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July 11 - August 28, 2022
The purpose of inquiring about people’s parents isn’t to join them in blaming, judging, or criticizing their parents. In fact, it’s not about their parents at all. It’s solely about understanding how their early experiences inform who they are as adults so that they can separate the past from the present (and not wear psychological clothing that no longer fits).
(although, as the saying goes, “Before diagnosing people with depression, make sure they’re not surrounded by assholes”),
“Without thinking about it, what three adjectives come immediately to mind in relation to your mom’s [or dad’s] personality?”
outpatient practice, we mostly see patients in cluster B. People who are untrusting (paranoid), loners (schizoid), or oddballs (schizotypal) don’t tend to seek out therapy, so there goes cluster A. People who shun connection (avoidant), struggle to function like adults (dependent), or are rigid workaholics (obsessive-compulsive) also don’t look for help very often, so there goes cluster C. The
antisocial folks in cluster B generally won’t be calling us either. But the people who experience difficulty in relationships and are either extremely emotional (histrionics and borderlines) or married to people like this (narcissists) do make their way to us. (Borderline types tend to couple up with narcissists, and we see that pairing often in couples therapy.)
In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood
disorders, on the other hand, are ego-dystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.
also try to see the underlying struggle and not just the five-digit diagnosis code I can put on an insurance form. If I rely on that code too much, I start to see every aspect of the treatment through this lens, which interferes with forming a real relationship with the unique individual
“no memory, no desire.” I
“How about we agree that you’ll be kind to yourself while you’re in here? You can go ahead and beat yourself up all you want as soon as you leave, okay?”
Therapists delve into a mind rather than a brain, and we can see from the subtlest gesture or expression if we’ve hit a nerve.
But unlike neurosurgeons, we gravitate toward the sensitive area, pressing delicately on it, even if it makes the patient feel uncomfortable.
People want to be understood and to understand, but for most of us, our biggest problem is that we don’t know what our problem is.
Honesty is stronger medicine than sympathy, which may console but often conceals.
In therapy, you’ll be asked to be both accountable and vulnerable. Rather
Why are they telling me this? What significance does this have for them? People who are aggressively boring want to keep you at bay.
know that therapy won’t make all my problems disappear, prevent new ones from developing, or ensure that I’ll always act from a place of enlightenment. Therapists don’t perform personality transplants; they just help to take the sharp edges off. A patient may become less reactive or critical, more open and able to let people in. In other words, therapy is about understanding the self that you are. But part of getting to know yourself is to unknow yourself—to let go of the limiting stories you’ve told yourself about who you are so that you aren’t trapped by them, so you can live your life and
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There is a way out—as long as we’re willing to see it.
freedom involves responsibility, and there’s a part of most of us
Is this something that’s being done to me or am I doing it to myself? The answer gives you choices, but it’s up to you to make them.
Our work is an intricate dance between support and confrontation.
She was approaching “emotional sobriety”—the ability to regulate one’s feelings without self-medicating, whether that medication comes in the form of substances, defenses, affairs, or the internet.
was just one of those things.
Sometimes the only thing to do is yell, “Fuck!”
The second people felt alone, I noticed, usually in the space between things—leaving a therapy session, at a red light, standing in a checkout line, riding the elevator—they picked up devices and ran away from that feeling. In
a state of perpetual distraction, they seemed to be losing the ability to be with others and losing their ability to be with themselves.
self-sabotage as a form of control.
don’t know what will happen next—how potentially exciting!
The hiccup at this stage is that change involves the loss of the old and the anxiety of the new.
“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.”
“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
The truth releases us from shame.
joy isn’t pleasure; it’s anticipatory pain.
forgiving. There are many ways to move on, and pretending to feel a certain way isn’t one of them.
We may want others’ forgiveness, but that comes from a place of self-gratification; we are asking forgiveness of others to avoid the harder work of forgiving ourselves.
“Because at the end of the day, love wins.
some point, being a fulfilled adult means taking responsibility for the course of your own life and accepting the fact that now you’re in charge of your choices.
The grief psychologist William Worden takes into account these questions by replacing stages with tasks of mourning. In his fourth task, the goal is to integrate the loss into your life and create an ongoing connection with the person who died while also finding a way to continue living.
That week, I’d told Wendell again that my greatest fear is leaving Zach without a mother, and Wendell said that I had two choices: I could give Zach a mother who’s constantly worried about leaving him motherless, or I could give him a mother whose uncertain health makes her more acutely aware of the preciousness of their time together.
