THE MIRACLE OF ADAPTATION AND MR. WHITE EGRET

I was on a walk the other day.  The sun was out after many days of rain.  The creek along which I walk so often had become almost a river.  For the very first time, I noticed a white egret standing motionless  by a man-made waterfall on the creek.  The elegant bird looked as if she were trying to figure out how to navigate the cascade.  The creek had been but a trickle all summer.  But this fall had been unusually wet and stormy.  And the water was high and fast.

Strangely the bird was still there in the same spot, standing like a statue, unchanged, 30 minutes later when I passed on my return trip.  I raced home for my camera, sure he/she would be there when I returned.  In the meantime I had an elaborate fantasy (the kind of fantasy only a psychotherapist would have!) about that poor bird.  It went something like this:  The bird, probably young, had adapted to the stream at its lowest ebb during the summer.   Growing up beside a trickle, it was well adapted to those conditions.  When the stream swelled, her/his adaptation style no longer sufficed and he/she could not figure out what to do.

Of course, this reminded me of the essential human dilemma.  We adapt as children,  with brains, nimble and flexible,  to the conditions of our environment:  the family we are born into,  the emotional surround be it one of privation or abundance.  We are veritable geniuses of adaptation.  Problems arise latter when our brilliant adaptation styles no long suffice.  When the floods of later life come, we are often at a loss.  The tools of the earlier years are more than likely useless.

The child Holocaust survivor who starved and had to scrounge for whatever food was available in order to live,  may well have trouble at the dinner table as a middle aged adult now seated at the groaning board of American abundance: obesity and diabetes II ensue. The woman who has witnessed the suffering of older siblings who resisted a controlling parent only to be vilified, and rejected by that parent, learns submissiveness at home and fails to develop the assertiveness she needs to succeed in adult life.

I returned with my camera,  maybe 15 minutes later.  Mr. White Egret was gone.  There goes my theory.  Somehow he had navigated the falls.  Maybe he was just a patient fisherman all along.

Days passed,  no egret.  No egret, but another lesson came my way.

A week or two later, I had the good fortune to reconnect with a client I had known over many decades.  She was in her mid twenties (I in my mid thirties) when we met.  We worked together for many years and then just on and off thereafter.   She was in tough shape in those early years, nearly mute in our sessions for probably two years.  I did the talking, guessing at her pain, her shame, her fear.  She cancelled more often than not.   But often I could talk her into coming.  She had adapted well to an early environment in which it was dangerous to speak up,  it was dangerous to be noticed at all.  From a very large family, dominated by alcohol, violence, including sexual violence,  she was denigrated, humiliated, unprotected.   She felt insignificant, unsafe, and unworthy. 

Most significantly she was separated from herself—to survive  her childhood her essential self had gone into hiding.  What was left was a child hovering in fear, whatever strength there was seemingly defeated.   She was the only one among 17 children who had managed to finish high school,  but there was very little evidence of pride, and certainly no accolade from the family.  Any sign of independence, strength, intelligence was seen as a negative not a positive by her family.

Fast forward 20 years.  In the interim this woman went to college, gave birth and raised a child single handedly  and successfully without a father. She bought a home,  rose in her profession to a role of leadership,  survived a life threatening illness through sheer grit.  On and off she used therapy to help her navigate these crises, at times I was the second parent to her daughter, but for long stretches of time she did not call or come in to see me.

The one longing unfulfilled,  was the inability to sustain an intimate relationship with a man.

Now in her 50’s we are again back in touch and this time because she is in an intimate connection with a man, someone who sounds mature, loving, and accepting and who wants to marry her.  She knows she needs a little extra support until she decides what to do. 

The white egret has adapted to the falls.  A sustaining relationship with me over the years was certainly part of that critical adaptation.  But the real wonder here,  the awesome reality, is that she had the capacity to use that relationship and all other positives in her life, the terrific child she gave birth to,  her teachers in school,  friends, neighbors,  a few members of the extended family that did not put her down—whatever came her way she used to grow and change and reconnected with all that was positive in her. 

She herself has described it as the child within, the one I saw cowering in the early days mute and frightened, has grown up.

This is not the only story I have of the awe-inspiring nature of our ongoing, life-long capacity for change.  It’s just the latest.

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.

Why Does Psychotherapy Treatment Take So Long?

This is a question I have heard, in one form or another, many times from my
clients/patients.

Sometimes the question is not posed explicitly, but the client assumes at the opening of our work together that he/she will be in and out in six weeks (said client having just told me that she has a long history of failed relationships, periodic dark depressions, and an eating disorder).

There are of course treatments that are shorter, but I tend to think in terms of years, if a client is suffering a great deal and has for some time.

Explaining why psychotherapy treatments are not generally brief affairs is complicated. My model of therapy is of course not everyone’s model. Models of short term therapy exist. I am not a practitioner, although I am aware of these modalities and have read their literature.

I think of the realtor’s motto—there are three things important in the sale of a home “location, location, and location.” In the kind of psychotherapy treatment that I practice, those three important things are : “relationship, relationship, and relationship.” What happens between therapist and patient is the cornerstone for effective change with and for the patient. The relationship is the crucible for change. Obviously building a trustworthy resilient (if not perfect), mostly predictable relationship takes time. If there has been a major betrayal at the heart of a person’s life experience, building trust can take a very, very long time.

In the ordinary course of events the relationship stumbles, there are crises, loss of faith, mistakes made, failures of understanding and empathy. As in life, so in therapy, it is in the repair of those rents in the fabric of the connection that hold the real promise of lasting change in the structure of the self. This is a basic tenet in many theories of therapeutic change.

Within the context of the mostly safe relationship, our clients have the opportunity to develop new skills. Most of us developed our coping skills early in life. We adapted to whatever conditions we faced with the best tools available to us at the time, that time being childhood. Checking out (dissociation), cheerful denial, taking care of others, distancing ourselves from others, controlling others, numbing ourselves, living in a fantasy world are only a few of the popular choices.

As circumstances in our life change we fail to update the toolkit. We go on automatic. This is true for all of us. If you have always been cheerfully unaware of thunderclouds on the horizon you will probably continue to be so, even if the consequences are dire. It takes a lot to get us to reconsider our choices or even to become aware that we are making choices(!) and to re-evaluate the appropriateness of our adaptations.

That’s where the therapist comes in. Its their job to identify those automatic choices and to help the client evaluate them. Dissociation, to take an obvious example, is wonderfully adaptive for a child trapped in an abusive family. Why not check out, if there’s nothing you can do to remediate the situation? Obviously this is not so adaptive for an adult who needs to find the wherewithal to get out of an abusive marriage, a heinous job situation, a sadomasochistic friendship. But now the dissociation is ingrained and it takes real work and real time (!) to turn that around.

So the blood, sweat, and tears that it takes to build a relationship and the difficulties of learning new tricks are two important factors contributing to the long term investment involved in change.

These are only two of several factors that make therapy very hard work. I will leave more commentary for another post.