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have found that four givens are particularly relevant to psychotherapy: the inevitability of death for each of us and for those we love; the freedom to make our lives as we will; our ultimate aloneness; and, finally, the absence of any obvious meaning or sense to life.
In my many years of work with cancer patients facing imminent death, I have noted two particularly powerful and common methods of allaying fears about death, two beliefs, or delusions, that afford a sense of safety. One is the belief in personal specialness; the other, the belief in an ultimate rescuer.
It is through willing, the mainspring of action, that our freedom is enacted. I see willing as having two stages: a person initiates through wishing and then enacts through deciding.
Without opinions, without impulses, without inclinations, they become parasites on the desires of others.
One of the great paradoxes of life is that self-awareness breeds anxiety. Fusion eradicates anxiety in a radical fashion—by eliminating self-awareness. The person who has fallen in love, and entered a blissful state of merger, is not self-reflective because the questioning lonely I (and the attendant anxiety of isolation) dissolve into the we. Thus one sheds anxiety but loses oneself.
Beware the powerful exclusive attachment to another; it is not, as people sometimes think, evidence of the purity of the love. Such encapsulated, exclusive love—feeding on itself, neither giving to nor caring about others—is destined to cave in on itself.
Love is not just a passion spark between two people; there is infinite difference between falling in love and standing in love. Rather, love is a way of being, a “giving to,” not a “falling for”; a mode of relating at large, not an act limited to a single person.
Only when one feels an insight in one’s bones does one own it. Only then can one act on it and change. Pop psychologists forever talk about “responsibility assumption,” but it’s all words: it is extraordinarily hard, even terrifying, to own the insight that you and only you construct your own life design. Thus, the problem in therapy is always how to move from an ineffectual intellectual appreciation of a truth about oneself to some emotional experience of it. It is only when therapy enlists deep emotions that it becomes a powerful force for change.
The more the therapist is able to tolerate the anxiety of not knowing, the less need is there for the therapist to embrace orthodoxy.
The creative members of an orthodoxy, any orthodoxy, ultimately outgrow their disciplines.
The first step in all therapeutic change is responsibility assumption. If one feels in no way responsible for one’s predicament, then how can one change it?
Whenever the patient begins to develop symptoms in respect to the relationship with the therapist, therapy has really begun, and inquiry into these symptoms will open the path to the central issues.
“Betty, what’s the danger in letting me matter to you?”
“Refusing the loan of life in order to avoid the debt of death.”
Patients, like everyone else, profit most from a truth they, themselves, discover.
I have come to believe that the fear of death is always greatest in those who feel that they have not lived their life fully.
A good working formula is: the more unlived life, or unrealized potential, the greater one’s death anxiety.
One of the axioms of psychotherapy is that the important feelings one has for another always get communicated through one channel or another—if not verbally, then nonverbally.
“Remember, you can’t do all the work. Be content to help a patient realize what must be done and then trust his or her own desire for growth and change.”
Nietzsche was a seer in many domains, he was no guide to interpersonal relationships—has there ever lived a lonelier, more isolated man?
I used the metaphor of a thermostat regulating self-esteem. Hers was malfunctioning: it was located too close to the surface of her body. It did not keep her self-esteem stable but instead fluctuated wildly according to external events. Something good happened, and she felt great; one criticism from someone, and she was down for days. It was like trying to keep your house heated with a furnace thermostat placed too close to the window.
