Month: August 2024

August 25, 2024

Is Therapy a Search for the Truth?

Movies characterize therapy as an effort to unveil the repressed memories of a troubled life. The counselor is portrayed as a wise, empathic, trustworthy Sherlock Holmes, trying to uncover what has been buried, denied, or misunderstood.

In other words, as portrayed in films, a psychoanalyst’s goal is to know his patient better than the patient knows himself—what blocks his happiness—and guide him to a more rewarding life.

How much of the unknown should be known? Therapists would use a lie detector if knowledge, truthfulness, and fact were the aim. At the least, they would probe and dig until everything knowable became known.

Truth, however, is not what most patients want from a clinical psychologist. They want relief or an end to depression and anxiety, for example. Coming to know themselves better is often required, but not the revelation of every dark place in the heart.

The psychologist must determine what is helpful, not judge an inventory of his client’s moral choices and mistakes. Before long, if their work together leads to a newly hopeful story, both parties have done their job.

With luck, the patient is on his way to living a satisfying life.

The parable might include endurance, overcoming challenges, and triumph. The tale might involve mourning, the release of profound emotional pain, and the patient’s recognition of his value. 

Despite his ups and downs, mistakes, injuries, and harm done, the new slant on his life history would require acceptance of what is behind him. At that point, counselors hope the client understands that the game of life isn’t over and visualizes the possibility of unshackled accomplishment, blooming relationships, and joy ahead.

Not every knot must be untied. We are vulnerable creatures—brave, creative, and imperfect—and psychotherapy is unlikely to make us superheroes or saints.

We humans help, and we sometimes wound others. We are honest but lie on occasion. We shop for things we don’t need, use, or keep — and walk home without stopping for a homeless woman requesting money for her next meal.

We love our spouses but display unkindness and are tempted to cheat on them. We rationalize our unfaithfulness but teach our children to be noble and good.

Therapists are trained to accept you as you are, not to scold you. Sometimes, your imperfections, moral or otherwise, contribute to your problems, but they do not always.

The transfigured world has been more challenging in recent years, and some pursue treatment to find the capacity to manage their own lives when corporations, climate, and congressmen can’t be counted on.

The late sociologist Zygmunt Bauman spoke of that uncertainty:

“What is novel (today) is not uncertainty. What is novel is the realization that uncertainty is here to stay. The task is (therefore) to develop an art of living in uncertainty.”

The ancient Stoics advised us to focus on what we can control, but our newer world allows many of us less sway and influence than our elders had. It is, therefore, our responsibility to help change not only ourselves but the community of man in small but necessary steps, hand in hand with others. 

Successful counseling puts us on the doorstep of making more of our lives, even though repairing the world is not why people search for a therapist.

One of psychotherapy’s benefits is opening the unexpected treasure chest of the patient’s hidden strength. The gift can be used in many ways.

It can enable finding the place where the best of him can be put to constructive use—use beyond selfishness, use beyond the accumulation of wealth, and acquisition of unnecessary things.

There is more to life than the self and its desires—more that creates a sense of worth. If healing the Earth and all its forms of life and beauty is a responsibility, it is also a privilege. Though the therapist’s job is not to point you in that direction, it is nonetheless the truth.

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The first image is Mental Health by Tumisu. The second is The Truth Was Revealed by Egon Schiele (1913). The final photo is The Blue Marble, by Apollo 17, December 1972. The first was sourced from Wikimedia.org, while the second is from Wikiart.org. The image of the Earth comes from NASA.

August 18, 2024

Sex With Your Therapist: The Ethical Issues

Erotic transference always involves the patient’s desire for the therapist. The complexity jumps when the counselor reciprocates the craving.

It is in the client’s interest to guide the patient in resolving her feelings while the therapist contains his own. When he cannot accomplish the latter, even after consultation and supervision from another professional, the danger of malpractice becomes enormous.

The first principle governing all helping professionals is to “Do no harm,” which includes prohibitions against physical intimacy with clients, present and past.

Today, I will present relevant sections of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association. I’ve added a few comments along the way:*

**10.05 Sexual Intimacies with Current Therapy Clients/Patients

Psychologists do not engage in sexual intimacies with current therapy clients/patients.

Comment: Patients often feel gratitude toward the person helping them through a difficult patch. Sometimes, their psychologist might have been the first to “see” and understand their essence, carry their secrets, and not betray them. Whether accurate or not, these observations and emotions in the client can give the counselor unequal influence in the dyad and the power of one who stands on a pedestal.

**10.06 Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients.

Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.

Comment: The reasoning is simple. Involvement with other family members can disrupt and injure the client. 

For example, imagine the client’s sister becomes the lover of her sibling’s psychoanalyst. Fear of the counselor sharing details of conversations with the relative might occur. Jealousy and friction between the sisters can’t be ruled out. Anger at the doctor and feelings of betrayal in more than one direction might also erupt.

**10.07 Therapy with Former Sexual Partners

Psychologists do not accept as therapy clients/patients with whom they have engaged in sexual intimacies.

Comment: Ex-lovers, where one wants to become the healer’s client, involve two people who might carry a torch for the other. Office counseling sessions can reignite the flame. Everyone knows how many complications occur in the ordinary course of a relationship. In the dual role of lover/therapist, the counselor unintentionally invites harm to the person his profession tells him he must protect.

**10.08 Sexual Intimacies with Former Therapy Clients/Patients.

(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.

(b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client’s/patient’s personal history; (5) the client’s/patient’s current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the client/patient. (See also Standard 3.05, Multiple Relationships .)

Comment: The essential point here is more than the time-designated prohibition of an affair. Even when the two-year post-treatment “ban” has elapsed, the ethical guidelines suggest the counselor and client should still not have a carnal liaison.

Imagine an ardor-filled mutual attraction that is unresolved during professional contact.

Perhaps one party suggests waiting for the other until the two-year prohibition has expired. If they agree to start the clock, they might terminate the psychotherapeutic element of their connection and count the days.

The ethical guidelines focus on the professional’s responsibility because of the power imbalance in the relationship and the possibility of harming the now previous patient. They put “the burden of demonstrating that there has been no exploitation” entirely on the psychologist.

Some years ago, I heard the answer to a crucial question in a required educational seminar on professional ethics. The question was obvious but necessary:

Is there ever an adequate legal defense against a malpractice claim due to sexual intimacy occuring after the termination of treatment?

The wise presenter offered an imaginary defensible scenario similar to this:

The doctor and patient, both married to others, concluded a substantial period of psychotherapy. About five years later, they recognized each other on the same flight across the Pacific Ocean. They each traveled alone.

The plane crashes, and the pair find themselves the only survivors on a deserted island. Of course, they both hoped to be rescued and had no sexual contact during this time. After two more years, they gave up the hope of rescue. 

Then they began to have sex.

More time went by, and they were rescued and returned to their waiting spouses. 

In this hypothetical example, the woman eventually sued for malpractice, and the psychoanalyst had a reasonable chance of acquittal—or so the presenter believed would happen if the story were real.

As you can understand, the seminar leader was saying that only under extreme and unusual conditions might there be an adequate defense for a sexual relationship between the counselor and his previous patient. 

Translate that into this implicit guidance within the code of conduct: Never, never, never do it.

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*Therapists who are not psychologists typically follow other, not necessarily identical, guidelines.

The four paintings in order: Man and Woman, Embrace by Egon Schiele, 1917, sourced from Wikimedia Commons. The Lovers by Rene Magritte, 1928. Blue Lovers by Marc Chagall, 1914. Green Lovers, also by Chagall, 1915. The final three images are sourced from Wikiart.org/

August 11, 2024

Have You Met “The One”? Questions before You Say “Yes”

Attraction is powerful, but dating someone is also a matter of discovery. Before you choose a permanent partner, you might want to find out about the person behind the dazzle.

Ponder this:

“A majority of dog owners say they would consider ending the relationship if the pet disapproved of the partner,” according to Nicholas Kristof in the New York Times on August 4, 2024. Some suitors would try to finesse this by bringing a morsel for the animal, but I suspect the fellow’s attitude toward man’s best friend would come out in the long run.

What follows are a few more areas you might want to investigate as you get to know each other.

Does your possible future mate have children? Then it is best that you like kids.

One cannot stop there. You have an Ex to deal with and find out about.

How did the relationship with that person begin, what was the problem, and why did the connection collapse? What part of this was your new honey’s responsibility? Is there a pattern to her history of heartbreak?

If the children are older, do they do well in school? Are they kind? Do they hold any prejudices? Where have those attitudes come from?

What about your lover’s parents? You may want to find out about their background. The family a child marries into has been the most frequently used parental measuring stick in the history of betrothal. Old-fashioned? Many parents believe it is an essential element of suitability.  

More about potential in-laws. Did either of the parents survive a trauma? It is not unusual for there to be second-generation effects of that misfortune. Parents who lived through poverty, serious illness, the loss of loved ones, or wartime can pass on their opinions, anxieties, and other forms of unhappiness to their offspring without even knowing it.

Who are your sweetheart’s friends? What are they like? What does he like about them? Can he hold onto buddies? Does he give you enough time?

Are you comfortable with your friend’s diet and lifestyle? Can you live with his preoccupation with his phone? Are your politics and religion (or its absence) compatible? 

We live in a time of marriages between people of different ethnic groups, races, religions, and national origins. LBGT, too. Unfortunately, it is also a moment in which white supremacists and Christian nationalists are threatened by those who they believe are inferior or wrongheaded.

Individuals who marry outside conventional boundaries can encounter various forms of resentment and prejudice, both within and outside of families. These complications and how to handle them are appropriate topics for conversations. Reaching out to a couple who have encountered judgmental disdain and unkindness might be helpful.

Values and preferences are worth uncovering. I treated a man who worked as a music teacher. His new wife taught English.

It wasn’t long after their marriage that they came to an impasse. He wanted to attend concerts, while she favored theater. The lady did agree to hear live music but never enjoyed it. The man appreciated theater and never complained unless the play was poorly done.

The fellow told me this:

What am I supposed to do, Doc? If I ask her to join me, she wants to know if she will like it. If I say ‘yes,’ then she complains after. If I say ‘no,’ she replies, ‘Then why are we going?’

There are infinite questions, and I’ve touched on only a few of them. Many go with their gut instead, but remember you can be swept away in love’s early stages. Later, in a more sober period of your twosome, you realize who you are attached to.

Perhaps the biggest question is whether the one you care for knows you and if he sees you. Can you look past the honeymoon phase to his essence, just as he recognizes your own?

If there is a mutual understanding between souls who care for each other, much happiness is possible.

May you have every good wish.

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The two paintings above share the same name: The Happy Lovers. The first is by Jean-Honore Fragonard, while the second is the work of Gustav Courbet, 1844. Both are sourced from Wikart.org/

 

August 4, 2024

Face-to-face with Willem van Otterloo

It would be hard to call it a meeting. I wasn’t introduced to him, and he didn’t know my name. Still, there was an emotional connection between us. I irritated him, and a couple of thousand people watched it.

It was December 1964. I was on break from my first college semester and a newly hired usher at Orchestra Hall, the home of the Chicago Symphony.

The guest conductor was Willem van Otterloo, a Dutchman soon to be 57. He was serving as music director of the Residentie Orchestra in The Hague, and making a guest appearance in the Windy City. The program included the first Symphony of Brahms, a stupendous work I looked forward to.

My new colleagues were black and white, mostly music students, an amiable bunch in love with classical music.

The job was easy to learn. I already knew the auditorium seating locations, and handing out the program booklets required no well-trained skill. We wore mufti to the concerts, including required dark trousers. Once in our section of the basement location, we picked out a fitting uniform jacket from the rack.

Small tears in the cloth were common. We were paid little but didn’t care much about that or the outfit. We came for the music.

One of the instructions we received was not to seat anyone after the signal to close the doors that led inside. If a patron came to the first half late, he had to wait for a break in the music to be seated. Even less opportunity to enter existed if he missed the beginning of the second half.

On the evening in question, the interval was ending, and the doors for the second half had already been closed. I was stationed in front of the entrance to the center aisle of the main floor.

The audience was quiet, anticipating Maestro van Otterloo and the magnificent Brahms, full of big tunes and towering climaxes. The composer had waited until he was 43 to create this masterpiece.

Suddenly, a man appeared before me, asking if he could be directed to his seat and pushing his ticket toward me. I assumed I could find the location quickly and return to the lobby before the music began.

I opened the door, stepped in, and only then looked at the ticket. “Oh, geez,” I said to myself and sped up. The fellow’s place was the first seat of the first row, right of the aisle. That was not good news.

Halfway down the path, the audience began to applaud, indicating that the conductor had started his walk to the podium from backstage. I was still on a bullet train to the end of the line. Skidding to a stop along with me, the gentleman was seated.

Then I made my mistake.

I looked up at the baton-smith, maybe 10 feet away.

He looked down at me, which can be understood in two ways, both true: I was beneath him and a lowly usher in a crappy uniform who intruded on his art, to boot.

Willem’s expression was the equivalent of a slap in the face while simultaneously sticking out your tongue. It was the dirtiest look I have ever received.

To call it a sneer sounds too mild. A momentary fit of disgust. His visage displayed contempt as if he were uttering, “What in God’s name are you doing here? Do you know who I am”

I spun around, completed my return trip to the lobby, and the music began.

Like you, I have had more than a few subsequent embarrassments since my first year at a university. Never, however, in front of a filled auditorium.

Wikipedia states that Willem van Otterloo lived until he was 70 in 1978. In the Netherlands, he was married and divorced four times (including one remarriage and divorce). A fifth marriage occurred in Australia.

All of this suggests that he had much more trouble than I caused him.

I guess I got the last laugh.

August 2, 2024

For the Love of a Father

A father’s love is a “sometimes” thing. Looking back, the words “I love you” were not often spoken. Physical and verbal affection were more in the mom’s job description. The dad was the disciplinarian, a formidable presence, not a cuddly protector.

“Wait until your father gets home” was a familiar TV sitcom line because it was an accurate and foreboding statement in many homes.

Men are more prone to telling their children of their affection these days, but many still don’t. They assume, as their male parents did, that their emotional attachment to their children is evident.

It isn’t. Words matter. They must be spoken with eyes open and face to face—not once, but repeatedly.

If they aren’t voiced, a problem is created. The dilemma is exacerbated if the father doesn’t embrace his child in all senses.

In my psychotherapy practice, I heard too many lamentations to count describing an unfilled space between child and parent. The dead zone held the words never said, the eyes that rarely met, and the unfulfilled desire for touch.

My patients told me that they still felt the absence. Middle-aged men and women continued to wonder if their father or mother loved them. Moreover, they were afraid to ask. Why? Because the possibility of lacking the guardian’s love could become a reality with words like, “No, I don’t,” or offhanded comments such as “Sure, I do. Don’t be stupid. I don’t want to talk about it.”

Adult children wait, hope, and fret. Time passes. The hope lives, but the question remains unasked and unanswered.

The death of a parent stamps the death certificate with a question mark. The question becomes unanswerable, no matter how many people tell you how much your father praised you in their company.

Such praise is second-hand merchandise and, therefore, of less value. In the counselor’s office, doubt must now be mourned: the unsaid, unknown, possibly unwanted, and uncared-about person who not only misses the parent but will never know what the relationship amounted to with certainty.

If you are a parent, say the words to your child repeatedly. If you are an adult child, consider asking the question. No matter the answer, there will still be time to repair the relationship if the dad is willing. Indeed, your dad might even be grateful to finally open himself to you.

Wynne Leon and Dr. Vicki Atkinson have just released a new podcast with me. We discuss expressions of love, particularly the words “I love you.” I also talk about some personal examples related to friendship and apology, using a few wise words from Aristotle.

I hope you enjoy it: Episode 78: The Blessings & Responsibilities of Friendship with Dr. Gerald Stein

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The top image is Father and Son 27. It is followed by Bert Fields Embracing His Friend Mario Puzo from Heart Times Coffee Cup Studios. Both photos are sourced from Wikimedia Commons. Special thanks to my friends Ron Ableman and Jeff Carren, and a fond farewell to our friend Neil Rosen.