How to start a session – 2

Last week I wrote about Ted and we saw how to start, and not to start, a therapy session.  The same day I saw Ted, Frank made similar breakthroughs for the same reasons we discussed last week – because he freely dove into the session and was into it almost without realizing we’d started.

Frank came to treatment with a history of “anger problems”; these had caused him no small trouble over the years with friends and in his work – he is a high level executive in an international business and has blown important deals because of his flashes of impulsivity and rage.  At the same time, he described being married for 12 years to a woman who for almost all of that time has shown no interest in him, physically or otherwise, and who he greatly loves.  In contrast with other people in his life, he tends to talk about his wife as if everything that goes wrong between them must be his fault.  Upon detailed inquiry, it becomes very clear that regardless of his failings otherwise he is a very good, attentive, responsible, and long-suffering husband.  His loneliness and frustration at home have recently intensified because his daughter who used to “hang on my every word and burst with joy when I got home at night” is entering puberty and withdrawing more into her own interests, friends, and adolescent moodiness.

Over the two years I have seen Frank, he has come a long way in learning to identify and control the misbehavior at work and other places which interferes with his success and social life.  His unhappiness, however, has worsened because 1) he now lacks the distraction, the illusion of power, that the self-destructive angry outbursts were providing, and 2) he has not addressed the source of that anger and unhappiness – and it is not only his marriage.

As Frank talks about his wife, parallels with his childhood are striking.  His great complaint about his parents is that they are self-serving, have never listened to or taken any interest in him; he says they have never supported his interests but instead funneled him into his father’s career, something in which he has only casual interest as compared with his passion for other things.  He was praised for those other things in school and offered scholarships which his parents encouraged and even gave him financial incentive to reject (they would not pay for his living expenses during college if he did not go to business school, even though they had plenty of money and had to pay more for him to attend business school for which he had no scholarships or other aid).  Most important, however, are very moment-to-moment interactions with his parents, especially his mother; Frank inwardly rages at even the thought of these because he feels so completely ignored amidst their “fake smiles and cheer”.  Much of this, however, has remained only superficially conscious; that is to say Frank has never really noticed how much all this bothers him, just as he minimizes his unhappiness in his marriage and tries to turn our discussions into a lesson plan for how to be a better husband.  Such sessions are always unproductive because in fact, as I stated above, he is already an excellent husband.

Because of resistance, it has taken a long time for Frank to notice what he is truly unhappy about – as opposed to whatever he raged about this week at work – and how deep that unhappiness runs, i.e. that it stretches beyond his 12 years with his wife and pervades his prior history with his own family.

But on the same day I saw Ted and thanks to the same casual start to the session, Frank finally noticed just how bad he feels and found some direction in addressing the problem; like Ted, he left the session feeling clearer, calmer, more focused, with direction, and as another patient put it “saner but sadder”.

Frank kicked off the session in the most banal way a person can – by talking about the weather.  Outside my window it was a stunning fall day and the leaves were bright and multicolored.  He commented on them and on how the change of season looks in Japan where he used to live.  I told him that over the years of his discussing Japan I had developed an interest in visiting there, even though I don’t have much interest in traveling in general.  At this point he perked up even more and all but offered to find me lodging should I ever decide to make the trip.  Right about then he became self-conscious, realizing that he had perhaps crossed some boundary between therapist and patient (he hadn’t), and reverted to recounting how his day had been.

As I did with Ted, I observed aloud the contrast between his demeanor as he recited the day’s incidents vs. as he spoke to me of fall leaves, Japan, and shared interests in them.  He thought for a moment and then admitted that he often leaves work feeling similarly energized, but by the time he gets home 15 or 20 minutes later he is grumpy, depressed, “sagging”.  He described habitually sending a message to his wife at the end of the day as he prepared to leave for home, perhaps sharing how good he feels, and getting either no response or a very superficial one; his daughter’s recent retreat into her own interests and his fall from the place in her life as “the world’s coolest dad”; and his dread of the habitual evenings at home in which his wife and he share virtually no contact of any kind, and how his efforts at communication with her are always fruitless.  Worst of all, he says that his wife told him perhaps a year ago “I’m not divorcing you yet” and he has been afraid to broach the topic of their relationship since then.

At this point I did not have to say much more to open the floodgates, just as we saw with Ted, because the contrast was so vivid and present in the session between his two moods – the contrast was not something he described or I inferred from his descriptions, not something we talked about; it was alive in our interaction only seconds earlier.  Thus, Frank himself suddenly realized where the great problem in his life is.  He realized that his irritability, moments of rage, and lack of involvement in the hobbies that truly engage him are all caused to a large degree by a relationship to which he has committed and in which he receives the same sense of being invisible that he grew up with (and in which he felt so helpless).  He described being “starved” with his wife for some kind of response.  He recalled an almost physical allergy to being hugged by his mother, starting when he was a teen ager but continuing into the present, because “she talks about and to me like I’m some jewel she’s proud to own, but she doesn’t hear ANYthing I say; never has!  And on the rare times I tried, she laughs!”  Again, all of this was worse now that he’d lost the “special connection” he felt he had with his daughter – “she used to share all my interests, we loved the same music, grooved to the same things; now she goes to her room and chats with her friends over the computer”.

What seemed to galvanize all this insight was the contrast between how it felt talking to me who seemed to take in his words vs. his life with his wife and before that his parents.  (As Carl Rogers once said in response to a question of how treatment works “Just being heard”.)  All our previous work of course contributed to this breakthrough, but it was this in vivo moment between us in real time that opened him up to realizing just what had been hurting him in recent years – what he’d been missing – with his wife and with his parents when they were around, as well as what tortured him all his life, before the marriage.  Suddenly he was clear about what hurt, about how “starved” he was in his marriage and before, and how he only perceived and expressed that starvation via irritability and rage.

Frank was tearful as he discussed all this, something that does not usually happen to him, and he left feeling sadder but much calmer, more focused, clearer in his thinking, and even strangely optimistic; regarding the latter, he noted that he felt he had some direction and could now addressed rationally “this nameless, overgrown black cloud I’ve never been able to identify and usually tried to ignore” (he had a history, like Ted, of drinking too much as part of these efforts).

The lesson here, as in last week’s entry about Ted, is that starting a session is actually quite easy.  Don’t try to talk about your mother just because you think that’s what we therapist will hear about.  Don’t talk about anything for that reason.  Don’t try to pick up where we left off last time.  Instead, talk about whatever feels real, alive, and of interest to you now.  If you do that, if you just dive in, the therapy will happen.

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