Sometimes, it makes all the difference.

Not everyone requires an in-depth therapeutic look at their childhood. Many people can benefit from short-term treatment to get over a crisis, a recent loss, or current relationship issues.

Others will profit from a cognitive-behavioral approach (CBT) that works to change present day action, thought, and emotion.

But there are times when the past is a dead-weight on one’s life, preventing any kind of lift-off into a more productive, joyous, lofty, airborne, less anxious and guilty way of being; one that is not grounded by a gravity — an invisible force — that seems to pull one back to a repetitive cycle of sadness, regret, and chronic avoidance of challenges.

An example:

Take an intelligent young woman in her 20s — movie-star beautiful — with a quirky sense of humor, and more than average intelligence. Her parents praised only her beauty, but derided everything else about her. From an early time their constant criticism made her worried about displeasing friends; and later on, lovers.

She learned that she could make a dazzling first impression while hiding her anticipation that others would find out what she offered was only skin deep.

This woman’s super-model exterior and surface gaiety belied her belief that there was nothing inside of her that was really valuable. She hid the thoughts and feelings that her parents had always put down, so as to prevent people from discovering her vulnerabilities.

But even when she was successful at “fooling them into thinking” that she was better than she really was, the praise and approval she received only persuaded her that she was a good actress — that beneath the stage makeup she was nothing — just nothing but an empty, worthless shell.

Her anxiety about being “exposed” for the fraud she felt herself to be was combined with a depression that grew out of her failure to win her parents’ love. And, in order to achieve that love, she continued to try to extend herself and prove herself to them, only to be rejected or neglected or taken advantage of once again, thus confirming her sense of worthlessness.

Unfortunately, she was also drawn to potential boyfriends and platonic companions who resembled her parents in their mistreatment of her — as if the only love worth having was one that would allow her to triumph over rejection and win the affection of someone who resembled her parents in their lack of affection for her.

Our heroine succeeded in graduating from college and getting a good job. But none of this filled her up more than temporarily, just as a new purchase of an attractive dress might make her feel good for a few hours or days until she sank back into her default state of sadness and misgiving.

Now imagine that you are her therapist. What would you do?

Tell her that she is beautiful, talented, and accomplished (as evidenced by her academic and vocational success)?

She has already tried to tell herself this, she has already heard this from others, and she still feels bad.

Work with her to improve her social skills?

She is already skilled socially; “a good actress,” as she would characterize it. She is able to be assertive professionally and put-up a good front; until, of course, it involves a personal relationship about which she feels strongly.

Send her to a psychiatrist for anti-depressant or anti-anxiety medication.

Perhaps, but this does not guarantee that she won’t continue to have the same self-doubts and make the same bad relationship choices of people who treat her poorly.

Use Cognitive Behavioral Therapy (CBT) to help her “talk back” to her negative self-attributions (put-downs of herself) and help her to evaluate herself more objectively.

This is not likely to be sufficiently helpful by itself if she continues to favor people who reject her, caught in some version of the old Groucho Marx joke: “I wouldn’t want to be a member of any club that would have me as a member.”

Use CBT to help her gradually stand-up to the people who are treating her badly.

Again, this might be somewhat useful, but will be countered by her belief that there is something wrong with her, and that she deserves the mistreatment she receives. Moreover, it will be hard to be assertive because of her terror that she will lose these same people if she pushes back against them.

What then is left?

In my opinion, this lovely young woman will have to begin to see (really see) and feel what has happened in her life, going back as far as necessary to the mistreatment she received at the hands of her parents: their failure to give more than lip-service to loving her, their cruelty, their inattention when she did something that should have been praised, their criticism, and their tendency to make her feel deficient and guilty.

If she does not see them for who they are, she is likely to continue to believe that it was largely her own inadequacy that caused her to fail in her quest for their love. And, if she continues to place them even on a relatively low pedestal, she will also keep reaching out for love from all the wrong people — the people who remind her of those parents; those who possess the only kind of love she wants because it is unconsciously associated with her parents.

It is not enough that this patient becomes intellectually aware of all that I’ve described.

For therapy of this kind to be successful, she will have to feel it, not just know it.

Feel it intensely.

Why?

Early life is a “hot” moment in virtually any life. Emotions are highly charged in children. We have not yet learned how to regulate those feelings, and so we are very, very vulnerable to injury. Nor do we have any of the defenses or the intellectual understanding of things and of people that will help us later to navigate the choppy waters of life.

And so, in this “hot” and challenging early time in our existence, we begin to formulate solutions to the difficulties of life.

For example, if voicing opinions different from dad’s beliefs results in his condemnation, many kids will learn to keep their mouths shut and internalize their feelings. Meanwhile, they are likely to feel diminished and less good about themselves if there is too little love and too much criticism.

A parent’s opinion counts enormously in the formation of the child’s self-image.

Time passes and the child perhaps has succeeded in reducing, at least a little, the amount of displeasure, anger, and targeted discontent coming from his mom or dad. So the behavior of keeping a low profile and “acting the part” that the parents expect is reinforced, even though depression and self-loathing are below the surface.

Such choices are made by the child unconsciously, but seem to make the best of a bad situation and become a well-ingrained pattern of behavior.

Eventually the child becomes a teen and soon a young adult, away from a good portion of the daily parental disapproval. Now, having established some defenses and skill in handling life, the crackling tension of early childhood is over. Instead of the ever-present hot moments of early life, existence now consists mostly of many more “cool” moments in which the pattern of behavior becomes solidified and habitual.

Think of it this way. A small child is like a piece of metal in a forge or foundry. The searing affective cauldron of early life is like the super-heated nature of a forge, designed to make the metal malleable so that it can be wrought or cast. Unfortunately, in the childhoods I’ve been describing, the little piece of metal that is this tiny life is shaped by the destructive forces of the household into a form that is warped; not fully serviceable.

With the passage of time and the “cooling down” of the emotional intensity of that life, the newly shaped adult — like the forged or cast piece of metal — is no longer malleable. The pattern and outline he or she is now in — the self-opinions and self-defenses that were established in the forge — have taken on a permanent, fixed form. The same ways of living developed while young continue to be used to some extent, even if they are not all that useful; even if conditions have changed.

Obviously, new learning is still possible, but at the deepest level — the level of self concept and self-love, as well as the tendency to be drawn to certain kinds of people when looking for love — alteration of the shape or form or way of living is much harder to achieve.

What then does therapy do to assist with this much-needed alteration?

The therapist and patient work together to re-enter the “forge” of childhood, that time of “hot” moments when personality was fashioned into its current image.

Once back in the foundry, the emotion generated in recollecting that time can make one malleable again: capable of being reshaped and of reshaping oneself into a less self-critical person who believes in his value and no longer seems so drawn to people who are excessively critical.

Therapists who do this kind of “depth” or “psychodynamic” psychotherapy may well encourage the patient to journal — even to write autobiographical essays. They can be assisted in remembering what seem like incidental details of early life such as their school teachers, the friend who sat next to them in third grade, the path they took to walk home, what TV shows they watched, the time of day that mom or dad came home, the summer vacations that were taken, the sounds present in the home, the aroma of cooked foods, and so forth.

Anything that might be useful to jog emotion and memory is fair game, including old photos and report cards, conversations with siblings or childhood friends, and revisiting the neighborhood in which one was raised.

The process can be painfully difficult. Indeed, it must generate significant emotion to reproduce, as far as possible, the forge-like nature of early life — the conditions which permit a realignment of internal interpretations, understanding, and feelings. Grieving over the losses of the past can only come with openness to whatever is felt and discovered in digging up the psychic “can of worms” that sometimes is to be found in one’s past.

And it is the emotion connected to the early trauma that, when finally re-experienced to at least a partial degree, proves cathartic and informative; allows one to realize that “it wasn’t your fault;” at least not to the disqualifying extent that you have come to believe it.

Sometimes there is a “break through” moment, as in the film Good Will Hunting with Matt Damon and Robin Williams. But even without that kind of emotionally generated epiphany, this type of treatment can be transformative.

Of course, not everyone needs to do this. A more cognitive behavioral approach along side this type of exploration may also be helpful in some cases.

But sometimes there is simply no substitute for the hands-in-the-dirt and feet-to-the-fire process that I’ve described.

Take heart.

If your therapist wants to talk to you about your childhood, sometimes it might just be exactly what you need; just exactly the cauterizing instrument that your hurt is waiting for.

Remember — the heat of the forge can be hard to withstand, but upon emerging from it perhaps you will notice that its warmth has healed your lonely heart.

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The above image is Metallurgist working by the blast furnaces in Třinec Iron and Steel Works courtesy of Třinecké železárny, sourced from Wikimedia Commons.