No Contest

This article first appeared in the September/October 2001 issue.

Lorene was a witty, round-faced woman in her mid-thirties who showed up for our sessions with her arms swathed in bandages. Beneath tape and gauze, she hid the damage that she inflicted on herself, repeatedly, with a razor blade. Lorene was one of the first survivors of severe sexual abuse I had ever treated, and, eventually, she’d be at least as much help to me as I was to her.

One day, after we’d been working together for a few months, she arrived for therapy without her bandages. I knew that Lorene had been cutting herself, of course, but this was the first time I had actually looked at her carved flesh. I was horrified, repulsed, panic stricken—but more than anything else, Lorene’s self-inflicted injuries galvanized me. I was fiercely determined to get my client to stop brutalizing herself.

At the time, I had just begun to experiment with a therapeutic approach that I was very excited about. I called it the internal family systems model, and it involved identifying and engaging with one’s inner cast of characters, whether it was the frightened child, the rebellious adolescent, the perfectionist critic or any of the other sub-selves that live within all of us. These internal personalities, I had discovered, appeared to have iron wills of their own that often overwhelmed my clients’ judgment. When I questioned the part of Lorene that was cutting her, her usually placid face darkened and her voice deepened by an octave. “Lorene is evil and deserves to be punished,” the cutter growled.

I was taken aback by the cutter’s tone, but I also liked a good fight. “Lorene is not evil,” I said forcefully. “She is good and I will not let you keep hurting her.”

“You will never help her,” the cutter spat back. “She’s mine.“

The more I implored the cutter to acknowledge Lorene’s essential goodness and to stop the abuse, the more intransigent she became. During the third session devoted to this standoff, I upped the ante: I told Lorene that she could not leave my office until the cutter agreed not to mutilate her for the next week.

Two and a half hours later, she surrendered. “I promise not to cut myself,” Lorene whispered, her eyes downcast. I was triumphant. So that was the secret—letting people’s destructive parts know that I meant business. Who knew, maybe I’d found a way to cure the whole phenomenon of self-mutilation!

At Lorene’s usual appointment time the following week, I opened the door to my waiting room to greet her. What I saw stunned me into silence. Running from the top of Lorene’s forehead down to her right eyebrow was a fresh, deep gash. “What?” I gasped. Lorene shrugged noncommittally and moved quickly past me into the office. As I followed her, I was assaulted by a jumble of feelings—horror about the possibility of permanent scarring to her face, fear about what the cutter might do next and, coursing through it all, a roaring fury because I had failed. “Why did you do this to Lorene?” I demanded of the cutter.

Lorene narrowed her eyes and looked at me with the purest contempt. “I told you she was mine!”

Looking for Games to Win

My therapeutic style with Lorene—take-charge and relentlessly focused on results—had been honed for more than a decade. Almost from the moment I first learned of family therapy in 1973, I was attracted to its structural and strategic models because they seemed to conceptualize therapy as a kind of contest. Though I stood only 5 feet, 7 inches tall and weighed 145 pounds, I had played four years of college football as a defensive back, and deep down I was still looking for games to win.

To me, the structural “game” involved using the force of your personality like a crowbar to pry apart enmeshed relationships and open up blocked communication channels. The strategic version seemed more like a chess match, where you outwitted your clients by dreaming up clever and sometimes deceptive prescriptions. Needless to say, my perspectives on these approaches were somewhat skewed by my own need to jockey for position and to come out on top. Winning was a high and I pursued it everywhere, from dominating theoretical debates to decimating my tennis partners. So I felt an immediate kinship with these highly directive therapies.

Not incidentally, I also had grown up in a family that prized achievement. My father was a noted endocrinologist who had published more than 100 papers in highly prestigious medical journals and had contributed to treatment advances for several diseases. I was the oldest of his six boys and, lacking a head for hard science, I believed I was a big disappointment to him. I also sensed that he, the quintessential scientist, was disdainful of my entry into the “fuzzy” field of psychotherapy. If I could prove that it was effective, maybe he would come to respect the field I had chosen. Maybe he would come to respect me.

No surprise, then, that by the early 1980s, I found myself collaborating on an outcome study of 30 bulimic clients and their families. We treated them with a hybrid structural/strategic approach, and I’m only exaggerating slightly when I say that we expected to achieve the same rate of success that Salvador Minuchin and his colleagues had gotten with anorexics. But, though some clients in our study did improve, a surprising number seemed immune to our interventions. We carefully reorganized the clients’ families just the way the treatment manual prescribed, yet their binge-and-purge episodes continued unabated, powered by some invisible, inexplicable force.

Bewildered and frustrated, I broke an unspoken family therapy taboo and began to ask my clients what was happening inside them before, during and after their binges. Their answers rocked my theoretical world. They talked about different “parts” of their personalities as though those parts were autonomous beings. I’d been trained to recognize and manipulate family systems, but now I began to see that each of us contained what I came to think of as an internal family system, and that these disparate parts of ourselves could feel every bit as neglected by our dominant part as a child does by his demanding father.

In a simple and linear world, the discovery of my clients’ influential inner worlds would have been the turning point that catapulted me, full force, into a genuinely new understanding of my purpose and role as a therapist. But truly transforming that role would have required me to face myself in a way I was not yet ready for. True, my explorations with clients were leading me to listen more carefully within myself. But what I found there disturbed me: some of my own inner family members were every bit as extreme as those of my clients.

Whenever a student yawned in a class I taught or whenever a colleague was too busy to join me for lunch, an inner voice sneered at me: “You’re so stupid and boring!” Whenever I lowered my competitive and combative shield—even for a moment—I found myself awash in the feelings of worthlessness, loneliness and sadness that had accumulated throughout my childhood. At those times, I would find myself gripped by a sudden urge to write an impressive article or find someone to flirt with. Slowly, I became more aware of how automatically I used achievement—in work, relationships and sports—to distance myself from those scary emotions.

The pain that I felt when I focused beyond the striving and critical parts of myself redoubled my desire to coerce those parts into changing. I tried all sorts of strategies: ignoring my internal critics, commanding them to shut up, reassuring the self-doubting parts that they were okay. I used the same bulldozer techniques with my clients, arguing with, motivating, and manipulating their recalcitrant parts. But the harder I tried to get these sub-selves to do my bidding, the more rebelliously uncooperative they became. I responded by pushing harder. Inside, I felt knotted up and increasingly hopeless.

Letting Go

This, roughly, was my state of being on the morning that I opened my waiting room door and saw Lorene, looking like the victim of a subway mugging. As I sat across from her, unable to deny the jagged, plum-colored slash across her face where a razor blade had been, nor the small, nail-bitten hands that had done this deed, something popped inside me. It was not just that Lorene’s self-maiming made me see in graphic, incontestable terms that my methods were bankrupt. It was also that this new level of viciousness toward herself jolted me into understanding that I could no longer afford to remain stuck in my fruitless fantasies of winning. These were not harmless games I was playing with my clients: they could lead to savage and enduring consequences. I had to let go.

“You win,” I told Lorene’s cutting part with sincere resignation. “I give up. I’m not going to fight you anymore.” Lorene’s face relaxed slightly. “I’m tired of fighting with you, too,” I heard the cutter respond in a small, weary voice. I was astonished by this shift. Softly, I asked: “Why do you need to hurt Lorene this way?” Haltingly, the cutter began to explain that it cut Lorene whenever she felt on the edge of despair. In order to cut, she first had to numb her body, which effectively wiped out her emotional pain as well. I sat back, speechless. So the cutter was not trying to destroy Lorene, but to preserve her. I had been trying with all my might to eliminate something that Lorene’s system believed it needed for her very survival.

My morning with Lorene began a humbling, transformative process of being taught by, rather than teaching, my clients. Tentatively and often painfully, I began to shift from my expert’s mindset to what Buddhists call “beginner’s mind.” From that new vantage point, I learned that all of the addictions, self-hatred, impulses, fears and rage that I saw in my clients covered a layer of pain and shame that left them breathtakingly delicate and vulnerable. I began to try to create a safe enough environment for them to explore the center of their worthlessness, reunite with exiled pieces of themselves and listen compassionately to the harrowing stories that the neglected members of their internal family had to tell.

When Lorene, for example, got permission from her cutting part to enter into her despair, she began to see scenes from her abuse. These were not necessarily new memories, but now she was able to witness them in a new, openhearted way. Gradually, she began to feel intense love and empathy for the children trapped in the scenes, and no longer needed a cutter to help her deaden her emotions. The cutting stopped for good.

This was not easy work for me. At first, I often found myself getting distracted or distant whenever things heated up. My clients’ pain activated my own, and to protect myself I would simply space out, missing whole chunks of my clients’ stories. At other times, I would purposely lead an emotionally-fraught conversation in a different, less turbulent direction. I was shortchanging my clients and I knew it. Seven years ago, I went into therapy myself to begin to sit with, and listen to, my own inner exiles.

Looking Within

Because I had always thought of my childhood as pretty mild and unremarkable, I expected to be done in 10 sessions, max. A year later, I was still sitting in my therapist’s office, holding my young, childlike exiles and witnessing their stories. It was the first time I had ever allowed myself to recognize how alone I had felt in my childhood family. Nor had I ever let myself fully feel the rejection and cruelty I had suffered at the hands of a brutal peer group. Over and over again, I had simply counseled myself to “let it go, it wasn’t all that bad, other people have it much worse.” Now, I revisited all the ways I had kept the world at arm’s length and recovered sensitive parts of myself I had disowned years before.

One of my biggest fears was that if I went toward the pain I had spent a lifetime avoiding, it would trigger anger at my father and I would distance from him. But just the opposite happened. The frightened boy inside me needed my father’s approval less because it finally had mine. As a result, I could more easily see past the tough, judgmental parts of my dad that had once hurt me and enjoy his endearing qualities—his humor, his gifts for storytelling and teaching, his bursts of warmth.

Several years ago, my father gave me the gift of a glimpse into his inner world. He had recently retired and was struggling with the loss of identity that accompanies retirement. We entered into a deep conversation about the parts of him that were making him feel so bad. He described the hectoring voice that was so familiar to me. It was telling him he was worthless now, that no one would respect him without a job and a title, that he would spend the rest of his life simply waiting to die. I asked if he knew how this striving inner critic had come to have so much power in his life, and he spoke about childhood experiences—getting the lowest grade on a big exam in elementary school and having all the scores posted on the wall; feeling less valued than his siblings in his struggling immigrant family—that had left him determined to achieve. As he talked about how he had piled up accomplishments in an effort to counter his own sense of inadequacy, I was touched by the similarity to my own life and understood, finally, that my father’s critic had been harder on him than it had ever been on me.

As I listened to my dad, I was getting a mind-blowing lesson on how we pass along pieces of ourselves within our families. I began to feel a deepening acceptance of my own ever-striving critics, along with a strengthened commitment to stop inflicting them on my wife and kids. Conversations like that one also brought my dad and me closer, both of us overcoming the fear that if we were vulnerable with each other we would lose each other’s respect.

I owe a lot to my experience with Lorene and her cutter. Thanks to the process set in motion by our early standoff, a lot of the pushing is gone from my work as a therapist. My competitive parts—the unstoppable defensive back and the professorial guy who gets a rush when he makes a good point in an argument—still lurk inside me. But their roles are smaller now, and quieter. As I work with my clients, I need less and less to come up with big insights or interventions that get them to change. It’s an enormous relief to no longer have to be the clever, masterly therapist and instead to trust that, if I can get people to listen within, they’ll find the answers and the healing they need. To paraphrase Mark Twain, I’m amazed at how much wiser my clients have become over the past 20 years.

PHOTO © MARC POKEMPNER