In 1978, The Family Schtick—a little newsletter intended to connect and coordinate the scattered tribe of family therapists in the Washington, DC area—made its debut. A few years later, when it was renamed The Family Therapy Networker and became a full-fledged magazine, it was still pretty humble, as magazines go: 38 pages cover-to-cover, black-and-white illustrations (some distinctly, um, amateurish), on clearly economical low-gloss paper. But even so, there was something even then about the magazine that fundamentally distinguished it from virtually all other psychology and psychotherapy journals—and has unto the present day.
In what academic journal, for example, could you find therapists describing their own fears and fascinations, triumphs and failures, as they work with particular clients? Where else would you read how it feels to witness a real psychological breakthrough in a client, or to stumble into a clinical blunder—and then figure out, on the fly, how to repair it, perhaps even deviating from standard clinical practice? What journal article could describe times when the therapist’s own personal life story makes itself uncomfortably felt in the presence of a client with a particular, resonating issue? In this sense, the readers of the Networker are much like an entire crowd of flies on the wall, listening and watching in perfect anonymity as individual therapists, much like themselves, give their all for their clients and never stop worrying about whether or not they’ve done enough. Such stories from the point of view of the individual therapist—curious, enlightening, often moving, sometimes thrilling—have always been the lifeblood of our magazine.
From the beginning, we’ve considered our writers—no less than our readers—part of the community, the Networker tribe, the extended family, or maybe even a very large group therapy collective. In fact, the editor–writer relationship sometimes bears more than a passing resemblance to the therapist–client relationship, as the first-time writer—an accomplished, self-confident clinical expert in his or her other life—suddenly discovers just how unexpectedly difficult, not to say miserable, it is to put words to paper in a coherent, interesting, readable way. It is, to put it as delicately as possible, a process between editor and writer, one not always free of sharp differences of opinion and hurt feelings. But in the overwhelming majority of cases, not only has the process resulted in fine work, but the resulting article has been a revelation to the author, who uncovers—just as in good therapy—valuable insights about the way he or she works and thinks that can now be handed over to readers.
In addition, the Networker has always done, as interestingly as possible, its official duty to follow closely various new approaches, advances, and perspectives in the field—paradoxical therapies, narrative therapies, brief solution-focused therapies, mind-body therapies, trauma therapies, attachment-centered therapies, neurobiologically informed therapies, to name a few. And we’ve covered our share of brilliant, new instant-cure methods that eventually proved not quite so brilliant and instantaneous, after all. But that’s what happens when you make an effort to let a thousand flowers bloom in your magazine—some are bound to be weeds.
Just as valuable, and often more immediately compelling, were the sometimes bitter controversies we covered that periodically roiled the field, perhaps none as rancorous as the so-called “false memory” debate, in which therapists were widely accused of implanting entirely bogus memories of childhood abuse in their clients’ minds. That most therapists did no such thing made little difference at a time (mid-’90s) when therapy’s reputation was at something of a low point—as therapists were accused en masse of purveying simplistic, feel-good solutions to life’s complexities, coddling whiners and malcontents, and generally creating a culture of victimology. But the field recovered nicely, perhaps helped by our contributors’ shining an honest light on the field’s foibles and missteps, as well as its triumphs. Even when their opinions seemed irreverent, sometimes widely unpopular, they broadened perspectives by encouraging important debates.
Over the past 40 years, it’s become very obvious—if it was ever truly in doubt—that the supposedly sacrosanct boundary between the private space of the consulting room and the larger outside world is a myth. All clients, all therapists, bring into every therapy session their experience of race, ethnicity, culture, class, gender, and sexual orientation—and the way those identities are perceived by the world at large. From the beginning, Networker writers have sought to explore how these socially constructed identities affect the way both clients and therapists experience themselves, their relationships, and their interaction in the therapy room. Similarly, taking its cue from the family therapy movement’s capacious view of human “systems,” we’ve taken into account not just the client’s personal psychology (family therapy’s pioneering theorists could, it’s true, be a little dismissive of as retrograde an idea as individual selfhood), but also the intergenerational family constellation, the community, and the society in which all clients are embedded.
Thus, it was perfectly within the mandate of this magazine to include searching articles about the traumatic impact of war on military vets, the unexpected prevalence of domestic violence, the role of poverty in defining family life, the vast destructive power of the AIDs epidemic (and the popular homophobia that made it worse), the changing roles of men and women in society, the “second family” of teen culture that threatened to entirely supplant family authority, and of course, the digital revolution, which, even now, seems to be fundamentally transforming culture in a way the old geezers (including many of us!) could never have dreamed. One day, a thousand years from now—should the human race survive—maybe humanoids will pick up ancient, preserved copies of the Networker to decipher the astonishing, marvelous, and perfectly terrible rules, conventions, and folkways surrounding the cusp of the 21st century.
Meanwhile, back in our own little corner of the known universe, the process of making this magazine goes on pretty much as it always has, barring some amazingly useful technical changes (no more hauling huge layout sheets across town to the printer!). Certainly, we owe much of our evolution over the past four decades, to our large, often fractious, but ultimately mutually committed and, for the most part, loving and loyal family of subscribers. As in all families, we have our quarrels, and from time to time, certain family members get mad and go off in a huff (often making their grievance known in Letters to the Editor). But that’s all to the good. We may be a tribe, a clan, a family, but we’re a family comprising many thousands of distinct voices, rugged individualists every one—though, of course, individualists who are always, or almost always, wise, empathic, compassionate, and attuned to the feelings of other people. We are, after all, therapists.
And with that, we extend to you an assortment of Networker highlights from our archives that showcase what we consider to be at the heart of what we do. The following are excerpts from much longer articles. We’ve posted the full versions on our website and in the digital edition of this issue on our app.
— Mary Sykes Wylie
Personalities & Changes
Take It or Leave It
The Therapy of Carl Whitaker
Carl Whitaker was family therapy’s master of the absurd. This Networker profile described him in action demonstrating his belief that the unsocialized inner world of fantasy and impulse is a source of creativity to be defended against society’s abnormal normality.
Cal Whitaker is being crazy again. At a week-long summer workshop, he’s set aside one morning to be interviewed alongside a 24-year-old man, once diagnosed as schizophrenic, whose family Whitaker saw in therapy for five years. With hands clasped tightly in his lap, Eric, his rail-thin former patient, addresses the floor as he’s questioned by a therapist chosen from the workshop audience. Asked about his struggle to support himself and separate from his family, Eric explains that “adaption is a horrible word” to him and insists that his inability to hold a job is a result of his refusal to accept his various employers’ shady ethics.
Whitaker, who has earlier described schizophrenia as a “disease of pathological integrity,” announces to the therapist that “Eric is the me that I wished had happened.” Turning to the young man, Whitaker says, “I want to talk to you about the sacrifice you’re making in fighting so intently for your growth.” He begins to muse about his own isolated adolescence and his belief that he was a schizophrenic throughout high school. “But I became a trickster and social robot in order to make my way in society,” says Whitaker. “I am very admiring of you for having the kind of guts I didn’t have.”
The young man, who has been sitting on the edge of his chair as if expecting some gigantic foot to descend suddenly and squash him, begins to fidget, offering a modest protest to his distinguished admirer’s praise. “Please don’t . . . ” he begins, groping for the right word. “Idolize you?” ways Whitaker. The young man nods his head warily, still mesmerized by the carpet.
It’s the kind of odd encounter Carl Whitaker has become renowned for over the past 40 years. As Lynn Hoffman put it in her book Foundations of Family Therapy, he “specializes in pushing the unthinkable to the edge of the unimaginable.” During his long career, he’s outraged and fascinated the world of therapy with his belief that what he calls “craziness,” the inner world of fantasy and unsocialized impulse, is a source of creativity and selfhood to be resolutely defended against civilization’s abnormal normality. Guided by an unrelenting confidence in his own craziness, Whitaker has challenged all the rules and conventions of therapy. At various stages of his career he’s bottle-fed his patients, arm-wrestled with them, refused to allow them to talk, even fallen asleep on them. All this in the interests of righting a balance he believes society has upset, allowing people to acknowledge the unacceptable twists of their inner life, to find some way to hold onto their craziness without “getting their throat cut.”
Whitaker’s colleagues haven’t always shared his confidence in his own intuition. As one senior family therapist says, “I don’t think there’s anything curative in having an encounter with a crazy man.” But Atlanta psychiatrist Thomas Malone, who spent 20 years in close collaboration with Whitaker, believes that such criticism is inevitable. “Carl is about as right brain as you can get,” says Malone. “In a goal-oriented, left-brain culture, he’s an oddity. But you can’t make judgments about Whitaker from the context of the left brain. That would be like a grammarian doing an analysis of James Joyce.”
Today, the 73-year-old Whitaker is still someone whose work elicits extreme reactions, but he’s become such a beloved, grandfatherly figure that it’s a bit jarring to hear about him once being denounced as a dangerous figure.
— Richard Simon
Good-Bye Paradox, Hello Invariant Prescription
Palazzoli and the Family Game
After Italian psychiatrist Mara Selvini Palazzoli became celebrated for her work with therapeutic paradox in the 1970s, she stunned the family therapy world with an even more flamboyant intervention—the invariant prescription.
Parents mildly chagrined at their rebellious teenagers, couples vaguely aware of something missing in their marriage, families who think it would be a nice idea to learn how to communicate better—steer clear. Milan’s Nuovo Centro per lo Studio della Famiglia is not for you. This isn’t a center for your run-of-the-mill family problems; it’s for the cases most therapists would consider impossible, like that of the Santinis.
It’s hard to imagine that Mr. and Mrs. Santini, both sourly avoiding each other’s gaze right now, ever cared very much for each other. Nevertheless, they’ve stayed married for over 30 years, even though most of the time they live in separate residences. Of their five children, two are former heroin addicts and a third, 19-year-old Rudolpho, has had auditory hallucinations for the past year and insists his older sister speaks to him through the TV set. In their first session, 60-year-old Mr. Santini accused 20-year-old Paolo, a handsome university student, of sleeping with the family maid. It was soon revealed, however, that it was actually Mr. Santini who was sleeping with her. Mrs. Santini is now threatening to get a divorce. After the second session, Paolo called the Center to report that his brother Rudolpho had propositioned him and told him, “I want to have your baby.”
It’s now the middle of the third session and the family’s therapist, Mara Selvini Palazzoli, a small woman with an enormous, electric smile, is keeping up an almost constant barrage of what she calls “terrible questions,” her method for quickly penetrating to the family’s emotional core. She’s asked Mrs. Santini why her husband cheated on her in her own home, inquired of Paolo whether he thinks Rudolpho’s homosexual proposition was a message to his mother or to his father, and requested Rudolpho’s help in understanding why his father sleeps with maids. Meanwhile, the Santinis sit, almost motionless, as if mesmerized. Despite Palazzoli’s provocative questioning, they appear fascinated by what’s going on, as fascinated with Palazzoli as she is with them. Whatever terrible things she may be asking, her rapt attention, her expansive gestures, and that blazing smile keep saying to the family, “However uncomfortable this may make you, you can trust me. Nothing you can say will throw me off.” But there’s more than that—a kind of delight she takes in the whole process.
Readers who associate Palazzoli with Paradox and Counterparadox, the celebrated book she cowrote with Luigi Boscolo, Gianfranco Cecchin, and Giuliana Prata, may at this point be wondering what she’s up to. That book proposed that client families enter treatment with both a request and a warning, a double-level, paradoxical message that goes something like, “Please change us/Don’t you dare change us!” To deal with help-seekers who resist help, Palazzoli and her colleagues argued, therapists must be change agents who argue against change. At the heart of their paradoxical approach was an unswerving commitment to clinical neutrality and “positive connotation,” a way of explaining to the family how even the most troublesome symptom was ultimately in the service of family harmony.
But whatever happened to positive connotation and neutrality? And when is she going to advise the Santinis against change? Well, Palazzoli’s ideas about treatment have changed dramatically since the days of Paradox and Counterparadox. Right now with the Santinis, she’s confronting what she calls the “dirty games,” the maneuvers family members use to hide their coalitions and strategies for controlling each other. It’s Palazzoli’s controversial contention that schizophrenia always begins as a child’s attempt to take sides in the stalemated relationship between parents. And what’s even more controversial is she believes that she’s developed an “invariant prescription” that can shake up the whole family game and, in the process, cure schizophrenia.
— Richard Simon
Panning for Gold
Michael White and the Promise of Narrative
Australian narrative therapist Michael White captured the imagination of the therapy world by introducing the method of “externalization,” a way of personifying and concretizing clients’ everyday struggles, giving them a larger-than-life, often heroic dimension.
According to Australian therapist Michael White, a disconcerting effect of his new celebrity on the international therapy conference circuit is the recurrent experience of getting off a plane and being told something like, “We sure have a real humdinger of a family for your live consultation. Oh, and about 500 people have signed up to watch.” Whereupon White, the most visible representative of what’s loosely called the “narrative method” of therapy, is plunked down in front of an impossible situation while the audience waits breathlessly for a therapeutic miracle. But White denies that there’s anything magical about what he does. He says he’s just very “thorough.”
During sessions, he hunches down over his notepad and seems almost to recede from view. He almost never asserts anything, rarely utters a declarative sentence, and patiently asks questions, hundreds of questions. Like an archaeologist, White sifts through the undifferentiated debris of experience for minuscule traces of meaning—the tiny, precious shards of struggle, defeat, and victory that reveal a life—all the while doggedly taking notes. Indeed, there’s a startling tenacity about the process, a kind of polite but unshakable insistence on participation, a refusal to let people off the hook, even after hours and days of long silences, embarrassed shrugs, parrot-like reiterations of “I don’t know.” White will not allow the people who consult him to slip away into the sad night of their misery. He simply won’t give up.
In one session, the parents of a deeply shy and isolated preadolescent girl are trying to coax her away from her perch in front of the TV and go walking with her father. But the girl’s reluctance is such that even when she does consent, she dawdles so that her father must then take a second walk in order to get any exercise for himself. He’s disheartened and wonders if the effort is worth it. Trying to get a statement of feeling from the girl herself is uphill work. White asks, “Do you have different paces of walking? A snail’s pace? A tortoise’s pace? Are you faster or slower when you go walking with your dad?” After a long pause, she murmurs, “Probably slower.” “Probably slower,” volleys White. “That means you do have more than one gear. Do you walk more slowly because you don’t want to go walking with him?” “I don’t want to do it,” she says finally.
Ignoring this response, he asks her how she could help her dad figure out whether to abandon their walks together or persist. She yawns hugely. Building on a microscopically tiny advance that emerged earlier in the session (when he’d elicited from her a barely spoken acknowledgement that she might like to be “taking more initiative in life”), White asks, “What would you like to do with your dad that would fit with this new direction of yours?”—a “new direction” that would’ve been invisible to anyone but White. She mumbles, “Go walking.” “Going walking would fit this new direction?” he pushes. “Fits,” she barely murmurs. “It does fit,” White continues enthusiastically, “so would you like him to keep on trying to go walking, or would you like him to stop?” “Hmmm,” she replies. “You have to say what you’d like,” says White—the closest he comes to making a demand. “Keep on walking,” she finally answers.
By the end of a later session, while she doesn’t exactly seem chirpy and communicative, she’s clearly much more engaged. She looks at him out of the corner of her eye and smiles shyly, even producing some whole, unequivocal answers (short ones) to his questions, obviously delighting her parents. Their daughter, who’d rarely been able to identify any of her own likes, dislikes, desires, or interests, who’d rarely even talked to anybody, has begun, however hesitantly and timidly, to say out loud what she wants for her life.
This kind of work may look to some practitioners like cutting grass blade by blade, but it’s probably more like panning for gold in an overworked stream long abandoned by other prospectors. Slowly, meticulously, steadfastly, White sifts through the sandy deposit, patiently extracting almost invisible flakes until, by imperceptible increments, he’s amassed an astonishing mound of precious metal. Clearly, White’s reputation rests less on therapeutic bravura than on the extraordinary, transfiguring moments that occur in his practice—epiphanies that take place with people most therapists would write off as hopeless.
— Mary Sykes Wylie
The Women’s Project Prepares to Pass the Torch
For two decades, the members of the Women’s Project in Family Therapy were the outspoken feminist conscience of psychotherapy and, with their humor and warm camaraderie, became beloved role models in a field that had long been dominated by male leaders.
Despite its monumental-sounding name, the Women’s Project in Family Therapy owns no real estate and doesn’t even have a listing in the phone book. In the 20 years that it’s been in existence, it’s produced only a handful of monographs, presented a few dozen public workshops, and published one book that sold all of 24,000 copies. Why, then, do so many people in the field believe that without the Women’s Project the development of family therapy over the past 20 years is practically unthinkable?
Perhaps, in part, the Women’s Project owes its paradoxical success to the high-voltage friendship between four of family therapy’s most commanding and savvy practitioners—Betty Carter, Peggy Papp, Olga Silverstein, and Marianne Walters, who took time off from their individual careers as clinicians and teachers to moonlight together as the field’s longest-running think tank cum road show cum social protest rally. As gender became the hottest, most divisive issue in family therapy in the early ’80s, they became both revered and reviled as feminist sheroes, bold and brassy women unafraid of ruffling feathers, who openly and publicly challenged the field’s patriarchy and its conventional wisdom. Bringing the ideology of the women’s movement directly into the consulting room, they sought nothing less than to transform the very picture of family life that undergirded the classic family therapy approaches.
When they looked at Gregory Bateson and Jay Haley’s double-bind hypothesis, or Murray Bowen’s theory of differentiation, or Salvador Minuchin’s concept of enmeshment, they saw not so much a revolutionary new way of thinking about human behavior, but more of the same old sexism done up in fancy terminology. However abstract and evenhanded the theory sounded, they claimed that, again and again, in practice, the family dysfunction was balanced on the back of the mother. Rather than offering an eye-opening perspective on the inner workings of the family, they argued, family therapists were too often guilty of perpetuating the same cultural myths about men and women that got families in trouble in the first place.
When the Women’s Project first strode onto center stage, family therapists still aspired to the removed calm of astronomers peering through a telescope. In contrast, Carter, Papp, Silverstein, and Walters, all of whom knew firsthand the life of the traditional homemaker in prefeminist, post-World War II America, talked of the family from the inside out. And early on, they developed their own ritual for planning workshops, collapsing the personal into the professional. Camped out in Silverstein’s Manhattan apartment, with its panoramic view of the Upper East Side, the women would schedule two days for themselves and devote the first day entirely to updating one another on their lives and travails. “We talked about everything,” says Silverstein, “our husbands, our divorces, our kids. As we talked, we saw the connection between what we did as parents and wives and friends and what we did as therapists. We saw that all those roles weren’t something that interfered with your professionalism; they made you more of an expert on families.”
Their book, The Invisible Web, published in 1988, went beyond dissecting the sexism of traditional therapy to offering practical, nuts-and-bolts approaches to the issues of gender and power in ordinary practice. But the women’s broader achievement has been their role in persuading the field to move beyond the interior of the family to incorporate social and cultural issues into mainstream clinical thinking.
Of course, they could be scathing and combative at times, but the Women’s Project never fit the stereotype of grim feminist crusaders. When they talked in their workshops about the impossible imperatives to be both the perfect mother and the successful career woman, their tone was more knowing and ironic than angry. Somehow they managed to embody the voice of time-weathered clinical wisdom and the wise-cracking spirit of sorority sisters, teasing one another about their clothes, trading one-liners. Once at a workshop, a participant remarked, “The four of you seem so at ease with yourselves. What do you do when you’re anxious or uptight?” Before anyone else could respond, Walters grabbed the microphone and replied, “We eat!”
— Richard Simon
Challenges & Changes
Confronting Homophobia in the Therapy Room
Are We Still in the Dark?
Back in the therapeutic Dark Ages of the 1990s, many clinicians, like the rest of the population, were still just beginning to confront their own discomfort with gender and sexual nonconformity. Today—when an “unstraight” client might be transgender, gender fluid, agender, gender dysphoric, or genderqueer—this article on homophobia, which seemed daring 25 years ago, may strike some readers as an almost quaint reflection of a simpler time.
Thirty years ago, the agenda for therapists working with homosexuals, stated or otherwise, was likely to be conversion to heterosexuality. Whether through confrontation, subtle persuasion, exploration of childhood trauma, or even electroshock, the goal was to reclaim the homosexual from the ranks of social misfits. Not surprisingly, gays and lesbians were, at best, reluctant consumers of the therapies of that era.
In 1969, the Stonewall riot, a spontaneous protest triggered by a police raid of a gay and lesbian bar in Greenwich Village, marked the beginning of the fight for gay and lesbian civil rights and the move out of the closet for millions in the United States. By 1973, the American Psychiatric Association had struck homosexuality from its DSM II, ending sanctioned prejudice by mental health professionals and finally conceding there was no more pathology in gays and lesbians than heterosexuals. But while homosexuality was depathologized, therapists were given no guidance as to how to think about or work with their gay and lesbian clients.
This is still largely the case. Within the field of family therapy, for example, there’s little or no discussion of gay and lesbian treatment issues at conferences or in the mainstream literature. Those who do participate in workshops on these issues, or who write about and study them, are almost always homosexual themselves. Few graduate programs include required reading on same-sex couples or how to deal with homophobia—not just the blatant form, but the quieter, more subtle type that might sneak into therapy sessions when our unthinking assumptions about sexual identities get jostled. We may not go on the attack when we feel these stirrings, but despite our best intentions, our anxiety, fear, and discomfort often spew out.
Assumptions about homosexuality are usually based on a lack of information or outright false notions, and most people, including mental health professionals, aren’t sensitized to recognizing these errors. At one end, a faulty assumption is that, whatever the presenting complaint, homosexuality is the fundamental problem. “I went to therapy after I’d been out in most areas of my life for 15 years,” says one 55-year-old man. “We spent the first session arguing about whether homosexuality is biologically or sociologically based. Finally, I told him it didn’t really matter—I was gay, and that was a fact. I’d come to therapy to deal with my anger toward my alcoholic father who was close to dying. He asked me if I’d come out to him and I said no, our relationship had never been so good, and there were so many other problems between us that I didn’t want to add another. The therapist told me that until I came out to my dad, I wouldn’t be able to have an equal relationship with him. I was frustrated—he was missing the point. It was like knowing I was gay was a clinical buoy the therapist could cling to, that somehow everything in my life was going to be about my sexuality.”
At the other extreme, a therapist might believe that homosexual preference makes absolutely no difference at all, so why make a big deal about it? “I was miserable because it was another Christmas and my family hadn’t invited my lover home with me for the holiday,” remembers 32-year-old Heidi, a graphic artist. “I’d been out to them for a few years, and they were civil to Becky, but they never really acknowledged our relationship. Invitations to family events never included her. I felt angry and asked my therapist what to do. She seemed surprised, and said she thought I was used to the arrangement by now, and wondered why I was so upset. When I said I thought my parents were being homophobic, she asked me, ‘Don’t you think they might want to have just family for the holidays? After all, Christmas is traditionally a family-only holiday.’ When I told her that Becky was my family, she asked me why I was taking such a belligerent stance.”
— Laura Markowitz
Welcome to the Postmodern World
Tired of Your Old Reality? There Are Plenty More to Choose From
Over the past four decades, a new word entered our lexicon—postmodernism—the awareness of the multiplicity of many possible realities and belief systems, along with the increasing difficulty of believing in the importance of any one. Therapists, as usual, had a front-row seat on the psychological uncertainty of living in a “postmodern society.”
Jerry feels overwhelmed, anxious, fragmented, and confused. He disagrees with people he used to agree with and aligns himself with people he used to argue with. He questions his sense of reality and frequently asks himself what it all means. He’s had all kinds of therapeutic and growth experiences: gestalt, rebirthing, Jungian analysis, holotrophic breathwork, bioenergetics, the Course in Miracles, 12-step recovery groups, Zen meditation, Ericksonian hypnosis. He’s been to sweat lodges, the Rajneesh ashram in Poona, the Wicca festival in Devon. He’s in analysis again, this time with a self-psychologist. Although he’s endlessly on the lookout for new ideas and experiences, he keeps saying that he wishes he could simplify his life. He talks about buying land in Oregon. He loved Dances with Wolves.
Jerry is like so many well-educated professionals who come in for psychotherapy these days. But he’s not quite the typical client: he’s a well-established psychotherapist. He conducts stress-reduction workshops nationwide; his current foray into self-psychology analysis is another attempt to find some conceptual coherence for his own work—and of course, for his own life.
Today, people are shoppers in the great marketplace of realities that the contemporary Western world has become: here a religion, there an ideology, over there a lifestyle. They browse among a vast array of possibilities and in the process, change not only their beliefs, but their beliefs about belief—their ideas about what truth is and where it’s found. They change not only their identities (I’m a woman, I’m a Jew, I’m a Jungian, I’m a liberal, I’m a Libra), but their ideas about what identity means. Some enjoy the freedom that can be found in this, some try to escape from the freedom, and some are nearly destroyed by it. Meanwhile, new products keep arriving at the marketplace. If old-time religion doesn’t do the job for you, perhaps Deep Ecology will.
Without quite noticing it, we’ve moved into a new world, one created by the cumulative effect of pluralism, democracy, religious freedom, consumerism, mobility, and increasing access to news and entertainment. This is the world described as “postmodern” to denote its difference from the modern world most of us were born into. A new social consciousness is emerging in this new world and touching the lives of all kinds of people who aren’t the least bit interested in having a new kind of social consciousness. We’re all being forced to see that there are many beliefs, multiple realities, an exhilarating but daunting profusion of worldviews to suit every taste. We can choose among these, but we can’t choose not to make choices.
Frequently these cultural/ideological/religious consumer choices become the “problems” of psychotherapy. They underlie family conflicts and identity crises; they generate deep uncertainties about what—if anything—is real. This shopping for The Truth among the postmodern smorgasbord of belief systems is playful for some, deadly serious for others. Confused by the staggering variety from which they may choose, clients come to therapy hoping for some sure guidelines. But frequently the therapist is as confused as they are.
As such, most of Jerry’s professional life has been spent pursuing the therapist’s equivalent of the holy grail: a universally true psychological theory and practice in which he can find himself—his true self—mirrored. He’s spent tens of thousands of dollars searching for an approach that he can trust unreservedly and that dependably meets the needs of his clients. Yet it seems to Jerry and to many others like him that the longer he searches for therapeutic certainty, the farther away he gets from it.
— Maureen O’Hara and Walter Truett Anderson
The Second Family
The Decline and Fall of Parental Authority
When family therapist Ron Taffel wrote this article, an explosive upsurge of youth pop culture was calling into question the very idea that parents must reestablish firm authority over teens. With the advent of smartphones and instant, constant access to peers, this cornerstone of family systems theory has crumbled even further. The central question Taffel asks is even more urgent now: if pop culture reigns, and teens are firmly embedded in a peer-driven “second family,” what role, if any, can parents play in providing guidance to troubled adolescents?
When his family was referred to me, 13-year-old Jimmy was on the verge of being expelled from eighth grade because of his obvious, but heatedly denied, pot-smoking. To his parents’ horror, he also intended to have his ear, eyebrow, and lip pierced. His parents seemed to agree with the unanimous diagnosis presented by his various therapists and counselors. The boy’s problems, they’d all said, could be traced to classically dysfunctional family dynamics: father was distant and insufficiently involved with his son, mother tended to be overindulgent and intrusive. In short, Jimmy suffered from an archetypal inadequacy in the family hierarchy.
Since Jimmy had grown disengaged from his parents some time ago, I asked who’d been the significant adults in his life, his role models, confidants, friends, or advisers. It soon became obvious that Jimmy hadn’t experienced any significant connection with a grownup, including his parents, since middle childhood. Beginning in about the third or fourth grade, he’d almost completely drifted away from the adult world into the closed society of the kid pop culture—communing mostly with his TV, Nintendo, Sega Genesis, CDs, and comic books. Friends came to hang out, but his parents knew none of them, except for brief sightings as they slunk from the front door to Jimmy’s inner sanctum and out again.
The other therapists had been partially correct—there was no meaningful authority or hierarchy in Jimmy’s family. More to the point, however, there was little significant connection in the family. Insidiously, without his parents quite noticing, Jimmy had, over the years, been completely engulfed by a voracious, commercially driven youth culture. Beginning in preadolescence and certainly by now, the “second” family of his peers had, in fact, become his primary family, the one that really mattered to him.
Unquestionably, Jimmy’s parents needed help, but what use would classic family therapy interventions be when the fundamental assumption upon which they were based—the parents’ central importance to the child’s life—hadn’t been true for quite some time? When it comes to millions of kids like Jimmy, family therapy hasn’t kept pace with several decades of massive social upheaval. The world of an adolescent is now so powerfully defined by systemic forces other than home that working with the family alone is rarely powerful enough to effect change in the life of a troubled teenager.
The disintegration of the first family, for decades bleakly apparent in urban populations, has finally become palpable at all socioeconomic levels. As we all recognize by now, divorce (50 percent of marriages), mobility (up to 20 percent of the population moves every year), and economic pressures that generally require both spouses to work ever-longer hours have undermined the old stability of the family. Time-squeezed parents have few moments to spend with their children. As MIT economics professor Lester Thurow wrote in The New York Times, two million children under 13 have no adult supervision either before or after school. Furthermore, the family’s informal support systems—the extended kin networks, church and community organizations, PTAs, and neighborhood ties—that buttressed family life have gradually disintegrated.
Into the void left by the withering away of adult community life has rushed the vast wave of adolescent peer groups and pop culture. Their influence has been hugely expanded and energized by a technological explosion that’s proven its power to blast into every home. Two-year-old children, without developed language ability, can recite the McDonald’s jingle; researchers have found that 18-month-old kids are already capable of brand-name recognition. At a time when external systemic forces—peer groups and mass culture—are at least as powerful in defining the adolescent’s world as the internal family system, we can no longer focus only on the first family in the therapy room. It isn’t enough—and it doesn’t work.
— Ron Taffel
Alice in Neuroland
Can Machines Teach Us to Be More Human?
As neuroscience was becoming the topic du jour of the therapy field, we sent Senior Editor Katy Butler to MIT on a mission. The result was, literally, a mind-expanding article that thrust readers into the brave new world of behavioral neuroscience. Nominated for a National Magazine Award for Feature Writing, this piece conveys both the excitement and eerie strangeness of therapists’ plunge into a “new rabbit hole into the psyche.”
It’s a rainy morning in early March. I’m in a hotel conference room near MIT in Cambridge, Massachusetts, running a dressmaker’s tape measure through the reddish blonde locks of a mildly anxious physician named Marcia Lipski. At tables all around us, assorted psychotherapists, MDs, and speech pathologists are clustered in groups of three, with laptop computers, electrical wires, plastic tubes of unfamiliar goop, and white Styrofoam heads bought from a wig-supply house and pasted with orange stick-on dots denoting various parts of the brain.
We’re in the midst of a training presented by EEG Spectrum and accredited by the Biofeedback Certification Institute of America in the fundamentals of neurofeedback: a hybrid of biofeedback, old-fashioned counseling, and cutting-edge brain science. Attendance is restricted, on the whole, to healthcare professionals.
The clinicians around me are attempting to integrate their 20th-century therapeutic skills with 21st-century electroencephalography (EEG) and affective neuroscience. Those who once aspired to be sages, healers, and wise women will struggle over the next few days to make sense of hertzes, thalamocortical relays, frequency reward bands, and inhibitory postsynaptic potentials. I feel like a student at the beauty school run by the Bride of Frankenstein.
Consulting my wig-head, I move my finger to a point on Marcia’s scalp about two and a half inches above her right ear. In the spot below my finger, beneath a quarter-inch of bone, lies a cluster of 20,000 pyramidal neurons stacked three deep on the outer layer of her brain’s sensorimotor strip, which governs body sensation and movement. I smear a chickpea-sized lump of clear, viscous wax onto an electrode—it looks like a tiny, gold cokespoon with a long, yellow, electrical wire attached—and press it onto the freshly cleaned spot on Marcia’s scalp. Like a stethoscope pressed against a wall to eavesdrop on a party, this little spoon is capable of “hearing” faint electrical signals pulsing from neuron to neuron beneath the bone.
We clip earring-like electrodes to Marcia’s ears, run a few electronic tests, and plug the electrode wires into a small amplifier leading to a laptop. On the screen, four squiggly lines, like tracings from an earthquake-monitoring machine, dance grayly across a dark field. It’s Marcia’s EEG—a display of the electrical activity occurring in about one-millionth of the total of 20 to 40 billion neurons in her brain. It’s magic.
No longer is the skull a black box, its clockworks invisible, as it was to Sigmund Freud, Carl Jung, and the seminal thinkers and clinicians who have shaped 20th-century psychotherapy. For the past decade, in well-funded university neuroscience laboratories from Boston to Madison to San Francisco, the black box of the skull has been opening and spilling out diamonds. And in offices across the country, therapists today are struggling to make sense of this treasure.
Here, in this rented room, the demarcations between the psychological and the neurological are melting. With the help of a $5,000 computer program, Marcia Lipsky’s skull is thinning like an eggshell before our eyes—sensitive, vulnerable, semitransparent. But we’re doing more than just looking into Marcia’s brain—we’re resetting its inner clockworks. Neurons close to the surface of her skull will, we hope, come to fire in slower, calmer rhythms. They, in turn, should entrain other neurons deeper in her brain, relaying their calming influence from her cortex to her thalamus, which helps govern physiological regulation.
The fleeting, repeated, bio-electro-chemical patterns of neural functioning that Marcia calls mild anxiety—once thought to be hardwired by temperament, early childhood development, and fate—are turning out to be malleable after all. On the basis of a 14-page questionnaire she filled out, we’re thinking of her as “overaroused” and are trying to teach her brain to reregulate itself at its most basic, cellular level. But our healing technology isn’t the imperfect body and soul of a therapist or meditation master, both of whom, in slow, time-tested ways, attempt to teach the psyche self-regulation. We’re diving down a new rabbit hole into the psyche.
— Katy Butler
Controversies & Debates
It’s not My Fault!
Political Correctness vs. Therapeutic Correctness
When Networker film critic and in-house provocateur Frank Pittman wrote this piece 25 years ago, the concept of “political correctness” was just beginning to seep into our national consciousness. With an iconoclast’s passion and a dash of dry wit, he cataloged the hazards of PC thinking for the field of psychotherapy—and for the souls of therapists themselves.
Years ago, at a national meeting, I interviewed a black family with overwhelming problems. The audience wanted to talk about racism, but after a while I interrupted with, “Racism is society’s problem, and we may not solve it in time to help these people, and they don’t have the luxury to postpone their lives until we do. These people are black in a racist society, and they can’t afford to treat that as a social problem. For them, it’s an individual problem, and we have to help them on that basis.” While the family appreciated what I was saying, it set off a furor in the audience, which was PC and believed it was unfair to let the disenfranchised solve their problems, since that took society and the enfranchised off the hook.
I worry about how political correctness affects the practice of family therapy. We therapists encourage, maybe even require, people to rethink their sense of themselves and of the universe. By every word we say or don’t say, by every movement we make or don’t make, we’re transmitting our values and our world view, and if therapy is working well, we transfer our sanity, or lack of it, to the patients. We can’t risk doing therapy unless we regularly rethink our views about gender, class, race and ethnicity, and religion, because our prejudices will affect everything we do and everyone we see. But is political correctness therapeutic?
Those of us who are battling for gender egalitarianism, for instance, find ourselves bumping into a PC sensitivity regarding ethnicity. I once saw a family that had immigrated from Iran during a revolution. Abdul was a physician who’d worked his way up from humble origins. Fatima, his wife, was an aristocrat. Abdul practiced in Chattanooga, an hour and a half away, where he was licensed. Fatima stayed in Atlanta where she had relatives. The couple had two daughters, both physicians, and Abdul wanted them to join him in his practice. But the daughters couldn’t move to Chattanooga because unmarried women shouldn’t live apart from their mothers. And they couldn’t commute, since Fatima didn’t believe it was theologically correct for women to drive. But she had a pothead young, male cousin in Atlanta. So this stoned, 15-year-old boy drove the two physician daughters around, though Abdul ranted and raved to no avail. The daughters rebelled and demanded family therapy.
Therapy was directed toward Fatima’s sense of powerlessness in the face of this overwhelming new culture. Fatima was hard to empower because she insisted she should be powerless, as befitted a Muslim woman. She refused to acknowledge having any power of her own, except to interpret the dictates of her religion. In therapy, it was a struggle to keep the daughters from rejecting their mother as they freed themselves from the powerful bonds of her powerlessness. I wonder whether it was PC of me to impose my egalitarian values on these people from an incompatible culture. When gender and culture collide, I have no idea how to do the PC thing and still solve the problem.
I’m also concerned about the effect of all this political correctness on the practitioners themselves. Taking offense at so many things, all the time, must wither the soul and do terrible things to the sense of humor. I keep thinking of a tombstone I saw in Dorchester Abbey near London. The rather romantic tombstone of Sarah Fletcher, who departed this life at the age of 29 in 1799, read: “If thou hast a heart famed for tenderness and pity, contemplate this spot in which are deposited the remains of a young lady whose artless beauty, innocence of mind, and gentle manners once obtained her love and esteem of all who knew her. But when nerves were too delicately spun to bear the rude shakes and jostlings which we meet with in this transitory world, Nature gave way. She sunk and died a martyr to excessive sensibility.”
— Frank Pittman
The Shadow of a Doubt
The False Memory Debate Strikes at the Heart of Our Belief in a Just World
For many clinicians, the false memory debate of the 1990s was a chilling experience, rife with accusations that therapists had “implanted” fictitious memories of child sexual abuse in the minds of clients. This piece, part of an issue nominated for a National Magazine Award for General Excellence, plunged us into the many dimensions of this debate—the bizarre, the dreadful, the bewildering, and the deeply sad.
On a pleasant Friday morning in early spring, a group of well-dressed, prosperous-looking men and women, most in their 50’s and 60’s, gather for a conference at a large convention hotel in the manicured suburbs of Philadelphia, not far from the rolling greensward of Valley Forge Historical Park. From the subdued, convivial roar of the 600-plus voices, these people sipping coffee and peering at one another’s name badges might be here for a conference of senior sales representatives or real estate agents.
That is, until unnerving snatches of their conversation are overheard. “My daughter has accused me of raping her from the time she was 7 until the time she was 17,” says one grey-haired man from Wisconsin, in the slightly amazed tone of someone who can’t get used to making this statement. In another small group, an Ohio woman, about 50, reports that her daughter—a Harvard MA in public policy—convinced the state police to dig up a public park in search of the bodies of many young boys who, the young woman claimed, her father and mother had sexually abused, murdered, and buried there. A woman in her 70’s, standing in line to register, tells a companion that her 46-year-old daughter has cut off all family contact with her parents, charging that during her childhood they’d engaged in satanic ritual abuse that included rape, murder, torture, and mutilation. “We wanted her to go to the Mayo Clinic for psychiatric testing,” said the woman, “but she said her therapist had told her that the Mayo staff was made up of Satanists who’d get control of her mind.” Across the room, a Minnesota woman, elegantly dressed in a tweed suit and looking younger than her 61 years, starts weeping quietly as she talks about her 33-year-old son, who’s accused his father of sodomizing him when he was a child. One sister believes him; the other hasn’t taken a stand. “At least one is neutral,” she says forlornly. She looks around, suddenly embarrassed. “Am I the only one here crying?” she asks.
Every one of the parents gathered here can tell a similar story of adult children suddenly, and without warning, turning on them with accusations as horrible and fantastic as they are incomprehensible. Every parent here talks about the absolute shock and horror of hearing their children make these accusations, and every parent here vehemently denies the charges. Often, they say, they don’t even know what the alleged details are, or exactly when and where the abuse was supposed to have occurred—the son or daughter levels general allegations and then refuses to disclose particulars, saying something like, “You know what you did. I don’t have to tell you.”
It’s not hard to identify with these parents—in this post-Kafkaesque era, who can’t imagine the helpless bafflement of being charged with terrible but unremembered crimes, assumed guilty, and condemned without hearing? Furthermore, in a psychotherapeutically inspired double-bind typical of our times, denial itself is evidence of . . . denial, the pathological indicator that makes declarations of innocence virtual proof of guilt.
It’s this strange commonality of experience that brings these families together for the first meeting of the False Memory Syndrome Foundation, a support and advocacy organization formed in March 1992, comprising the parents of 4,000 families who say they’ve been falsely accused of sexually abusing their children. Some stand accused of committing even more heinous and sadistic acts—emerging in cultish orgies of animal sacrifice, rape, torture, mutilation, forced abortions on preadolescent girls, murder, and cannibalism.
— Mary Sykes Wylie
The End of Innocence
Reconsidering Our Concepts of Victimhood
Part personal story and part social critique, this article argued that in its treatment of survivors, the therapeutic pendulum had swung from complete denial to an overfocus on the wounded inner child. It asked: how can we help clients establish a delicate balance that fully acknowledges the pain of a traumatic past while not being identified by it?
As a systems therapist, incest survivor, and recovering alcoholic, I’ve lived through several stages of our culture’s attempt to come to terms with child sexual abuse—as a victim in the silent ’50s; as a therapy client in the oblivious ’60s and ’70s; and as a psychotherapist in the ’80s and ’90s, when once-dismissed accounts of abuse filled my therapy practice (and my television screen) only to be partly discredited within the decade during another swing of the cultural pendulum.
We clinicians are still feeling our way toward a middle path, one that avoids the extremes of disempowering pity and “buck-up” denial. Our clients (and if we’re survivors, we ourselves) still struggle to negotiate what sociologist Ervin Goffman called “spoiled identity”: the isolating experience of being cast outside the circle of “normal” life. Helping a client move from subjugation by the worst thing that ever happened to me to a nuanced and effective life has turned out to be more complex—and oddly enough, more commonplace—than I imagined when I first sought help.
I’m now close to 60—a middle-class, middle-aged professional living in Northampton, Massachusetts, where I occasionally see women in town with teddy bears in their backpacks and buttons reading, “It’s never too late to have a happy childhood.” I want to tell them that their button is wrong: it is too late. Time is a river that runs in only one direction. Trauma survivors—be they Vietnam veterans, Cambodians, Holocaust survivors, sexually victimized women, or firefighters who escaped from the World Trade Center—never become people to whom trauma didn’t happen. But the ripples that flow outward from every traumatic event don’t have to sink us, define us, or assign us a single identity. Victim, I want to tell them, describes a specific moment in time, not a permanent self-definition. This is a comforting aspect of the impermanence that transforms every emotional state.
As a culture, we’re only just waking from sleep. It’s long been easier to blame people covertly for their reactions to childhood abuse than to face what happened to them. We pay staggering public health bills for the addicted and traumatized, but we balk at spending on preventing that trauma in the first place. Protective workers charged with investigating crimes against children, for example, make less than half what we pay the police officers who investigate adult crimes.
There are a few hopeful signs that this may change. In the wake of the priest scandals and the collective public wounding of the September 2001 attacks, words like victim and trauma have enlarged their meanings beyond the mostly female holders of this particular spoiled identity. The psychic damage suffered by the firemen and construction workers of Ground Zero made it clear that not only Vietnam veterans and sexual-abuse survivors suffer from PTSD. Nobody’s yet suggested that the heroes of 9/11 are part of a culture of complaint. As Jack Rosenthal put it in the New York Times Sunday Magazine, “Before 9/11, trauma often referred to the horrible physical injuries seen on ER. Now the psychiatric use of the term may just as likely be referring to the time bombs that 9/11 lodged in the minds of thousands.”
These days, I sometimes think back 30 years to the desperate, unconscious, distrustful, and enraged young woman I was when, three days drunk and covered with self-inflicted cuts, I was shot full of Thorazine and bundled off to a state hospital in Connecticut. She’d be both contemptuous and amazed to see who she’s become: a physically healthy professional woman who works inside the system without ever quite joining it. And although I still hold in my heart that wild young woman and understand how she came to be, the river of life has flowed a long way since then, and she’s now only part of me.
— Dusty Miller
The Cult of DSM
Ending Our Allegiance to the Great Gazoo
Written just after the release of DSM-5, this masterfully sardonic look at the diagnostic charade many practitioners play argued that it was finally time to take the dissatisfaction with DSM seriously and find an alternative to an increasingly empty ritual.
A client comes to see you. Let’s call him Fred. He tells you he has a dream job, one in which he’s mostly left alone to do what he loves. But there’s a hitch: in order to get paid (which he does, and well), he has to stand in front of a video camera once every hour, raise his left hand, stand on his right foot, and say, “I declare obeisance to the Great Gazoo.” He tells you that he knows the Great Gazoo doesn’t exist. He tells you that he, and all his coworkers, think the ritual is stupid and undignified, and that he’s appalled at himself, at the ease with which he engages in a pointless exercise purely for the sake of money and then drives awareness of his bad faith out of his mind.
At first, the complaint seems rich, intriguing, even piquant. It provides fodder for conversation about his expectation that the world will conform to his needs, his disappointment at finding out that it won’t. It gives rise to meaningful talk about the fear of poverty, the cruelties of capitalism. You discuss alternatives with him: finding a different job, refusing to participate in the ritual, organizing a protest with his coworkers. Sometimes he leaves your office determined never again to declare allegiance to the Great Gazoo, only to come back a week later, sheepish and forlorn, with a story about how he just couldn’t follow through.
After months of this, both of you are becoming impatient. Fred’s stasis now strikes him as failure and cowardice, which means he’s unhappier than when he began. For you, the intriguing conversations have become boring. You’re ready to throw in the towel—or, as therapists call it, to reframe the discussion. The new therapeutic task is to push the ritual into the background, to accept it as part of reality—like death and taxes and the inevitability of loss. And, you tell yourself, the ritual isn’t such a bad thing: it doesn’t harm anyone and only takes about 30 seconds, and besides, its crosslaterality is probably good for Fred’s brain. You and Fred agree on a new goal: to stop worrying and learn to love the Great Gazoo.
You’re feeling pretty good about this outcome as he leaves your office and you sit down to make your session notes. To sign the note, however, you have to provide a diagnosis. You’ll probably use the same one you entered when you first saw Fred: 309.28 (adjustment disorder with mixed emotional features), or perhaps 300.02 (generalized anxiety disorder), or any of the other of the handful of diagnoses whose codes you’ve memorized. You probably think this is an innocuous enough diagnosis, not likely to impede his access to life insurance or to become an issue should he decide to seek a security clearance.
And it is, except for one thing, or more accurately, three things. First, you know that the only reason you’re entering that diagnosis is that Fred’s insurer isn’t going to pay you to sit around with Fred and figure out the meaning of his life. It’ll pay for therapy only if he has a medical disorder, which is why you shelled out a hundred bucks for your copy of the DSM in the first place.
Second, you know, or at least you should, that there’s no such thing as adjustment disorder or generalized anxiety disorder or any of the other 200 or so diagnoses in the DSM—at least not in the same way that there’s such a thing as strep throat or diabetes. Although it’s debatable whether the DSM provides an accurate anthropology of suffering, a working catalog of our common miseries, its status as scientific medicine isn’t in doubt.
Third, you know that your diagnosis isn’t helping you figure out how to treat Fred. It’s not really for his benefit (other than that it helps him pay for it), and ultimately, it’s not even for your benefit, but for the benefit of a mental healthcare delivery system that increasingly demands a kind of accountability that has little to do with mental health.
If you’ve ever felt guilty about this, you might take comfort in the fact that after a couple of years spent talking to virtually every prominent psychiatric nosologist in the country, I can report that finding someone who will say that the DSM is of clinical value is like walking around Athens with a lamp lit in the daylight looking for an honest man.
For everyone, from lunchbucket therapists like me to the nation’s psychiatrist-in-chief, making a DSM diagnosis is the ritual you have to perform to get the system to work. It may not be quite as silly as Fred’s ritual at work, at least not on the surface, but we therapists have responded to it just as Fred did. We’ve engaged in all sorts of evasions and subterfuges to avoid the glaring and simple truth: the DSM is our Great Gazoo. Invoke it, and the cash rolls in.
— Gary Greenberg
Sex, Marriage & Parenthood
The Facts of Life
Of Sex and Loss
This piece started out as a reportorial piece on sex therapy, but nontherapist Fred Wistow soon blew past that assignment to investigate the ways in which our terror of intimacy can subvert the fragile magic of sexual contact. Here, he lyrically conveys both the thrill of genuine lovemaking and the terrible losses we sustain when we run from it.
I’m barreling out of the city, driving north. A relationship with a woman, yet another, has just ended. I’m anxious to get away from that hurricane of self-doubt and pain that marks the end of a love affair, the collapse of a world. Maybe the wind whizzing by will blow it all away. But the past will not rest. Moments of closeness jostle against flashes of betrayals and rejections. Issues of character and trust seem paramount in understanding why we broke up; sex, surprisingly, is secondary. Yet sex is at the core of the loss: if we hadn’t been physically connected, the pain wouldn’t have been this acute; if we had been more connected physically, I painfully consider, perhaps we might not have broken up.
As memories of recent and more distant pasts line up for inspection, certain moments stand out in such bold relief that they seem to be of another order than the rest. And it’s then I realize that I’ve made love no more than five or six times in my life.
My mind stops. Does the number merit gratitude or more self-pity? From the vantage point of a rest stop, all the other times start to resemble masturbation, except that whatever woman I was with substituted for my genitals, as I did, hers.
During sex, even with someone I love, it seems that in spite of everything I know or want or feel, I too often wind up in a mutual manipulation whose only ultimately understandable aim is orgasm. Touching and being touched, kissing and being kissed, sighs, smells, sights—the intimate murmuring presence of otherness, the excitement of difference—all of that wonder inevitably seems to boil down to the question, stated or not: “Did you come?” Two people become two objects.
I make her come. She makes me come. Our job is done. I’ve been macho enough to break through her wall of not-coming, to overpower her not-coming state, thereby proving my manhood and the wizardry of my technique. She’s reconfirmed her own desirability through my erection and ejaculation. Through coming, our anxieties about not coming—of not pleasing and being pleased—ease. Relaxed, we can each feel protective of the other. And protected: some private part of us has not been touched; some hidden part has remained hidden.
I feel like an imposter.
Then, the few havens in the heart of my memory rush forward, the half-dozen times when love and the transcendence of shame overshadowed the orgasms and power trips.
Those few times something broke, something very strong and ever-present, yet so invisible I’m never aware of it—or what’s behind it—except when it’s broken. It’s a wall behind which hides a self, adamantine in its refusal to emerge, a private self which seeks protection in remaining unseen. It’s primal, needy, and desiring, and most of all, ashamed and oh so fearful of the pain it might encounter if, in revealing its need, it should be spurned.
The few times I’ve been brave enough to peer out from behind the wall, a woman always showed me the way. Through a word or gesture she let a terribly private part of her be seen and I followed.
On those few occasions when the wall has broken, I’ve felt myself spill into another person. It’s a me I rarely see, the trusting desiring child-me. The threat, the competition—the ability to hurt—that other people represent, ceased needing to be defended against and I, I who was liquid—semen, sweat, sometimes tears—flowed without restraint. And she at those times became not just a doll to touch and rub in order to make come, but instead, a tender welcoming, resonating bowl who in the course of holding me I held, her own private trembling self revealed, by me embraced. The magic of discovery, disclosure, and acceptance. Mutual acceptance of secret selves. We were separate yet entwined.
Looking back, I realize I shouldn’t complain: I shared one such magic experience with my most recent lost love. But we’re living a connect-the-dots game. The dots are moments of contact, special intimate moments when we see ourselves and others see us, too. Most of our lives is spent in the passage of time between the dots. But when we recall what’s meaningful about our lives, we remember the dots, forget our lines. Sex, the greatest opportunity for contact, makes for the boldest dots. It can also afford the most complex labyrinths in which to hide. The few times I hadn’t hidden myself, something magical happened.
— Fred Wistow
The Mother Journey
Traveling on an Unmarked Road
Before Molly Layton became a mother, she was a graduate student who pondered philosophy and allowed herself some existential angst. But becoming a first-time mother rocked her to the core, forcing her to confront the awesome responsibility of parenthood—not just in the wailing, diaper-changing present moment, but forever.
When I was a 23-year-old graduate student and finishing up notes for an oral report on the Philosophical Investigations of Wittgenstein, I went into labor. My husband, Charles, and I dropped the paper off at a friend’s house so he could present it in my stead at a philosophy seminar. Then we drove through Austin’s balmy November twilight to the local hospital, where David, six pounds and so-many ounces, was born early the next morning.
It was the ordinariness of becoming a mother that first struck me with a hot blast of wonder. Women had babies all the time, and yet in the great novels I’d read, no one ever talked about the experience of becoming a mother, nor about the sticky details of birthing and nursing. As a person accustomed to research, I found even the most practical information hard to come by. This was in 1966, and I had to send off to France for a book about the new Lamaze method of childbirth. Because of the popularity of bottles, even the informal lore of breastfeeding, handed down from older to younger women, had been lost. It seemed I’d landed at the center of human life and, surprisingly, found myself alone, engulfed in an inchoate and banal silence. How bewildering that a process as grand and scary and tedious as becoming a mother should be so unremarkable, literally not worthy of remark.
I myself was adrift in immaturity, about as unformed and malleable as my own small baby, who, I was now genuinely startled to discover, needed my intense concentration. Before he was born, the fetal David was a rosy abstraction in a blithely comfortable pregnancy. I glowed, I thrived, I brushed aside the cautionary tales. Not until I saw Rosemary’s Baby much later did I consciously recognize the dark side there all along—the baby as parasite, the sinister “other” placed within the soul self by strange and alien powers, the invasive fetus vanquishing the helpless mother. This isn’t merely the baby of horror stories and psychotic nightmares: this is the shadow side of symbiosis.
Truly the infant David overwhelmed me. In his presence, I could neither read nor write. Eventually, I abandoned my training in philosophy to study instead this small, willful, and physically beautiful person. I had to push away my books and my thoughts so that I could hear his tiny demands. David was the person who made me pay attention to the world outside myself, to boiled eggs and washed sheets and flirty babies.
In remembering the early days of motherhood, I feel again that first shock of my own responsibility for this tiny fragile person, the clear and compelling demand that I harden into a self, a definite persona, that I come out of the mists of graduate study. Because we stubbornly identify with the helpless infants, we human beings find it hard to accept the frail and tenuous humanity of the mother. We easily and sentimentally resonate to the emotional nurturance that we as infants need from mothers. Our infant-selves are masters of longing, and masters too in imagining the mother’s unlimited strength and unlimited supply of love. The mother soon learns what’s required to support the life of her child. Then she just does it. Whatever she thinks the child needs, that’s what she does.
Specifically, the mother’s motivation arises from her discovery of a terrible truth: she must keep and hold someone who’s perilously fragile in a world now suddenly filled with danger. This demand—the demand to preserve—is so clear and so penetrating that it forces even the most philosophical among us to abandon our relativism and shuck off our existential blues.
It was the bald inescapability of my new identity that shocked me the most, sometimes making me proud of myself, sometimes guilty and confused, sometimes just exhausted. But of course, I had to stay in role: my baby held me as I held him. Until then, I’d never been so located in time and space.
— Molly Layton
Bringing up Father
How My Children Taught Me the Secret of Fatherhood
When author Frank Pittman became a father, he discovered that the childhood absence of his own father left him with no idea how to relate to his kids. This piece plumbs many men’s difficulties in connecting with their kids, and suggests how therapists can best help “amateur dads” learn the vital lessons for raising their children.
Mother taught me that fathering was the most noble of man’s callings. Her own father—a judge, senator, poet, and editor—had died when she was two, but she brightened my childhood with her glorious fantasies about what he would’ve done had he lived and how wonderful her life would’ve been as a result. In Mother’s fantasy, happiness was a father who would just hang out with you and talk about the nature of the world and the meaning of life. I fell in love with this heroic myth of father as the man who knew all the secrets of life and sat around telling them to you.
Even though I knew I wanted to be a father when I grew up, I didn’t know exactly what skills were required. I needed a model of a father, a real live one who could talk to me about what the profession was really like, and how it might differ from my mother’s fantasies. That shouldn’t have been too difficult a job. My mother had thoughtfully provided me with a fine father, and it would seem natural for me to have talked to him. But that wasn’t the way it worked out—for me, for my friends, or for just about any other man growing up in my generation.
We of the ’40s and ’50s grew up with fathers who were off at war or at work, and who weren’t part of the family even when they were at home. We were essentially fatherless. When we had children, we became fatherless fathers. We either had no concept of what fathers were for, or some glorified fantasy of the paternal ideal. Lost and confused, we waited for somebody to tell us what we were supposed to do. Some of us assumed that our wives knew what fathers were about, forgetting that our wives hadn’t had fathers either.
Fatherless men may go through life in a childlike position. Having been raised by women, they assume that women are supposed to take care of men and children. But they may not know what men are supposed to do in return after they get the women to take care of them. Some of these fatherless men have never known a grown man well enough to know how to act when they themselves become grown men. Men who’ve been raised without fathers can’t help but be amateur parents, and may even be amateur human beings.
I was wrong when I thought that being a therapist would help me as a parent. I’ve tried all the tricks, but none of them worked with my kids. They’d mastered paradox by the second grade, and made clear that they like enmeshment, as long as it was on their terms. As parents, we can’t get by with mouthing truths the way we can as therapists. We have to embody them. We can’t kid our kids. They know what we do, not just what we say. We can’t erect boundaries against our children. Parent–child relationships are mutually intrusive. Our children may not pay very much attention to what we say, but they’re studying us, and absorbing us. I’d always seen much of my mother in me, and much of me in both my daughters. I’m gradually becoming my father, much as I might resist it, and my son is rapidly becoming me, now that I’ve given up on forcing him to do so.
I continue to believe that expertise at living is more helpful for a therapist than expertise at therapy. But then I assume that people, whether they be patients, parents, or children, are generally well intentioned, but misinformed. I don’t understand those theorists who think that families want nothing more in life than to defeat the therapists, or who believe that parents are out to destroy children, for unconscious or conscious reasons. I just assume that people are amateurs at life—this is their first time doing it, and they’re just muddling though the best they can with whatever they’ve learned in their own families from their own amateur parents. Our job is to respect their good intentions and amateur status, and provide our professional expertise in identifying and correcting their misinformation.
— Frank Pittman
Reconciling Sensuality and Domesticity
It’s been said that “sex without sin is like an egg without salt.” In this piece, couples therapist Esther Perel outraged some readers by arguing that the therapeutic ideal of egalitarianism in the bedroom may actually dampen sexual pleasure, and that couples therapists would do well to revamp their definition of healthy sexuality.
A few years ago, I attended a presentation at a national conference, demonstrating work with a couple who’d come to therapy in part because of a sharp decline in their sexual activity. Previously, the couple had engaged in light sadomasochism; now, following the birth of their second child, the wife wanted more conventional sex. But the husband was attached to their old style of lovemaking, so they were stuck.
The presenter took the approach that resolving the couple’s sexual difficulty first required working through the emotional dynamics of their marriage and new status as parents. But the discussion afterward indicated that the audience was far less interested in the couple’s overall relationship than in the issue of sadomasochistic sex. What pathology, several questioners wanted to know, might underlie the man’s need to sexually objectify his wife and her desire for bondage in the first place? Perhaps, some people speculated, motherhood had restored her sense of dignity, so that now she refused to be so demeaned. Some suggested the impasse reflected long-standing gender differences: men tended to pursue separateness, power, and control, while women yearned for loving affiliation and connection. Still others were certain that couples like this needed more empathic connection to counteract their tendency to engage in an implicitly abusive, power-driven relationship.
After two hours of talking about sex, the group hadn’t once mentioned the words pleasure or eroticism, so I finally spoke up. Was I alone in my surprise at this omission? I asked. Their form of sex had been entirely consensual, after all. Maybe the woman no longer wanted to be tied up by her husband because she now had a baby constantly attached to her breasts, binding her more effectively than ropes ever could. Didn’t people in the audience have their own sexual preferences, preferences they didn’t feel the need to interpret or justify? Why automatically assume that there had to be something degrading and pathological about this couple’s sex play?
More to the point, I wondered, was a woman’s ready participation in S&M too great a challenge for the politically correct? Was it too threatening to conceive of a strong, secure woman enjoying acting out sexual fantasies of submission? Perhaps conference participants were afraid that if women did reveal such desires, they’d somehow sanction male dominance everywhere—in business, professional life, politics, economics? Maybe, in this era, the very ideas of sexual dominance and submission, conquest and subjugation, aggression and surrender (regardless of which partner plays which part) couldn’t be squared with the ideals of fairness, compromise, and equality that undergird American marital therapy today.
As an outsider to American society—I grew up in Europe and have lived and worked in many countries—I wondered if the attitudes I saw in this meeting reflected deep cultural differences. I couldn’t help wondering whether the clinicians in the room believed that the couple’s sexual preferences—even though consensual and completely non-violent—were too wild and “kinky,” therefore inappropriate and irresponsible, for the ponderously serious business of maintaining a marriage and raising a family. It was as if sexual pleasure and eroticism that strayed onto slightly outré paths of fantasy and play—particularly games involving aggression and power—must be stricken from the repertoire of responsible adults in intimate, committed relationships.
After the conference, I engaged in many intense conversations with other European friends and therapists, as well as Brazilian and Israeli colleagues who’d been at the meeting. We realized that we all felt somewhat out of step with the sexual attitudes of our American colleagues.
Ironically, some of America’s best features—the belief in democracy, equality, consensus-building, compromise, fairness, and mutual tolerance—can, when carried too punctiliously into the bedroom, result in very boring sex. Sexual desire doesn’t play by the same rules of good citizenship that maintain peace and contentment in the social relations between partners. Sexual excitement is politically incorrect, often thriving on power plays, role reversals, unfair advantages, imperious demands, seductive manipulations, and subtle cruelties. American couples therapists, shaped by the legacy of egalitarian ideals, often find themselves challenged by these contradictions.
— Esther Perel
Katy Butler, a former features editor and staff writer for Psychotherapy Networker, is the author of two award-winning books about aging and living meaningfully in life’s final quarter, especially in relation to modern medicine. Knocking on Heaven’s Door (2013) was a New York Times Bestseller and Notable Book of the Year. The Art of Dying Well (2019) is a road map —practical, medical, and spiritual —through the significant passages of life after 55. Katy’s groundbreaking work for the Networker was nominated for one National Magazine Award and contributed to several other NMA awards and nominations. Her writing has also appeared in the The New Yorker, The New York Times Magazine, Tricycle: the Buddhist Quarterly, Scientific American, Best American Essays, and Best American Science Writing. Other honors include first-place awards from the National Association of Science Writers and the Association of Health Care Journalists; a “Best First Book” award; and a finalist nomination for the Dayton Literary Peace Prize. She lives in northern California and loves to dance in the kitchen to Alexa with her husband Brian.
Dusty Miller, EdD, is director of the Atrium Consultation and Training Institute in Northampton, Massachusetts. She’s the author of Women Who Hurt Themselves; Your Surviving Spirit: A Workbook of Spiritual Resources for Coping with Trauma; and numerous other publications on trauma and addiction. She’s also the co-director of the Willing Spirit Retreat Center in Cape Cod, Massachusetts.
Psychotherapist and New York Times bestselling author Esther Perel is recognized as one of today’s most insightful and original voices on modern relationships. Fluent in nine languages, she helms a therapy practice in New York City and serves as an organizational consultant for Fortune 500 companies around the world. Her celebrated TED talks have garnered more than 40 million views and her international bestseller Mating in Captivity: Unlocking Erotic Intelligence became a global phenomenon translated into more than 30 languages. Her newest book is the New York Times bestseller The State of Affairs: Rethinking Infidelity (HarperCollins). She is a Licensed Marriage and Family Therapist, an AASECT certified sex therapist, a member of the American Family Therapy Academy and of the Society for Sex Therapy and Research. Esther is also the host of the hit podcast “Where Should We Begin?” which is available on Apple Podcasts. Her latest project is “Where Should We Begin – A Game of Stories with Esther Perel.” Learn more at EstherPerel.com.
Frank Pittman, MD, was a longtime contributing editor to The Family Therapy Networker.
Fred Wistow is a former contributing editor to the Psychotherapy Networker and lives in New York City.
Gary Greenberg, PhD, is a practicing psychotherapist, the author of four books, including The Book of Woe, a contributing writer for Mother Jones, and a contributing editor for Harper’s.
Laura Markowitz is a journalist, editor and multimedia producer in Tucson, Arizona, and winner of a National Magazine Award for writing and coeditor of The Evolving Therapist: Ten Years of the Family Therapy Networker.
Molly Layton has been writing for the Psychotherapy Networker for more than 25 years. Her short stories have been nominated for a Pushcart Prize and included in the Writing Aloud Series at the InterAct Theater in Philadelphia.
Richard Simon, PhD, founded Psychotherapy Networker and served as the editor for more than 40 years. He received every major magazine industry honor, including the National Magazine Award. Rich passed away November 2020, and we honor his memory and contributions to the field every day.
Ron Taffel, PhD, is Chair, Institute for Contemporary Psychotherapy in NYC, the author of eight books and over 100 articles on therapy and family life.