Friday, August 27, 2010

More on Story-Telling: The Cambodian Healer

Phaly Nuon is a Cambodian survivor of Pol Pot’s killing fields of the 1970’s. An educated woman who managed to disguise her origins and her learning in order to survive the mass murder of the educated classes, she witnessed the rape and murder of her teenage daughter and the starvation of her baby. She survived for three years in the jungle, trying to protect her two surviving children, living in isolation, hiding and eating only what she could forage in the jungle. She and one child walked out of the jungle. Her baby died.

While in the refugee camps following the war she noticed many women whose mental state made them virtually inert, unable to care for themselves or their children. Their PTSD (post traumatic stress disorder) was going to kill them and their children. She set out to help them and developed her own system of psychotherapy which was remarkably effective. This woman has been on the short list for the Nobel Prize many times for her work with these depressed women as well as the development of an orphanage (the Future Light Orphanage), which the recovering victim/survivors run.

Phaly Nuon has a three part system of therapy (which actually has at least 5 parts).

1. She teaches the women to forget their atrocities. 2. Then she teaches them to work. Some of the work is with orphans who have lost their parents in the war. 3. Then, she says, I teach them to “love.’

Interestingly both she and Andrew Solomon (¬The Noonday Demon: An Atlas of Depression ( ). fail to notice that the first step is not the first step. The first step in her system of therapy, as Solomon recounts this, is the telling of the story of their ordeal. And then the re-telling.

I quote Solomon:
"First, she would take about three hours to get each woman to tell her story. Then she would make follow up visit to try to get more of the story, until she finally got the full trust of the depressed woman. "p.36

"Forgetting,"  involves getting them involved in their present life.

Step two, work, is an important part of that. And step three, teaching them to love, is all about focusing on relationship. The women that Phaly Nuon has ministered to have formed a healing community. Just as a footnote, Freud thought the ability to love and to work were the hallmark of mental health.   Evidently Phaly agrees.
There is another step, by the way. This is teaching the women to give manicures and pedicures to each other (!) This is the final phase and as a lover of pedicures myself, I can testify to the healing potency of this process, which is both intimate and impersonal.

This step, perhaps, represents the importance of engaging the body, in the healing process

This story, I believe reinforces the importance of story-telling in healing. Phaly took it as a starting point and created something truly amazing.

I first heard Andrew Solomon tell this story on the Moth broadcast on WNYC. Here’s the link:

For more on Phaly:

Thursday, August 12, 2010

Why Does Psychotherapy Take So Long--Part 2

An important part of the psychotherapy process, as I understand, and have practiced it, involves constructing a narrative of one’s life.

This may seem like a curious task given that we all know, or should know, the story of our lives. We’ve been imagining the movie to be made from that story, forever, right?

Well, that may be true of some us, but a surprising number of people actually don’t have a coherent story, something that hangs together, makes sense, and has some internal consistency to it.

There is some compelling evidence that the coherence of one’s story is a key component of sound mental health. I derive this from solid research findings that the quality of one’s attachment to one’s off spring is strongly influenced by said coherence. What researcher’s found was that the strongest predictor of stable, secure attachment in babies was the caretaker’s (read mom’s) ability to recount a coherent story of her own life. That story didn’t need to be historically accurate. It didn’t need to be positive. It was not necessary for her to have had a happy childhood. She just needed to be able to narrate the story to herself and the interviewer, of course, in a manner that hung together.

A baby’s “attachment” status reflects the ability of the young infant to bond with their parents, an important, maybe the most important, measure of their emotional well being.

Given the robustness of this research finding, frankly, I don’t understand why everyone who wants to be a parent, or is a parent doesn’t run to their nearest therapist. It would seem to be the best argument for undertaking this admittedly arduous and expensive process.

So back to what we do in therapy. We construct a story. This is the story of the client/patient. Its not mom’s story, dad’s story, or the story of the siblings, its not the therapist’s story, it’s the patient’s story.

So many of us have accepted, wholesale, someone else’s version of our lives. If you have been told forever that your childhood was idyllic you might be tempted to go along and not validate some of your own memories, or even weak suspicions that things were not always perfect. If you were always told that you were an overly sensitive child you might buy this wholesale. Never mind your own observations that people were actually pretty mean to you

This is tantamount to not being on your own side. Empathy for others, those adults who did the best for us growing up is a positive thing. But not if it’s prioritized over empathy for the self.

It is truly amazing how much fog, depression, confusion, and anxiety begins to lift when the story one narrates starts to be one’s own. It needn’t be a pretty story or even a wholly accurate story—just one’s own.

Sometimes the story is there but it is self-condemnatory and unfair. A woman who was raped at the age of 16 has told herself forever that she consented to sex with a man much older than her that she barely knew and was therefore a slut. All the adults in her family would agree (if they knew the story): a 16 year old is a grown up and responsible for her actions.

I had her look up the definition of “statutory rape.”

It took years for her to empathize with her frightened and confused 16 year old self and for her to re-structure the story to reflect her naiveté, her fear, her helplessness and her isolation at the time.

Story construction is central to the project of psychotherapy. Coherent stories evolve only slowly.

Friday, August 6, 2010

Parental Narcissism, The Good, The Bad, and the Ugly

You might think the  words “parent” and “narcissism” don’t seem to go together, right?

Actually, wrong.  

First a short dissertation on “narcissism.” Narcissism, self-love, is really key to human survival and healthy development. It morphs over time, as we grow, from believing ourselves to be the center of the world as young children, to something maybe slightly less over-weaning, like being confident of our abilities, and having the instinct for self preservation. Having a good relationship with our narcissism helps one navigate adult life.

I know a 4 year old who confides to me that he is “super-good” at soccer, running off to kick the ball to kingdom come. He thinks he’s great, and this makes him happy, happy.

Over time he will probably come to evaluate his soccer skills in a more modest and balanced way.

Becoming a parent often gives us another stab at satisfying these wishes, for we do become the center of our young children’s universe and for a substantial period of time, we get to vicariously enjoy their triumphs, their achievements, their incredibly rapid development. The besotted-ness that is the norm for young parents absolutely in love with their offspring could be viewed as a very benign form of narcissism, the child as an extension of self.

This is mostly good. It facilitates the kind of adoration that young children need to grow. It is fertilizer, sunshine, and water.

That’s the good stuff.

The bad stuff comes in when they are just themselves, not us, not an extension of us. Inevitably they will frustrate our expectations, the ones we are aware of and the ones outside of our awareness. This happens in small ways when they are small and in huge ways when they are not so small.

A digression: The Simpsons. As popular as this TV show is, I have probably seen a half dozen episodes in my lifetime. Strangely I saw the same one twice, as if it were calling to me! This featured Lisa, the saxophone playing sister and the blue haired mother. I was blown away by how very smart was the script. As I recall, Lisa had the blues. She felt unpopular and rejected at school. She was frankly depressed. Marge, the blue haired mom, had trouble with this and kept telling Lisa to cheer up, it wasn’t so bad, don’t be sad, etc., etc. This drove Lisa further into her depression.

One night the mother had a dream, I don’t remember the content. But the dream woke her up to the realization that Lisa’s doldrums were making her, Marge, feel inadequate and she was not really thinking of Lisa when she told her to cheer up and get over her bad feelings. Man, how often does that happen in our lives, that we filter our children’s problems through our own injured narcissism. We can’t stand their pain maybe for lots of reasons, but one may be that it makes us feel we have failed to do our job, it’s a reflection on us. Lisa ended up feeling alone.

Marge teaches us an important lesson about parental narcissism, one that the writer’s of The Simpsons think is important to reflect on. How often are we motivated when responding to our children difficulties with school, friends, sports, whatever, with our own injured self pride forgetting to try to get closer to their trouble, their pain, their felt experience. That can transform a problem for both parent and child.

What do you think?