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My relationship with psychology began when I was eight. My mother started seeing a therapist she called Sylvia, and soon enough my father began going, too, after--as he would tell me many years later--my mom suggested the problems he was having in their marriage were not solely about her. What my mother meant was that my father was reexperiencing old feelings from his earliest formative relationship in the context of a new and different one. In other words, he felt treated by his wife how he'd felt treated by his mother. No one who knew my grandmother Mina (who openly derided every gift she'd ever gotten and had once shown up at my parents' apartment with just-purchased underwear for her newlywed son) could have imagined my father's old feelings to be benevolent. So my parents embarked on separate journeys of self-understanding, which I inferred allowed them to remain together. It was 1981, and we lived in the western suburbs of Detroit. Ronald Reagan had just become the country's first divorced president, and many of the fathers on our street were moving on. That therapy had facilitated my family's escape from the hovering menace of dissolution was no small thing to me.
And so I became curious about psychotherapy, but I never asked my parents to describe it. Like all of the adult concerns that evoked pointed interest in me, it seemed illicit. I also wanted badly to discourage all open discussion of their latest pastime, lest they feel comfortable enough to mention it in front of my friends, whose families I vehemently believed had stepped straight off the soundstages of the late-1950s sitcoms I'd seen in reruns. That my parents went to therapy became one more dreary secret that I added to a list, though what I was really most desperate to keep under wraps was how much they disliked me. Were others to know, they could only reject me as well.
Not long after they started seeing Sylvia, my mother went back to school to become a social worker, a therapist herself. I was in the fourth grade and my sister in kindergarten, and though my mom had once been a teacher, she'd been at home, more or less, since I was born. After her graduation from social work school, she started seeing patients, and like anyone else she would talk about her work. Her stories were more anecdotes than case presentations, but I didn't know enough to distinguish between the two. By the time I got to college, I assumed psych classes could only be superfluous, and I refused to sign up for any, defying all expectations of my gender and ethnicity. But also, as determined as I was at eighteen and twenty and even twenty-five to be sublimely unlike my mother, it never crossed my mind that I would become a therapist. I thought I'd be a lawyer--like my father.
It did occur to me to become a patient. The first time was my senior year of college after my mom suggested it. She thought I was "too anxious," a pronouncement I felt she might have delivered in any number of gentler ways, but still I considered it. She had colleagues near my campus in Ann Arbor, and she gave me a number. I called and got an answering machine but could not think of a thing to say. The second time was a couple of years later. I had finished undergrad and moved to New York to take an internship at a rock-and-roll magazine, but more to the point to live somewhere exciting. If things were going fine on paper, I often felt rotten. I couldn't make any sense of myself. One lesson I had learned from half-listened-to conversations from my adolescence was that there were a lot of bad therapists out there, and so I got another referral, from a friend of my mother's who knew a psychologist in Manhattan. I made an appointment but showed up on the wrong day, leaving Dr. Aronoff's office in angry tears when nobody answered the buzzer. As I walked south on Fifth Avenue along the park on the way back to the entertainment magazine where I had by then become an editorial assistant, I thought, "I am trying so hard and still cannot get any help," a masochist's mantra.
Years later I would learn from the therapist's side of the experience that the way in which a patient begins the therapy relationship is a proclamation of sorts--a snapshot of what he or she is struggling with--and I sometimes thought back on the way I began my own treatment. When I called Dr. Aronoff after that first afternoon to tell her that I'd traveled all the way from midtown at her behest just to find her absent, I was demonstrating this expectation: I would be the victim here and she my giddy torturer. "I teach on that day," I remember her responding kindly. "I don't think I would have scheduled an appointment then." Look now, she was alerting me, we have some other options.
What relieved me most in those first years with Dr. Aronoff was a nascent appreciation for my own internal consistency. Where my feelings had once seemed arbitrary and free-floating as particles of dust, it was now clear that they related to one another and also to the entire span of my backstory. As I had grown up fed and clothed and never so much as smacked on the bottom, it was easy to maintain a dogged belief that everything had been fine. It hadn't felt fine, but I'd learned to ignore that--hands over my ears as I hummed--because certainly that was my fault, a confirmation of my innate and immutable decrepitude. Only slowly and with Dr. Aronoff's listening could I begin to know more about my old feelings and the imprint those feelings had left.
I'd been lucky enough to stumble into therapy, and so slowly--how lucky I was--I began to see that the things that were most distressing as I moved through my young adulthood barely existed outside my head. It cannot be underrated, that ability to distinguish between outside and in. Left and right I was distorting external realities to make them match my earliest internal ones, or involving myself with people who confirmed old and sorry expectations, or unconsciously cajoling others into buttressing my most unpleasant fears. Neurotic misery, Freud called it. Condemning the future to death so it can match the past, the singer-songwriter Aimee Mann called it. Dr. Aronoff, influenced primarily by the Freud protegee Melanie Klein, called it clinging to the bad breast. Over and over together we found evidence of this insistent grasp. With time I understood that the way I had come to see the world, my place in it, was more about perspective than any absolute reality, and if that was true, at least many more things were possible. I had never been religious, but for the first time in those years I knew what it felt like to believe absolutely in something intangible, to have faith, though Dr. Aronoff made no claims of divinely sanctioned insight. It was simply an education, allied to a temperament more patient than my own, that had allowed her to bestow her gifts. To be able to offer others what she had given me, some freedom from old bad feeling, I just had to go to school, nothing I hadn't done before.
In terms of formal education, several options were available to me on the road to becoming a psychotherapist. The simplest, because of its relative brevity, would have been social work school, but having spent many years listening to my mother lament that social workers got no respect (another masochist's mantra), I was not about to sign up for that. The most lucrative was likely to be medical school, which would set me up to become a psychiatrist, but psychiatrists were no longer necessarily trained in talk therapy: instead, they prescribed pills. I had nothing against medication, but I did not find it interesting in any but the most cursory way. A doctoral program in psychology--comprising four years of theoretical course work and concurrent talk therapy with actual patients, followed by a yearlong clinical internship--seemed like the obvious choice. Dr. Aronoff was neutral but supportive. I half wished for her to tell me she thought I would be good at what she did, but I was well schooled enough by then in the ways of therapy to know we would only examine this desire. For her to explicitly say so would have felt superficial in the context of our relationship anyway, and also less powerful than the fact that in my heart I believed she felt it, as she had for many years been my stalwart teacher.
The first patient I ever saw in therapy had a problem with a kitten. A nineteen-year-old undergraduate at the same university where I was by then in the second year of my doctoral training, she had recently adopted this kitten and had found herself faced with the terrifying realization that she was not responsible enough to care for the animal. She was distraught, really in a panic. Could she simply return it, she wondered, or was it destined to become a victim of her reprehensible immaturity? "He would be so much better off with somebody else," my patient told me with fierce passion as tears stained her translucent skin.
I don't remember how the issue was resolved, if the kitten stayed or went. What I do recall vividly is that my patient and the young cat had some striking autobiographical similarities. Like her pet, my patient had been stuck with a nineteen-year-old single mother, one too irresponsible to parent her to boot. My patient had silently endured her mother's unpreparedness, waiting for what had felt like lifetimes in front of schools or friends' houses for a woman who'd promised earlier that day to pick her up, or in bed for her mother, who she always feared dead, to relieve yet another late-night babysitter. To cope, my patient, like every child before her, honed psychological defenses: ways one protects oneself from anxiety and grief and injuries to self-esteem. She spent many hours lining up her dolls--not playing, just arranging.
While I listened to my patient lament for her poor cat, I knew for certain that she was re-creating an earlier emotional experience of her own, trying the whole scenario out on the kitten to see what would happen. Psychologists call this particularly creative defense "acting out"--replaying once terrifying situations to transform old feelings of vulnerability into experiences of power. Acting out is driven by the unconscious need to master anxiety associated with old and powerfully upsetting fears. We act out what we cannot allow ourselves to remember, and usually even once we've remembered, we forget again and do the whole thing over. Psychologists call this forgetting "repression," the doing over "working through." When viewed from a therapist's chair, it's rather like watching a play in which the star is also writer and director for an unsuspecting supporting cast. By the time I'd met my first patient and heard about her cat, I had read papers on "the repetition compulsion" and "core conflictual relationship themes" and so on and so forth, but I also knew firsthand what it was like to feel so unconsciously compelled to repeat. My own mother's explosiveness had early on left me with two rotten choices: either she was very crazy, or I was very bad. A fair portion of my early adulthood was spent trying to work out which it was, and to that end I befriended more than a couple of high-strung girls, each of whom I grew close to and then finally cut off abruptly, exclaiming "She's crazy!" to anyone who had patience enough to listen. Dr. Aronoff finally asked whom I actually thought I was trying to get rid of.
"When you listen to yourself talk about this cat, does it remind you of anything?" I asked my patient cryptically in our early days together. Of course it did not. It was too soon. She was not yet ready to know. Later, as invariably happens, she would re-create an aspect of her childhood dilemma with me, regularly missing sessions as I waited bereft in my office, longing for her to appear just as she'd once ached for her mom. A good therapist uses her own emotional reactions to help the patient put her early experience into words, but I wasn't there yet.
"The unconscious doesn't know who is abandoning whom," one supervisor said to me, explaining that my patient was likely feeling left by me, even though she was the one who was not showing up.
"If she had come regularly and had experienced you as a consistent part of her life, she would have had to grieve all that she didn't have as a child," one of my professors commented in my final weeks of school when I presented the case--which had by that time spanned three years.
I saw many clinic patients during my four years in graduate school. They arrived with their problems and their stories, and because I was being educated in the psychoanalytic tradition, I learned to begin by asking myself two questions. First, what was their developmental level? At what point in their emotional development had things begun to go awry--the earlier it had been, the worse off they were. Second, what was their character organization? In what ways did they tend to distort reality in an attempt to feel less pain? Together these answers provided an important if gross starting point for every treatment. A patient's developmental level was psychotic, borderline, or neurotic; his character organization within that level masochistic or obsessive or narcissistic or depressive--the list goes on some--depending on the constellation of defenses he tended to favor. (Myself, I was neurotic, and my own character style a tinge masochistic with stronger undercurrents of depressive: having felt from quite a young age that painful experiences with my parents were my fault, I believed I was so bad. I was not unlike other psychotherapists in that regard. What better way to alleviate a constant and nebulous sense of guilt than to devote one's life to helping others?)
These two dimensions shed light on the patient's internal experience, on how he organized and perceived his life. What had become more popular in the world at large, under the rubric of cognitive-behavioral therapy, or CBT, was an emphasis on discrete symptoms, say social phobia or panic attacks, that could supposedly be alleviated in short, rote bursts of ten sessions or fewer. At my school patients came to us for long-term work and character change, to alleviate troubling thoughts and behaviors and then some, as true well-being is more than just the absence of symptoms.