Constructing the Psychotherapy Narrative

Writing [THIS POST IS A BIT DIFFERENT FROM MY USUAL STYLE; IT’S ADAPTED FROM SOME IDEAS I’M EXPLORING IN MY NEW BOOK ABOUT NARCISSISM]

At the beginning of our first session I ask MacKenzie, a 32-year-old single woman, what prompted her to seek treatment. Although she mentions occasional depression and anxiety, she seems most focused on her inability to maintain relationships. She has never felt truly intimate with any man she has dated. It might go on for several months, but inevitably she finds reasons to break it off. He’s not smart enough. He’s not ambitious. He’s too needy. She doesn’t like his friends and family. By this point in her life, she recognizes that these ostensible reasons are mere pretexts. She knows that she’s afraid of intimacy but doesn’t understand why.

Over the next few sessions, she fills me in on her personal history. Mom was an alcoholic and MacKenzie often came home from school to find her drunk or passed out on the couch. Dad was a workaholic and neglected the family, then divorced her mother and largely disappeared from their lives when MacKenzie was in her early teens. My client was left more or less in charge of her younger sister and stood in for parent as Mom disappeared deeper and deeper into her addiction. As an adult, MacKenzie has always been hard-working, utterly reliable and valued by her employers. She consistently advanced in her career at a major corporation and now occupies a mid-management level position.

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On Optimism

OptimismOver the course of my practice, I’ve come to know a few men and women who emerged from families so toxic and dysfunctional that I often wondered how they managed to survive, emotionally speaking, and why they hadn’t long ago surrendered to despair. Given how little goodness they encountered in their post-uterine world, why did they continue to believe in and keep looking for something better? What was the source of the ongoing hope that brought them to my office in the belief that someone could help? I think of these clients from truly awful families as optimists; this piece serves as a bookend to my last post on pessimism but maybe I’m misuing the word optimism. In this case, I mean that my optimistic clients, encountering a world without love, almost entirely bereft of goodness, nonetheless believed in the possibility of good and kept on searching for it. Hopeful might be a better adjective to describe these people.

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On Pessimism

Pessimism I haven’t been posting much lately because I’ve been focused on my book about narcissism, plus I just completed another article for The Atlantic, which you can find here. It’s about bullying as a kind of narcissistic behavior, linking the Richie Incognito story with the suicide of Rebecca Sedgwick and further thoughts on Lance Armstrong. Anyway, I’ve now emerged from my research-and-proposal-writing cocoon; it feels good returning to the “outside” world!

So in my practice, I’ve lately been thinking about pessimism as a character trait. Selena, the client I described in my post about the importance of joy in psychotherapy, tends to be very pessimistic about her future. She believes that she blew her opportunity to launch a career right after college and that nobody will want to hire her now because newly-minted college graduates will be applying for the same positions. Not long after she graduated, Selena was fired from a job that didn’t particularly suit her, and she found the experience painfully humiliating. Most of us would feel the same way, but Selena has had a hard time recovering and moving on. She feels that getting fired has “tainted” her. Pessimism about her future keeps her immobilized.

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Joy in the Psychotherapy Relationship

Joy2Naomi, one of my long-term clients and a therapist herself, has been talking in session lately about joy. The importance of joy in the mother-infant relationship, in adult romantic relationships, and in the relationship between therapist and client. Her ideas have grown out of her own practice, partially stimulated by our work together and informed by Allan Schore’s writings on enjoyment-joy (part of the inborn affect system). Naomi’s views have had a strong influence on my own: we therapists learn so much from our clients, especially when they are thoughtful, gifted clinicians themselves.

This is an over-simplification of her views, but Naomi believes that joy is what makes the agony of infancy bearable. Helplessness and vulnerability, the reality of separation from mother, intense emotional pain of all kinds — these experiences are an inevitable part of early infancy. The joy we optimally experience in relation to our mothers helps to make the pain bearable. Fe