While I think that most therapists are far too ambivalent, guilty, dishonest, or exploitative to be able helpfully and healthily to fuck a patient, I do not believe that any form of interaction can or ought to be banned or ballyhooed in and of itself.
Q: What would you most like to do right now?
A: I’d like to stop this intellectualizing and go back to the Tantric Road.
* Countertransference refers to an emotional response on the therapist’s part that is not rooted in the reality of the present situation, but is rather an inappropriate carry-over of unresolved feelings and attitudes from his childhood. These old attitudes are then presumably “transferred” onto the present situation.
XX
Surprise, dear reader. Another roadblock must be circumnavigated before returning to my Tantric path. Peter Wyden has returned this manuscript to me with all sorts of notes scribbled upon the pages of the preceding chapter. There is one “much too brief” annotation, followed by a “much, much too brief,” followed by a “very vague,” followed by a request for “more incidents.”
He thinks I have given short shrift to my years of college and medical training and to my personal psychoanalysis. He wants to know the way I work with patients, and wishes to hear of my successes and failures—“to know what the things are that work.” And he presumes that you will share his curiosities.
Who am I to say whether or not this is true? You are, unfortunately for me, a faceless, nameless person. If you are a vulgarian, as I am, such exposition will not interest you. If so, I allow you to stop reading right here, and skip to Chapter 21. For I am in a conciliatory mood and am inclined toward answering Peter Wyden’s questions.
Dear Peter:
The first thing that I should tell you about medical school (and my year of medical internship) is that it was, by and large, irrelevant to the practice of psychotherapy. I suspect that the three most valuable things to come out of it were public respect (it is simply marvelous to see how much “authority” people give to doctors, how respectfully they listen when we talk about almost any topic under the sun), the ability to earn much more for my services than, say, psychologists, social workers, or paraprofessionals, and finally—and perhaps most importantly—getting M.D. license plates for my car.
Now I know you’re going to accuse me of being flip concerning that last point, Peter. Perhaps I am. But unless you’ve tasted the freedom of driving about New York City, parking wherever you wish, and not being ticketed for it, I ask that you withhold snap judgments.
This is not to say that medical school was a bad experience. I enjoyed myself there more than I had in any other school I’ve attended. I learned how the body functions in health and in disease. I learned how to diagnose and treat sickness. And I experienced the joys of obstetrics, that special branch of medicine that deals with life instead of death, that specialty where you can share a mother’s smile as she beholds the infant you have just delivered. But of course this has little to do with psychotherapy.
I should say this: the passage of those years between eighteen and twenty-seven (four in college, four in medical school, and one as a medical intern) were essential years of maturation, years in which I could get my own shit together before being allowed to deal with other people’s emotional problems. But this growing-up was a process that came about incidentally and not through any formal class work or clinical experience.
Indeed, my decision to become a psychiatrist occurred in this informal and apparently accidental fashion:
I first went to the High School of Music and Art with the idea of becoming an artist, like my father. But as graduation neared, I felt totally unprepared to sacrifice the social contacts that further schooling might afford. I had yet to develop anything even remotely resembling a satisfying affectional relationship with my peers, either a close mutual friendship with another guy or an intimate love relationship with a woman. And the idea of leaving school meant to me that I would enter the job market as an adolescent in a sea of adults. No. I had to go to college in order to make one last attempt to succeed socially. But what would I study?
In an attempt to define my own future plans I asked my classmates what they were planning to do. Yet none of the careers suggested made sense to me until someone told me that he planned to be a dentist.
“A dentist!” I exclaimed. “Why a dentist?”
“Because it is virtually impossible to earn a living as a fine artist. This way I figure I can earn enough money working only three hours to paint for the rest of the day.”
The occupation made perfect sense to me. I registered at New York University as a pre-dental student.
The chain of “accidents” continued, for I started (for the first time since the third grade) to excel academically. I suppose this was in part due to my reading my assignments for the first time in years, an endeavor fostered by my father’s wise insistence that I work to pay the costs of my own schooling. After all, I was not a good enough high school student to gain admission to the tuition-free city university. And if I wasn’t going to study (and was trained as an artist), why should my dad overburden himself with the additional expenses?
A part-time job as a stock clerk served both to pay my way through school and to cause me to study. I realized within a year that I could readily qualify for medical school. The idea of becoming a doctor (something I would never have conceived of in my adolescence) excited me far more than art did—and certainly more than the prospect of looking into people’s mouths for the rest of my life.
The other event that moved me along my career path also occurred while I was at college. I began to study psychology. Not out of any academic interest, mind you. Rather, simply so that I might surreptitiously straighten out my imagined madness without having to tell anyone else that I felt mad—that I felt “yyuuggh” about myself, that I felt shy, and bumbly, and foolish, and inept, and insecure, and frightened.
Out of this “secretive” and narcissistic study came a genuine fascination for the field of psychology itself. But in the end it was the validity of my own personal psychoanalysis (entered into as a patient, not as a student) that later led me to choose psychiatry as a career from among the many interesting fields of medicine.
I can imagine you reading this now, Peter, and thinking “How did you feel foolish? … Frightened of what? … Why were you so apparently neurotic?” Yet I must honestly say that I doubt that my added explanations will make things any clearer. For my home life was not all that bad. My mother never abused me, although we fought a lot (as many kids do with their parents). And as you can gather, my father was as close to ideal as a parent can possibly be. It was, rather, with my peers that I felt isolated and unsuccessful.
Perhaps it had to do with moving twice when I was eight years old—having, in rapid succession, to give up one set of friends and to gain another. Perhaps it was because I was beaten up regularly by a bully in the public school I finally settled in. Perhaps it was because I was frightened but didn’t dare to admit it for fear of having teasing insults added to my injuries. Perhaps it was because, at the time of graduation from elementary school, I was the shortest of the thirty students in my class.
And yet, are there not many children who have had similar experiences and didn’t feel “yyuuggh” about themselves? So how can I attribute it simply to that?
All I know is that once you start to feel badly about yourself, you selectively interpret the events in your life to justify your misconceptions about your worth. At least I did that. What happened, then, was that a vicious cycle became established. Thus, if someone liked me, I gave the liking little weight and suffered, instead, because somebody else didn’t. It was a case of accentuating the negative and eliminating the positive.
My psychoanalysis began while I was in medical school. This, too, was one of those “accidents” that came about by virtue of my medical education. One of my classmates was an older fellow. He had his master’s degree in psychology and decided to go t
o medical school in order to become a psychiatrist. He eventually wanted psychoanalytic training and he knew that most analytic institutes considered M.D.s a breed far superior to Ph.D.s in psychology.
Well, to be brief, I respected this man enormously. Loved, would be an even better term. Once I dared confide in him my uncertainties about myself in general and my doubts about my ability to love and/or be loved in return in particular.
I babbled on in a state of confusion, uncertain of direction, unclear about what I was asking for. But my older friend had been psychoanalyzed, and he told me that he thought analysis might help me. When I told him I couldn’t afford that, he told me about applying to The William Alanson White Institute’s low-cost clinic. I applied, was accepted, and began a dollar-a-session analysis with a student analyst that, as I said, turned my life about completely.
I’m not sure what I can tell you about my analysis that makes sense. There were no sudden breakthroughs, no great dramatic moments, no core insight that explained all of my problems. And yet I began to make friends more readily, began to establish better love relationships (freer of dependence, guilt, and hypocrisy), and began to value myself.
I do know that all of the theories as to why psychoanalysis works seem like so much bullshit to me.
It was not the lying on a couch four times a week that “cured” me. Nor was it my analyst’s interpretive skills that made me realize the absurdity of my self-contemptuous, vicious cycle. That that was a blind-alley way of thinking emerged gradually as I listened to all of the claptrap I was free associating.* And once emerged, it seemed too stupid to continue it.
Another thing that helped was my daring to go beyond my fears and old ways of dealing with myself and others—what I’ve previously referred to as my counterphobic tendencies. Last, and perhaps most significant, was the fact that I felt fully accepted by this woman analyst of mine.
I could tell her about my “worst self”—both historically (stealing money from my mother and lying about it) and in the present (passing by an auto accident at a roadside and not stopping to see if I could help)—and I felt she still was interested in me. I dared to ask her if she liked me, and she said that she did. I dared to insult her by sneering at her “superkindness,” and yet she remained kindly disposed. I risked being thought “disgusting” because of my sexual interest in her. Yet she found this flattering.
It was this acceptance by her of all these parts of me that I felt also led to my accepting myself. I could even have compassion for my shyness. My quiet moments could be interpreted by me as moments of peace, rather than as my being so stupid as to have nothing to say. How different she was from so many other analysts I’ve come to know professionally, who really don’t accept parts of their patients’ resentments, actions, sexuality, and interests.
Yet I also felt that there must be some way to speed up this process that for me consumed over four years of three-times-a-week and four-times-a-week visits.
My actual experiences and training as a psychiatrist did not begin until I began my residency training at age twenty-seven. For the next three years I saw psychiatric patients in mental hospitals under the supervision of senior psychiatrists. And this formalized “apprenticeship,” which medical training had not in any way prepared me for, made me realize that any intelligent, humane, sensitive layman could be equally fit to be a therapist after apprenticing himself to some good teachers for a period of time. (What was I, after all, but a layman with an M.D. degree?).
I am not arguing against “experience” as a necessary ingredient in the formation of a decent therapist. Nor am I arguing against “training.” What I am arguing against is the necessity of obtaining that “training” and “experience” within our formalized educational structures. For these structures contain far too many irrelevancies. Ages ago, before the growth of our mass-production university system, a man learned a skill by living with and studying with some master. There were no “degrees” granted, nor was there a prescribed series of classes.
But we have become so accustomed to accreditation nowadays that true worth and value are not recognized unless a person has a host of letters following his name. It is only recently that some segments of the mental-health profession have come to realize the folly and the waste of our overtraining and have begun informally to train paraprofessionals (including housewives, school dropouts, and the like) to perform some of the therapeutic functions of M.D.s and Ph.D.s. And studies of the psychotherapeutic efficacy of these selected paraprofessionals show that they match our highest paid professionals.
So you see, Peter, there is not too much to say of a positive sort about those years of training. And even with my later experiences—to talk about my “successes” and my “failures” seems to me a rather hokey way to proceed. Or silly and pointless.
I’ve had my share of successes and failures, I suppose, as has every other therapist. But to boast of my success with my clients—or to excoriate myself for my lack of successes—is really antithetical to what I believe in. For I feel that everyone I see is essentially responsible for himself. Just as I am responsible for myself.
I am a bright man. I have seen and experienced many aspects of life. If any client/patient/student (choose your terms—they are all one and the same thing) decides to stick it out with me and honestly tells me how he lives his life and what he feels on his passage through it, he can’t help but learn something from me. If, on the other hand, he fears me, chooses to break off “treatment” with me, or doesn’t level with me, that is up to him. For all I know, he might derive some positive value out of that, too.
So if he gets better, that is up to him. And if he gets worse, that too is up to him. I can only do the best I can.
What is it that I expect from myself? Well, for one thing, I expect to be honest with those people who come to see me. I am willing to tell someone anything that is on my mind. I don’t mind being brusque if I feel that way, nor do I mind, terribly, dealing with retaliatory rage for my brusqueness. I feel free to ask the most personal questions of other people, and also free to share my most personal experiences with them. I’ve come to feel that when you strip “psychotherapy” of all of its technical jargon, what it comes down to is one person commenting upon the life of another and authentically sharing that other’s experiences. If these comments make sense, and if the sharing with and acceptance of the other is sincere, then the client/patient/student profits from his or her experience.
My style is unpredictable when I work with people. It is intuitive, and I will do what I feel most like doing. By and large I listen as attentively as I am able and make comments about what I see happening. I rarely pull my punches. Some people respect and appreciate this. Others consider this crude and cruel. I don’t consider myself to be especially cruel.
Lately, I have originated a new wrinkle in therapy. “Hat Therapy,” I call it. And I employ “Hat Therapy” regularly in my groups. The hat becomes a gimmick that focuses attention on the fact that people are ultimately responsible for themselves and capable of fulfilling their own needs.
The more I see in my professional capacity, the more I become aware of the fact that people suffer either from not clearly knowing what they want or, more likely, from not daring to ask for what they know they want. For they don’t want to appear foolish, deviant, awkward, ignorant, or wanting.
Too many people come to see a psychotherapist in the hope of being magically cured, believing that some magical words on their therapist’s part—some great interpretation—will cure them. Hat Therapy simply represents an attempt to place responsibility for cure back where it belongs—not with the “therapist,” but with the “patient.”
I will start a group session by explaining to those present exactly what I’ve just explained to you. Then I will pass somebody my tennis hat.
“When you get the hat, your job is simply to get in touch with what you really want RIGHT NOW … and ask for it,” I will say “whether it be help with a problem,
a kiss on the cheek, or a desire to have somebody lick your left buttock. Whatever it is that you really want to do or express—be it mundane or dramatic, serious or silly, proper or perverse—try to do it. While you may not get what you ask for, you stand a much better chance of fulfilling yourself if you make your wishes, thoughts, dilemmas, and desires known. And when you’ve finished using the hat—finished getting what you want (whether it takes ten seconds or two hours)—you are responsible for passing the hat to someone else.”
So that is the stage I set for Hat Therapy. And that is the essential message I have to teach. Of course, I will comment freely about what I see happening in myself and others along the way.
More often than not, people, with the support and encouragement of the group, meet their needs. Eventually, hopefully, they come to realize that they don’t need my hat to ask for what they want, and, moreover, that they can do just as well asking for what they want outside of the group—in the “real world,” so to speak. They learn that there are people in the world who will help them if they ask, who will date them if they ask, whom they can confront with their grievances if they dare. What I look for as a therapist and what I comment on is, more often than not, how they fail to follow through on this process. I expose the pseudo-wishes and the self-deceptions, the lack of daring, and the failure of self-responsibility.
At times I will do seemingly outrageous things in order to make my point, to highlight the condition of another’s existence, or to help someone learn more about some facet of life. Once, when a man said that all he wanted out of treatment was to feel pain, I bit his belly. This action not only exposed his pseudo-wish by giving him what he supposedly wanted, but helped him to understand (and eventually overcome) his reluctance to become vulnerable by sharing his pains with others.
On another occasion I played This Little Piggie Went to Market with the toes of a fifty-year-old man while his wife and daughters sat about. He claimed to have been depressed for eleven years and I had promised to make him smile. Try as he might, he could not keep himself from laughing at the absurdity of the situation. But as he struggled to maintain his dour countenance, he became a bit more aware of the gains he supposedly enjoyed by being a gloom merchant. And yet, in his eventual laughter, he found that he lost nothing. His family was just as solicitous when he enjoyed himself as they were when he was morose.
The Reluctant Exhibitionist Page 11