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.

1 comment:

  1. Thanks May-very poignant to read. Love the bit about how the story needn't be pretty or accurate-reminds me of a lovely (long! sorry) passage in Of Human Bondage by Maugham when the main character thinks he has figured out why a friend gave him a scrap of Persian rug, telling him that it represented the meaning of life (admittedly the character delights in deciding that life HAS no meaning and so is liberated from trying to impose a status quo framework on his own but...still resonates):

    "Out of the manifold events of his life, his deeds, his feelings, his thoughts, he might make a design, regular, elaborate, complicated, or beautiful; and though it might be no more than an illusion that he had the power of selection, though it might be no more than a fantastic legerdemain in which appearances were interwoven with moonbeams, that did not matter: it seemed, and so to him it was...His life had seemed horrible when it was measured by its happiness, but now he seemed to gather strength as he realised that it might be measured by something else. Happiness mattered as little as pain. They came in, both of them, as all the other details of his life came in, to the elaboration of the design...He seemed for an instant to stand above the accidents of his existence, and he felt that they could not affect him again as they had done before. Whatever happened to him now would be one more motive to add to the complexity of the pattern, and when the end approached he would rejoice in its completion. It would be a work of art, and it would be none the less beautiful because he alone knew of its existence, and with his death it would at once cease to be."