Should I stay or should I go.

“Anyone desperate enough for suicide...should be desperate enough to go to creative extremes to solve problems: elope at midnight, stow away on the boat to New Zealand and start over, do what they always wanted to do but were afraid to try.”

Richard Bach

One of my most salient memories as a child occurred when my family and I went to visit San Francisco when I was about 8. While there we saw the sights, toured the city, and did the kinds of things that happy families do.

But that wasn’t the end of the story. On our last afternoon we went out to the Golden Gate Bridge to enjoy the view and take some pictures. It was a crisp, clear autumn day and the sun was shining brightly.

While we were walking I saw a man and it was clear that something was not right with him. He was talking to himself, pacing back and forth, and seemed to be in a great deal of distress. My mother told me to keep walking and not to stare at him, but I simply could not.

A minute later the man stepped over the railing, made the sign of the cross and dove into the water. Although it only took him seconds to reach the water below, in my mind he was suspended in the air for what seemed like forever.

I didn’t really understand that I had just witnessed a suicide until several minutes later. Eventually a crowd formed and began looking down into the water, but the man was gone, having been swallowed up by the water below.

What I didn’t know then was that the Golden Gate Bridge is one of the most popular suicide destinations in the world. Approximately 35 people a year do exactly what that man had done by diving into the water from that beautiful vista. Perhaps it is the beauty of the spot, the symbolic nature of the structure, or simply a matter of convenience, but whatever the reason it has become the most popular place in the world for people who simply can’t face the reality of living another day to end their lives.

Watching that scene left a permanently imbedded memory in my mind that I have never been able to shake. I was so stunned by what I had seen that I couldn’t talk about it, couldn’t cry, and had no real outlet to process what I had seen.

But something profound happened to me in that moment, and looking back the roots of wanting to “save” people probably started then. Although I was deeply troubled and even scarred by what I had seen, I knew that I never wanted to ever see anything like that again, and the seeds of the young “rescuer” of people were planted.

But… rescuing people is not what a psychologist always need to do. It is in fact dangerous to think you can save all of the people who come into your office, as essentially the client has to do the heavy lifting that provokes real change themselves. The therapist may guide, assist, laugh and cry, and even plead with a person to change, but until that person is ready these things may all fall on deaf ears.

Furthermore it can be seriously draining to the self to become wholly invested in saving all of the people that come to see us. It is our job to plant the seeds of change and use all of our own skill and power and empathy to plant these seeds, but ultimately the outcome depends on a great many factors that we can never fully anticipate or comprehend.

So I’m learning, slowly, how to not think like a lifeguard. I have often been effective in my career because I have poured every bit of myself into saving others, but along the way I have also forfeited much of my own happiness. I’ve also realized that some people are simply to damaged or in too much pain to change their lives. Although this is a seemingly cynical outlook, my work has taught me that it is unfortunately the truth. Psychology is often an impossible profession, but ultimately it is the one that we chose.

So you learn to live with the little victories. The wonderful surprises people sometimes come in with, the tears, the laughter, and all the emotional growth we see all make it worth while. I am learning this every day. Will always be learning this every day. I need to keep thinking, examining and reflecting. As I was pulling people from the water, I myself was drowning. Perhaps this is because I forgot that the one person who needed saving the most was myself.

Do not go gentle

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Dylan Thomas

Between seeing my therapist, exercising, and not drinking, for the first time in many years a new feeling is creeping into my consciousness. That feeling is freedom. Learning that nearly every battle I’ve fought over the last several years has been based on unresolved emotional turmoil was enlightening while also being quite humbling.

Chuck Palahniuk said that it’s only when we have lost everything that we are free to do anything. That is how I feel. Gaining insight and truly confronting the pathos in the deepest recesses of by character has allowed me to question nearly every comment that comes out of my mouth. I am choosing my words much more carefully now. I have saved my life but also feel like I’ve lost my edge. I realize this is the last remnants of faulty thinking seeping into my awareness.

And what’s left is a man that wants to make the most of the rapidly fleeting time he has left. Half my life is gone. I may have done things to my body that will be difficult to repair. I still have much to say, and don’t want to waste another second.

So the first thing I did today was call a woman I have been thinking about for quite some time. I feel courageous and I feel like I can, for perhaps the first time ever, be totally honest with another human being.

The second thing I did was accept a teaching position at a local college by my home. I’m taking a little break from therapy. Although helping people move through the deepest channels of their troubled souls was incredibly enriching, I want to take a little time to understand what that process did to me. I was effective because I was so deeply wounded, myself, I realize that now. But I have freshly healed scabs, and jumping back into the ring right now might spill some blood I’m not ready to part with. Not now.

So now I will teach. I want to inspire, to share what I have learned with people at the beginning of their own journeys. Surely my own adventure has left me with some wisdom to impart. So one door closes and another one opens. This is the nature of life, to make an ending is also to make a beginning. This is exciting to me.

Awakenings

“All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves; we must die to one life before we can enter another.”

Anatole France

Most of my life I have felt like I have been poking around in a dark room. Much of the time I have been able to make extremely thoughtful assessments of why I do the things I do, but almost always after the fact, and often when it was just a little too late.

In the grand accounting of difficult conversations I have had in my life, today was absolutely at the top of the list. I heard and confronted some things about myself today that cut very deep into the core of my deeply-flawed self.

The crux of what I discussed today in therapy was about Tommy, my actions with his father, and my subsequent actions arising from his case. After all my protests, all my rationalizations, and all my anger, the session reached its climax when I was asked by my therapist, point blank, just which little boy I was trying to save, Tommy or myself.

This question found its mark. I sat in stunned silence for what seemed like several minutes and truly contemplated everything I had done over the last couple days regarding this case. To react with the level of anger that I did was indicative of a far greater reaction than simply protecting a child, I knew this. Somehow Tommy’s father, in one moment became for me a representation of all of the powerful objects I have been unconsciously fighting with for my entire life.

Facing this was important. When one accepts the responsibility of becoming a psychologist, it is a virtual certainty that we will hear stories of some of the darkest and most sinister actions people are capable of. Our job is to listen with empathy and compassion and build affective relationships with the people who put their trust in us. This demonstrates the power that can occur when two people truly and honestly connect. We are not avenging angels and it is not our duty to set things and people right.

And yes, this even means not striking child-molesting monsters despite the fact that our every instinct tells us to do so. This is a fantasy most people would love to indulge, but by the very nature of my position I am not entitled to do so. It’s not what I’ve signed on for.

As to my desire to save Tommy, I clearly see a number of parallels between his life and mine. He is angry and he is confused and he has a terrible secret, and life has brought the two of us together to deal with these problems. Ultimately a psychologist has only one thing to use in therapy and that is himself. This is only entirely possible if we have really examined our own issues and learned how to put them to rest. Those of us who have not done this allow our emotional difficulties to seep into our work, and when this happens therapy is just not that effective.

I go home totally drained. One thing I don’t seem to want anymore is a drink. I’ve been through to much to surrender to such a petty and temporary solution to my problems. No the real battle is now with myself, and deep down I know it always has been.

In this battle honesty is my best ally. With the help of my therapist I am learning to truly examine how, in my case the child has truly been the father of the man. I’d like to learn to examine my own behavior in the moment. My whole life I’ve always been a half step behind, and this one half step has dramatically affected my ability to find happiness.

Sychronicity

“We plan our lives according to a dream that came to us in our childhood, and we find that life alters our plans. And yet, at the end, from a rare height, we also see that our dream was our fate. It's just that providence had other ideas as to how we would get there. Destiny plans a different route, or turns the dream around, as if it were a riddle, and fulfills the dream in ways we couldn't have expected.”

Ben Okri

I saw Tommy again today and am continually amazed at how well he seems to be holding up. I realize that a great deal of the damage that has been done to his psyche is still buried deep inside of him, but he has begun to talk about it, and if we can talk about it I can reinforce in him that it wasn’t his fault. If he can begin to internalize this, the intense guilt and shame most victims of sexual abuse feel may be at least partially neutralized. Much good came of his talking about what happened so soon after it happened, as now we can process this “secret” and not allow it to become buried deep in his unconscious and destroy his life.

There is much work still to do, perhaps a lifetime’s worth but we have started, and he is incredibly resilient. His strength has made me strong, and I hope he has also drawn something from me. I am beginning to feel responsible for him, and he is pulling a very strong paternal, nurturing feeling from me. This is dangerous. Although he absolutely needs a strong, familiar presence in his life right now, I have to be careful not to create a relationship based on dependence, for him or for me.

Later that night I go and see Darren, my patient who is a musician play a big show he has been looking forward to for quite some time. He told me it would mean a lot if I came to his show and so I came, but this too is problematic. Perhaps I am becoming to attached to my patients in the absence of any significant substance in my own life. This is something I want to think over and consider.

The issue here is one of boundaries. In a therapist’s office two people discuss some of the most intimate moments in a person’s life. The job of the therapist is to first build a powerful relationship with this person, and model, through this relationship, skills that the person can then take back to their lives. The therapist is not supposed to literally return with the person to his life.

Attending a concert of a patient certainly walks this line. Although we have a very easy-going therapeutic relationship, it is still ethically questionable. I went to this show with the intent of showing support and seeing someone I believe in realize a dream. I have always thought some of the ethical rules concerning this kind of thing were a little rigid and even silly, but at this point in my career I am in no position to be playing cowboy with the rules. I have to make a real examination if I am using my patients to fulfill some of my own needs related to loneliness and a need for companionship. I will give this some serious thought.

But sometimes you also have to throw the book out the window. In the case of Tommy, he needs an advocate, a friend, a surrogate parent, as well as a therapist. I am well aware that I am perhaps over stepping my bounds by trying to be all of these things for him, but I want to at least see him through a few weeks before I start thinking about the implications of this. I know all too well how children can get lost in the system. I myself was lost in the system. The sychronicity of this does not escape me. Tomorrow I will make another appointment to see my therapist.

A day of reckoning

During the twenty months in which I experienced psychotherapy, perhaps one of the major constants was surprise……..This voyage of discovery was the most incredible I’ve ever known.

Roger Walsh

When you’ve worked as a therapist long enough you become a master debater. The process of challenging illogical thinking, offering counterpoints, issuing challenges, and when necessary outright confronting people all make a therapist a verbally agile craftsman in the use of language. I’ve talked my way out of many tight situations over the years, averted crisis after crisis, and untangled myself from more potential messes than I’d care to remember.

All of that ended today. My new therapist saw right through all my cleverness, diversions, and subterfuges, and made me face some hard truths about why I do the things I do. I was amazed at his gall, incredibly irritated, and appreciative that this might be the first person in my entire life who truly holds a mirror up to me in a brutally honest way.

Today we got into the twin demons of my defense structure, humor and intellectualization. I have become highly adept at shifting in and out of these two modes of communication throughout my entire life, and in doing so have managed to wind up exactly where I sit today. In other words they have allowed me to reach a position of some degree of success and even prestige, while also helping walk me right to the brink of the cliff of self-destruction.

The nature of defenses is they protect us from pain. Most people have several, and many of these are adaptive responses to stress and anxiety. Denial is a very common defense, as is rationalization, and I am more than familiar with both in my own life. Defenses become important when they begin to strongly interfere with our everyday functioning.

As was pointed out to me today, I have learned to talk circles around my own drinking problem and explain, rationalize, and expound on it in a myriad of different ways. What I haven’t done is take a long look into the mirror, and admit that what I am doing is utterly destroying me physically, mentally, and spiritually.

As was also pointed out to me today, I constantly deflect problems by telling little jokes, which creates a temporary subterfuge to avoid talking about my own problems. Hard to argue with this one. But hearing it so directly and so bluntly was still aggravating, which was of course because it struck directly on top of a nerve.

When I left today I felt stripped naked. The cardinal rule of stripping people of their defenses is you don’t engage in this process unless you have something else to offer in its place. No such offer was tended to me today. Perhaps he wanted me to experience what is known as “optimal frustration.” Which, according to constructivist therapy is necessary for fostering independence

optimal frustration has these main points:

• “Children, especially young ones, have fundamental tendencies toward being dependent, selfish, and irrational.
• The child must be forced through frustration to develop: a sense of self separate from caregivers; control of emotions and impulses; respect for others; adaptation to reality; and the skills of independent living.
• While caregivers should be sensitive and nurturing (that's the "optimal" part), frustration is the necessary and primary pathway through which children build the cognitive and affective structures of the self.”
• 
  

The difficulty with understanding this, is that, despite the fact that I am in my thirties, I am the child in this scenario. This is known as “reparenting” and today I got some tough love. I’m trying deep down to shake off my anger and fully engage in this process.

Because…..Somewhere there is a real child who is depending on me, and I owe it to him to give him every bit of what I have to give without my personal baggage getting in the way. This is keeping me going right now. So yes, I will be “the child” in therapy if it means I am better able to help a real child who is teetering on the verge of the abyss. I am collecting and integrating myself and gathering strength for him, and for me. This time the stakes are much higher.

A nagging question

If you have made mistakes, even serious ones, there is always another chance for you. What we call failure is not the falling down but the staying down

Mary Pickford

I met today with my local review board of the American Psychological Association. While in front of them I faced a very serious decision. I could tell them that I felt I was in physical danger from Tommy’s father and acted in self-defense, or I could tell them what really happened. In thinking about this decision I wanted to factor in what the best decision would be for Tommy in this case, and I decided to tell a lie. I realized the seriousness of this decision, and what I would have to live with as a result of it.

With the receptionist corroborating my story, the review board agreed to let me retain my license and practice if I agreed to enter into counseling of my own to discuss any possible issues I may have with excessive anger. I agreed to this stipulation and stepped out into the afternoon sun, basically free to return to my livelihood, which had taken on newfound significance given the seriousness of what had happened with Tommy over the last week.

And the fact is I do have some serious issues to address. This is obvious. The credo “first do no harm” is as relevant to psychology as it is to medicine, and I had nearly killed a man. Whatever this man was, I’m quite sure I could have easily beaten him to death if other people weren’t around.

In the back of my head a sinister and daunting question has been forming that I have been afraid to let crystallize. This question thumps in my mind like a tell-tale heart beating louder and louder until finally I have to stand and face it. The question is “whose father was I beating up, in that moment, Tommy’s or my own?” The question sickens me but I know I have to answer it. There may not be an answer to this question. Perhaps my past and present selves are so intertwined that I’ll never completely untangle them. I know this is likely true. But if I am violent I have to face that. I have responsibilities and people counting on me.

Later that day I make an appointment to see a prominent yet eccentric therapist, who has the reputation as being extremely tough, yet also very kind. Therapy is going to be quite difficult this time around, and I am looking forward to it while also being a little apprehensive. A part of me thinks this might be the last shot to get it right, but I don’t want to get down on myself.

For once in my life

“For once in my life I have someone who needs me
Someone I’ve needed so long
For once, unafraid, I can go where life leads me
And somehow I know Ill be strong

Stevie Wonder “For once in my life”

I saw my friend Tommy today. He is staying with a foster family who seems very nice, and because I am his therapist of record I was allowed to take him out to lunch. He does not know what I did to his father and I’m not sure I want him to know, not yet anyway. For now I want to act entirely in his best interests, and that means not adding any more stress or worry to his life right now.

We had pizza and talked sparingly. It was clear he is incredibly scared and confused, and I realize it may have been better to do this in my office. I know he is still in a great deal of shock, and I don’t want to push him to talk if he isn’t ready. On the other hand I know it is important he does talk about it and for me to let him know that whatever it is he is feeling it is ok for him to feel like that. He is, quite literally, being attacked by guilt and shame right now, and I want to let him know that he can tell me anything and have it be OK.

Halfway through our meal he says he likes it with his new family and how nice they have been to him. I am again amazed at his strength and resilience and tell him how proud I am of how strong he has been which makes him smile. We switch into a conversation about the Chicago Bears, and I am perfectly OK with this. Although I have been ostensibly trained to deal with these situations, I am terrified of saying the wrong thing. In this moment, I am trying to operate simply out of human kindness, and be there for him if and when he is ready to talk.

As I dropped him off, he looked up at me with sad eyes, and asked when we’ll see each other again. The truth is I don't know. Although I haven’t officially been suspended or reprimanded, I know that there will be some serious questions I have to answer before I go back to work. I explain to him that I’ll see him as soon as possible, but this doesn’t seem to satisfy him. It is an evasive answer and for someone who has been lied to as much as he has it’s a poor choice of words. Still, I really don’t know.

“I love you,” he says as he opened the car door, anxiously looking at me to see what my response would be.

And in this moment I am truly at a loss about what to say. Clearly the response he craves very badly is, “I love you too”, but this may be a dangerous thing to say. I’m not sure what his definition of love is given his history, and am afraid of evoking any confusing feelings. On the other hand, this is a human being badly in need of reassurance. His pain is likely of a magnitude I haven’t even come close to experiencing. I look down and he was still looking at me with expectant eyes.

“I love you too kiddo” I said, “And I want you to know that you can count on me to stand by your side, whenever and whatever you need, okay?” I ask.

“Okay”, he says and heads to the house with a faint smile. As I pull away I see him turn his head back towards the car and wave, and I wave back as I pull away. I look in my rearview mirror and see that I have begun to cry again, and I pull over and try and make a fair assessment of my feelings. The universe has thrown me a very difficult challenge, and I need to reach deep inside myself and rise to this extremely difficult task. For the first time, perhaps ever, I’ve come to understand what it is to be truly needed by another human being.