{"id":90,"date":"2014-05-12T01:28:11","date_gmt":"2014-05-12T01:28:11","guid":{"rendered":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/?p=90"},"modified":"2014-05-12T01:28:11","modified_gmt":"2014-05-12T01:28:11","slug":"the-basics-never-assume","status":"publish","type":"post","link":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/the-basics-never-assume\/","title":{"rendered":"the basics – never assume"},"content":{"rendered":"

I’ve written about Simon in two entries.\u00a0 It\u2019s 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<\/a>.<\/p>\n

When I first mentioned him (see this entry<\/a> several paragraphs into the article)\u00a0I 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.\u00a0 I discussed him in more length here<\/a> and we saw how by putting his preconceptions aside and just answering simple questions like \u201cwhat’s of interest to you right now, this moment?\u201d was so productive and kick-started what had been a pretty empty, stalled session.\u00a0 Once he let himself just talk to me (the psychoanalysts would say \u201che began to free associate\u201d), 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.<\/p>\n

This was about a year ago and you might ask why he has continued to see me.\u00a0 Take a look back at the first paragraph in the extended entry about him here<\/a>.\u00a0\u00a0 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.<\/p>\n

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.\u00a0 If his problems persist, it must mean that they run deeper.<\/p>\n

This is precisely the situation.\u00a0 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.\u00a0 Quite recently, for example, he caught himself lying to me about how he met a woman he was dating.\u00a0 He explained that he was embarrassed at having met her through an online dating site.\u00a0 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.\u00a0 He quite accurately said the sessions often feel like we\u2019re 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.\u00a0 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.<\/p>\n

Over the past year, Simon has persisted with somewhat contradictory habits.\u00a0 First he often expressed his dismay that he\u2019s not getting “back to normal”, i.e. to the way he imagines he was prior to age 20.\u00a0 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. \u00a0Simon 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\u2019s mood and how best to handle it so that there would be no violence.\u00a0 (He was particularly worried, he recalls, about his mother and younger siblings.)<\/p>\n

What was missing in all this, however, was for Simon to actually remember the experience<\/span> of these moments, how they felt to him.\u00a0 Because of this gap, these unremembered feelings continue to be acted out in the present.\u00a0 Thus, 1) he gets extremely worried about what mood I \u2013 his therapist 20 years later \u2013 am in, whether he\u2019s boring me, whether I\u2019m about to kick him out as a hopelessly dull patient; 2) he\u2019s 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\u2019s absolutely no data to suggest he\u2019s in such danger, that anyone is unsatisfied with his performance.<\/p>\n

Recently, he had a breakthrough. \u00a0It 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.\u00a0 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.\u00a0 From here he suddenly told me that he was particularly at night struggling with “feelings of unease\u201d; and then he said something quite new.\u00a0 He described the feeling as unpleasant and often leading to panic, but also as very familiar.<\/p>\n

From here, he suddenly saw that this \u201cfamiliar\u201d anxiety was in fact a comfortable state for him, even if only because it is familiar.\u00a0 This is an important moment in anyone’s treatment \u2013 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<\/span>.\u00a0 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.\u00a0 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).\u00a0 Also you may see here how symptoms are \u201cdefenses run amok\u201d, as described in the website, especially\u00a0here<\/a> and here<\/a>.<\/p>\n

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.\u00a0 He remembered living in this tense, frantic state of worry and obsessive thinking at ages “8, 16, always”.\u00a0 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.\u00a0 This, then, is why treatment is taking more than a year or so with him:\u00a0 Simply put, it\u2019s 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.<\/p>\n

One last point about this case.\u00a0 Symptoms \u2013 the problems that bring people into psychotherapy \u2013 are caused by unacknowledged feelings, by agendas that are either just under the surface or, as in Simon’s case, more deeply buried.\u00a0 Those problems, therefore carry information.\u00a0 They are like peaks of mountains that just break the surface of a large lake.\u00a0 They show us that there may be a whole mountain underneath.<\/p>\n

That mountain is a big part of your personality.\u00a0 It\u2019s made up of your history, years of experiences, at the most basic level.\u00a0 It cannot be excised; you can’t slice it out like a tumor.\u00a0 Relief \u2013 cure \u2013 come by exposing the mountain beneath.\u00a0 When that is done people feel better and they function better.\u00a0 At the end of this session, for example, Simon was visibly calmer, looser, and he told me as much, saying that he felt \u201cless crazy\u201d, more relaxed, more grounded, even if somewhat sadder.\u00a0 He left the session with a new ease and confidence.\u00a0 This is something I’ve witnessed many times over the years.\u00a0 When people make contact with who they really are, even if the news is unsettling, upsetting, unflattering, that contact is healing.<\/p>\n","protected":false},"excerpt":{"rendered":"

I’ve written about Simon in two entries.\u00a0 It\u2019s 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 … 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\/90"}],"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=90"}],"version-history":[{"count":4,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/90\/revisions"}],"predecessor-version":[{"id":94,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/posts\/90\/revisions\/94"}],"wp:attachment":[{"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/media?parent=90"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/categories?post=90"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.aboutpsychotherapy.com\/aboutpsych-blog\/wp-json\/wp\/v2\/tags?post=90"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}