Thursday, August 28, 2014


Many years ago I viewed a documentary, on a PBS channel that addressed the effects of
the Holocaust  on the second generation, children born of concentration camp survivors.    Much has been written and studied on the effects on the second and even third generation of survivors of the Holocaust.  The secondary wounding of  offspring of trauma survivors, whether they be survivors of war, concentration camp or childhood trauma are well documented.

It must have been in the mid 80’s that I watched a PBS documentary on the relationship beween adult children and their parents, Holocaust survivors all.   It was fascinating and heartbreaking.  Engraved on my memory over the intervening decades is one scene in particular.

In the film, adult “children” were discussing with their parents what it had been like for them to be shut out of their parents’ experience and/or to be victimized secondarily by it.  There were poignant dialogues between the generations.  Among other things, the younger adults had felt that their own suffering, their own experiences of pain were never quite as valid, as the horrors and loss that their parents had suffered.  Some felt it fell to them to redeem, to heal their parents.  

The scene that has stayed with me was a unique one.  One daughter, tearfully addressed her mother with her suffering.  The mother, who had been a child during the Holocaust, and clearly unaware of the effect her experiences had had on her daughter, was at a loss, initially, as to how to respond. Finally she said “I’m sorry, I’m really, really sorry.”   More than any other words intoned in those dialogues, those words held the most power.
Viewers witnessed the potential for repair in that very moment.

I’ve held on to this scene in the intervening decades and even shared the story with patients who clearly were in need of having this kind of validation in their own lives.  It is both a phrase that I have not heard enough in my own life, and one that I have employed far too sparingly myself.  Two words that we all long for.

We read and hear a lot about the importance of the balm of forgiveness, how it heals the giver and as well as the given too.  But I think we don’t think enough about the power of of  asking for forgiveness, to knit together what feels irretrievably broken. Forgiveness is a hard nut to crack—that is, offering forgiveness that isn’t a thinly disguised form of denial.   But we can all apologize for wrongs we have committed.   An attuned apology is not  necessarily asking for forgiveness but rather an expression of empathy, compassion, “heart feeling” for the person we have wronged in some way, or at least they have perceived a wrong and have been wounded.

It happens  sometimes in my clinical practice that an angry client confronts me with some way in which I have hurt them.  Maybe I have been too blunt, insensitive, or just plain wrong. My timing has been lousy.  Sometimes I’m not guilty, but more often than not I am.  At least a little.  After years of trying to explain, clarify, interpret, really to defend myself,  I have come to realize that it is all a waste of time.  A simple, but “attuned” apology is what is called for here.  Whatever my motive or the context for my misstep, I have hurt someone.

This is sometimes difficult in the midst of an attack—an angry, no holds bar, maybe even abusive client is not someone easy to apologize to.  But there is always time for the interpretation, the exploration, and the meaning of the attack.  In the moment “I’m sorry” may be the only way to get back on track.

Recently a client shared with me what was a pivotal moment for him.  He was berating me for a misstep, which he had done before, and hinted strongly that he was seriously considering leaving therapy.  I asked: do you want to repair the rent in our relationship?  Stopped in his tracks by the question he had to admit that that was indeed a novel idea, “repair.”  He had never witnessed it within his own family.  Either a violent argument was forgotten, denied, disowned or it “broke” the relationship forever.  The notion of repair was alien.  Eventually he replied in the affirmative, yes he wanted to see if this relationship could be fixed.  I offered an apology and he was able to re-join  the collaboration and let go of the all too familiar role of wounded adversary.

Dan Siegel, the interpersonal neurobiology psychiatrist, clinician, and researcher makes the important point in a recent publication: the ability to initiate repair requires a certain humility, an acceptance that we are inperfect. 

It is part of being human to contribute to disruptions in connections with others.  Yet processes like shame can keep us from freely acknowledging our role and making a repair to reconnect with the other person.  These impediments to repair can severely constrain the health of a relationship (The Pocket Guide to Interpersonal Neurobiology).”

In other words my general tendency to defend my actions was probably rooted in an expectation of myself that I would never wrong a patient.  “Mistakes might be made,” but never by me!

I will let Rumi, the 13th Century Sufi poet summarize for me:

Out beyond ideas
of wrongdoing and rightdoing
There is a field.
I’ll meet you there.

Monday, May 5, 2014



In a few months, I will turn 70.  It will be over 40 years that I have been in clinical practice.

That sentence is actually a pretty shocking one to compose.  It hardly seems possible.  Forty years is a very long time.  So many of my colleagues from the early days no longer practice psychotherapy.  They left the field for various reasons, some very early on.  Being a clinical social worker, or a family and marriage therapist doesn’t pay very well.  The working conditions are not always pleasant, clients are disappointed, they are angry, they lash out, they fire you without notice and sometimes even explanation.  You are sitting still much of the day absorbing the pain, the shame, the trauma, the fury of your clients.  If you work in an agency you can be subject to crushing piles of paperwork and a remarkable lack of respect.

And then there is the weight of responsibility, or felt responsibility, for the well-being of others.  There is always the prospect that you will fail.  There is the dire prospect that the client will harm themselves or others. 

But like the song says, “I’m still here.” 

Quite a surprise.  Starting out I thought I would never make it, that my high level of anxiety would kill me.  But as I client once scolded me, I am persistent, “like a dog with a bone” is the way she put it: not pretty, but apt.
I’ve never been much good at puzzles, either crossword puzzles, picture puzzles, or Sudoku.   You can always have the puzzle page of the New York Times out of my newspaper anytime you want. 

But the puzzle of a personality I find intensely engaging.  Without exception every new client is a new puzzle, an original.  Why this symptom and not that?  What happened? Why (seek treatment) now and not before. Why did he survive and she didn’t?  Why did this sibling make it through an abusive childhood and the other one, not so much?

And the key to the puzzle is not written in a book anywhere, there is no standard protocol, the way I work anyhow.  It’s always a new task to figure it out, how to treat this person.  What’s going to work?

Then there is my fascination with the story, the narrative of a life. I spent a lot of time as a child with the “orange biographies,” biographies of “great Americans.”  Our small town library had what seemed liked hundreds of them.  I took a stack out every two weeks.  I consumed everything thing from the story of Davy Crockett, frontiersman, to Florence Nightingale, Mary Todd Lincoln, Jane Addams, George Washington.  So was it the history that I loved so much, or the prospect of greatness?   Perhaps if I read enough of them, maybe I could join their ranks?   No, I think it was the story of lives, lived.  And I’m still here, with those stories.

It is a privileged perch, the perch of the therapist.  One gets to witness all the lives not lived: what it’s like being related to the mob, or to be the neglected child of great wealth.    I get a taste of growing up in Lake Woebegone, Garrison Keillor’s fictitious small Midwestern town, without having ever been to Minnesota.  I get to talk to the voices that populate the inner world of seriously traumatized individuals.

The “privileged perch” can be hazardous.  There is no doubt that if you work with trauma, as so many of us do, that your world view is darkened thereby.   The tales of ritualistic abuse and sadistic cruelty toward children are often hard for people to believe, even therapists.  A supervisee, new to the treatment of the long term effects of extreme trauma, once asked if I believed the tales of multiple rapes and torture that her patients and mine recalled.    I really cannot, of course, offer a definitive answer in any particular case. No one can. But we did live through a century when state sanctioned murder and torture and rape were applied on a mass scale, so why not? 

Here are a few things I have learned from being a therapist:

1.       Motivation counts more than the extent of pathology. People who desperately want to get better, generally do.

2.      Safety counts more than anything.  Anything one can do to help a client feel safe with you and in your office facilitates the healing.  Maybe it is the healing.

3.      Chemistry counts. Who you are is what counts:  “The person of the therapist is the converting catalyst, not his order or credo…not his exquisitely chosen words or denominational silences” (from A General Theory of Love, Lewis, T.,Amini, F., Lannon, R., p.187).

4.       Spirit often arises from the extremities of suffering.  It’s almost uncanny how those who have survived early and extreme trauma and make it into my office, arrive with rather robust spiritual lives.  Not conventionally religious, they are still believers in the transcendent and credit those experiences with their survival.  These patients have taught me a lot about resilienc, spirit and spirituality.
Over 40 years of almost continuous practice: it is hard to really comprehend that amount of time. I do comprehend, though, what a blessing it is to have been part of a profession that has brought richness and meaning to so many days of my life.  I am grateful.