Optimism has been in short supply in recent years, leaving many to struggle with anxiety and depression. Some have found relief from psychotropic drugs, but others have looked to one-on-one therapeutic interactions to bring them back to themselves. When these partnerships work well, the tools and insights learned during those sessions will last a lifetime.
Hope is psychotherapy’s emotional nucleus. Both the client and the therapist have expectations of positive change and, with time and effort, this is usually what happens.
The psychotherapist’s task is to invest in people who, for whatever reasons, have been unable or unwilling to buy into themselves. Once the roadblocks are uncovered, it inevitably leads to a better life with healthier choices. Psychological stress occurs independently of the times.
Giving my best
It has been 25 years since I closed my clinical psychology practice in Beaverton, Oregon, a suburb of Portland. Managed care drove me to that unexpected decision, though I was only 50. It seemed entirely possible I would be a shrink until I was physically or mentally unable. The profession was a perfect complement to my values, skills and personality. I loved it.
My partner and I had a busy practice. In addition to individual psychotherapy, we ran emotional intimacy and stress-reduction groups in the evening. I served as an expert witness in legal cases, was a frequent guest on a morning television talk show and gave speeches to community groups.
With up to 40 people’s intimate lives living inside my head each week, it was sometimes hard to leave my concern and investment at the office. I had to remind myself that I could only give my best effort and could not take responsibility for the decisions made by others. I admit, though, sometimes while driving down the freeway, I remembered that it was the day for a fraught event in some client’s life.
As we’ve collectively faced horrendous crises over the past few years, I can’t help but wonder what happened in the lives of those I sought to help, the people who came because they were unhappy, frustrated, confused or at loose ends.
They honoured me with their trust, inviting me into their inner world. It was inescapably intense and meaningful. Many of the clients’ struggles moved me, often to tears. I admired their courage to face the unthinkable demons from which they had sought to insulate themselves, sometimes at a great cost.
A quarter of a century has elapsed, complicating reconnaissance. I had no desire to contact the clients personally or to insert myself in their current lives. I only hoped they had continued to lead lives of agency that are helping them face subsequent challenges.
As I retrieved memories of the clients whose lives and issues stuck with me, there were a couple of common denominators; most significantly, the longevity of our work. Before HMOs, it was not unusual to work together for years, usually weekly. Each client experienced life-interrupting anxiety or depression, even if they didn’t recognize it on the day they entered my office.
Thanks to Google and Facebook, I could cobble together a little bit of their post-therapeutic stories. Of course, it’s mere speculation to gauge their quality of life, their degree of satisfaction with their choices, and their perseveration of therapeutic growth.
Clients had sometimes come to my office because of my teaching psychology at Portland State University. Back in the free-wheeling 1970s, there were few boundaries between students and teachers, and many would hang around my office after class. The usual therapeutic detachment was nearly impossible under those circumstances, a major reason they came to me as a therapist when confiding in a “stranger” was too formidable.
Here are their stories.
(potentially identifying facts changed to preserve confidentiality)
Unafraid of growth
Marilyn was a bright, articulate student who already possessed a graduate degree in economics. She took several of my classes (she solemnly called herself a “Munter Major”) and was an active participant in class discussions. She made an appointment to see me in my practice because she was depressed, trapped in a loveless marriage with a controlling husband. He was traditional, threatened and unsupportive of her desire to better herself.
Marilyn was among the many clients who were receptive to evaluating and examining every aspect of their lives. In the course of one session, after several months of work, she tentatively raised the possibility that she might be bisexual, which we explored over many months.
Eventually, Marilyn found the courage to leave her husband, entered a graduate program in psychology, and there, met a woman with whom she fell in love. Marilyn eventually became a licensed psychologist and moved to another state. Today, photos on Facebook show her retired, married to her partner and in frequent chats with her grown children. I get notes from her every few years, referring to her peaceful state of mind and the depth of the work she was able to accomplish.
Marilyn presented challenges on several levels, but she was always present in our sessions, unafraid of growth and where it might lead her. She faced her issues with clear-headedness and curiosity. I admired her courage. My goals were to help her get at what mattered to her, mute the controlling “shoulds” of her evangelistic upbringing and discover what she wanted at a deeper level. She came to trust herself and, as a result, rekindled hope for her life.
The pursuit of self
Evie was also a former student. When we met, she was in a long-standing relationship with an occasionally abusive woman, the maltreatment not disclosed until much later in our work. She admitted that she drank too much, which she said helped quiet her anxiety and cloud her low self-esteem.
Evie was working at a fast-food restaurant when we met, feeling scattered and unfocused in every realm. She and her partner had a wide social network, which provided convenient, busy distractions from their issues.
Evie, like Marilyn, was personable and warm, easy to like. She was able to handle most everything I’d throw at her, often with a quick retort. She lived life on its surface with little relationship to her inner self. It took more than a year, for example, before she could think about a career other than counter work.
Through our explorations, she discovered a passion for politics and obtained a position as a political aide, opening doors for advancement and a more secure financial future. Good decisions in one area don’t always translate to others, though. As she ratcheted down her abusive relationship, she began a number of indiscriminate affairs with men.
Her often frenetic social and sexual life was a smokescreen for her larger issues regarding anxiety and shame. The pursuit of self can be frightening, sometimes filled with unpleasant surprises. Underscoring our work was a focus on developing her resilience and coping skills, and moving her focus to problem-solving from within. This took time, gentle therapeutic confrontation and her willingness to engage—both with me and with herself.
During one of our occasional hiatuses, Evie pursued an intimate and more stable relationship with a woman she had known for years. It was at this point that we began to wind down our work together. She was building a healthy relationship and had found a career she loved, with renewed hope for her own future. She had fashioned the life she knew she deserved.
Now, 25 years later, she is retired and has maintained her domestic partnership. She recently emailed me to thank me for our work together. She said she often thought about our discussions, much to my pleasure.
When Rachel and I met, she was in her thirties and unmarried. She had a long-term “Same Time Next Year” relationship with a married man in a distant state, predictably problematic. She struck me as well-defended, quick to push away anything that might further provoke her discomfort. She was a tall woman, her demeanour suggestive of power and intimidation. And yet, there was a cloud of sadness just behind her eyes.
My initial task was to navigate gingerly through the defenses, work to gain her trust and encourage an investment in her own value, so we could undo whatever damage was so apparent on the surface. Curiously, she didn’t reveal that her father had sexually abused her until a year or so later, when she found a potential (and available) partner. She had buried the resulting vulnerability within a tough veneer.
As with many victims of sex abuse, she assumed responsibility for its occurrence until she came to understand her father’s exploitive control was inappropriate.
We all carry around our past like existential luggage. We can’t erase it, but we can contextualize it, both historically and within the person we are today. The partner, who subsequently became her husband, was an uncomplicated, old-shoe kind of guy, comfortable with himself and no threat to Rachel. The main challenges were his two young children and an ex-wife, which Rachel was ill-equipped to handle.
We began multi-generational work, as I met with the new partner and with each of the children. When Rachel had worked through the difficult history and felt safe again, a wedding was scheduled. According to Facebook, the couple is still together, both retired. The “kids” have their own families and socialize with the parents.
I felt a strong attachment to each one of them and think of them often. Rachel’s courage in facing her father’s victimization was a key to her moving on with her life.
Shelley worked as a clerk for one of the large corporations in the business park in which I had my office. Her initial cheerful and animated demeanour was almost overwhelming, her anxiety palpable. She was in habitual performance mode, with reactions so studied they resembled bad acting.
She worked at being entertaining during our sessions, but I wondered what was so frightening that would merit the elaborate defense system. She acknowledged feeling both anxious and depressed, but blamed others for her emotional state. I struggled to cut through her worldview to get to whoever lived inside that fortress.
Shelley was nearing 50 and, though she was on her own, she was still very attached to her maternal aunt and uncle, who formed the centre of her social life. Her dates with men ended with them walking away without explanation, after just a few encounters. She bounced off people, seeking to make an impact by manipulating them to get what she wanted, rather than to honestly engage.
She shared with delight some of the pranks she played on her female friends, in denial about the embarrassment and pain it caused others. It was a tribute to her charm that she had lifelong pals, in fact, who could see through the blustery personality to the fragile, needy person underneath.
Our regular task was to debrief the crisis du jour, exploring how she might have dealt with things differently, and to discover what her behavioural choices had to do with how she saw herself. I wanted Shelley to take responsibility for her own life, to come to know and trust herself, so she didn’t need to perform for others.
In spite of our therapeutic dances, I liked Shelley and, while our sessions likely comforted her and raised her self-esteem, I left feeling unfinished. Checking Facebook, I can see her friendships have apparently endured. She has sufficient resources to travel, both alone and with friends, and seems to have carved out a satisfying life on her own.
One of the most complicated relationships I had was with Terri. I don’t recall how she found me, but she came prepared to work at the very first session. Almost bolting into my office, Terri looked as if she dressed in thrift store rejects, frumpy and dishevelled. I was immediately drawn to her honesty and almost naïve directness. She was bright but unsophisticated, her bold opinions and openness to inner exploration engaging me quickly.
Shortly after we began, I met her domestic partner, Deb. While Terri was articulate and voluble, Deb was quietly depressed, reticent and withholding in every aspect of her life. It was clear that Terri did the social and emotional work in the relationship.
At the start, Terri announced she wanted therapy to consist of a thorough developmental review, beginning with her earliest years. I agreed, so long as she was willing to dig into substantial issues as we went along. Over time, she acknowledged that her bombastic personality helped deflect her anxiety, putting her in charge of any situation.
Her fears were rooted in a dysfunctional early family, compounded by self-defeating decisions along the way. She confessed, a few months into our work, that she had lied to her employer about having a college degree. When she faced her misrepresentations, she found that she was stronger than she thought. Telling her boss the truth did not produce the chaos she had feared, which dissipated some of her ambient anxiety.
I thought we had ended our sessions amicably, so I was astonished when I received a letter two years later, declaring her anger with me for “premature termination.” We exchanged a few letters and resolved the situation, but it caused me both confusion and distress.
When I found her on Google, I saw that a few years after we ended our work, she became a vocal and combative community advocate for her small town. Her relationship with Deb apparently stayed strong, until Terri’s recent death.
Though her revisionist history made life difficult for me, I consider our work together a success. Ironically, she had left therapy with a sense of optimism and hope, with concrete plans for her future that worked out well. It would seem she channeled her subsequent anger at me towards the political establishment.
Accessible healing process
The existential/humanistic psychotherapy I practiced for a quarter-century is no longer possible in today’s penurious insurance market. While we had the luxury of time to explore a client’s inner world, and to help them decide how to rearrange their existential furniture, now insurance-reimbursed therapy consists of short-term directive counselling.
That metamorphosis was the primary reason I left the profession 25 years ago. Of late, however, there’s a movement towards Zoom and online therapy. The healing process is now more accessible than ever, a hopeful sign in these troubled times.
Whatever form it takes, the therapeutic relationship is integral to change, to restoring the person within. For me, the mission was to deepen the clients’ connection with themselves, to identify and ground them in their own values and beliefs. When successful, the anxiety and depression that crippled their existence became less causal and sometimes even disappeared.
I loved the work, even with the more challenging clients. Their personal journeys inevitably impacted me, broadening my own perspective. It was a constant reminder that living life authentically is a daily challenge. And that conquering anxiety and depression is attainable, but it takes time and commitment.
My hope for each of these people remains as it was then—that they continue to grow and to live complex, rich and satisfying lives.
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