What cures.

Here’s a story that might sound trivial.  Reminiscing with her husband about childhood dinners, Elaine reached across the table to cut the meat for her young son. A vision struck Elaine of staring at a steak on her plate as a young girl and not knowing what to do. In a light tone, as if it was a silly memory, she mentioned this to her husband.  “You mean your folks didn’t cut the meat for you?” he asked.

At this point Elaine suddenly remembered and became sad.  Although she vaguely recalled the image described above, for some reason her husband’s question brought back the rest of the memory.  She suddenly could remember staring at the meat, feeling helpless, hopeless, and usually just giving up.  Sometimes she would get help, often not.  When she told me the story I asked about other people at the table and she remembered, looking even sadder and more distressed, that her older siblings never said anything, that no one commented or offered help, and that in fact nobody seemed to notice her dismay.

Elaine was remembering only the barest outline of the story, “just the facts” and none of the pain.  This is a common defense, called “isolation”.  It’s particularly prevalent in people who have a tendency to obsess, intellectualize, worry, rationalize, and have anxiety symptoms.  You can find some more dramatic examples of it here and here.

Now why is this story important?  Originally, Elaine came to see me with a long history of anxiety, night terrors, awakening in a cold sweat but not recalling any dreams, social anxiety, a growing estrangement from irritation with her husband, and despite her great success as a businesswoman increasing feelings of impotence which were becoming visible to others in that she was no longer as assertive as she needed to be.  She found herself quickly retreating from effusive or demonstrative colleagues in meetings, felt bullied and sank into silence and feelings of hopelessness.  These problems had plagued her much of her life; she came to me when she was in her mid-30s.  At various times over the years she had been able to keep the problems at bay, minimized, sometimes with the help of antianxiety medication.

Elaine and I made slow, steady progress with all of her problems.  She gradually became more appropriately assertive when she needed to be, better handled her three young children, one of whom had some disabilities and required extra attention and patience, and she gradually began sleeping better.

And then came the session where she remembered the steak story.  It was here that her relationship with her husband and her handling of business associates and clients took a rather dramatic turn.  She had complained to me, in this same session, about a client’s request for something that was impractical but understandably naïve coming from a layman.  It was the kind of request that Elaine handled with every new client, the kind to which she brought her well-paid expertise.  As Elaine talked about one such recent client, however, she became extremely irritated and sour, and she compared this person to “those people who don’t vaccinate their kids”.  I commented on this oddly intense reaction to a frankly reasonable and innocent request from a new client, and also asked if this was at all similar to what she experienced with her husband.

Remember, Elaine had come to me complaining of problems with him, in particular a feeling of deep irritation combined with a hopelessness to work out even the most minor disagreements.   As we discussed the details of their relationship, however, it became quickly clear that in fact this man was not particularly unreasonable, difficult, or demanding.  Rather, Elaine seemed quickly to sink into grumpy and silent helplessness at the merest resistance or even input from him on any trivial topic, e.g. which one of them would stop at the store on the way home from work.

In response to my question Elaine answered that yes the feeling with the client was the same as that she felt towards “those impossibly unreasonable people who don’t vaccinate their children”, and the same as she felt towards her husband.  On something of a role, her speech accelerating in pace and energy, she acknowledged similar feelings when her four-year-old daughter was difficult to control, and even at the low stress environment of her tennis association when someone spoke forcefully at a meeting.

And what has all this to do with steak?  I suggested that all these feelings sounded the same as what she must have experienced sitting at the table at age 4 or 5 unable to figure out how to eat, believing that no one around her would help, had any interest in what she was going through, or even noticed her predicament.

Then came one of those moments that we therapists live for.  Elaine’s face softened, her eyes glistened, she became much more expressive, and out came a flood of associations – memories and ideas from past and present – in which so much of her life and difficult moments became clear to her as reenactments of that dinner table scene (and similar experiences from those days).

Now:  As much fun as the session was for me, how do we know any of it matters?  Because the change I saw in Elaine during the session was immediately echoed by changes in her mood and behavior outside the office.  Pushy people at meetings suddenly lost their threatening quality because she was no longer rocketed – unconsciously – by such stimuli back to that early experience of very real helplessness and despair.  Her husband ceased to be the impossible man she was perceiving him to be – again because of her unconsciously living in the past.  Instead, she rather naturally began to answer him and, to her surprise, the two began negotiating easily, quickly, even lovingly and playfully.  She was startled to find out how reasonable he was if she simply spoke up.  She had been reacting to him as if doomed to the same invisibility and hopelessness that she experienced when she was very young.  In fact, all she needed to do was answer his mild objections with something like “I don’t have time, you said you’d be off by six, so can you please do the errand for me.”  He responded with casual acquiescence, and their relationship dramatically improved.

What we see here is a demonstration of two great truths of psychotherapy, and of life:  1) What we don’t feel, what we don’t remember, we are doomed to re-enact.  (Or:  Those unfamiliar with the past are doomed to repeat it.)   2) When we do remember – when we face what we’ve been avoiding, what we’ve kept buried or unconscious – we feel better and we do better. These simple truths are at the core of almost all psychotherapies, except for the purely behavioral ones like EMDR, exposure and response prevention, and a very few others.  In all the rest of the therapies, this is where relief comes.  You can read more about all this on the main website

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