Outside my window, all the time, this raggle-taggle group of white mystics known as Conamara sheep wanders back and forth, showing no level of metaphysical disturbance at all. They're as completely at one with the places they're in as the stones and lakes and mountains. We are the only creatures who are in-between. We're of the earth, but don't belong to it, because we strain after the heavens; and yet the heavens aren't fully in us. So this wonderful, restless, eternal longing in us has us always on a quest."

Mary Sykes Wylie, Ph.D., is a senior editor of the Psychotherapy Networker .

 

The Poetics of Progress Notes

Using Your Imagination with Tough Cases

by Brad Sachs

Like many therapists, I know what it's like to dread having to write up case notes after my sessions, and how tempting it is to find ways to put off the task. But through the years, I've discovered that because of the many overlaps between psychotherapy and writing, broadening the definition of what it means to "write up case notes" can actually heighten my awareness of what's happening in my work.

While we're generally trained to focus on preparing notes that are clinical and objective, confining ourselves to this format severely restricts the creative potential of the process. It's interesting to consider, in fact, that although many clinicians encourage their patients to keep a journal, draft real or imaginary letters to family members, and compose poetry, few clinicians use creative writing in their own work.

The act of writing is, in its most elemental form, an act of self-discovery. At its core, it brings into awareness a conversation between what's alive and what's dying in ourselves, what's limiting and free, what's observable and shadowy. Writing isn't just a transcription of what we know; it can also reveal to us what we don't know, what we don't know that we know, and what we don't want to know. When it comes to progress notes, delving into our reluctance to write about a particular client has the potential to help us think about a case in new and clinically valuable ways, rather than simply making us feel guilty.

There are many ways to write progress notes that tap a therapist's imagination and enhance what goes on in therapy. One is what I call the Reverie Poem. As clinicians, all of us have had the experience of having our minds drift during a session. With practice and self-discipline, most of us learn to gently nudge ourselves out of our reveries. But another approach involves being more attentive to our inner meanderings to see whether they lead to useful clinical clues.

I was once treating a woman, Wendy, with whom I was having great difficulty empathizing. Despite the litany of quite legitimate complaints she had about her life--a callous, philandering father; a mother who was simultaneously clingy and rejecting; a thwarted escape from her family into a dismal marriage with a remote alcoholic who absolved himself of almost all childrearing responsibilities--during sessions, I'd almost instantly find myself reflecting upon anything but what she was saying.

 

Writing up my sessions with Wendy was a further exercise in futility. I remembered very little about what she'd said as I struggled to implement some kind of treatment plan. Then, after one particularly frustrating session, I wrote the following poem to try to make sense of the trancelike musings that overtook me in Wendy's presence:

Three Minutes of Therapy

It's like I can't feel

I can't even feel

The feeling of not feeling

The O'Keeffe on my wall

Its glowing wombs

When I'm with my kids

It's as if I'm not with them

They could be anyone's kids

The mocha drink in the fridge

I'm like my own mother with them,

So cut off, so remote

It's 9:53

I despise her

But I'm just like her

It's all I can do to get through the afternoons

And I'm desperate for my glass of wine

Sometimes two

A glass of red wine

The late afternoon sun

Will I ever return to Italy?

dizzy with wine

Until I can get them off to bed

And then the emptiness

The sandwich I made for my lunch

So much earlier this morning

It's just me and my husband

Did I bring the rice?

Although he's so busy with the computer

I can avoid him more easily

Than the kids

My daughter fell asleep before I got to say goodnight to her

Last night

Because I was too busy on the phone

asleep before he even gets upstairs

And then he's gone before I wake up

9:55, halfway through

months, I guess,

I don't even think about it anymore

I don't even think he thinks about it anymore

Yes, I believe the rice is there,

I know I brought it

divorce, but would I be better off?

What would it accomplish?

The O'Keeffe on my wall

The glowing, empty wombs . . .

 

Reading the poem afterward, I became aware that my personal wool-gathering had to do with profound emptiness --the wombs in the O'Keeffe painting on my wall, the incessant focus on food and drink, the absence of contact with my own child (playing the role of my patient's callous father, "philandering" with whomever I'd been on the phone with when my daughter was ready and waiting for me to tuck her in). I realized that it was my own fears of encountering my patient's profound emptiness that kept me so disengaged from her.

Reading the poem inspired by my session with Wendy crystallized for me how dutiful she was. She was essentially raising her two children as a single mother while tending to her adolescent-acting husband. She volunteered at the children's school and was team manager for her girls' lacrosse teams. She also regularly fielded her mother's calls for medical advice and made herself available to drive her to appointments, even though they lived almost an hour apart.

Perhaps, it occurred to me, her responsibilities were so oppressive that they were oppressing me, prompting me to avoid attending to her by allowing my own attention to roam. My reverie may have been serving the same purpose for me that her drinking did for her--allowing for a momentary break from a suffocating reality. After this insight, I was able to rouse myself from my previous torpor and focus on our sessions with more clarity. I helped Wendy begin to examine her ambivalence about setting limits with her children, her husband, and her mother. I encouraged her to start looking for ways to nourish and gratify herself that didn't rely entirely on meeting others' needs.

Thinking more about her own needs, she joined a senior swim team, and insisted that her husband be home the two evenings a week she practiced to supervise the girls' homework and nighttime routine, which, to her surprise, he agreed to do. She made some calls to a senior-support services center in her mom's neighborhood, and found that they offered free transportation for local seniors' medical appointments, which unburdened her as well. She also began attending Al-Anon meetings.

 

In retrospect, my poetic exploration of my own absentmindedness enabled me to enter Wendy's psychic landscape more fully than I'd have otherwise been able to. Connecting with her in this new way changed the whole direction of our work together.

Since then, I've explored other ways of using writing to offer fresh perspectives on a case. Sometimes I've written a reverie-based poem, along the lines of the one I wrote about Wendy, but from the patient's viewpoint, imagining the subnarrative that might be going on within her during a session. Other times I've interviewed my inner censor in an effort to ascertain why I'm reluctant to write about a patient, posing questions like:

What do you want from me?

What do you want to keep me from ?

Who do you remind me of?

Who does this patient remind me of?

How might we become partners, rather than adversaries?

What keeps me separated from my patient, making me unable to write about him/her?

How could I honor you and still write what needs to be written?

What would I lose by being freed to write about this patient?

What would I gain by being freed to write about this patient?

 

Therapists have often asked me whether it's ever a good idea to share their creative progress notes with their patients. I've never done so, although I've been tempted to many times. I suppose it's a judgment call, much like any form of personal disclosure during treatment--there are times when it's certainly warranted and can be quite illuminating, but it also can be hazardous.

Whether shared with patients or not, though, whenever therapists find new and imaginative ways to invest in clinical documentation, the process generally pays handsome dividends. In some sense, it's really just another form of clinical supervision, but one in which the supervisor is inside us. n

Brad Sachs, Ph.D., is a family psychologist in Columbia, Maryland, and the father of three children. He's the author of The Good Enough Child: How to Have an Imperfect Family and Be Perfectly Satisfied . His poetry books include Blind Date; In the Desperate Kingdom of Love ; and I Have Told You This to Make You Grieve . Contact: brad@bradsachs.com. Letters to the Editor about this article may be e-mailed to letters@psychnetworker.org.

 

 

The Art of Therapeutic Conversation

by Jay Efran and Mitchell Green

In a memorable scene in Fiddler on the Roof, the main character, Tevye, pretends to have been awakened by a nightmare that he concocts to convince his wife to change her mind about who their daughter should marry. As he describes this "dream," dancers and singers act out the story, accompanied by a small band of strolling musicians. In the original Broadway production, this scene was always a crowd-pleaser. In the revival, however, Zero Mostel (as Tevye) found a way to turn it into a showstopper. In the new version, as he recounts his tale, the audience watches him become increasingly distracted by the deafening cymbal crashes of the nearby percussionist. Suddenly eyeing a solution, Tevye grabs for the nearest bed pillow and hurls it at the musician. It lodges between the cymbals just in time to stifle the next crash. This improvised bit of comedy elicited such howls of laughter from the audience that it was permanently incorporated into the show.

Such consummate pieces of stagecraft are the lifeblood of a theatrical production. However, because they develop organically out of the "conversation" of actor, role, and audience, they're virtually impossible to plan. (Mostel didn't "find" the pillow bit until he'd played Tevye hundreds of times.) For similar reasons, effective psychotherapy interventions can't be fully scripted in advance. Like Mostel's innovation, therapy's most effective moments are improvisations that arise out of the conversational flow between client and therapist. Indeed, every therapeutic journey is unique, involving unexpected twists and turns. These aren't signs of the therapist's lack of skill or treatment failure; they constitute the very heart of the process.

From this perspective, the growing emphasis on treatment manuals and empirically validated methods is a step in the wrong direction. Yes, the public needs to be protected from quacks, and managed care organizations certainly want some assurance that their money is being spent wisely. In the final analysis, however, the effectiveness of a client-therapist pairing is a function of their collaborative dialogue--a process that resists standardization. Undoubtedly, one can specify general principles and guidelines, and therapy can be anchored in a contract that defines roles and sets boundaries. However, therapy also requires a certain creative ambiguity that can't be reduced to stock exercises or "bottled" like an antidepressant.

The past three decades of research on psychotherapy have added little to Lester Luborsky's famous 1975 "dodo bird verdict," that "everybody has won, and all must have prizes." In other words, with only a few circumscribed exceptions, every empirically tested therapy has shown roughly the same level of (some would say mediocre) results. As Mark Hubble, Barry Duncan, and Scott Miller note in The Heart and Soul of Change in 1999, the vaunted list of empirically supported approaches amounts to little more than a recognition that some methods have been tested and others haven't.

 

Even in the case of heavily researched treatments, such as Marsha Linehan's Dialectical Behavior Therapy (DBT), we still know almost nothing about how particular components of the approach operate. All we really know is that the potpourri of methods Linehan assembled--skills training, mindfulness techniques, phone contacts, group sessions, etc.--works somewhat better for certain types of emotional problems than the ragtag assortment of treatments generally available. It's possible, even likely, that the advantages in outcome the DBT studies report are mainly attributable to the skills and enthusiasm of handpicked, crackerjack research teams and the comparative abundance of resources available to them. Thus far, we haven't seen the kinds of dismantling studies that would enable us to understand more about how DBT works.

Unfortunately, manualized treatment protocols, designed to make treatments replicable, create a false impression of objectivity. For instance, we know many who've worked on manual-driven projects and who report, off the record, that they were only able to adhere to the manual for the first few sessions--during the intake phase. After that, the content of their sessions became increasingly variable and idiosyncratic, tailored, as one might have predicted, to the exigencies of the developing client-therapist dialogue. In some of these studies, the therapists dutifully continued to administer the prescribed exercises, but they also felt obliged to slip in side conversations that more directly addressed their client's needs. Unfortunately, such procedural deviations rarely make their way into the published literature. Therefore, readers are left with the false impression that the manualized procedures are easy to implement and reliably produce the desired result. Manuals may not be entirely worthless, but they certainly don't tell the whole story of what transpired between client and therapist.

Several years ago, we watched a manual-driven group treatment from behind a one-way mirror. Time after time, group members were actively discouraged from discussing issues that concerned them because these didn't fit the session's prescribed agenda. The leader kept complaining that the group had to move on because they were "falling behind the schedule." Ironically, it was those forbidden "disgressions" that group members later remembered as the most valuable aspects of the sessions. At a feedback session with an outside evaluator, members were quick to say that they liked being in the group and profited from meeting the other members, but had little use for the leader's heavy-handed attempts to administer "the treatment."

Even the best manuals tend to devolve into a series of vague instructions, such as "continue checking the client's homework," "review the previous week's gains," or "identify other instances of catastrophic thinking." Such directives hardly achieve the goal of insuring standardization. Most such studies emphasize group statistics, ignoring the therapist variability that exists even though each client is supposed to be receiving the same treatment. In fact, much of the field's scientific sweat equity has been invested in studies of therapy's lowest common denominator--group findings from hothouse projects of canned therapies, using inexperienced graduate-student therapists and highly selected populations. The shame is that these studies convey an erroneous message about what works, focusing attention on particular techniques and away from the kind of conversational improvisation that good therapy requires.

 

We can trace the current conundrum we're in--over the difficulty of making real therapy fit into a scientific paradigm--to the "slow-acting poison pill" that former American Psychological Association president George Albee says the mental health profession ingested several decades ago. With this pill, we swallowed the deeply flawed medical/psychiatric assumptions about diagnoses and dosages, culminating in the unrealistic expectation that forms of psychotherapy can be administered with the reliability of, let's say, a surgical protocol. The belief that this level of consistency can be obtained derives from a serious confusion of models--what philosopher Gilbert Ryle called "a category mistake." In other words, psychotherapy has been misclassified; it should never have been considered a treatment in the first place. Rather, it's a specialized form of inquiry--more philosophical journey than medical procedure.

In fact, if Jungian James Hillman had his way, the therapy enterprise would be categorized "as an art form rather than a science or a medicine." At root, therapy is just two people conversing. That would be evident if you peeled back the layers of mystification and simply listened to a therapy tape. "Consciousness," says Hillman, "is really nothing more than maintaining conversation, and unconsciousness is really nothing more than letting things fall out of conversation."

The derivation of the word conversation is worth examining: it comes from vertere (to turn) and con (with). This is a perfect metaphor for the therapeutic process. As Hillman describes it, you "walk back and forth with someone . . . turning and going over the same ground" from a variety of directions until "what we already feel and think [has been converted] into something unexpected." To be effective, therapeutic talk must have an edge: "It opens your eyes to something, quickens your ears, . . . and keeps on talking in your mind later in the day," adds Hillman, and, hopefully, for days to come. Instead of talking of cures, the therapist's job is to "cure our talk."

A week ago, a client came in for her first session. She described the frustrations of having engaged in years of self-improvement efforts--meditation classes, body disciplines, empowerment groups--only to find herself as confused as ever about whether to stay in her marriage and if a career shift might bring greater fulfillment. At that moment, I found myself contradicting Socrates, telling her that sometimes the unexamined life is worth living. That statement struck a chord. She lit up, laughed, relaxed into her chair, and said, "Thanks for saying that."

 

My remark couldn't have been preplanned and wouldn't necessarily have been appropriate for either a different client or even the same client at a different time. Like a thousand other such bits of conversational ingenuity, it worked because of its positioning in the ongoing dialogue--it was exquisitely responsive to the several layers of meaning contained in the client's communication.

It's practically impossible to explain how such comments are generated or exactly what clients make of them, yet the immediate reaction and subsequent discussion in this case made it clear that comments such as these catalyze important shifts in perspective and advance the collaboration inherent in therapy. Like Mostel's bit of chicanery, such spontaneous remarks are not learned from manuals and can't be dispensed on demand, yet they're the essence of the therapist's conversational craft.

Our recent informal survey of real-world practitioners--the folks who actually make their living seeing clients--suggests that most therapists don't use cookbooks, don't place their faith in techniques, and don't pay much attention to what's on the latest list of validated treatments. Moreover, the longer they've been in practice, the less their treatments resemble the rule-bound procedures they learned in school. Experienced clinicians intuitively follow Hillman's advice to avoid fixed positions, realizing that any prejudgments can "stop conversation dead in its tracks"--leading to a sterile monologue rather than a productive dialogue. When that happens, you might just as well send a memo.

Jay Efran, Ph.D., is emeritus professor of psychology at Temple University. He's the coauthor of  Language, Structure and Change: Frameworks of Meaning in Psychotherapy and of The Tao of Sobriety . Contact: jay.efran@verizon.net. Mitchell Greene, Ph.D., is clinical director of Main Line Clinical Associates in Wayne, Pennsylvania. Letters to the Editor about the article may be e-mailed to letters@psychnetworker.org.

 

 

The Big Moment

Inspiration Vs. Perpiration in the Therapy Room

by David Waters

It was the kind of tense stalemate between an angry, critical father and an increasingly withdrawn teenage son I'd seen many times through the years. Greg was a single parent who seemed to regard every exchange with his shy, 14-year-old son, Tad, as an opportunity for a "corrective experience." But they were both bright and articulate, and therapy started off with both of them readily agreeing to spend more time together.

Having contact isn't the same as making contact, however. Greg routinely ended up angry and disgusted with his son, rarely missing an opportunity to find fault, much like his description of his own father's behavior. Rather than focusing on Tad, Greg spent many of our sessions talking about how bad his father had been. In short, therapy wasn't going anywhere.

Finally, in one session, I decided to get Greg's full attention. As he launched into yet another rant about his father, I said, "Forget your damn father, Greg, and focus on helping your son!" I tried to say this with just enough mock exasperation that I wouldn't sound like a critical dad myself. I went on, "You came here because you couldn't connect with your son, but every time you approach him, you get tangled up in all your old anger toward your father. It's time to cut it out! Your father's already done enough harm. Don't let him come between you and your son."

Greg was stupefied, and incredulous. "Forget my father ? Stop having these feelings ? What the hell kind of therapist are you?"

 

"Good question," I replied. "I'm the kind of therapist who hates to see the same painful pattern repeated over and over, and, today, I'm a therapist who hates to see long-dead fathers ruin the bond between their sons and grandsons. So your father isn't welcome in this room, for the time being. I don't want to hear a word about him until further notice. I want all of your attention on your son, and on the present. I want you to focus on doing what your father couldn't do, instead of repeating what he did."

This wasn't a well-rehearsed therapeutic routine. It was improvisation, with a purpose: to flip an all-too-repetitive moment into what I like to call a Big Moment, a therapeutic event that raises the stakes and deepens the possibilities, creating the climate for a conversation that might otherwise never happen. In this case, I knew from Greg's response--a mix of startled anger and hesitance--that I'd gotten his attention with my statement in a way I hadn't been achieving with therapy-as-usual.

As a younger therapist, I'd have thought that this moment with Greg was an unadulterated triumph. I'd have basked in the feeling of new energy between us that I sensed when Greg was caught off guard, and I'd have assumed that Greg had been stimulated to consider a new way of behaving. Basically, I'd have thought my job was all but done and transformation was just around the corner. For, as a younger therapist, I was convinced that the challenge of really getting the client's attention couldn't be overstated. In those days, I didn't ask questions about the larger context of a Big Moment--how it could be employed in the totality of a client's life. I believed there were just two kinds of cases: your usual, low-level-of-attention cases, in which clients put in their time, did their homework, and incrementally moved out of their old ruts, and the far more interesting, high-attention-level cases, in which clients embarked on a project, a therapeutic undertaking that seized clients' imaginations with the potential to alter them on every level. I also believed that these two types of cases were mutually exclusive.

I'm writing now to document my discovery that they are, in fact, not mutually exclusive, but that both approaches, combined, produce the best results. This is a story of learning the hard way.

 

Big Moment Addiction

I used to get very excited when I thought that clients were about to embark on what I called a project--a course of action that crystallized a problem into a unifying undertaking; a Big Moment extended over time. Here's an example.

Tammy's family came to see me after moving to Charlottesville, Virginia, to get 16-year-old Tammy away from Tony, the boyfriend-from-hell who'd slept with her and later given them all a pregnancy scare. But moving the family hadn't changed gorgeous, talented, spoiled Tammy's feelings about ne'er-do-well Tony. While the parents lectured and cried, she stayed absolutely glued to her dream of true love. This in spite of her admission that Tony cheated with other girls and had walked away when she feared she was pregnant, saying, "It could be anybody's."

When I couldn't get the family off a fruitless repetition of the same battle over changing their daughter's mind about Tony, I decided to see Tammy alone. In these individual sessions, I appealed to the princess in her--a major feature, to say the least. I asked her how a guy should treat a girl in general. Her answer included every romantic cliché from flowers and jewelry to spaniel-like devotion. I had to fight the temptation to point out that Tony hadn't met a single one of these criteria. Instead, I asked her to muse about how it looks when a guy comes through, how it looks when he doesn't, and how a girl can tell the difference.

As Tammy became increasingly involved in our discussions, a project emerged: Tammy would go on a field trip back to her previous hometown to see whether Tony could pass this test of how a guy should treat a girl. I didn't bring up this excursion directly, because she needed to come up with the idea and structure the "test" herself. When she did, I was very skeptical, and made her think through every ramification. She listened to me and plotted her "data collection" with an energy and verve I'd never have thought possible in the early, listless stage of our work together. I began to see a maturity and level of insight I hadn't suspected she was capable of. Once she'd considered every aspect of the visit, we planned how to go to her parents with this outrageous idea.

 

When she did approach parents, they hit the roof, as we'd expected. But she was able to convince them that she really had to see for herself whether Tony was a creep. So, with lots of preparation, we sent her back to spend the weekend seeing her old boyfriend.

The week of the experiment, her parents and I had our hearts in our mouths. Then Tammy came back reporting that Tony was "okay," but there was now a noticeable shift; she no longer seemed to feel any real excitement about him and had no plans to continue the relationship. The project seemed to have gotten her into a new mode of thinking--critical and observant, rather than mushy-headed and romantic. The more she talked about Tony, the clearer it became that she didn't particularly like him. We all breathed a sigh of relief, and I felt great that the project had worked so well.

But then the unexpected happened. After the project was over, Tammy dropped back into her funk. She got into meaningless struggles with her parents and lost the spark that had made her an attentive, excited collaborator. I couldn't get her interested in taking on any other challenges and, ultimately, lost the family to their resigned sense that they'd done all they could. After our creative leap, it seemed, no real change happened.

Why didn't it work? Why did I lose Tammy's interest? While the trip to see Tony had captured her imagination, once that adventure was over, she was again staring out the window and asking whether the session was up yet. Tony wasn't the white knight she'd imagined, but she remained obsessed with finding one. This quest was far more interesting to her than working on boring issues of self-worth and empowerment, which had been important only in the context of the "Tony test." I couldn't translate the excitement generated by our project into an ongoing interest in growing up. So what I'd thought of as the beginning of the work turned out to be the end.

 

Now I understand that I was expecting too much of a 16-year-old. She'd faced a challenge and met it, and this increased her awareness. She wasn't going to grow up according to my timetable. I was paying more attention to my goals than to her life and her teenageness. Perhaps I should have suggested that she and the family digest the experience, and that we meet again in six months to compare notes. Almost certainly, she'd have pursued another white knight with similar results. Then, with work, I might have been gotten her to perceive the repetition and begin to root out the white knight myth. But I was so enthralled with our Big Moment, our project, that I couldn't get focused on how to keep her interested in growing up. Once the excitement of the project was over, both Tammy and I got bored with the grunt-work of change. I failed to understand that if I wasn't excited with gradual growth, I couldn't expect excitement from my clients.

Learning to Fly

What first made me fall in love with being a therapist was the idea that I could make a living by having conversations that cut through everyday pretenses, got directly to the heart of the matter, and helped people change their lives. This was profoundly appealing to someone who came from a reticent, emotionally avoidant, WASP family that was devoted to the creed "If you do have to feel something, for God's sake don't let on." Unfortunately, I entered grad school in the late stages of the psychoanalytic hegemony, when therapeutic impact was thought to derive from the therapist's ability to remain silent for years--not exactly what I had in mind. As a result, my early supervisors diagnosed me with poor impulse control. My play-therapy supervisor used to say to me, "Dave, 'play' refers to the child, not the therapist!"

But I wanted to make things happen! I was too impatient to wait while a child came up with his own version of a game, so I'd help him out a little by teeing it up for him. After watching him roll the same car back and forth in the sand tray for three sessions, I'd say something like, "Let's race the cars around the track and see which one goes faster." I just knew that this would give me good data about how he dealt with competition (read: Oedipal drama). But my supervisor didn't agree, insisting that I merely reflect and validate the child's play, however poky it might be.

Adult therapy went pretty much the same way. That supervisor would say things like, "That was an excellent interpretation, Dave, but six months too early." And I'd think, "I'm supposed to sit on that idea for six months?!" They didn't understand: I wanted to earn my keep--a lifelong anxiety--and have clients get excited about what we were doing. It was less about my ego (a not inconsiderable factor) and more about my need to prove, to myself and my clients, that this work could make a difference. I believed that the possibility of breakthrough should always be at the forefront. But in most of the therapy I saw and experienced, there was little place for novelty and few indications of real impact. It made no sense to me to move so cautiously through the valuable therapeutic hour.

 

Luckily, just as I was starting out in the profession, the whole field of therapy began to shift. A cacophony of raucous new voices started drowning out the quiet, refined tones of the psychoanalytic old guard. In this heady new world, my impulse-control problem suddenly became an asset. Spontaneity, energy, imagination, daring were now therapy's new watchwords. The low-decibel collective drone of analytic therapy morphed almost overnight, it seemed, into encounter groups and T-groups with exotic and radical ways of working, often led by people without much knowledge and expertise. The basic idea seemed to be that restraint was old-fashioned and unnecessary, and that people needed encouragement to listen to their healthy, but usually ignored, impulses. I still recall my Student Health Therapy Group petitioning me to meet as a nude encounter group, in order to "get past the charade of self-presentation." My supervisor nixed the proposal in a heartbeat (more's the pity), but it still represents for me the freewheeling zeitgeist of the period.

Even psychoanalysis, that conservative bastion of methodical control that had set the rules for so long, experimented. There were schools like Direct Psychoanalysis, in which, for example, the therapist would bombard a psychotic patient with interpretive feedback to break through defenses. "So you want to fuck your mother?" the direct analyst would ask the patient, often repeatedly, as the patient got more and more upset. I couldn't imagine how it could work, but it was certainly exciting to see even the hoariest old schools of thought join the creativity parade.

To me, the most radical and interesting innovation was family therapy, with people like Jay Haley and Salvador Minuchin and Carl Whitaker doing things that scandalized the therapeutic old guard. Imagine my excitement when I discovered this brand-new, brave new world! At the family therapy workshops and externships I began attending, film clips would be shown of dramatic breakthroughs and amazing turnarounds. Minuchin would create stunning metaphors on a stage, in vivo, that visibly changed the family. Harry Aponte would have an outright battle with a child or an adult about their part in the problem. Whitaker would say crazy things. One time, he said to a recently discharged young man, who was looking at a chair before sitting down for a family session, "Don't sit there, I think there are little pieces of shit all over it." The man bonded with Whitaker immediately.

As I sat in workshops and watched these little miracles happen, feeling terribly mundane and unimaginative by comparison and wondering whether I'd ever have what it took to say and do such remarkable things, I got hooked on the Big Moment. Like many others in the field, I became enamored of the point in therapy when the problem is transformed or the solution is achieved in a flash. The creative breakthrough became the moment of therapy for me. Everything else led up to it, supported it, or built on it.

 

All of a sudden, I felt a new freedom as a clinician. I stopped waiting for people to bring things up and started leading the way; I stopped settling for small gains and started pushing for more, trusting that there'd be more. True, what I did might not seem thrilling now, but against the backdrop of total analytic quietude, it seemed daring and exciting.

Once, for example, I pushed a timid, intimacy-phobic husband to give his wife "a real hug" at the end of a hard session. He gave her a tepid, A-frame hug worthy of a distant cousin. Although hug therapy was already a radical departure for me, I made myself tell him it wasn't good enough and ask him to give her a real, "I'm-crazy-about-you," hug. He claimed it was   a real hug, and told me to leave him alone. That didn't deter me. I asked his wife if the hug felt "real" to her. In her nice gentle way, she indicated that she was eager for more contact. He tried again, and three minutes later, when they were definitely getting the hang of it, I slipped out. I wasn't going to upstage Minuchin with work like this, but I think it helped more than a few of my clients find some new potential in themselves. I know I did.

The Limits of Creativity and Change

That was then, and this is now. Today as a profession--and as a society--we're much more fearbound and rule conscious than we used to be. Many professionals live in terror of making a mistake, getting sued, and being politically or socially or bureaucratically incorrect. It's become a lousy atmosphere for creative leaps and Big Moments, or even for reaching beyond "approved" forms of interaction. Yet the sacred space of the therapy room is the ideal place to really exercise your creativity. What individuals can accomplish together in a private, protected undertaking is as amazing as it ever was.

In spite of the current restrictive atmosphere of fear permeating the therapy profession, I've hung on to my early passion for change and impact. However, Tammy and many other clients have taught me that after a breakthrough moment in therapy, it can often be quite difficult to interest a patient in the work necessary to maintain the gain or put the new ideas to work. All too often, patients drawn to the Big Moment have started immediately looking for the next one, rather than focusing on the hard work of applying and embodying more fully what the Big Moment had revealed. In this way, patients are no different from us--just as we go to workshops hoping to learn how to do magic, patients often come to therapists hoping to have magic practiced on them. Slow, hard struggle is much less appealing.

 

The danger is that the therapist and/or the patient can get hooked on creating the Big Moment and lose the will for the hard work that can slowly change unfulfilling habits. The real challenge, I began to realize, isn't just to create interest and intensity in a session, but to incorporate the movement generated by sessions into habits of thought, feeling, and action that patients can establish as part of their lives.

Having become disillusioned with the Big-Moment approach to therapy,  I made a classic mistake of overcorrection. I began to look longingly at the CBT manuals and their methods for hammering home therapeutic gains. I became envious of the clear protocols presented by workshop veterans of one school or another. Even totally programmed therapies like EMDR began to seem appealing. I started distrusting my creative impulses and began to seek out some reliable way to really change people.

Of course, this kind of search for new tools and more dependable methods is common in this field, a profession in which it's so easy to develop doubt about one's effectiveness. An older psychiatrist I admired a lot once described therapy as "the only profession that gives you five or six chances a day to feel like a failure." At this stage in my career, my self-doubt became so strong that even when things went well, I'd often ask myself, "Would it have gone that way anyway? Did the therapy make a difference, or was I just on the scene when the improvement happened?" I'd hear my friends describe great outcomes and wonder if I'd ever helped anyone that much.

Then I began to place my bets on the more formal, structured rigor of getting people to actually do what we were talking about. In couples therapy, for example, I'd always spent a lot of effort helping people connect in my office through physical contact, honest revelation, and taking chances with each other in ways they couldn't do without me. Call it Relational Creativity 101. But it never included much by way of homework, carefully checking back about what actually happened, or discussing what had helped most in getting someone to really do things differently. So I decided to start placing more emphasis on giving couples small but consistent actions they could take home and build on.

 

I began giving a homework assignment I called the Shape-Up, inspired by what happens on the docks every morning when stevedores gather around to divvy up the day's responsibilities and make sure everyone is pulling their weight. I asked couples to have a Shape-Up time every evening when the second person came in the door. They were to meet, shoo the kids away, and take just 5 to 10 minutes to check in with each other: How was your day? What do you need to get done tonight? How can we help each other? What happened today that we both need to know about, especially kids-wise? What other preoccupations are you carrying?

I soon found, however, that even after a wonderfully connected session, many couples only managed to do the Shape-Up once or twice. Even when I exhorted them to build this ritual into their lives and they agreed enthusiastically, they often got sidetracked and never went back to it. I began to wonder why I could get couples over a huge barrier in the session, but couldn't help them make a small, day-to-day adjustment.

Certainly, part of the reason was that I wasn't at home with them to encourage and enforce change. But I also realized that scheduling the daily Shape-Up felt too small and inconsequential, too ordinary to make a difference to them. People will reach deep for a moment of high drama and poignancy, but won't go upstairs to make the small contact that might change the course of an evening--and cumulatively, over time, a relationship.

So I decided to make much more of the small follow-up steps with clients --to try to get the level of involvement from them at home that I could get in the office for big changes or enactments. But it's hard to get people to pay the same attention, take small steps seriously, and really commit to gradual change. It was a replay of how I felt about the difference between the energy of making small changes required to get out of a rut and that of undertaking a project when I first did therapy. They couldn't get very interested, and, at first, I felt a little foolish following up our breakthroughs with nickel-and-dime exercises. It felt rote and unimaginative, not creative enough. But I noticed that when clients did take the exercise seriously enough to follow through on it daily, it often made a bigger difference than the Big Moment.

 

If I were showing tapes at a workshop, like everyone else, I'd be more apt to show the point at which I was able to create the dramatic change than the difficult negotiations needed to get couples to sign on for the Shape-Up. But clearly, there's a place for both models--breakthrough and working-through--in our work. The Big Moment is good for getting people's attention, but we always need to bear in mind what we're getting people's attention for. The role of the creative leap in therapy is to establish a strong involvement with an issue and engage clients fully in the difficult and laborious business of change. But however valuable creativity can be in setting up the conditions in which transformation may take place, change itself requires repetition and commitment to altering habits and revisiting an issue over and over and over again. People often need a startling moment of awareness to build the small changes around, but the startle itself usually won't suffice to shift lifelong patterns

Consider the case of Kelly and Jack, who've been married 20 years, during much of which they've agreed on only one thing--they don't want a divorce. They both felt "truly married for life," even if that life was a big pain in the butt. They fought more or less nonstop--mostly niggling little put-downs, punctuated by occasional nasty battles. One particular source of conflict was how to raise the kids, and every evening was a pastiche of disagreements and rolled eyes over the right way to do things. I tried to mediate and deflect their arguments; I got them agreeing on better ways to work with the kids; I tried to institute the Shape-Up. In short, I worked to help them make a lot of small changes that could have made a difference, but didn't.

One day recently, they were starting to repeat the old mantras of criticism and disgust, in their usual playful manner, when I had an idea. "Slide over on the couch, Jack, and put your arm around her," I requested. He moved one inch and laughed. I pushed on this request for several minutes, in an atmosphere of growing tension. They both said it was artificial and forced and not worth bothering with, but I held my ground. The tenseness increased. Finally I said, "You just can't do it. Admit it. You're afraid to get really close. You're both scared of intimacy, and you maintain this game of playful meanness as a substitute; but you're not comfortable with actually being close." They froze.

Neither said anything for what felt like 30 or 40 seconds, and I wasn't sure whether they felt attacked or helped. Then Jack said, very slowly, "It's absolutely true. I can't get close to her. I sometimes admit to myself that I'll pick on her and start a fight if things are getting too cozy." Kelly was surprised by this admission, but then copped to the same pattern. "I know I can always get his back up by talking money."

 

The younger me would have felt like we'd cracked the case, and moved on from there toward the next breakthrough. But as a veteran of far too many Big Moments that ultimately led nowhere, I realized that what had just happened was merely an indication that Jack and Kelly needed to spend time doing all the little things required to break that pattern. Fear of intimacy and their unconscious contract to stay together but not close became the focus of our therapy sessions. Then we began working on the small steps needed to change these ingrained patterns.

We went back over the Shape-Up, the rules of engagement around the kids, and the ways they could help each other out. We looked repeatedly at how to deal with the moments in which they have to choose how to be with each other. We talked about their having the courage and presence of mind to do something different. We examined the roots of their avoidance of intimacy, with an emphasis on patterns of thinking and reacting, and how to change those. The shock and dismay they felt at seeing the issue starkly became a touchstone for making these small changes.

We now had a project together that synthesized the Big Moment and the day-to-day work of getting out of a rut. Without the big issue in our sights, I wasn't able to keep them focused on moving toward something better. But at the same time, without the small changes and the ongoing attention to doing little things differently, the creative leap we'd shared was an interesting insight, but wouldn't have changed anything.

In these days of Managed Care and Therapeutic Minimalism, my biggest concern about therapy is that we don't ask enough of it. Too often, we don't push ourselves or our clients hard enough to make the changes that make a real difference in people's lives. It's taken me more than 30 years to realize that it's the combination of two strange bedfellows--imagination and repetition--that holds the key to change.

 

I still cherish and nurture my ability to sometimes make a dramatic intervention that gets my clients' attention, but today, when it works, I immediately recognize that I have a new task: keeping it in our sights. How do we tie it in to the day-to-day realities of life and get our insight to play out in real ways? Often that's harder to do than the original breakthrough, but that's what makes our job as therapists challenging. I realize now that, for many years, I was letting myself off the hook too easily by thinking, "Now that I showed them the way, my work is done." Today I know that good therapy requires a whole second sequence that builds on insights and carries clients forward in a variety of ongoing, daily events.

To move clients out of their ruts, their numbness, and their stuck places, we need to get their attention and start their adrenaline going at a rate that wakes them up and helps them to experience the fullness of life again. Creative Big Moments can be indispensable for this. They also get us out of our own ruts and make us feel more alive, making them a great antidote to the pitfalls of this profession and the perils of burnout. Intense, vibrant, liminal, human interaction--experience that goes off an edge and soars--is wonderful stuff for everybody involved. It's something to strive for in therapy, to recognize and cherish when it occurs, and to help clients build upon in their daily lives. But the Big Moment needs many little moments to make it stick.

That may sound like an underwhelming conclusion, but something else I've learned as a therapist and a man is that the simplest things to say can be the hardest to do, and can take the better part of a lifetime to learn.

David Waters, Ph.D., is a professor of family medicine, psychiatric medicine, and psychology at the University of Virginia in Charlottesville, Virginia. He's practiced family and marital therapy for 30 years. Contact: dbw@virginia.edu. Letters to the Editor about this article may be e-mailed to letters@psychnetworker.org.

 

 

Beloved Stranger

Temperament and the Elusive Concept of Normality

by Alice Shannon

One morning 25 years ago, as I was out walking my newborn son, I was stopped by a woman who insisted on fussing and fawning over him. I was irritable and exhausted from yet another night of interrupted sleep, but, for a few moments, I was as proud and pleased as any new mother. Then she asked if Ryan was a "good" baby. Already I knew the definition of such a baby--an infant who's generally content, easily soothed, and sleeps a lot, especially at night. I don't remember my reply. I only remember my heartsick awareness that my son had none of the characteristics of a "good" baby.

Ryan was a welcome and much-loved infant, born after a healthy pregnancy and uncomplicated labor. We were fortunate to have my mother helping us out, and we were all thrilled and enthralled by Ryan. But we were soon too utterly worn out to maintain those positive feelings. One tiny but fierce infant managed to exhaust three healthy adults.

Child-development books claim that newborns spend most of their time sleeping. My newborn didn't. Fretfully awake much of the time, he was easily upset and hard to soothe. It wasn't unusual for him to cry as I put him into his car seat, and to continue crying throughout an entire ride, debunking the notion that car rides calm fussy babies. Anything, it seemed, could upset Ryan--dressing or undressing him, getting him in and out of the bath, changing a wet or soiled diaper, attending to him or letting him be. He cried before going to sleep, sometimes inconsolably. Holding him, nursing him, rocking him, or walking him often didn't help.

Ryan was physically healthy. He never had so much as a cold during his first year, and he was advanced in motor development. Yet when his first birthday came and went and life with him was as difficult as ever, I felt a sobering dread at the prospect of year upon year much like the one I'd just endured. I felt a growing sense of incompetence as a mother. A common assumption, then and now, is that all infants are born equally receptive and responsive to the influence of their caregivers, particularly their mothers. Implicit in this idea is another, more libelous, assumption: a baby's level of contentment, feeding habits, and sleep patterns reflect maternal skill, or lack thereof. Behind a difficult baby is, perhaps, a mother who hasn't "bonded well," or whose depression and anxiety are affecting her child.

 

The books I read and other mothers I met were full of contradictory advice about what might ensure a happy, well-adjusted, settled baby. "Take your baby everywhere with you and he/she will get used to travel." "All you have to do to get your baby to sleep through the night is let him sleep in your bed." "Make sure she stays in her own crib and never sleeps in your bed." "If you nurse your baby on demand, . . . pick up your baby when she cries, . . . massage your baby . . . ." Adopt these approaches, or others, and you'll have an easy and well-adjusted child. I tried a variety of approaches, to no avail. A mother who "tried hard" and still had no success must be unconsciously communicating hostility or insecurity to her child, the common reasoning went. If Ryan continued to be a challenging child, there was clearly nobody to blame but his mother.

Finally, I saw a therapist. For several months, I talked a great deal about life with Ryan. My therapist kept steering the conversation to my childhood "issues" and tried to connect them to my current unhappiness. She seemed to believe that depression was at the root of my troubles as a mother. But what if my troubles as a mother were themselves causing my depression? Incredibly, we never addressed this possibility. Nor did she have any practical suggestions about how I might improve things for Ryan and me.

Like any couple, when I'd become pregnant, my husband and I couldn't help but imagine what our baby would be like, how he'd grow up, and what kind of man he might one day be. We knew it wouldn't be easy, but we expected and assumed, without even being aware of it, that we'd intuitively know our child, and that our child would reflect who we are. We were learning that things don't always work out that way. We were learning that the ricochet of genes, the mysterious exchanges of DNA, and all the million variables of the gestation process, from conception to birth, could introduce us to a stranger--a beloved stranger, but someone as different from our expectations and imaginings as it was possible to be. Fortunately, we were about to reach a turning point in our understanding of Ryan.

 

Temperament 101

The year Ryan turned 2, I started graduate school in clinical counseling. Keenly sensitive to the feel of his clothing, and resistant to each transition, Ryan often had loud, prolonged tantrums as we got ready to leave the house each morning. By the time I picked up the friend who rode with me, I was close to tears myself. My friend suggested I look into the research of Stella Chess and Alexander Thomas, pioneering husband-and-wife psychiatrists who'd initiated a study of children's temperament when their psychoanalytical backgrounds had failed to account for the differences and difficulties they'd seen in children's behaviors.

Chess and Thomas were psychiatry professors at New York Medical Center. Launching what would be a 30-year longitudinal study of children and parents in 1956, they were among the first to describe the role that inborn temperament plays in accounting for children's behavioral styles. In their groundbreaking work, they brushed away decades of environmentalism, which had rigidly held that babies were born "blank slates," their growth and development dependent entirely on the quality of their parenting. In their view, infants weren't born empty vessels, but came into the world exhibiting remarkably different hereditary differences in how they responded to the environment. Furthermore, argued Chess and Thomas, what often struck parents and professionals alike as unusual, difficult, or even abnormal behavior might instead be perfectly natural and benign variations in innate temperamental makeup.

I think it was Behavioral Individuality in Early Childhood by Chess and Thomas that I read first, sitting in the college library. What a revelation! I'd never heard of temperament, yet here was an impressive body of scientific research that dealt with normal children of normal parents who acted just like Ryan! And thank goodness for my friend. In the entire course of my graduate training, temperament was never mentioned.

In their studies, which included disabled children and children from different socioeconomic and cultural populations, Chess and Thomas identified nine distinct dimensions reflecting differences in temperament that influence how children respond to the world around them. I'd been mystified and dismayed, for example, by Ryan's chronic irritability, his difficulty getting to sleep, especially when he was overtired or overstimulated, and his strong negative reaction to anything new. It was deeply reassuring to read in Chess and Thomas that Ryan fit the temperamental profile of a child born with low adaptability: he had a hard time adapting to and tolerating even ordinary daily transitions, such as waking and sleeping or being dressed and undressed, which accounted for our difficult mornings. According to Chess and Thomas, he was also a highly sensitive baby, demonstrated by his reactivity to the feel of clothing and how easily he became overstimulated and overwrought.

 

There was almost no practical advice in Chess and Thomas's publications about how to handle a temperamentally extreme child, and reading their work didn't make Ryan easier to handle. What they had to say was so comforting and empowering, though, that I could begin to relax and respond to him with more understanding and far less anxiety and self-blame. Chess and Thomas call the compatibility between a child's temperament, the environment, and the parents' caregiving style "goodness of fit." There's an abundance of techniques that work well to increase goodness of fit--techniques that I'd learn over time, with some trial and error. For instance, I'd learn to reduce novelty whenever possible for Ryan by not attempting too many changes at once, to familiarize him with a new situation beforehand whenever possible and allow him time to warm up, and sometimes to let him refuse to do even fun things that "all" the other kids seemed to enjoy. I was able to respond more neutrally to Ryan, since his behavior no longer took on potentially loaded meanings. He was coping as well as he could. My job wasn't to make him a different person, but to find ways to help each of us improve our coping skills. And with our worries eased, my husband and I occasionally found a lifesaving sense of humor about our parenting challenges.

Ryan, and later his sister, who had a different but also extreme temperament (highly active, very intense, and low adapting), practically compelled me to specialize in temperament-related issues. I now knew with certainty that there were other children like mine and other parents who needlessly felt worried, alone, and even hopeless. I knew firsthand that learning about temperament could be life changing. Having an awareness of temperament has helped me as a therapist to be curious, rather than judgmental or prematurely diagnostic. I have a much broader tolerance and understanding of a wider range of normal, if unusual, behaviors in children.

Dimensions of Temperament

A foundation in temperament informs my listening as a therapist. If the therapist I saw when I was trying to find my way with Ryan had been familiar with temperament, she might have identified my own low adaptability. In a short space of time, I'd experienced numerous changes, including getting married, giving birth to my first child, and moving several times. Ryan's temperament required a huge adjustment on top of many others, and my coping skills were sorely taxed.

 

While the concerns of parents of temperamentally extreme children have often been dismissed or minimized, I've seen many families hurt when teachers, doctors, and therapists have overreacted to a child's unusual behavior. When parents and therapists don't know the child and are unfamiliar with his or her particular behavior, it can lead to assuming pathology in the child when no pathology exists. When toileting problems, biting, major tantrums, school refusal, and other serious behavioral concerns in children come to my attention, I don't automatically assume there's a serious disorder in the child or family. It isn't, of course, appropriate to assume that all unusual behavior in children is normal. Still, as a parent and therapist, I've seen many unusual and potentially alarming behaviors that make sense when I take into account who this particular child is--what his or her temperament is--and within what environment the behavior is occurring. Even a seemingly big problem doesn't necessarily scream for a big response, but it does call for an effective response. Responding to a child in a way that results in a good fit and is more likely to be effective requires understanding of his or her temperament.

Each of the nine temperament dimensions defined by Chess and Thomas helped me understand my son and figure out strategies for dealing with his temperament. What follows is a summary of these dimensions.

Activity measures the amount of physical energy a child puts into behavior and daily activities. A very active infant moves around a lot, even when sleeping. Highly energetic children often prefer more active kinds of play--large-motor activities and outdoor exercise--over quiet, indoor pursuits. Even when they engage in presumably quieter occupations, they often do them in an active way. They fall off their chairs while playing a board game, twirl about or fidget when reading, get up repeatedly and walk around the room while doing homework. Some of them go nonstop, willingly falling into a deep sleep only when they're exhausted and their bodies give out. Others rarely appear tired and often resist sleep, but become cranky, overwrought, and hard to settle if kept up too long. Active children need plenty of physical outlets and may need help when it's time to calm down. For example, roughhousing before bedtime isn't a good idea, although they love it. Baths--widely supposed to calm all children--do calm some down, but rev others up. Parents need to notice what works for their child--quiet music, no TV, a back rub, and time alone with books or quiet toys before sleep are all means of settling active children.

Intensity refers to the level of energy a child puts into self-expression; it's a measure of a child's volume and drama. Intense children express all their emotions with vigor and gusto. They may talk and sing, laugh, and fly into rages with equal abandon. They tend to speak in extremes: they had the "best" day of their lives or the "worst"; you're "the most wonderful mother in the world" or the meanest and rottenest. These children are delightfully enthusiastic when they're in a good mood; a negative reaction, however, often in response to seemingly minor daily events, may induce a righteous tantrum, startling mouthiness, or threats to run away, kill someone, or kill themselves.

 

Because parents and teachers naturally find these expressions alarming, they may fear these children have deep-seated anger issues, suffer from depression or abuse, or are on the road to juvenile delinquency. When these children have frequent negative outbursts, they're often referred to therapists. Of course, this kind of behavior must always be carefully assessed to be certain the child isn't dangerous to himself or others, and isn't being put in danger by home circumstances. But often it's their temperament speaking, not any pathology.

You always know how intense children feel. It's important not to escalate with them (they can out-escalate you). Speak in a matter-of-fact tone of voice with them, send them outside to yell, or suggest they talk it over with their bear or to their audio recorder. At a calm time, you can help them learn to choose words more wisely to express their negative feelings in ways that don't alarm people.

Sensitivity is a measure of a child's sensory threshold. A child who's low in sensitivity is better equipped to handle a stimulating environment, such as company or a shopping trip. A child high in sensitivity has a low tolerance for these settings and is prone to falling apart with too much exposure. Sensitive children are very reactive to physical stimuli--sight, sound, taste, smell, and touch. They may react strongly to soiled diapers, tags in clothing, snug elastic waistbands, and scratchy material, lumpy foods, or a noisy classroom.

For years, my highly sensitive son found jeans too uncomfortable and lived in sweatpants. He rarely wore jeans until the seventh grade, when sweatpants were suddenly not very cool. Thankfully, he could tolerate the baggy jeans then in style. When parents learn to make adjustments, such as cutting tags out of clothing, this issue becomes more manageable. Parents should refrain from jumping through hoops, however. They might respond sympathetically when, at a restaurant, the right brand of catsup isn't available ("Oh, that's too bad"), without dashing out to buy the preferred brand.

 

Regularity measures how predictable or unpredictable a child's biological functions are, such as hunger, fatigue, or bowel movements. Irregular children may not be hungry at regular times. Parents should resist both nagging a child about eating at mealtimes and becoming a short-order cook. A reasonable solution is to make acceptable, healthy snacks accessible on a pantry or refrigerator shelf. Children who are very regular are easy to predict (which helps with toilet training) and to put on a schedule. They tend to do well in the structured, predictable environment of school, whereas irregular children may have more difficulty. By contrast, children who are more irregular may handle a chaotic or spontaneous home life with greater ease than more regular children.

Persistence, or Frustration Tolerance measures a child's ability to complete a task in the face of obstacles. Children who are low in frustration tolerance tend to give up easily when faced with a challenge, such as trying to reach a toy, build with LEGOs, dress a doll, tie a shoe, or learn a new task. Infants who are low in frustration tolerance often protest being left to sit, lie, or play by themselves. Parents sometimes measure their child's persistence by how much he or she pesters them. However, children who pester their parents relentlessly to get or do something for them are actually more likely to be low in persistence, unable to try patiently to finish a task or get something themselves, and reluctant to take on challenges by themselves.

Children who are low in frustration tolerance can be helped to increase their persistence by gradually stretching out the adult response time to their demands for help and, for older children, by breaking tasks down into smaller pieces, so they're less likely to be overwhelmed. Parents can set the timer repeatedly during cleanup time, telling their child to pick up only the blocks during the first five minutes, only the books during the next five, and so on. Children high in frustration tolerance will persist in the face of difficulties and are comfortable entertaining themselves. They may, however, be resistant to leaving an activity before they're finished. Giving them warnings about upcoming transitions and telling them when they can get back to their picture or project can be helpful.

Distractibility measures a child's tendency to be diverted by noise, interruptions, and other environmental stimuli. Children high in distractibility are acutely aware of everything that's going on around them. They may seem a bit like hummingbirds, flitting from one distraction to another, especially if they're also active. Easily distractible infants tend to be easy to soothe, whereas infants who are low in distractibility are often hard to soothe: they want what they want. Simply observing to a distractible child, "You're getting distracted," may help her become more aware and regain her focus. Children low in distractibility can focus even in challenging environments, and tend to work well in school.

 

Approach/Withdrawal measures an infant's initial reaction to a new food, person, experience, or situation. Approaching infants tend to have a positive first reaction. Children who are very approaching are often also very active; they may barrel into new situations, sometimes intimidating other children, and may benefit from some help in learning to slow down a bit. Withdrawing children have a negative first reaction, though they may warm up in a short time if the experience isn't forced on them. It's important to remember that the tendency to withdraw is an initial reaction. If given gentle encouragement and the time to assimilate, these children may become the life of the party. But when they're rushed or pushed, they may become extremely resistant.

Adaptability measures a child's adjustment to changes and transitions after their initial reaction to them. Infants who are high in adaptability are the ones you can take anywhere. They can sleep anywhere and handle disruptions to their routine well. Highly adaptable children do well with changes and transitions--which tends to make them easygoing. Often very tractable and undemanding, they may need help learning to stand their ground. Parents and teachers who are busy with squeakier wheels sometimes need to make a conscious effort to spend more time with adaptable children.

Low-adapting children, like my son, react negatively to transitions and need much more than the 20 minutes a withdrawing child might need to settle in to a new situation. Almost all children will have some difficulty adjusting to big changes, such as the birth of a sibling, a move to a new neighborhood, or attending a new school. But children low in adaptability also have difficulty with day-to-day changes and transitions. An unexpected meal change or an unplanned stop for errands can lead to big negative reactions. They cope with their discomfort by resisting change, and they may insist that every detail of daily routines be followed exactly the way they want them done. Their resistance to change is an aversion to novelty, any novelty; they may be as resistant to going to a party as they are to seeing a doctor.

Children low in activity and low in adaptability tend to be very transparent in their resistance to change, engaging in clinging behaviors, such as hanging on to a parent's leg or hiding behind them. Children low in adaptability and highly active may have a high enough appetite for life that they seem initially fine or even eager about changes (approaching), but may be resistant or suffer a meltdown after getting beyond the initial excitement. Low-adapting children, especially if they aren't high in intensity or activity, know their comfort zones. They're unlikely to follow along just because everyone else is doing something. Giving low-adapting children a finite choice--tooth brushing or hair brushing first, for instance--helps to make them feel more in control.

 

Mood is a measure of a child's disposition. Some infants fuss and cry a lot; others are smiley and contented babies. Some children experience their cup as half full and tend toward a positive outlook; others experience their cup as half empty and have a more negative or pessimistic outlook.

A child who's more serious or negative in mood may have a more analytical way of looking at things. It may be helpful to encourage this analytical streak in a child inclined to pessimism and negativity. When speaking to a child who's upset by some occurrence, it may help to take an observing stance and speak in a neutral tone. "Wow. Was it such an awful day for you? That's an interesting way of looking at things. It's true you didn't come in first. And yet you were the only one to come in third, and most kids didn't get any award." This kind of response may help these children broaden their perspectives. It's important not to try to fix a bad mood, though. That's an exercise in frustration that tends to land parents in a negative mood, too. By contrast, children who are often positive can easily see the upside of things; however, they may need help looking at things a little more critically, when appropriate.

The great value in the temperament perspective of Chess and Thomas is in how widely applicable and useful it is. It gives parents and therapists a neutral framework for analyzing and dealing with difficult children. Taking temperament into account empowers parents by adjusting and enlarging their perceptions of who their children are, and helps them respond to children in ways that are a good fit for their individual personal styles. It allows all infants to be "good" babies without blaming mothers (or fathers) for implied "bad" babies, who happen to be temperamentally challenging.

A temperament approach isn't a panacea. Learning about temperament doesn't transform temperamentally challenging children into easygoing boys and girls. We had tough times with Ryan all the way through high school. But knowing about temperament helped us understand and parent him better, and over the years, we noticed an important shift--the hard times weren't so hard, nor did they last as long.

 

Ryan at 25 is still very reserved and can be hard to read. But his calm has served him well on the baseball field and in emergency situations working as a medical technician. He still has to work at extending himself beyond his comfort zone to communicate more. And yet despite his seriousness, he has a wonderful sense of humor.

Recognizing and honoring a child's temperament allows you to go with the flow better and work with the situation that exists, rather than to try to make a child into someone else. Learning how to accept and work with a child's temperament requires time and attention, but, ultimately, can make everyone's life easier

Our society is quick to judge and want to "fix" unusual behaviors in children. More than likely, these children will exhibit certain personality styles for life, and parents will need to adjust their parenting styles to fit. This is a hard truth for many parents to accept. Initially and periodically, they may need some time to grieve and rant and rave about how hard their daily lives are with their puzzling, infuriating child, who's probably nothing like the child they hoped for. A big part of parents' adjustment rests in the kind of support they get and the skills they're taught for handling the daily challenges with their child. This is what we, as therapists, can give them.

There's no "cure" for temperament, nor should we want such a cure. Perhaps we get so accustomed to looking for a diagnosis that we lose sight of how variable normality really is. As therapists, we can help families make sense of their personal experience, even when it doesn't match preconceived ideas of how things should be. Our society has become increasingly intolerant of behavior that strays beyond familiar norms, and too inclined to diagnose, pathologize, and medicate what are simply temperamental differences. Our field needs to help parents recognize the variability, richness, and sheer capaciousness of the hard-to-define category we call normal. n

Alice Shannon, M.S., is a family therapist who specializes in temperament-related issues. She's in private practice in Arcata, California. Contact: aeshannon@earthlink.net. Letters to the Editor about this article may be e-mailed to letters@psychnetworker.org.

 

 

The 8 Minute Cure

Can Watching Dr. Phil Change Your Life?

by Michael Ventura

You sort of know who he is, even if you don't know who he is. You may not watch afternoon TV, you may be in bed by the time The Tonight Show airs, you may not like talk shows in general, but our media-infested world buzzes certain names into our ears until they're inescapable--names like Leno, Oprah, Dr. Phil. So you know, by a kind of osmosis, that Leno is a comic, Oprah is a force of nature, and Dr. Phil is some sort of therapist. And you know he's "huge," as we say of "hot" celebrities. You see his name at the top of bestseller lists, you see his face in bookstore displays--a genial, ruddy, not unintelligent face. There's something accessible about his presence and he's . . . some sort of therapist.

For those aware of him only out of the corner of the mind's eye, so to speak, it may be something of a shock to learn that, for millions, Dr. Phil is the therapist, paying daily house calls via TV to countless living rooms. His TV show is watched by an average of 6.6 million people every day, and five of his books have been number one on the New York Times bestseller list. He not only offers celebrity endorsements for weight-loss products and regularly goes on sold-out speaking tours around the country, but even has a muppet on Sesame Street named after him--"Dr. Feel." So you might ask yourself, as I asked myself, "What's going on in this world when the dominant male star on daytime TV is a clinical psychologist?"

A few months ago, The Economist shed some light on why a therapist might command so much attention: "About one in five Americans now suffer from a diagnosable mental disorder. The National Institute of Mental Health estimates that more than 13% of Americans--over 19 million people between the ages of 18 and 54--suffer from anxiety disorders, 9.5% from depressive disorders and millions of others from conditions ranging from post-traumatic stress disorder to schizophrenia and bipolar disorder." In addition, "in 2001, 5.5 million more Americans were taking prescription drugs for mental health problems, or problems of substance abuse, than was the case only five years earlier."

Of course, statistics on psychiatric diagnoses are questionable at best. How many people who are simply going through a hard time are classified as "depressive"? How many recovering from traffic accidents have "post-traumatic stress"? Still, there's no denying that in post-9-11 America--with its color-coded terror alerts, two continuing wars, rising gas prices, and an uneasy economy--the general level of anxiety is higher than it was during the boom years of the '90s. So, while it may be an exaggeration to state that one out of five Americans suffers from mental disorders, it's a safe bet that the general level of fear and uncertainty is higher than it's been in the memories of most people born after the Depression. The social climate has never been riper for a TV therapist. It's no wonder that many are calling out (as they do every day on his show), "Help me, Dr. Phil!"

Who then is Dr. Phil? What sort of help does he offer? How did he show up on the scene, and what is his scene?

 

Enter Dr. Phil

In the '70s and '80s, for the first time in the history of recent civilization, it became acceptable to speak openly of the terrors in the family closet. The women's movement, the men's movement, Adult Children of Alcoholics, and various survivor movements outed the all-too-common agonies that had previously been terrorized into silence. Every conceivable variety of incest, abuse, addiction, and destructive relationship became part of our daily dialogue.

This phenomenon represented a tremendous breakthrough for psychotherapy. After nearly a century, its insights and practices had finally filtered into the general culture to the extent that lay people, many of whom hadn't had direct contact with therapy and therapists, incorporated the language of the consulting room into their lives. Psychotherapy served as a powerful ally to this self-disclosure movement, giving it legitimacy and authority. Secret shame was publicly confronted, taboos were swept aside, and what had been unspeakable was not only spoken, but shouted from the rooftops, and from our radios and televisions.

There can be no denying this movement's fundamental benefits. Millions have been helped and healed, abusers have been held to account, and the onus of shame has been at least partially lifted from sufferers and victims. But it's just as undeniable that things went too far. For many, traumas were enshrined and victimhood became a central source of identity. What began as curative became a new kind of malady.

For many people, including therapists, it became obvious that identifying trauma is valuable, while identifying with trauma is destructive. Victimhood devolves into whining, and whining is tiresome, solves nothing, and leaves people stuck in their traumas. It also became obvious that new strategies were necessary--strategies that focused on coping in the present, while not denying the past.

Many therapists worked hard developing and refining new ways of helping clients deal with a traumatic past. But many outside the circles of therapy--either through ignorance, financial necessity, or simple distaste for the process--were still in need of something or someone to point the way out of victimhood.

Enter Dr. Phil. Tune him in and you see an affable, vigorous, eloquently plainspoken man, radiating certitude. His presence on screen has a 3-D effect. He looks directly into your eyes, talks directly to you, effortlessly including you in every conversation with his guests. He seems not to be "on television," but rather to emanate from the television. Jay Leno and Oprah Winfrey are in studios somewhere, and you watch; Dr. Phil is in your room, and you react. No man since Walter Cronkite has commanded the television medium with such seemingly effortless intimacy. Authoritative and comforting, Dr. Phil confronts victimhood with what has become his signature phrase, a challenging injunction spoken with earnest concern: "Get real."

 

A Star Is Born

Dr. Phillip Calvin McGraw, a clinical psychologist, began his practice in his native Texas in 1979, just as the revelation of taboo secrets was picking up steam. He practiced therapy for 10 years during the heyday of tell-it-all trauma. He quit clinical practice because, as he's famously said, he "didn't have the patience for it"; he saw no virtue in whining, or on dwelling upon pain. And the intricacies of therapeutic delving didn't suit his solution-oriented mind. But he did see that psychological insights might be commodified and sold.

He cofounded Courtroom Sciences, Inc., a company that employed psychological research to assist trial lawyers in areas like jury selection. His company's client list is impressive: Exxon (in court over the Exxon Valdez oil spill), The New York Times, many Fortune 500 companies, and, as fate would have it, Oprah Winfrey herself. Oprah had offended the cattle industry and was fighting a suit in an Amarillo court. She hired Courtroom Sciences, Inc., won her case, and hit it off with Courtroom Sciences' Dr. Phillip McGraw.

Invited on her television show, he became a Tuesday regular, and her Tuesday TV ratings quickly became her highest. On Oprah, he morphed into Dr. Phil, a doctor who had no patience for victims. His attitude might be summed up as: "You can talk about that stuff, and that's good, but now get real. What are you going to do about it?!"

Dr. Phil struck a nerve--and had a point. To people identifying solely with their pain, he offered other, more traditionally American, self-reliant avenues of identity. Dr. Phil was a corrective to a victim-oriented psychology that had bloated into a fad.

His approach might have been popular coming from any charismatic guy named Phil, but he's Dr. Phil. His background as a clinical psychologist was his entry pass, his source of authority. Clearly, he wasn't practicing psychotherapy on Oprah. Just as clearly, though, Dr. Phil spoke for himself, but as a psychotherapist. As his website says, he draws on "30 years of experience in psychology and human functioning." In the context in which he's presented, there's no mistaking that, when he speaks, we're listening to a therapist.

With his popularity proven by her Tuesday ratings, Oprah and her producers conceived a wider format for him-- The Dr. Phil Show. It was an instant megahit, second only to Oprah herself in the daytime ratings. Dr. Phil went from being a celebrity to being a phenomenon: tune in the show, buy the bestselling books, visit the website, and get real.

But the question remains, what's the reality behind "get real"?

 

An Internet Phenom

Dr. Phil's "get real" is based on an appealing assumption: that well-informed common sense can be successfully applied to any dilemma. Here's the dilemma; here are your options; choose and enact the wisest option, and the dilemma will be fruitfully resolved.

It sounds like it should work. Certainly, for everyday situations, there's no arguing with it. There's not much to argue about for complex situations either, at first glance anyway. For instance, here, on his website, is Dr. Phil answering a mother who can't believe her daughter is gay--the "get real" approach:

"Homosexuality is not a learned behavior. A sexual orientation is inherited; you are wired that way. Certainly some people will experiment with a gay lifestyle, and a gay person might experiment with a heterosexual one. If she is really gay, she will find a place in that life and in that community. The important thing is that you just love her through that. What difference does it make if she is gay? Accept her, support her and do not be judgmental. It is difficult enough for her to live openly and honestly in this society; don't put your judgment on top of that."

Is this sound advice? In most cases yes, though if you're a fundamentalist convinced your gay daughter is doomed to Hell, "What difference does it make?" brings up major issues that can't be solved by love alone. Is Dr. Phil's statement a brave thing for a public figure to say? In today's cultural climate, his stance probably angers a hefty chunk of his audience. He's clearly not pandering. He's taking a stand that the vast majority of therapists would support and that gay activists must welcome.

 

But it's no small thing to drop judgments about your child. Most therapists know that the "real" work begins after the paragraph is read. Therapy might come next, because, for most people, taking such a step alone is beyond their emotional resources. In fact, such a situation is exactly what therapy is for. But in that web offering, there's no suggestion that if you find these issues too difficult, you might want to seek counseling.

Dr. Phil's advice falls loosely into the category of self-help. Now self-help is, by definition, something you do yourself, without the need of additional relationships. If you're in good enough shape to do that, then books and sites are enough, and you aren't in need of therapy or any other kind of help. The danger is when you're not in good enough shape or haven't the coping skills to get real and make the self-help sites and books useful. Then you may pile up self-help advice as an act of denial that keeps you in the problem. In that case, self-help becomes like self-medication: you may be alleviating symptoms without treating the disease.

Any person of common intelligence can see that what's on the website is bare-bones stuff. More help may well be needed, and it's offered: the appropriate Dr. Phil book is displayed alongside the site's spare advice, with a convenient link for purchase. He definitely wants his website to be part of your life, because it's a colorful hook for his books and a running ad for his show. The show hawks the books and the website, the website hawks the books and the show, the books cite the show, and the show cites the books--a perfectly contained conceptual universe in which there's never the slightest hint of doubt. The instructions are so clear and unnuanced as to be absolute. Over and over, in his writings and on his show, there's a clear message: everything will be all right, if you do what Dr. Phil says.

Dr. Phil sells certainty. In an ever more uncertain world, a world craving clear direction, certainty certainly sells. But is Dr. Phil really so certain? And is he even offering self-help? Not according to a link on his site's first page, "Legal Disclaimer."

 

"All material provided on the DrPhil.com web site is provided for entertainment, educational or informational use only, is not necessarily created or approved by a certified mental health professional, and is not intended to be used in lieu of medical or emotional therapy for those in need of psychiatric or emotional care. We suggest you consult an appropriate health care provider or servicer in your community . . . ."

In politics this is called "plausible deniability."

The honorable alternative of self-help is demoted to the adjective "informational," as though to deny any serious intent. The message is: if you follow Dr. Phil's advice, you don't need a doctor--unless of course you do, in which case, Dr. Phil isn't your doctor. It says so in the small print.

The disclaimer makes an admission many of his fans might find disquieting: Dr. Phil does "not necessarily" have much to do with the content of the site that he says should be part of your life; nor does he "necessarily" stand behind its content, nor does any "certified" psychological authority. "Get real," indeed! To get real therapy, or substantial help of any kind, you must look elsewhere.

TV perhaps?

 

House Calls

Before tuning in to Dr. Phil, let me say that during the course of my life, I've seen four "traditional" therapists, amounting to some seven years in the consulting room. The first was Freudian, the second Gestalt, the third Jungian, the fourth--she didn't name it, but it was practical. All four were useful to me, and all four had much in common. The setting, for one: a consulting room is usually smallish and modestly furnished; the decor is tasteful, quiet, comfy; the lighting is gentle, intimate. The physical space between patient and therapist is well defined but living-room close. Two human beings have made an appointment for some serious talk. There are long silences. There are outbursts--I'm free to disagree, free to walk out. I'm paying for a service, which means I have a right to expect something. My therapist and I are protected by laws, both civil and professional, which regulate our boundaries and guard our privacy. Within those boundaries, a personal relationship develops: we have a stake in each other, my therapist and I.

There's nothing more alive than two people sequestered in a room who must deal with each other as human beings, and it's the aliveness of that contact that ultimately heals. Therapy is primarily a private, secluded relationship that develops over time, and therapist and patient must have the patience to get to know each other and to work on complex dilemmas that can only be addressed and solved gradually.

The words patient and patience are connected--both derive from Latin pati, to suffer. This is one reason I regret that the old usage patient has been replaced in psychotherapy by client . Speaking for myself, I didn't feel remotely like a client in therapy. I was a wounded, suffering, panicky person in need of help and healing, and I felt not at all demeaned if the fact of my situation was acknowledged by the word patient. Medical doctors can have "patients," why can't therapists? My being a "patient" also (so I fancied) gave my therapist a little more responsibility and class than, say, a lawyer or a publicist, for whom I'm certainly a "client." I was definitely not a "guest" or a "contestant," as Dr. Phil refers to his TV consultees. In any case, it's through my experience as a patient that I viewed Dr. Phil's TV show.

Contrast the consulting room with a television soundstage. A soundstage is bright--much brighter than it appears on TV. Watch any talk show or sitcom and you'll see that no one casts a significant shadow, barely any shadow at all (a living metaphor that Jungians can have fun with). For people to cast no shadows, no matter how they move, lots of light is required; banks of lights overhead, pointed every which way. Performers (talk-show hosts, actors, newscasters) are used to all this light, but watching TV can't possibly prepare the uninitiated for the bright reality of a soundstage. Dr. Phil's patients/guests--mostly working-middle-class folks from all walks of life--are like deer in the headlights. (Imagine walking into a consulting room and squinting into a thousand-watt spotlight.)

 

To that unnatural brightness, add a live studio audience. The vast majority of workaday people have never addressed a large room full of strangers. Nothing can prepare most patients/guests of Dr. Phil's for walking onto that soundstage, where their intimate problems will be the subject of "entertainment" and "information," to crib from DrPhil.com's disclaimer.

On that stage, the patients/guests interact with a consummate performer, who's also what we call "a star." They've already invested him with tremendous authority or they wouldn't be there. They've relinquished their privacy in return for his help. Now, under the bright lights, in front of rows of peering strangers and with Dr. Phil himself, they must make their stand. By definition, they're troubled. Now they're also surrounded and outnumbered. Can healing possibly take place in such an arena? What could be further from the environment and process of therapy? Yet these people think they're going to a doctor.

Any TV program, by virtue of its repetition, partakes of ritual. Quiz show and sitcom, newscast and episodic drama, talk show and sports show, each establishes a format and rhythm, enhanced by repetitive theme music, which creates a particular signature. A prime pleasure of television viewing is to sync in with the ritualistic repetitions of each favored program, surrendering to the (usually narrow) spectrum of responses that the program dependably, predictably elicits. A successful program achieves its own defined space, which it repeats and repeats and repeats. Each program is, in an archetypal sense, a kind of Mass, with its own particular and peculiar Communion. You know what's going to happen before you get there, though you don't exactly know--and this knowing-but-not-quite-knowing sustains both the comfort level and the interest.

Dr. Phil's TV show works this form masterfully.

To appear on the show, you send Dr. Phil a home video in which you reveal your troubles. If he and/or his staff chooses your video, they interview you on film, and sometimes place cameras in your home to watch your troubles firsthand and collect clips to be aired on the program. If they decide you're telegenic enough, you're invited on the show, where your average screen time with Dr. Phil is eight minutes (though subjects that are especially telegenic get more).

 

In those eight minutes, your situation is presented and analyzed, a solution is proposed, and you agree to it--cue up the applause! Dr. Phil has famously said, "I've never been under the impression that we're doing eight-minute cures on television." One wonders if the same can be said of his audience or his patients/guests, since he works so hard to give them precisely the impression that he can cure them.

In any case, viewers know when they tune in that they'll see footage of people much like themselves, beset with various dilemmas, and the footage will conclude with the cry, "Help me, Dr. Phil!" The subjects will be trotted out, talked to and talked about; various products will be hawked. And as the show ends, Dr. Phil will stride up the center aisle, to be greeted by his wife, and the two will walk off hand in hand while the audience applauds. There are variations in the middle, but the beginning and end are invariable.

Such is the essence and core of Dr. Phil's house call.

The opening footage of the first Dr. Phil Show I watched was calibrated to excite fear and disgust in whoever watched it: "nanny-camera" shots of babysitters beating and abusing infants and small children. The viewer couldn't help but think in terms of "monster" and "victim." Monsters and victims are common enough in our world, but in the consulting room, both are subjects to be understood. On the tabloid screen of Dr. Phil, both are excuses for titillation. After overwhelming viewers with this footage, Dr. Phil inserts, with all possible seriousness, "We're not saying that everyone's at risk." What he ­doesn't say is that there are millions of babysitters, nannies, and day-care workers, and only a tiny percentage of them are abusers. He also doesn't say we live in an economy in which many mothers have to work and have no choice but to employ the services of care providers. Instead, he makes working mothers feel guilty and frightened for a choice they can't avoid.

Immediately after his not-everyone's-at-risk qualifier, he shows staged "docudrama" footage of a true case: a 2-year-old who drowns because of a babysitter's neglect and bad judgment. The footage is far more powerful than the disclaimer. What can it do but excite--and excite is the proper word--guilt and fear in any insecure parent employing a babysitter? Meanwhile, on his soundstage, women who've lost their children to negligent providers, or whose children have been injured by same, sit unhappily in uncomfortable chairs.

 

What does Dr. Phil say to these grieving, piteous women? With the earnestness of a preacher and the authority of a cop, he tells them, "You've got to turn this thing around. Time heals nothing. It's what you do in that time that begins to heal the loss."

All the poor women can do is nod and, haltingly, agree.

Then Dr. Phil mixes good sense with vague sentimentality, both spoken in that preacher-cop delivery that makes you hang on his every word, never quite knowing whether you're about to be redeemed, arrested, or both. Good sense: "How much you loved that little boy isn't measured by how much you suffer." Vague sentimentality: "You can honor his life by doing a couple of things . . . by finding meaning to your suffering . . . something good has to come of it . . . I don't know what it is for you, but if you use the experience in some way . . . ." What could be more vague, in this context, than words and phrases like "meaning" and "something good" and "in some way"? Even Dr. Phil admits, "I don't know what it is for you." Then he says: "Do you think you're ready to try that?"--as though his "that" is something concrete. They nod. "I'll get you some good professional grief counselors, will you do that?" At last, something concrete. They agree, numbly, their faces set in baffled depression.

But Dr. Phil has just made an interesting admission. They need therapy, which isn't what he does. What he does is spectacle. For isn't it lascivious fun to watch other peoples' embarrassing miseries?

And it works. All our buttons have been pushed; we've been treated to a televised tabloid spectacle designed to arouse one basic feeling: fear. Fear of our surroundings, our neighbors, our world. And fear, as Dr. Phil knows, is a profitable commodity. So he introduces a woman who heads a company that installs nanny-cameras. She describes the price range of her installations and services. Money will change hands. Which hands, we don't know. But the object of the program has been to get fearful parents to spend money--and to spend money on something his guests and viewers probably don't need. What those women really need, even according to Dr. Phil, is grief counseling, i.e., therapy--personal, professional contact, committed to the slow, grueling process of learning to live with tragedy. But that fact gets lost in the program's emotional bath.

A guest's need for therapy is never the message Dr. Phil's viewers are left with. The image the show imprints is that of a tall Texan brimming with certainty--not unlike the present occupant of the White House--who has all the answers and is never wrong.

 

The Healing Power of Celebrity

For some years now, well before Dr. Phil came on the scene, television has thrived on shows featuring the public exposure of privacy: courtroom and discussion programs in which people from all walks of life--usually, though not always, people of the lower middle class--expose their most intimate difficulties, often in raucous settings. Couples quarreling, mothers and daughters fighting over the same lover, abusers and abused, all indulging in a kind of public celebration of humiliation. What would be anyone's motivation for exposing themselves in this way? Clearly, to be on TV confers a sense of reality and importance upon their lives--for in their subcultures, what's important is on the TV. To be on TV is to be real to oneself; it's to have one's existence confirmed by this culture's arbiter of existence. This is the syndrome on which Dr. Phil thrives.

In fact, he's unthinkable without it. The people who send him videos ("Help me, Dr. Phil!"), as well as those who watch, are counting on the healing power of celebrity itself--the authority of celebrity in our culture. To be closer to celebrity is to be closer to power, and is, symbiotically, to be more powerful. In that sense, Dr. Phil is a magic act, a witch doctor if there ever was one (shaman is the polite word). He confers a whiff of his celebrity upon the people he displays, and, in this form of teleshamanism, that's supposed to effect some measure of cure. His patients/guests hope to feel more real, more worthwhile, by being more of a celebrity and rubbing up against celebrities. They're on TV so they must be important--their shift from anonymity to celebrity will somehow magically help solve their problems.

Dr. Phil is an ¨uberelectronic daddy-figure, and his audience his children. He creates a relationship that's mere mystification. You can have no relationship with a human being named Phillip McGraw. You're "interactive" (as the fashionable phrase goes) with an image called "Dr. Phil"--psychology's Barbie Doll--on which you can project all the help you crave.

A show devoted to two boys obsessed with sports--basketball for one, football for the other--demonstrated perfectly Dr. Phil's ability to use his guests to display his particular brand of teleshamanism. Both boys had good grades in elementary school, but now, in the early stages of high school, they do nothing except play sports, and their mothers are desperate. Before introducing the first boy and his mother, Dr. Phil endorses and heavily plugs the movie Coach Carter, to be released later that week. He even shows clips. The movie depicts the true story of an inner-city high-school coach who, by all accounts, had a tremendously positive effect on his young players.

 

Then Dr. Phil introduces, to the adulation of the audience, the actor Samuel L. Jackson, who plays the coach. Then the real Coach Carter comes on. It's no exaggeration to say that the studio audience beams in all this reflected "star"-light--a TV star, a movie star, and a real-life guy who's so great they made a Hollywood movie about him. The screen fairly shimmers with celebrity-power.

Into this highly charged environment comes a terrified boy (the basketball kid) and his almost equally intimidated mother. The boy is convinced that he's going straight from high school into the NBA, though he admits he's not an exceptional player, not the best on his high school's team. In short: he's delusional. "When I can't play basketball," he says, "it's like I'm a drug addict." The kid himself makes the connection between basketball and drugs, but nobody picks up on it. That would be too much like therapy. Never is it suggested that the onset of adolescence and the slow realization of the kind of world he'll soon be asked to confront on his own has terrified this boy so deeply that the only place he feels safe is on a basketball court, and the only safe and meaningful future he can imagine is as an NBA player, shielded by money and celebrity from the rigors of the world.

This child is now harangued by Samuel L. Jackson, Dr. Phil, and Coach Carter, who lets slip the only cogent sentence of the hour: "You can't solve a problem on the same level as the problem."

Tell that to Dr. Phil.

 

The quips of the movie star and the star therapist get immediate audience applause, while the kid stares into the TV monitors on the soundstage with a fixed look. Of course he agrees to anything they say to him. What choice has he? How many frightened high school kids could stand up against all that star-power?

And Dr. Phil's solution to the boy's problem? A video is shown of a player on the same team as the boy's hero, telling him how important school is. Then he's told that if he gets his marks up, he can go to an NBA play-off game and meet his hero. Nobody displays the least interest in what the kid actually feels, or recognizes that he's feeling anything at all. Everybody tells him what to do, and he just nods agreement.

In the next segment, the football-obsessed kid, who thinks he'll be drafted into the NFL directly upon graduation, gets the same treatment. Then both boys are given jerseys identical to those of their heroes and assured that, if their marks go up, they'll get to meet their heroes. The problem is being addressed on the same level as the problem (and isn't that the essence of "self-help"?). But in reality, the problems of those boys aren't being addressed at all. They may be coerced into getting better grades, but how will intense exposure to the object of their delusions do anything but deepen their delusional desires? How does this "treatment" address their fears?

They sit there, beside their mothers, with the jerseys on their laps and their problems "solved" by superexposure to celebrity of every conceivable variety. How this might help families watching who have the same problem isn't addressed, and with good reason. And what's actually happened? Two terrified children have been exploited for the promotion of a movie.

One might well ask why the studio audience doesn't rise up in arms about such exploitation. But like the "guests," the studio audience has a great deal invested in Dr. Phil. They're invested in seeing the show they expected to see--the ritual they're accustomed to, enacted for their benefit, in their presence. If they didn't believe in the efficacy of Dr. Phil, they wouldn't be there. It would take an exceptionally self-possessed person to get disgusted and walk out, and the camera--the all-seeing eye of the program--wouldn't record their exit.

 

And yet, and yet . . . I wonder about Dr. Phil. His sincerity seems unfeigned. While it's hard to believe that he's oblivious to the crassness of his enterprise, it's equally hard to believe that he ­doesn't intend good. Nevertheless, meaning well doesn't excuse his means. A therapist friend said to me, "The show isn't cynical." Sorry, no. The show is cynical. Deeply and fundamentally cynical. It's cynical in direct proportion to how much it pretends not to be cynical.

Whether Dr. Phil himself is cynical--that's another issue. He may not have had the patience to practice psychotherapy, as he's famously said, because he may sincerely believe that digging into the depths is a waste of time. That's surely a defensible position. But the show is a different matter. Not only does the show ignore the depths, the show ignores the danger signs. Further, the show goes out of its way to ignore danger signs. That's cynical.

The Depths of Shallowness

Addressing a problem on the same level as the problem, and thereby deepening the problem, is one of Dr. Phil's formulas. Case in point:

 In January, Dr. Phil displayed six overweight women desperate to slim down to fit into their wedding dresses. In fact, some of them had scheduled their weddings at least once before, but canceled because they felt too overweight to walk down the aisle. Dr. Phil treated this strictly as a weight problem. The idea that they might not be losing the weight because they were frightened of getting married never came up.

These women were presented as "contestants," who, if they met Dr. Phil's weight-loss goals, would win upgrades of their wedding rings and many other gifts. "I'm going to throw every resource I have to help you lose the weight." "This isn't about willpower, it's about programming." "The wedding day is often the biggest day of a woman's life. All eyes are on her. Now there's a big problem if she's--too big." The implication being: her family and friends, and his family and friends, can't love or approve of her unless she's of an acceptable size.

 

Dr. Phil doesn't know or care or question why being fat is such a shaming thing in America, or why it's unhealthy. He's content to exploit the culture's loathing of fatness (even while we're a culture of fatties).

What does Dr. Phil tell these fleshy women? "The only way you can fail is to stop talkin' to me. 'Cause if you keep talkin,' I'm gonna keep pushin'." Dr. Phil says outright that he's The Answer. He's The Guarantee. His claim is to be Therapy personified. "The only way you can fail is to stop talkin' to me."

And the audience is delighted at the announcement that a copy of Dr. Phil's bestselling weight-loss book is under each and every one of their seats. Almost as an afterthought, he informs us all that the book is "out in paperback now, by the way." By the way, indeed. Of course these women should lose the weight; obesity, some studies show, is as unhealthy as smoking. But health is barely mentioned, much less stressed.

It's about fear. And it's about money. This program not only played upon the fears of these women--and of the millions like them viewing at home--but Dr. Phil used his considerable charisma to reinforce their fears and their shame, so that millions more would buy his book.

Dr. Phil may be sincere. He may himself be stuck in the illusions that he's selling. But the show isn't about therapy. It's about selling. And its immense popularity is, in large part, about buying. Dr. Phil exploits a consumer society's delusion that you can buy something--a book, a pill, a "programming" regimen--that'll fix your broken, sad life.

 

What may the Dr. Phil phenomenon mean for psychotherapists?

In one sense, nothing. Patients walk into your consulting rooms every day beset by illusions (as I certainly have), and Dr. Phil, if he comes up at all, is just one more illusion you need to help them through.

In another sense, a lot. Dr. Phil is the opposite of you. With, according to his website, 22 million books in 37 languages, countless hours of internet log-ons, plus (when you include reruns) an infinite number of television hours worldwide, he takes his viewers and readers to the limits of simplification. If they need to go beyond the banal and simple, they need you. Which is to say, they need the patience to be patients--they need the gradual fix, the personal touch. The working therapist is everything Dr. Phil isn't.

So the most famous psychotherapist in the world is the most famous therapist in the world precisely because he doesn't do therapy. And therein lies the secret of his phenomenal success. Therapy is personal, and messy, and takes time. What Dr. Phil sells is standardized, and efficient, and takes eight minutes. Therapy is expensive, and insurance covers less and less of it. Dr. Phil's website and TV show are free, and you can purchase the books at a discount at Border's. You can buy Dr. Phil, or click him on your remote. Your assumptions and defenses can remain intact, because, unless you're one of his unlucky guests, you're always at a safe distance from him. Therapy is serious work. Dr. Phil, by his own disclaimer, is entertainment--given that you're entertained by the heartbreak of strangers.

"Get real," counsels Dr. Phil.

But, alas, those two words take us back to where Dr. Freud began: What is the nature of human reality? What does it really mean to "get real"? And then the complications start. And where complications start, Dr. Phil stops.

Dr. Phil--the Anti-Therapist.

Michael Ventura's biweekly column appears in the Austin Chronicle . Letters to the Editor about this article may be e-mailed to letters@psychnetworker.org.

 

 

The Power of Paying Attention

What Jon Kabat Zinn Has Against "Spirituality"

by Richard Simon and Mary Sykes Wylie

In 1966, Jon Kabat-Zinn, a graduate student in molecular biology at the Massachusetts Institute of Technology, was walking down one of MIT's endless, pallid-green corridors when he spotted a flyer advertising a talk about Zen by somebody named Philip Kapleau. A former reporter at the Nuremburg War Crimes Tribunal, Kapleau had spent years practicing Zen in Japan, and was about to publish a book, The Three Pillars of Zen, that would become a classic text for American students of Buddhism. Kabat-Zinn was a very bright, hard-driving, 22-year-old kid from New York City, the son of a distinguished research immunologist, who was just starting out on his own promising scientific career. He had no idea what Zen was or who Kapleau was, but, in a sea of notices posted on one of the huge bulletin boards lining the corridor, this flyer somehow called out to him.

There were only five or six others at the talk, Kabat-Zinn writes in his new book, Coming to Our Senses. He doesn't remember much about what Kapleau said, except that conditions in a traditional Zen monastery sounded basic to a fault--primitive, no central heat, and freezing cold in winter. But Kapleau explained that within six months of moving into the monastery, his chronic ulcers went away, never to return. Kabat-Zinn was startled to hear that ulcers--a physical ailment--could clear up without medical treatment. This fact seems to have sparked in him some barely-conscious surmise about the mind's power to affect the body that would later form the nucleus of his own vocation.

More important to Kabat-Zinn at the time, however, was something he remembers about the way Kapleau himself demonstrated the power of paying attention as if it really matters . This orientation to being in the moment, embodied by Kapleau and at the heart of the ancient Buddhist practice of mindfulness meditation, sounds pretty mild today--taught as part of meditation and yoga classes in every "Y" in America--but it was radical stuff in 1966. It apparently evoked in Kabat-Zinn a deep curiosity about the possibility that simply being fully aware of each moment as it happens could subtly but profoundly transform the entire quality of life. As he began his own daily practice, Kabat-Zinn started to discover for himself how meditation can take you deeply into the living, pulsing heart of reality, the bodily, down-home feel of your minute-by-minute, second-by-second existence.

Today, nearly 40 years after that portentous afternoon talk, Kabat-Zinn is acknowledged as one of the pioneers in mind-body medicine--a field that integrates ancient spiritual traditions like yoga and meditation with mainstream medical practice. In 1979, Kabat-Zinn established the Stress Reduction Clinic at the University of Massachusetts Medical Center, the first center in the country to use meditation and yoga with patients suffering from intractable pain and chronic illness. Since then, the clinic--now housed in the Center for Mindfulness in Medicine, Health Care and Society (CFM) in the Department of Medicine--has treated about 16,000 patients and trained about 5,000 medical professionals, 30 to 40 percent of them M.D.s. More than 250 similar programs have been set up at other major medical institutions around the country. At least 1,000 research studies on mindfulness-based stress reduction (MBSR) are in print in peer-reviewed journals, showing it can reduce chronic pain, high blood pressure, serum cholesterol levels, and blood cortisol, and alleviates depression, anxiety, post-traumatic stress disorder, and eating disorders. MBSR can also change the way emotions are regulated in the prefrontal cortex and alter the immune response to an influenza vaccine. In short, Kabat-Zinn has been instrumental in bringing a body of practices and beliefs, once the considered a fetish of spiritualized hippies, right into the mainstream of contemporary medical practice.

 

Finding A Calling

At the time of his first exposure to Zen, Kabat-Zinn was very much on the intellectual fast track and engrossed in the pursuit of scientific knowledge. Nevertheless, he was beginning to question the entire edifice of academic science and the hyperintellectual, highly abstract, amoral worldview it spawned. Like thousands of other students of the era, he was deeply embroiled in the movement opposing the Vietnam War then beginning to inflame campuses all over America. And, like them, he was becoming disenchanted with what the best scientists of his era were actually doing with their sharp intellects--creating the next generation of highly sophisticated and lethal weapons systems.

He was dismayed that the world's most brilliant scientists, many of whom were on his own campus, could be so sophisticated about science, yet so unsophisticated about the nature of the mind that produced the science. "We use all these fancy instruments, which are extensions of the senses--electron microscopes, radio telescopes, spectrophotometers--to study the world, but we haven't paid much attention to who's doing all this studying. Who's doing all this knowing? What's the mind of the scientist? We were, and are, smart in a lot of ways, but idiotic in a lot of other ways," he says.

By the time Kabat-Zinn finished his dissertation, he'd been studying Buddhism and yoga for about four years and knew that the standard life of an academic scientist wasn't for him. His academic advisors got a hint that his career trajectory might be a tad unorthodox when they saw that the first page after the title page of his Ph.D. thesis on molecular biology contained only the aphorism, "He who dies before he dies does not die when he dies." He spent about half the time allotted to the defense of his dissertation answering the committee's questions about what he meant by those 12 words, delivering an earnest and high-minded exposition on Buddhist thought in the process.

It was all very well to get hooked on Buddhism and mindfulness, but a young Ph.D. still has to go out and make a living. If, after years of studying with the world's biggest brainiacs, he didn't now want to take his appointed place among them, what, exactly, did he want to do? Kabat-Zinn would spend the next eight or so years trying to figure that out.

 

He taught science as a substitute junior-high-school teacher--occasionally teaching classes from a yoga headstand to keep his students' attention--then taught biology to nonscience majors at Brandeis, did research on anesthetics at Harvard Medical School, and, finally, secured a post-doc in cell biology and gross anatomy at the University of Massachusetts. Part of the reason he took the position was to apply what he learned dissecting cadavers to increase his yoga students' understanding of how yoga postures affected the inner structures of the body.

All these years, he focused on the question of what he was meant to do, what job--"with a capital 'J'"--he was supposed to have on this planet. He never felt that his training as a scientist had been a waste of time; on the contrary, he believed that, somehow, science would figure into whatever he ended up doing--but what might that be? He'd heard architect-visionary Buckminster Fuller say that the seeker after a vocation should ask him- or herself, "What can I do that isn't going to get done unless I do it, just because of who I am?" This question obsessed him, becoming the subtext of all his meditations, the koan he lived with for 10 years.

The answer finally began to come to him while he was working in the U Mass anatomy department, where he had the opportunity to talk to doctors and go on rounds with orthopedic surgeons. What did the surgeons do to help their patients deal with intractable pain that drugs didn't help, he wanted to know. Send them for physical therapy, was the answer, though it didn't usually work very well. Patients tended to passively accept physical therapy, the way patients generally accepted drugs or any other medical treatment, as something being done to them to make the pain go away. In difficult and longstanding cases, when these interventions didn't work, patients felt themselves progressively ground down by their chronic pain. And Kabat-Zinn soon found that most of the doctors, of whatever specialty, had patients they could no longer help, didn't know what to do with, and secretly hoped would just go away.

At about the same time that he was discovering this little-advertised fact about the limitations of high-tech medicine, Kabat-Zinn embarked on a two-week Vipasana meditation retreat getting up to practice in the cold at 3:00 a.m., suffering the all-consuming discomfort of sitting cross-legged and motionless for hours and days. One morning, an idea serendipitously struck him with all the force of a keisaku --the wooden stick used by Zen teachers to administer a bracing, but physically harmless, whack on the back to wake up sleepy or daydreaming sitters. As he recalls, "It was on the 10th day, or something like that, and after all of those years meditating on what my job on the planet was, I suddenly thought, 'Oh my God, I could bring all this stuff--meditation, mindfulness, yoga--into the hospital!'" In a sudden epiphany, Kabat-Zinn could see the entire plan unfolding in his head--how these techniques could be taught to chronic-pain patients in a hospital setting and to healthcare workers from other hospitals and clinics, who could teach them to their own patients. Mindfulness training wouldn't necessarily relieve pain, but it could transform the experience of pain, help people change their relationship to it and thus soothe their suffering, even when no drug or medical treatment made any real difference.

 

But would these peculiar ideas fly back at U Mass Medical? There was already a relatively small, but nicely growing, body of literature suggesting that meditation and yoga could influence physiology. Studies in the early '70s by Harvard medical professor Herbert Benson, for example, had shown that practicing Transcendental Meditation promoted physiological relaxation and lowered blood pressure. So, when Kabat-Zinn broached the idea of teaching meditation to pain patients, the head of the pain clinic, the assistant director of the orthopedics department, and the director of the primary-care clinic, all agreed to send in patients right away. Soon after Kabat-Zinn began his one-man, two-day-a-week program in an office borrowed from a physical therapist, the chief of medicine (royalty in the hierarchical world of the medical establishment) came down and asked him if he wanted to run the program through his department--a vote of confidence, if there ever was one! Kabat-Zinn soon began gathering together a pool of "interns"--anybody in the hospital who wanted to learn about this new thing--developing in the process a small core team to run the rapidly expanding program.

How was it that Kabat-Zinn was allowed to try a decidedly fringy approach on patients in the absence of any professional credentials in this line of work? Or as he puts it, "How the hell did somebody with no training in clinical medicine or psychology, no credentials, and no license, get to work with medical patients?" He was given carte blanche partly because he was passionate and articulate, and also because his Ph.D. in molecular biology from MIT with a Nobel Laureate dissertation advisor provided an entr´ee in professional circles, even if it didn't have much bearing on his new job.

While the program was a "clinic," in name only when it began, today, it stands proudly housed in its own spacious quarters, with the full staff of directors, instructors, administrators, receptionists, and bureaucratic billing procedures of any self-respecting hospital department. Still, the basic content of the program has hardly deviated from what it was at the beginning. While patients are greeted with open-hearted kindness and authentic presence, they're also asked to commit themselves to full participation in the eight-week program--go to weekly classes, meditate for at least 45 minutes six days a week (using tapes provided), and attend a day-long, silent retreat in the sixth week.

The results patients experienced in the new clinic were almost immediate. One doctor told Kabat-Zinn, "You did more for my patient in eight weeks than I've been able to do in eight years." People with all kinds of medical and emotional conditions reported that they slept better, were more relaxed, and were less anxious. Persistent headaches went away, blood pressure dropped, and pain often decreased. What Kabat-Zinn had done for them was "astounding," they told him, "a miracle." To which, Kabat-Zinn, ever the stern empiricist, constitutionally allergic to both mysticism and hero worship, would reply, "Don't use that language. I didn't do anything for you. You did it yourself. All I did was arrange the conditions and give you enough support and encouragement and tools to do it."

 

The skills the clinic taught patients were hardly the stuff of science. Nonetheless, from the get go, science counted for Kabat-Zinn, who realized that if he wanted to have any impact on the world of medicine, his clinical cases would have to be backed up by solid research. So he quickly began learning how to do outcome studies in behavioral medicine. By 1983, he and his colleagues were publishing research papers and monographs on treatment outcomes related to chronic pain, anxiety, cancer, immune function, heart disease, and trauma. In a 1988 landmark study, he and Jeffrey Bernhard, chief of dermatology at the U Mass Medical Center, demonstrated that patients undergoing ultraviolet-light treatment for psoriasis--a chronic and unsightly skin disease--healed four times faster if they'd been meditating in the lightbox. The study powerfully suggested that, at least in some circumstances, the activity of the mind could speed healing of the body and save money in the bargain; in some cases, the meditating psoriasis patients needed many fewer treatments than did their nonmeditating cohorts. Meditation also reduced the incidence of skin cancer caused by the UV treatment.

A Well-Kept Secret

During the next decade, the clinic quietly went about its operations, attracting little fanfare in the wider world. As Kabat-Zinn recalls, "The work was a really well-kept secret. Nobody knew what we were doing, and no one cared. It was just fabulous--a kind of golden era, without all the challenges brought by notoriety or fame or whatever you want to call it." Then, in 1990, Kabat-Zinn published Full Catastrophe Living, a book describing the program at the Stress Reduction Clinic and his experience with the power of mindfulness training to help people cope with stress, pain (physical and emotional), and illness. With a preface by Buddhist monk Thich Nhat Hanh and plenty of testimonials from physicians and medical professors on the cover, the book blended ancient tradition, modern science, and Kabat-Zinn's own reassuringly commonsensical approach that appealed both to experienced students of meditation and people who'd never heard of it. It almost immediately began to attract a devoted readership, and has gone on to sell about a half-million copies.

HASH(0xc8dee0c) Full Catastrophe Living also caught the attention of celebrated television journalist Bill Moyers, who included Kabat-Zinn's Stress Reduction Clinic in his five-part PBS television series Healing and the Mind. The film crew shot about 54 hours of film for a 45-minute segment featuring the clinic, an improbably riveting piece of filmmaking, particularly considering that a great deal of the "action" consists of one chronic-pain patient silently meditating. "The film was its own guided meditation on television," says Kabat-Zinn, "and captured the feeling and tone in the room in a way that, I think, entrained the 40 million people who saw it to intuitively resonate with what they were seeing and feeling."

If the book made waves, the PBS special started a deluge. The hospital had to set up a special phone bank to deal with the onslaught of inquires about the clinic, which numbered well over a thousand calls in the month after the show. As many as 40 percent of the callers were doctors, many of whom said they didn't know what they'd seen, but whatever it was, they wanted it. Within six months, Kabat-Zinn and his staff set up a larger, more accessible training program for doctors and patients.

 

In 1994, Kabat-Zinn published Wherever You Go, There You Are, a kind of meditation on meditation, which has sold, to date, 800,000 copies. This January, his new book, Coming to Our Senses, about the power of mindfulness as a means to social change, will be published.

Although retired from his position as professor of medicine and executive director of the Center for Mindfulness in Medicine, Health Care and Society, Kabat-Zinn continues to be involved with his colleagues in pursuing a range of studies on the impact of mindfulness-based stress reduction on such conditions as prostate cancer, hypertension, asthma, fybromyalgia, chronic fatigue, and irritable bowel syndrome. They have also just completed, but not yet published, a paper on the impact of mindfulness training in Spanish and English on inner-city residents, and are writing a paper on a project looking at the practice of mindfulness in prisons.

In all of this blizzard of work and work in progress, one fact stands out: Kabat-Zinn is as much a scientist who also meditates, as he is a meditator who does science. In a world that prefers its distinctions to be clear-cut and mutually exclusive, he's someone who's successfully built bridges between different worlds and worldviews.

And a bridge-builder between wildly different ways of looking at the world inevitably embodies certain paradoxes. A student and practitioner of an ancient spiritual tradition, he's suspicious of the word spiritual, because he thinks it obscures and mystifies more than it reveals. In his view, while meditation may ground people in the fundamental reality of their being, in another sense, it's nothing special. In fact, practicing mindfulness may be the most democratic of skills. "Anybody can meditate," Kabat-Zinn says. "You don't have to be a college professor." And you don't have to be a Buddhist. Although many people assume that he's a Buddhist, he prefers to describe himself as a student of Buddhist meditation.

 

His entire career has been devoted to bringing this practice home, into the life of anybody who wants to find some peace of body and mind, some sense of clarity and calm, even in the midst of enormous challenges. "My interest has been to find a way to make mindfulness available to regular people, people who are suffering in one way or another, and who may benefit from mobilizing inner resources they may not even know they have."

In the following interview with Networker editor Rich Simon, Kabat-Zinn, who'll be a keynote speaker at the Networker Symposium in March, discusses the "science" of meditation, the nature of inner freedom, and the distinction between mindfulness and psychotherapy.

--Mary Sykes Wylie

Psychotherapy Networker: In Coming to Our Senses, you try to show the connection between the Eastern knowledge tradition of meditation and Western science. Could you start off by explaining what one has to do with the other?

Jon Kabat-Zinn: Western science, for the most part, has devoted itself to studying nature and what's observable in the outer world. Basically, meditation is about bringing the same kind of systematic discipline to understanding inner phenomena, and that, too, is a legitimate field of investigation for science. You could call it the science of subjectivity, of first-person experience, of interiority.

For example, my colleague and friend Richie Davidson is involved in inviting Tibetan monks who've devoted their entire lives to meditation practice into his laboratory of affective neuroscience at the University of Wisconsin to be studied by various means while they're meditating. What he's found is that these monks have an extraordinary ability to describe the inner terrain of subjective experience with reliability and objectivity. They can tell you exactly what's going on inside them when, for example, you're picking up changes in the fMRI scanner. When one of these monks says, "My mind is stable," you can actually see stability on the brain scan in that moment. And when the scan reads a shift activity associated with a particular meditation practice, they're able to reproduce the shift voluntarily in almost no time.

 

This isn't a question of having them meditate for an hour and then measuring the change in the brain pattern. They can shift into very different states and corresponding brain patterns every 90 seconds. By contrast, if you ask college students hooked up to the same equipment what they're experiencing in the mind, as a rule, they just don't know. They're not such reliable reporters on inner experience, and show much less coherence in their brain patterns or the ability to change them at will.

PN: In Coming to Our Senses, you also shoot down a number of what you consider to be popular misconceptions about meditation. What are these misconceptions?

K-Z: First of all, I wouldn't say "shoot down"--that's a little violent for my taste. But people do have a lot of misunderstandings about meditation. As it's become more popular in the West, it's also become loaded down with a lot of images, associations, and connotations that aren't necessarily useful. One common misunderstanding is that meditation is some kind of interior maneuver into a special state of relaxation, as if you're throwing a switch in the back of your mind and then you're in the "meditative state." But mindfulness is really about bringing awareness to virtually any situation or any circumstance or any mental state. It's not about staying in any one particular state. You practice it just to be awake.

Now we all have the capacity to be awake, but that wakefulness is usually so fleeting because we're so used to distracting ourselves or propelling ourselves or repelling ourselves that we normally don't do very much to feed that tiny little flame of recognition that awareness is.

PN: I remember years ago seeing Bill Moyers nonplussed on his PBS special when, after he asked you whether the purpose of meditation was to slow down the mind, you answered, "There is no purpose to meditation. As soon as you assign a purpose to meditation, you've just made it just another activity to get someplace or reach some goal." What did you mean?

 

K-Z: What I was emphasizing there was the nondoing element of meditation, getting away from the goal-oriented thinking that takes up so much of our lives. But, of course, in a larger sense, the purpose of meditation is really just to know yourself. In our everyday lives, we're not really aware of knowing as the fundamental organizing principle of who we are. So we're always trying to get stuff to complete ourselves, without recognizing that we may already be complete. And even if we need to work everyday to get food or problem-solve or handle the other stresses of being a human being, we can do that best by bringing the entirety of our being to bear on whatever we may be doing.

Most of us are usually out of touch with the present moment to some extent. We all create a certain kind of story about ourselves, and then proceed with our lives without realizing that, in doing that, we've removed ourselves from the actuality of living itself. We're so caught up in the story of "I," "me," and "mine" that we lose what's best and deepest in ourselves. That creates a huge amount of suffering and alienation. And, basically, meditation says that's unnecessary. The Buddha, who you could say was a great scientist of the mind, taught, based on studies in the laboratory of his own experience, that it's possible to liberate ourselves from many of the habits of mind that contribute to that suffering and alienation. Meditation offers us a chance to taste or feel or smell the actuality of our experience without all the stories we usually associate with it.

PN: But how do you live without a story? Are you saying that meditation is opposed to what modern neuroscience is telling us about the brain's apparent predisposition to organize our experience through story?

K-Z: What I'd say is that meditation enables us to reconstruct the stories we live by to make them more accurate and larger than they'd be otherwise. Of course, meditation doesn't give you different parents. Your mishigas (this is a technical Buddhist term) is going to be your mishigas the rest of your life. But meditation helps us to recognize that we're bigger than we think are. And it helps us to come to our senses, to wake up, to realize what's actually going on in the realm of experience.

Let's say we take the sense of our own breathing--because so many meditative traditions start with the breath for a variety of reasons. It's part of the body. It's close to home. You can't leave home without it. So you start to pay attention to the breath. You don't need to be "mystical" or "spiritual" to do that.

 

So, if you start to pay attention to something as simple as the breath, you all of a sudden notice some really dramatic and shocking things. You can do this as an empirical scientist. The first thing--never mind for the moment who's the "I" that's watching--but the first thing that happens is that "someone" notices that it doesn't take long for the mind to go off someplace else and lose the breath completely. Breath is still going in and out, but there's no awareness of the way it feels. That then gets noted because some corner of the awareness sooner or later remembers or detects, "Oh, wait a minute. I was supposed to be on my breath for these five minutes as if my life depended on it, and here I am emphasizing something or other or obsessing about this or that. What just happened?"

So then you notice what's on your mind, whatever it is. But instead of beating yourself up and saying, " I'm a bad meditator," the exercise would be more like, "That's interesting. I said I was just going to stay with the feeling tone of the breath, not thinking about breath, but just the sheer sensation of the belly rising and falling, or the feeling of the air passing by the nostrils, and five seconds don't go by and I'm off someplace else." Noted. Back to the breath. There you go again. Another five seconds go by. You're off someplace else. You rapidly come to realize this is a habit. "This is part of the way my mind is wired. Holy smoke. I can't even focus." Well, that, in itself, is very interesting data.

PN: Thus the "inner scientist."

K-Z: Yes. Life itself becomes your laboratory. This little experiment of observing your own breathing for five minutes can be quite revealing, and humbling. It's like, "Oh, I may think I'm free, but actually my mind is at the mercy of whatever crosses my field of vision, my hearing, or smelling, or whatever." There's nothing wrong with that. I'm not judging it. I'm just saying it's interesting to notice. It's not about good or bad.

So what we're saying is, for a moment, let's just see if we can be with our direct experience and not label it all. Just note it. Just see. The mind wanders. You bring it back. The mind wanders. You bring it back. The mind wanders. You bring it back. The mind wanders. You don't want to bring it back anymore. You're bored with it already! A minute has gone by. I get the idea. I'm not interested in meditation. Or, I'd rather be thinking whatever. I'm busy. And then something strikes you. "Holy smoke. This is kind of like the native space of my mind. When I want to bring it to something really important, say an emotional issue, relationships, work, or anything else, I'm bringing that same mind. It's like it has no capacity to get out of its own way or be more spacious, be more stable, more calm and open, or be less reactive and judgmental."

 

As I say, that's interesting. You know how long it takes for you to realize that? Less than five minutes, because in five minutes, the mind will wander an infinite number of times, or close to an infinite number of times, especially if you're living a busy life.

PN: At the same time that meditation has become so popular, I know so many therapists who insist that it does nothing for them. For whatever reason, they don't get what you're trying to describe here. How do you convey to people like that what meditation has to offer?

K-Z: Certainly, I hear from people all the time who say things like, "I just sat there and it was just nothing. Why would I waste my time doing that?" One of the best lines was from one of my patients at the clinic who said, "I might as well be ironing the couch."

Now I don't like to "sell" meditation or give people a sense of "Just meditate and these are the things that you'll feel." From my point of view, that's much too goal oriented. But I'd say that, at the most fundamental level, meditation can show you how to cultivate intimacy with your own body and be in what the Buddhists might call "right relationship" with it.

Many of us are just really encapsulated in our head and in thought, while our bodies are kind of on their own. Then when we experience pain or disease, we may realize that we're actually in an adversarial relationship with our own body. We may be obsessed or preoccupied with its appearance. Or when our body does something we don't like--like come down with disease--we want to drive it to the hospital and have it fixed, as if it were an automobile.

In our clinic, many people learn through meditation that the body is the fundamental ground of our relationship to the world, even if, most of the time, we're not paying attention to it. Through meditation, they learn to call on deep inner resources for healing that are biologically available to all of us.

 

I, Me, Mine

PN: What about how meditation shifts our experience of personal identity?

K-Z: Moment to moment, we're usually flitting around, living inside our heads. You might think about it this way: if you wanted to look at the moon, for instance, and you put your telescope on a waterbed, you wouldn't really have very much success focusing on, or even finding, the moon; your instrument of observation would first need to be stabilized. In the same way, if you want to understand something about the nature of your own life, then you have to learn to stabilize your mind.

But when you begin to meditate, you soon realize that your major instrument for understanding both your relationship with the outer world and your relationship with the inner world is so much more unstable and chaotic than you usually notice in everyday life. Pretty soon, you come up against this basic mystery that some people can spend a lifetime ignoring: who is this "I" who's doing all this experiencing? After all, if you ask biologists looking at how the 100 trillion cells in the body interface with each other, they'll probably tell you that it's an impersonal process--there's no "person" in there. Yet, somehow, out of this three pounds of meat we carry around inside our heads, we get the idea that there's an "I" involved in all this. Yet you can't find that "I" anywhere by looking at all those cellular interactions. It's an emergent phenomenon, so to speak, that comes out of the complexity of it all.

Maybe because it's all so complex, lots of people develop some reified notion of themselves and live their life based on some kind of diminished story of who they are. You can live a great deal of your life in delusion of one kind or another and miss altogether the larger mystery of being human. What meditation does is help us find a way to embrace our interconnections with the outer and inner worlds. It's what Whitman was talking about when he wrote, "I am large, I contain multitudes." Yet most of us feel small, and, if we contain multitudes, they're often at war with each other.

We're all out of a painting by Marc Chagall--figures floating in the air, twisting in this huge spaciousness that surrounds our lives. There's no solid, reified, absolute "me" that we can build a fort around. Meditation teaches us how to become at home in this groundless domain, like a fish in the water. We discover that we don't need to have the usual artificial props of our "identity" to ground us, when we realize that the ground actually is itself also floating.

 

PN: As you say this, I keep thinking of where we started this conversation and the connection between meditation and the scientist's drive to find order in the world.

K-Z: What I'd say about that is that meditation helps us find the relationship between the chaos and order that are both part of our lives. As we were saying earlier, the mind is chaotic: our focus keeps shifting, seemingly uncontrollably, from moment to moment. But inside of that chaos, at any and every level, you also find order. And then if you look inside that order, you find some other level of chaos. The interesting thing isn't to be too ordered--that's actually a state of stasis or death. But if the body gets too chaotic, you'll be in atrial fibrillation or a complete state of mania. Living systems are continually at the edge of chaos. That's why meditation can teach us the deepest lessons of what it means to be alive. It shows us how to surf the wave between the chaos and the order. Even when it's very, very turbulent, meditation helps us find the sweet stillness inside the wave. That's what I call being awake.

Ultimately, meditation teaches us that if you bring mindfulness to the present moment, you have more ways of seeing that are fresher, and you're less likely to be caught in conditioning. Then, of course, the next moment you'll get caught again. So that moment's already gone, and there's another one for you to experience. The question is always, "How am I going to be in right relationship, or wise relationship, to this moment at the level of the body, at the level of the mind, at the level of feelings, at the level of perception?" And it's all one piece: it's not fragmented. And that's why I say meditation isn't a technique that you deploy to get to some kind of special state. It's a way of being in your life that's embodied and awake, and without agenda. It's not about trying to get somewhere. I guess the way to put it is that you are where you are.

 

Therapy and Mindfullness

PN: As the man said, wherever you go, there you are.

K-Z: Exactly. Then your luggage is another story.

PN: What's the difference between the kind of mindfulness that you're describing and what therapists are trying to accomplish in their work?

K-Z: I know many therapists who are incredibly empathic with their patients and extremely good at listening and not being judgmental. They know how to make things spacious and cultivate calmness in the relationship, but they sometimes don't admit that they themselves haven't come close to dealing effectively with their own suffering. And their own therapy doesn't help all that much. Perhaps this is why many therapists are drawn to the interface between mindfulness and therapy as much for themselves as for their patients. In therapy, there's a huge amount of the compassion perspective, but the wisdom perspective--the ability to get beyond the psychological story of "me"--can be a long-term challenge, or even an obstacle.

PN: Can therapy provide anything that mindfulness doesn't?

K-Z: I think there is something that only good therapy provides: the opportunity for a relationship with someone who's honest and loving, yet recognizes the sovereignty of the individual other. That's a huge difference. In our clinic, we see 25, 30, 40 people at a time in our classes. We don't have the resources to spend hours a week talking with people about their personal issues, although we do to a degree, as required.

People who've been badly harmed may need that kind of attention at a much more in-depth level than we can provide; others may not. But the primary relationship in Mindfulness Based Stress Reduction is actually their relationship with themselves, not with us. That's why we start with the body and the breath. The challenge is, "Can I befriend myself?" In that sense, the therapeutic aspect of meditation doesn't start with the therapist: it starts with your relationship to your own experience. And if you hold that in a way that's benign and compassionate, some people might say you can serve as your own therapist, although putting it that way seems to pathologize something that's only a natural part of being human.

 

PN: From the viewpoint of mindfulness, what happens in the "relationship" that you're referring to? What is it exactly that the therapist offers the client?

K-Z: The therapist is trying to help the patient cultivate a kind of autonomy that's already here, that's at his or her core, even though the patient might not be able to experience it yet. Holding that kind of space for the other person is probably the most compassionate thing one human being can do for another. That's what I'd call love. But what's most important for therapists, in my view, is to approach what you do with real caring, and not just as a job to get done. That means truly recognizing that every single person is different, even though you've seen a million cases that may seem the same. That means experiencing each moment with them as unique--and that may mean reminding yourself, "This is a human being, who's always more than any small story she may be telling herself at any moment."

PN: What you're describing is what some therapists might call bringing a "spiritual awareness" into their work. But in your books, you seem to go to great lengths to avoid using the term spiritual.

K-Z: You're right. I almost never use it. In fact, in Wherever You Go, There You Are, the last chapter is called, "Is Mindfulness Spiritual?" There tends to be a lot of confused thinking about spirituality that comes perhaps out of a natural hunger we may have for some kind of transcendent experience. When I hear another person describe someone as "very spiritual," I often just find myself laughing inside. Who isn't "spiritual" when it comes right down to it?

Usually, it's just a projection. I prefer to use the term "fully human," rather than talk about "spirituality." For me, it's a way of speaking about waking up to what's deepest and best in all of us, and already here, if only sometimes in seed form, undeveloped.

PN: You don't need to go to some magical, rarefied place. We're already there.

 

K-Z: Not "there." There's no "there." We're talking about "here." What's happening right here is what it's all about. It's about realizing, with a hyphen-- real-izing --making real, what's actually already so. We're largely ignorant of those dimensions of our being that tend to be bigger than our thinking. As I ask in Wherever You Go, There You Are, is having a baby a spiritual experience? Is being a father a spiritual experience? Is chopping vegetables a spiritual experience? Is taking a crap a spiritual experience? If they're not, then what's a spiritual experience? Anything can be a spiritual experience. It depends on the quality of the being that's in the experiencing.

So if you're thinking, "Oh, now I'm having a spiritual experience. I can't wait to tell people about it," it's really just another way to show how accomplished you are--another advertisement for yourself, to yourself, more clinging without awareness to those knotty personal pronouns I, me, and mine. Acquiring new "spiritual experience" can be just another addition to one's CV, as opposed to actually becoming more aware of one's being and the obstacles to wisdom, compassion, and the ability to be balanced and helpful in the world. To me, it's utterly simple: the most spiritual people I've ever met don't look "spiritual." They're not trying to be spiritual. They're just who they are, whatever the costume.

 

 

Beyond Viagra

Why the Promise of Cure Far Exceeds the Reality

by Barry McCarthy

At 52, Alex was worried about the state of his penis. He missed the easy, automatic erections he once had and sometimes was mortified by his inability to be hard enough to engage in intercourse. With every such "failure," he felt his sexual confidence waning. Alex was sold by the Viagra ads on TV and went to his internist, who was more than willing to give him a free sample of pills.

The first three times Alex took Viagra, it worked as promised. "Whew," Alex thought, glad he hadn't raised this touchy issue with Lorraine, his wife of 28 years. He felt he shouldn't have to talk about sex; he'd always been a take-charge kind of guy, who certainly had never had any problems on this issue, thank you very much.

But the fourth time Alex took Viagra, he got an erection and was able to insert, but he promptly began to lose his erection and felt very panicky. Lorraine tried to restimulate him, but Alex pushed her away. This wasn't supposed to happen. How could the "miracle drug" not work for him? It had to be Lorraine's fault.

The Truth About Erections

Adolescent and young-adult men learn that erections are easy, automatic, and most important,  autonomous. They can experience desire, arousal, and orgasm without help, or even active cooperation, from their partners. Alex subscribed to the common belief about male sexual performance on demand: "A real man is able to have sex with any woman, any time, any place."

 

The Viagra media blitz both feeds and amplifies this male performance standard. The blue pill, the ads suggest, will restore to you the automatic, autonomous, rock-hard erections of your twenties. But even for successful Viagra users, 20 to 35 percent of the time, the drug doesn't work. More striking still, the estimated dropout rate for Viagra within a year is between 40 to 80 percent of users. This is caused by unrealistic expectations of returning the man to 100-percent guaranteed erections. Medication cannot be a stand-alone intervention. As with so many one-shot, simplistic solutions to human emotional problems, the promise of cure far exceeds the reality.

The real news

behind the Viagra sensation is what it says about men's misunderstanding of their own sexuality as they age. Young men can and often do get erections quite suddenly and unexpectedly, simply when a good-looking body swims into view or a sexual fantasy wafts through their brains. They don't need the stimulus of physical touch to become aroused. Middle-aged men expect the libido of young studs long past the time when their bodies can keep up the pretense.

Contrary to media myths, movies, and male braggadocio, sex is seldom 100-percent successful, especially as men age. The most important fact for our sex-saturated society to accept is that 5 to 15 percent of all sexual experiences among well-functioning couples are dissatisfying or dysfunctional. In other words, contrary to the cultural myth of ecstasy all the time as the norm, almost all happy, sexually fulfilled couples experience lousy sex occasionally.

 

Unfortunately, men who haven't gotten beyond the equation of sex = erection = intercourse become more vulnerable to sexual dysfunction as they age. Often, like Alex, they're only one or two flagging erections away from feelings of sexual inadequacy. Indeed, for men, the largest factor causing inhibited sexual desire is fear of erectile failure. By a certain age, men need to learn what most women already know: good, satisfying, pleasurable sex, particularly in midlife and beyond, is more a matter of intimate teamwork than of physical hydraulics.

Once "the machine" fails to function a few times as it always has, confidence in the normal cycle of positive anticipation, satisfying sex, and a regular rhythm of sexual contact is lost. Instead, a new, more pernicious, cycle takes its place: anticipatory anxiety, tense and failed intercourse performance, embarrassment, and sexual avoidance. The man becomes an anxious, self-conscious, sexual spectator, the worried and passive observer of his penis--a state of mind that's the very antithesis of eroticism.

Developing Teamwork

It was at this juncture--post-Viagra failure--that Alex and Lorraine, at Lorraine's insistence, came to see me, a couples therapist with a subspecialty in sex therapy.  As often occurs, Lorraine was more enthusiastic about addressing the sexual problem than Alex. He felt embarrassed, ashamed, and demoralized. In the first session, I normalized both the erectile dysfunction (ED) and his experience with Viagra.

Alex was used to being the expert, not the one seeking help, especially from Lorraine. Yet Lorraine was more than willing to help resolve this problem, as long as Alex didn't blame her for the ED. She enjoyed sex and wanted it to be a part of their lives. She missed not just intercourse, but the whole range of sensual, playful, and erotic experiences that went with it. At the end of this session, I gave them a chapter from Rekindling Desire , which I wrote with my wife, Emily, to reinforce the need for them to work together in the face of a common enemy: inhibited sexual desire and performance anxiety.

 

After the initial couples session, I see each person for one individual sexual-history session to tell his/her story of their psychological and sexual life. Then we have a couple-feedback session.

From those sessions, I developed a therapeutic plan aimed at revitalizing desire and helping Alex regain confidence in his erections. Alex needed to stop seeing sex as a competitive performance--in which Lorraine's existence and sexual feelings were almost incidental--and begin approaching his wife as his dearest, most intimate, friend, with whom he could share pleasure, eroticism, and arousal.

Alex had always felt that he shouldn't have to have his penis stimulated by Lorraine--his erection should be sufficient unto itself. I told him he'd need to be open to her penile stimulation. Even more potentially alarming for a man who so valued his own sexual self-sufficiency, Alex needed to learn to piggyback his arousal on Lorraine's arousal. Alex began to learn that it was both normal and manly to use the "give-to-get" pleasuring guideline, so that the more responsive and aroused she was, the more aroused he became. This was good news for Lorraine, who'd been afraid to let herself get too aroused for fear Alex would feel even more pressured to perform. I pointed out that a woman's arousal can be a major aphrodisiac for the man. The key to achieving change was Alex's willingness to try new ways of thinking about and experiencing sexuality, and Lorraine's enthusiasm for renewed intimacy and eroticism.

I asked Alex to tell Lorraine the emotional, physical, sexual, and interpersonal factors he found most attractive about her. Then he was to make one to three requests--not demands--that would make her more attractive to him. The next day, they were to switch roles, and Lorraine would do the same with Alex.

 

Alex told Lorraine that he appreciated her spunkiness, her interest in working with him to revitalize their sexual life, her work skills, her help in caring for his mother when she was dying, and her staying in good physical shape and carrying herself in an attractive manner. Making requests was harder for Alex. His three requests were to give penile stimulation before he had to ask for it, to be sexually receptive and responsive, and to not talk about sexual problems when in bed. Lorraine enthusiastically agreed to them.

Lorraine wrote out the characteristics she found attractive about Alex. Alex had developed such a negative sexual self-esteem, it was difficult to accept Lorraine's genuine compliments. From this exercise, Alex realized how contingent on performance his sexual self-esteem was.

Alex was surprised by Lorraine's first request--to remember her birthday and plan something special--but was quite willing to do this. The two sexual requests that followed--that Alex shower before a sexual encounter so that oral sex would be more inviting and that he not apologize if they didn't have intercourse, but to just hold her--were more difficult for him. Alex realized with surprise that he had no idea that these three issues bothered Lorraine. But as he thought about it, they really were pretty easy requests to fulfill. At this stage, both Alex and Lorraine felt more positive and hopeful, realizing this wasn't an adversarial process; they could be on the same intimate team.

Lorraine had previously only achieved orgasm occasionally during intercourse. I suggested they refrain temporarily from having intercourse, and encouraged them to explore erotic stimulation to orgasm. She reported that she enjoyed the pleasuring exercises she and Alex were trying and found it considerably easier to reach orgasm, and they were more intense and satisfying than those she'd experienced during intercourse. Alex was ambivalent about these developments. He was glad that he could please Lorraine sexually, but afraid that she might not enjoy intercourse as much as he. I assured Alex (and Lorraine reinforced this) that intercourse would continue to be an integral part of their sexual relationship. The problem wasn't intercourse, but Alex's pass-fail approach to it. The goal of therapy was, in part, to help him realize that there was more to making love than successful intercourse.

 

Alex was enjoying the pleasuring exercises, especially the comfort exercise, in which they engaged in playful (mixing nongenital and genital) touch in the living room with music on but no talking. The hardest thing for Alex to accept was that instead of being the Lone Ranger, he enjoyed and even needed Lorraine's stimulation.

The most helpful exercise was the "wax and wane erection" experience. When Lorraine stopped manually or orally stimulating him, Alex's penis would become somewhat flaccid. While this sent him into a panic at first, after coaching in therapy, he let himself simply relax and allow Lorraine to begin stimulating him again until his erection came back. The realization that relaxation was a more powerful erection enhancer than force of will was itself reassuring.

We reintroduced intercourse into Alex's and Lorraine's sex life at the sixth therapy session. I emphasized that intercourse wasn't the preeminent goal of sex, but a natural (though not inevitable) extension of the pleasuring/erotic play/arousal process. The experience now was far different from their previous pattern of foreplay before intercourse, in which Alex paid less attention either to Lorraine or to his own erotic sensation than he did to the problematic state of his penis. Once Alex accepted that Lorraine's arousal could be an aphrodisiac, he let go and was involved with the erotic flow, piggybacking his arousal on how sexually excited, aroused, and orgasmic she was. Lorraine's being highly aroused with Alex's stimulation was a powerful erotic stimulant.

 

Bridges to Desire

An important component in sex therapy is helping couples do what I call "building bridges to sexual desire--his, hers, and theirs." Bridges to desire means discovering individual cues, places, and scenarios that are sexually inviting for one or both partners. Alex was so used to the idea that the signal that he wanted sex was his erection that the concept of planning sexual dates or consciously inviting sexual encounters was foreign to him. Lorraine took the lead in setting the mood to be sexual. She compared making a sexual date to preparing to attend a play you really want to see: you plan for it, you set aside time to do it, you look forward to it, and, chances are, you enjoy actually doing it.

One of Lorraine's favorite "bridges to desire" was to shower with Alex and have a lit, scented candle in their bedroom. Alex's favorite bridge to desire was cuddling on the couch and becoming more and more turned on before moving into the bedroom. The bridge to desire they both enjoyed the most was a weekend away, especially to a romantic B&B with access to hiking trails. The different environment was a major desire cue for Alex. He liked variety and new challenges in other aspects of his life, and came to understand that was true sexually as well.

Now Alex was beginning to gain a more realistic sense of middle-aged sexual expectations. In one of our last sessions, Alex announced proudly that, a few nights previously, they'd not been able to finish intercourse but, for the first time in his life, he felt okay about it. He comfortably laughed it off and went to sleep cradling Lorraine in his arms. He and Lorraine were enjoying a broader sexual repertoire, and he valued a richer, deeper sexuality, even if it didn't always lead to intercourse.

Couples who are comfortable with their sexuality can genuinely value erotic play that leads to high arousal and orgasm for one or both partners, as well as sensual scenarios--mutual massage or close cuddling--that allow warm, loving, physical encounters without involving arousal or orgasm. Sharing intimacy, pleasure, and eroticism makes sexuality more human and genuine. The man who accepts and values a variable, flexible approach to sexuality in his fifties will inoculate himself and his marriage from sexual problems in his sixties, seventies, and beyond.

 

This isn't to say that medical interventions to facilitate erections and intercourse shouldn't be used. There are times when men are so anxious that they can't relax, even with coaching. Until the process of allowing their erections to wax and wane comes more naturally, Viagra can be used and integrated with pleasuring exercises as a backup resource. But these medications will only work--in the sense of contributing to a richer, more satisfying sex life--if a man values sharing intimacy and eroticism in both intercourse and nonintercourse sexuality.

The man who has a more spacious, healthy understanding of sex knows that it involves two people, not two sets of sex organs (with his clearly the most important). Sexuality is as varied as human interaction in general, encompassing many daily, intimate moments of tenderness, sensuality, pleasure, and mutual teamwork with a beloved mate and friend, not just the culminating drama of intercourse. Real-life, adult sex isn't a kid's game--it can be really well played only by men who've gained some wisdom and experience about the world and themselves, even if their penises are no longer the envy of the locker room.

Case Commentary

By David Treadway

While it may not be true that men's brains reside in their penises, their fascination with their own performance in the bedroom often gets in the way of the shared experience of sexuality with their partners. One woman in my practice said it very succinctly to her husband: "I feel like you're more involved with your thing than you are with me."

 

Barry McCarthy's discussion of his excellent work with Alex and Lorraine gets to the heart of the matter. Middle-aged men who are naturally losing some of their performance abilities may be drawn to some quick pharmacological fix, but, ultimately, they need to learn that sexuality isn't about performance. In fact, boys of all ages need to learn this message. As women become freer to express their own sexuality, performance anxiety in men is skyrocketing, and even college men are having more instances of erectile dysfunction.

 

Both men and women need to understand that men's preoccupation with their sexual performance isn't simply about testosterone and narcissism. Boys still are being socialized in latency to master and deny their neediness, vulnerability, and insecurities. When they go through puberty, all those socially unacceptable and repressed feelings suddenly assert themselves relentlessly below the belt. The tender feelings that little boys have are transformed into the insatiable demands of the ever-present erection. Thus the often voracious sexuality that drives boys and men, frequently experienced by women as impersonal and hurtful, is really an expression of the same yearnings that women bring to relationships: the desire to be seen for who one truly is; the wish to love and be loved without shame.

In teaching Lorraine and Alex how to truly make love with each other, McCarthy is really helping them risk being vulnerable, needy, and insecure together. Alex's fear of Lorraine's disapproval or disappointment and his reluctance to discuss these things with his wife are the real issues. Unfortunately, many men still presume that they're supposed to be skillful sexual partners without ever consulting their partners. Why does it take over a million sperm to fertilize just one egg? None of them will stop and ask for directions.

I confess that Alex and Lorraine's willingness to take direction in the couples therapy and do their therapy homework did give me a case of client envy. My clients frequently have difficulty doing their therapeutic homework, particularly in situations involving sexual intimacy. It would have been useful in this case if McCarthy had added a little more discussion about how Alex, who'd been very private and unilateral in his approach to sexuality, became such a willing participant in the exercises, both with Lorraine and in discussions in front of the therapist. Clearly, McCarthy joined with Alex very skillfully, and I wanted to see a little more how he did that. Unlike the doctors in white coats measuring blood flow with electrodes and prescribing medications, McCarthy is practicing sex therapy based on a strong therapeutic connection that's based on healing the couple's relationship. The case is a helpful demonstration of the limits of pharmacological solutions. Ultimately, it's not Viagra: it's the vitality of relationship that makes a difference in the bedroom.

Despite all the obvious distinctions between men and women, our hearts share the same fears and yearnings. Learning how to hold each other's hearts tenderly is the art of lovemaking.

 

Barry McCarthy, Ph.D., is a professor of psychology at American University and practices at the Washington Psychological Center. He's the coauthor of Rekindling Desire: A Step-By-Step Program To Help Revitalize Sex . Address: AU Psychology, 321 Asbury Building South, Suite 321, 4400 Massachusetts Avenue, N.W., Washington, DC 20016. E-mails to the author may be sent to mccarthy160@comcast.net.

David Treadway, Ph.D., is director of the Treadway Training Institute in Weston, Massachusetts. He's the author of Before It's Too Late: Working with Substance Abuse in the Family and Dead Reckoning: A Therapist Confronts His Own Grief . Address: 228 Boston Post Road, Weston, MA 02493. E-mails to the author may be sent to dctcrow@aol.com.

Letters to the Editor about this department may be sent to letters@psychnetworker.org.

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