the basics – never assume

I’ve written about Simon in two entries.  It’s time for an update because recently he’s come out with new information that further illustrates themes I’ve been trying to explain and illustrate in this blog and in the website.

When I first mentioned him (see this entry several paragraphs into the article) I was making the point that one has to try and put thinking, preconceptions, and of course self-analysis and self-diagnosis on hold in order to the work of psychotherapy.  I discussed him in more length here and we saw how by putting his preconceptions aside and just answering simple questions like “what’s of interest to you right now, this moment?” was so productive and kick-started what had been a pretty empty, stalled session.  Once he let himself just talk to me (the psychoanalysts would say “he began to free associate”), he began to articulate what was making him uncomfortable, related this to other times he felt similarly, realized how he was pressuring himself unreasonably, and he calmed down and functioned better.

This was about a year ago and you might ask why he has continued to see me.  Take a look back at the first paragraph in the extended entry about him here.   You’ll notice that he had the idea that he was fine until he was about 20 when from his point of view he suddenly developed panic attacks, obsessional symptoms, and chronic intense anxiety.

It seems intuitively true that if the problem only developed several years before he started treatment, such moments of discovery as I described in previous entries about him should have cleared things up.  If his problems persist, it must mean that they run deeper.

This is precisely the situation.  Simon enjoys our sessions, looks forward to them, is never late, and clearly values them, yet he remains persistently unable to just talk to me.  Quite recently, for example, he caught himself lying to me about how he met a woman he was dating.  He explained that he was embarrassed at having met her through an online dating site.  Similarly, the difficulty speaking that I wrote about in the last two entries about him has persisted, although now he can joke with me about it.  He quite accurately said the sessions often feel like we’re driving with someone who keeps tapping the break; it’s unsettling, halting, frustrating, as his speech comes out in quick bursts but rapidly cut off, censored.  Clearly the problems run deeper and simply teaching him how to cope with anxiety isn’t enough; the anxiety is too pervasive, affecting too many areas of his life, too easily triggered by almost any minor stress.

Over the past year, Simon has persisted with somewhat contradictory habits.  First he often expressed his dismay that he’s not getting “back to normal”, i.e. to the way he imagines he was prior to age 20.  But at the same time, he has been gradually sharing more and more stories of a fairly frightening childhood involving a very scary father who threw tantrums with little provocation, shook him violently at about age 3 because of the merest of accidental transgressions (Simon broke a light bulb), and in general gripped the family in a state of strong and persistent anxiety over what mood he might be in when he arrived home.  Simon remembers quite vividly now the stomach churning dread he felt that the sound of his father’s car in the driveway, and his immediate preoccupation with assessing his father’s mood and how best to handle it so that there would be no violence.  (He was particularly worried, he recalls, about his mother and younger siblings.)

What was missing in all this, however, was for Simon to actually remember the experience of these moments, how they felt to him.  Because of this gap, these unremembered feelings continue to be acted out in the present.  Thus, 1) he gets extremely worried about what mood I – his therapist 20 years later – am in, whether he’s boring me, whether I’m about to kick him out as a hopelessly dull patient; 2) he’s always convinced his friends are about to reject him, friends who we know from previous sessions are hardly the types to do so and who have a solid history of liking Simon, of loyalty to him; 3) he is often tied up in knots at work, sure that he is about to be revealed as the stupidest one of the room and fired, and again there’s absolutely no data to suggest he’s in such danger, that anyone is unsatisfied with his performance.

Recently, he had a breakthrough.  It was another session in which he struggled to talk freely, found himself sitting hunched over full of tension until I suggested he sit back, and only then did he realize how tight he had been, how uncomfortable and lurching in his speech.  He then told me about recently following a suggestion I had given him simply to notice his physical tension and then, once noticed, to breathe and loosen his shoulders.  From here he suddenly told me that he was particularly at night struggling with “feelings of unease”; and then he said something quite new.  He described the feeling as unpleasant and often leading to panic, but also as very familiar.

From here, he suddenly saw that this “familiar” anxiety was in fact a comfortable state for him, even if only because it is familiar.  This is an important moment in anyone’s treatment – when they begin to see that the symptoms they so want to be rid of may be exactly those to which they have an attachment.  From here, Simon finally connected this frequent tension in his current life to those memories of his scary father and how he felt at home.  All that tension, and all the over-thinking he does (see previous entries about Simon, links are above) was how he coped as a young boy with his frightening father (particularly in order to protect his younger siblings).  Also you may see here how symptoms are “defenses run amok”, as described in the website, especially here and here.

Simon also excitedly noted that this anxiety and near panic he was so often experiencing had been with him all his life; it did not start at age 20.  He remembered living in this tense, frantic state of worry and obsessive thinking at ages “8, 16, always”.  Finally, Simon realized that the panic which broke out when he was two decades old was the latest emergence of a lifelong problem with anxiety, something which had briefly been submerged as he left home for college and did some other independent traveling.  This, then, is why treatment is taking more than a year or so with him:  Simply put, it’s because we are rooting out problems that got into his system probably when he was less than three years old, things that are thus pre-verbal, even pre-conscious, and so long a habitual way of perceiving and being in the world.

One last point about this case.  Symptoms – the problems that bring people into psychotherapy – are caused by unacknowledged feelings, by agendas that are either just under the surface or, as in Simon’s case, more deeply buried.  Those problems, therefore carry information.  They are like peaks of mountains that just break the surface of a large lake.  They show us that there may be a whole mountain underneath.

That mountain is a big part of your personality.  It’s made up of your history, years of experiences, at the most basic level.  It cannot be excised; you can’t slice it out like a tumor.  Relief – cure – come by exposing the mountain beneath.  When that is done people feel better and they function better.  At the end of this session, for example, Simon was visibly calmer, looser, and he told me as much, saying that he felt “less crazy”, more relaxed, more grounded, even if somewhat sadder.  He left the session with a new ease and confidence.  This is something I’ve witnessed many times over the years.  When people make contact with who they really are, even if the news is unsettling, upsetting, unflattering, that contact is healing.

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