How to start a session.

Even experienced patients feel that twinge of anxiety at the start of a session – sometimes more than a twinge – wondering how to begin. The answer is simple: Start where you’re truly at, even if it’s last night’s ball game. Start anywhere. I’ve kept journals to confirm for myself that in fact the most productive sessions usually start this way, and that by contrast, when people try to talk about something “important” but their heart is not in it, it’s usually pointless and the session goes flat. You shouldn’t talk about your mother just because it’s therapy and you think you should, not unless that’s really where your heart is at the moment. (Obviously there are cases when a person is resisting the important material, and then has to be coaxed/reminded to get back to talking serious; hopefully your therapist will be able to alert you when that’s happening and can nudge you into something more useful.)

The same thing is true when talking about dreams. People sometimes ask “what does it mean when you dream x, y, or z?” Those of you who saw “Analyze This” may recall the maddening response the therapist gave his gangster-patient who asked the same thing: He said “I don’t know; what does it mean to you?”- maddening, but still the best answer.

The dream, or any element in it, might mean any one of 100 different things. What matters is which of those hundred things is being symbolized in that particular dream for that particular dreamer – and the only person who really knows that is the dreamer. The therapist can guide, the therapist may know which way to point the patient in considering what the dream or some element in it means, the therapist may know better than the layman what might underlie the dream. But only the patient knows when we’ve hit the right answer.

The therapist’s job is to help clean off the glasses. I can tell you when you are resisting, distracting, avoiding, intellectualizing, or otherwise lost, and I can point you in the direction of something more fruitful in how you start the session, in what topics you bring up, in the analysis of a dream. But it is only you who can tell us if we’ve hit upon anything true for you. If we don’t hit on such a moment where you recognize “oh that’s what I’m doing/feeling/dreaming-about/thinking/believing, then all the clever interpretations from my side of the room will probably remain useless.

Jared is a good example of this. He came to me with problems in his marriage, work, and relationships with his children. He frequently felt quite frustrated and powerless, and he spent much of his time enraged and unable to focus because of that feeling. He came from an abusive childhood. His father was depressed and at one point suicidal, often made Jared feel very guilty for being such a burden (he wasn’t); Jared recalls his father sadly talking about how much work it was to raise him, how he gave up so much to put him and his siblings through school. Jared also recalls his mother telling him that she hated him.

When his siblings were born – and he does not really remember this although it is clear from his recounting of the family history – Jared was replaced. He had been the oldest, gotten all the attention, and suddenly these stressed parents turned all their focus on the new twin babies. Psychology, history, and literature all teach us that what we don’t remember we are doomed to enact. This unremembered sense of envy, the resultant scrambling to recover his honored place in the family, his efforts and yearning to regain the attention and even minimal affection of his parents – all this dogged Jared the rest of his life.

And it tainted our early sessions. He wasted the first several months with me trying to control every aspect of our interaction, on the surface very polite but in fact quite demanding and intolerant. In the midst of that there was no room for us to actually engage and get anywhere; he had to establish his territory and all the ground rules before he could dare open up. Eventually I was able to help him observe behavior and the feelings underneath, and our work could begin.

One day he came in reporting a nightmare that had awakened him: In it, his wife had set him up to take the fall for a crime so that she could be with another man, and in the dream she told him so. My immediate thought was that, as the textbooks tell us, it was his wife’s betrayal that was so painful to Jared, not that she left him. But again what matters – and what cures – is not what the textbooks tell me is probably going on but what the patient actually registers, feels, recognizes in himself. So I asked Jared what was the most vivid element in the dream, the most vivid image, sound, moment, or feeling.

His answer was explicitly “that I’d been replaced” – not that he’d been set up and betrayed, not that his life and career were ruined. From here, with the help of a few questions and observations from me, he went on to elaborate on that feeling, that fear of being replaced. He spoke of it with visible pain and yet also excitement, how he could now see its constant presence in his daily life, how he was always scrambling to prevent being replaced across many areas of his life, at work, with friends, and so on. He saw his controlling behavior with clarity for the first time, how it was a response to that ubiquitous fear, how it pushed away the same people he wanted to connect with – including me, his family, his colleagues, his children – how it caused him to live in a constant state of unnecessary and destructive tension and anxiety. The session left him calmer, more hopeful, sadder but much more able to focus and move forward with the day and his life. He later told me the session left him feeling “energized, calmer, although sadder, and I handled everything better”. What more can one want from a session?!

Knowing his history, I’m sure you can see the parallel between this basic fear and his real experiences as a child, when he was in fact “replaced”. Especially if you’d sat with Jared and heard his stories at length, experienced his politely controlling behavior first-hand, and observed the anxiety and resentment stirred up in him when he felt left out, you would see what a perfect encapsulation of his life the dream was. Had I leapt in with my interpretations of the dream the session would not have been as productive and healing as it eventually turned out to be. Jared might have learned something, might have even felt some of that crucial recognition of himself in our discussion and felt a little better. But he had a much more powerful experience because I said less, asked more, and followed his lead. That is why we shrinks are always throwing your questions back at you, including “What should we talk about today?”

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