{"id":45,"date":"2013-04-02T23:13:23","date_gmt":"2013-04-02T23:13:23","guid":{"rendered":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/?p=45"},"modified":"2013-04-02T23:13:23","modified_gmt":"2013-04-02T23:13:23","slug":"what-should-happen","status":"publish","type":"post","link":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/what-should-happen\/","title":{"rendered":"What Should Happen"},"content":{"rendered":"

Despite the century long history of psychotherapy in this country people frequently ask me what happens in a session, how to tell if the process is working.\u00a0 Here\u2019s an example of a decent session with Simon, someone I wrote about in a recent blog entry<\/a>.\u00a0 You’ll remember this was a very bright, accomplished, but highly intellectualized young man who came in complaining of panic attacks, obsessing, indecision.\u00a0 In particular, he had trouble understanding how he had been so independent until about age 20, and then seemed to “crash”.<\/p>\n

He came in one day struggling \u2013 agonizing, really \u2013 over what to talk about.\u00a0 This is a common occurrence even with experienced patients.\u00a0 Everything he started to discuss petered out.\u00a0 For example, he told me that he was worried about his apparent loss of motivation.\u00a0 He said he used to stay up late doing research and reading in his field, but lately preferred to socialize.\u00a0 I asked when he had last felt motivated, however, and he told me that just two nights earlier he had in fact stayed up and worked.\u00a0 Then I asked him when he last had a sustained period of such behavior, and he could not answer.\u00a0 I asked him about the work he stayed up doing and he could not even answer whether he was in fact interested in the project or not.\u00a0 He started to say “yes”, then corrected himself to say “well, it might be something that later on\u2026\u201d, then said again \u201cyes\u201d, then added \u201chmm.\u00a0 I don\u2019t know why I can\u2019t answer\u201d.<\/p>\n

At this point I interrupted with the observation that thus far in the session he was unable to answer almost any of my questions without a great deal of hedging and at times muttering inaudibly as if in some private reminiscence.\u00a0 He acknowledged this, relaxed a bit, and then tried to focus on the question that is always useful one:\u00a0 What is of interest to you right now?\u00a0 What are you feeling or thinking about right now?<\/p>\n

He answered, feeling silly, “I\u2019d like to be somewhere warm”.<\/p>\n

Trivial as this bit of information may appear at first, here is where the session really began.\u00a0 If that seems hard to swallow, hang on for a few paragraphs.\u00a0 Unlike everything else he said, this was a statement without hesitation or backpedaling, which clearly expressed his feelings and his interests.\u00a0 At this point we can begin to find out something about him, his functioning, his issues, etc.\u00a0 Consider the possibilities:<\/p>\n

1)\u00a0\u00a0\u00a0 We might discover with further questioning that his fantasy is to be in the Caribbean.\u00a0 Further inquiry might reveal that the fantasy is one of escaping pressures, that he is troubled by his job, his love life, his friends, etc., i.e. that being cold or warm is not even the issue but that escape from stress and pressure is.\u00a0 He might be lonely, pressured at work, unsure about handling difficult people, or something else.\u00a0 At that point, clearly we have plenty to talk about some of which would very possibly resolve in a single session \u2013 how to handle a difficult boss, colleague, lover, work load, etc.<\/p>\n

2)\u00a0\u00a0\u00a0 Simon might tell us of a Caribbean fantasy involving water sports.\u00a0 Further inquiry might reveal that his problems could be solved by getting some exercise, that he has been gluing himself too persistently to his desk and needs to take a run.<\/p>\n

3)\u00a0\u00a0\u00a0 Simon might tell us that his fantasy is literally<\/span> to be warm, at which point the question becomes why doesn’t he put on another sweater or turn up the heat.<\/p>\n

This last possibility is the one Simon voiced.\u00a0 Without my asking anything, however, he then speculated as to why he had been sitting not only during our session but all morning (we spoke at noon) in a cold apartment.\u00a0 He then realized with frustration that he had not turned up the heat because of a preposterous concern with the heating bill.\u00a0 He did a quick calculation and told me that the morning\u2019s heat would’ve cost him less than a dollar.<\/p>\n

From here, Simon continued to talk about the way he\u2019d spend the day so far and noted that all morning he had been in his words \u201cworried about what I should do and doing none of it”.\u00a0 He had made a list of chores, projects for work, and some long-term goals, then had rethought these several times until before he knew it the morning was gone.\u00a0 Moreover, all the while he was aware of being cold \u2013 had even looked online at some sweaters and warm slippers he might buy, then decided against it because of the price and mainly because “I shouldn’t need those things”.<\/p>\n

At this point he articulated what had been barely conscious to him all morning although was apparent in how he spoke at the start of our session:\u00a0 \u201cI get consumed with whether what I’m thinking, what I want, what I feel, is okay, if it looks cool, like how would this look to me if I read it about me\u201d and so on.\u00a0 He then noted that his entire week had been dominated by such concerns with what he should and should not feel, think, want, do.\u00a0 This brought us back to where we had been the previous weeks, to discoveries and insights that have been brewing and consolidating in recent sessions in which Simon was realizing the degree to which he moved through the world in a state of apology, anxiety, insecurity, and indecision.<\/p>\n

All this emerged because I got him to stop fidgeting and answer the question \u201cWhat\u2019s on your mind right now (however apparently trivial)?\u201d\u00a0 After that I didn’t have to say much.\u00a0 The simple statement of where he was at \u2013 that he wanted to be warmer \u2013 got him back in touch with everything else about him and it all came pouring out, including a cheerful frustration with having wasted the day being cold when for the price of half a cup of coffee he could have worked in a comfortable home.\u00a0 (He also mentioned at that point his complaint \u2013 something he never dared pay attention to \u2013 that his tea had become cold; we laughed at this brilliant Ivy League graduate not thinking to warm it the microwave.)<\/p>\n

Amid this burst of insight, one of the things Simon said was “if I realize that I like it warm, what will I do when I can’t be warm in the house?\u00a0 It’s like I have to get used to it so I’ll be okay when it’s taken from me.”\u00a0 I did ask him to stop and take note of that issue \u2013 the idea that things will be taken from him \u2013 and see if it brought up any other thoughts.\u00a0 He immediately mentioned his father becoming very ill when Simon was quite young.\u00a0 From there he spoke about other memories that brought on that feeling of profound insecurity, of having to be entirely self-sufficient to the point of not even using heat or a sweater if he could possibly avoid such dependency.\u00a0 Amid all this, he calmed, made some decisions about his day and future without so much obsessing and anxiety, and ended the session feeling much better than he had at the start of it.<\/p>\n

All of this demonstrates several important features of psychotherapy.\u00a0 First, there really is nothing else to do until you answer the question “where are you at today? what\u2019s on your mind now? what\u2019s of interest to you?”\u00a0 It seems simple, but people sometimes have great difficulty simply starting here.\u00a0 Second, once you relax and let yourself consider that question everything about you can come out and be addressed \u2013 issues as immediate and trivial as physical comfort, as pervasively interfering as a neurotic preoccupation with perfectionism, and as deep as childhood trauma.<\/p>\n

Third, this session answers in part the question I’ve so often heard over the years, “How can you listen to people’s problems all day?\u00a0 Don\u2019t you get bored?\u201d\u00a0 In fact, it\u2019s life outside the office that can, by comparison, be dull.\u00a0 Think about it.\u00a0 If I were chatting with Simon in a pub and he was waffling as he was at the start of our meeting, it would be difficult to point out that he was rambling; I might have to listen to more of it and find some graceful way of ending the conversation, particularly if we weren’t more than casual friends.\u00a0 But in psychotherapy it\u2019s my job to point out to Simon what I see going on, that he\u2019s hedging, drifting away in the middle of saying something, and ultimately saying nothing, in short avoiding any substantive talk and thus boring us.\u00a0 As result of my speaking up, Simon came to life and the session became exciting for both of us.\u00a0 Outside my office, in some other social settings, telling someone that he’s boring you can be offensive (and one does not want to offend a man in his late 20s who lifts weights for recreation)<\/p>\n","protected":false},"excerpt":{"rendered":"

Despite the century long history of psychotherapy in this country people frequently ask me what happens in a session, how to tell if the process is working.\u00a0 Here\u2019s an example of a decent session with Simon, someone I wrote about … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/45"}],"collection":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/comments?post=45"}],"version-history":[{"count":1,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/45\/revisions"}],"predecessor-version":[{"id":46,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/45\/revisions\/46"}],"wp:attachment":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/media?parent=45"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/categories?post=45"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/tags?post=45"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}