Friday, November 20, 2009


We Bokonists believe that humanity is organized into teams, teams that do God's Will without ever discovering what they are doing. Such a team is called a karass by Bokonon "If you find your life tangled up with somebody else's life for no very logical reasons," writes Bokonon, "that person may be a member of your karass."
Kurt Vonnegut Cat’s Cradle

Among other things, you'll find that you're not the first person who was ever confused and frightened and even sickened by human behavior. You're by no means alone on that score, you'll be excited and stimulated to know. Many, many men have been just as troubled morally and spiritually as you are right now. Happily, some of them kept records of their troubles. You'll learn from them - if you want to. Just as someday, if you have something to offer, someone will learn something from you. It's a beautiful reciprocal arrangement. And it isn't education. It's history. It's poetry.
The Catcher in the Rye

The more I talk to people about the substitute pattern, the more I learn that, at one time other another, all of us have been the substitute person. When we can talk about this, share our stories, and even perhaps laugh about this, we can perhaps begin to free ourselves from the shame that threatens to swallow us when we don’t have the chance to share these feelings.

In considering this idea, I though about Yalom’s description of one of his group therapy exercises. In a nutshell he would ask everyone in a group to write down their deepest fears and insecurities, and then he would read them anonymously aloud to the group. You know what he found? That essentially these fears were all the same. All of us have felt unlovable, inadequate, and inferior at some point in our lives. Rather than look at this as a curse of the human condition, perhaps we can see it as a kind of strength. Because these feelings are so universal, they can also be something that helps bring us closer together.

This idea was why I included the quote at the beginning of this essay from Kurt Vonnegut’s wonderful book Cat’s Cradle. Some of the greatest human interactions I’ve ever had with other people came from strange and seemingly coincidental meetings with people that I wouldn’t normally cross paths with. Each time this has happened I stop and ask myself, is this person a member of my Karass? It always makes me smile, and usually I make a note to point this out to the person, and more often than not they are also familiar with Kurt Vonnegut and have actually heard the term before.

I point this out because our tendency is to surround ourselves with other people who look like we do, but in doing so we may miss some wonderful opportunities for understanding. Perhaps if we all challenge ourselves to meet at least one strange and new person each day, we would be much richer for the experience.

My hopes in writing this book would be that substitute people from all walks of life would begin to band together and shout from the rooftops that we are here, we are surviving, and that we matter. Is this going to happen? Probably not. Still, I firmly believe that if we can talk about and explore where these feelings come from in our lives, we can diffuse a great deal of the inadequacy that comes from being a substitute person. In my perfect world there would be support groups and meetups for substitute people to talk and laugh and drink and dance together, but again maybe I’m being too optimistic.

So what can we do? Although I hated to advocate therapy in each and every case, I do feel like it can be a wonderful start in rebuilding one’s sense of worth. You might think I say this because I am a therapist, but that is not the truth. I have been in therapy myself and personally undergone this rebuilding process. Probably the most important thing I emerged with was an ability to laugh at myself and my problems, without it being mean-spirited and hurtful. There is a significant difference between self-deprecating and self-attacking, and it a line I’ve found through many years of personal exploration.

We can read. A few recommendations I would suggest, are The Road Less Traveled, by M. Scott Peck, I’m Ok, You’re Ok by Thomas Harris, and Living, Loving, and Learning by Leo Buscalgia. These are all older books that I return to again and again when my own substitute pattern flares up. There are dozens of others, several of which have been mentioned throughout this book that might help.

Most of all though I think we can stick together. It has been my experience that is at least as exhausting to try and pretend we are without feelings of inferiority as it is to constantly remind ourselves of them and silently live with them, but really, neither is a good option. As Terrence said thousands of years ago, “I am human, therefore nothing human is strange to me.” Let’s not pretend anymore that we are above each other and exist on some kind of higher plane because of the quality of our clothes, cars, appearance, or any of the other thousands of things we use to categorize ourselves as different from one another. It doesn’t work. Not really. Not in terms of self-worth and feeling a sense of belonging.

In conclusion, if you have ever felt like a substitute person and wondered if you were the only one, please be assured you are not. Rich, poor, black, white, men, women, it truly doesn’t matter. As a therapist I can assure you people from all walks of life feel like this and they are just as hurt, lonely, and eager to meet someone who feels like this as you are. Give them a call. Ask them out for coffee. Get a group together and go do something fun and silly. We are all a little miswired and broken. Have all anguished about not fitting in, and have all wondered if we somehow were missing the parade everyone else was marching in. To feel like this is to feel human. To connect with others who feel like this is and to share this vulnerability is a scary and frightening journey, but it is also a major key in maximizing this short and strange trip we are on, and living it with a shared sense of purpose.

The Invisible Woman

Growing old is not all sweetness and light. Old women especially are invisible.
Ruth Rendell

When I am an old woman, I shall wear purple
With a red hat which doesn't go and doesn't suit me.
Jenny Joseph

Men die before women do. That’s a fact. As someone who has worked in a couple of nursing homes it is also something I’ve observed firsthand, as the ratio of women to men in these places is often about five to one. I’ve also worked with a number of widows as a therapist, and was particularly struck by a woman named Susan, who became a widow at the age of 53 and came in complaining that she was invisible.

When I first heard this I wondered if she actually meant she thought she was invisible, and if I was going to have to call for the guys in the white coats. Upon talking to her I learned that she was referring to the fact that she honestly felt that she didn’t even exist in the minds of most people she encountered on a daily basis.

One fortuitous byproduct of working with Susan was that she turned me on to the wonderful show Six Feet Under, which follows a family that owns a funeral parlor through all of life’s triumphs and tragedies. In particular she felt a kinship with Ruth, the widowed mother on the show who struggled with dating, connecting with her adult children, and facing her own impending mortality. In one scene in particular. Ruth’s friend Bettina informs her that women their age are invisible, and that therefore they could get away with murder.

I liked that second part, and wondered if that portion of the statement might hold a key to our future treatment, but in the meantime I wanted to learn more about what it was like to be invisible. Ruth had been a widow for a little over a year when she originally came to therapy, and had suffered from feelings of depression from both her original grief as well as the events that followed her husband’s death, which made her feel that she was increasingly of no importance to people.

The first step in cognitive-behavioral therapy is to see if a person’s thoughts actually match up with their experience in the world, but in Susan’s case I wondered if this would be a dangerous exercise. I knew from working with several members of this age group that there was in fact some validity to her invisibility hypotheses, and that the situational events of her life would in fact induce depressing feelings in almost anybody.

So how to proceed? Some people in therapy don’t need you to make earth-shattering interpretations about their childhood, but instead just need a supportive, encouraging person to listen to them. This can help people slowly find their confidence again and start to reconnect with the bigger world around them.

Sounds good, right? In theory yes, but Susan had almost totally lost her hope, and that is a very dangerous thing. As a married woman her every action had been based on doing things as a married couple, and now that she was alone she found her social circle no longer welcomed her.

What Susan did have going for her was a wonderful sense of humor, and it has been my experience, (and very personal bias), that if someone has this quality than they can survive nearly any circumstance life has to offer. Still, she was in therapy and she was in pain, and we had to come up with some kind of plan to deal with her invisibility.

Susan had never been in therapy, but took to it very quickly, as she was both an avid reader, and eager to try any suggestions that would make people start paying attention to her again. We discovered that Susan had for the most part of her life gotten validation from being the kind of wife that people expected her to be, and in the process she had never really explored all of her individual dreams, goals, and desires.

People have an ideas sometimes that therapy is just about exploring things that are wrong in a person’s life, and how all this started with some significant piece of their childhood. This is not true. In some cases, really in all cases, it is also important to find what a person’s strengths are, and then encourage these strengths and collaborate with them on how to maximize the things that are going right in their lives.

So in Susan’s case it was clear that, although she was depressed, she was also open to trying new things, and in this sense I knew she had the kind of resilience that would make her an excellent candidate for therapy. About 6 weeks in to the sessions I got an idea about how she might begin to feel a little less invisible.

When I was young I remember my mother told me quite often that when she was an old woman she would wear purple. The idea comes from a poem by Jenny Joseph, enclosed here,

When I Am an Old Woman

When I am an old woman, I shall wear purple
With a red hat which doesn't go and doesn't suit me.
And I shall spend my pension on brandy and summer gloves
And satin sandals and say we've no money for butter.
I shall sit down on the pavement when I am tired
And gobble up samples in shops and press alarm bells
And run my stick along public railings
And make up for the sobriety of my youth.

I shall go out in my slippers in the rain
And pick flowers in other people's gardens
And learn to spit.
You can wear terrible shirts and grow more fat
And eat three pounds of sausages at a go
Or only bread and a pickle for a week
And hoard pens and pencils and beermats and things in boxes

But now we must have clothes that keep us dry
And pay our rent and not swear in the street
And set a good example for the children.
We will have friends to dinner and read the papers.
But maybe I ought to practice a little now?
So people who know me are not too shocked and surprise

I have a very interesting history with this poem beginning obviously with my mother who recited the idea often and purchased the book for us to look at as well. I was always intrigued by the idea of an eccentric old woman with mismatched clothes who reeked of brandy, and I actually really liked the idea of my mom becoming this very woman as she got older.

Cut to years later and I am a waiter on sunny Mackinac Island up on the upper peninsula of Michigan. It is a wonderfully fun place, with no cars, dozens of bars, and nothing to do but enjoy the scenery and drink Rum Runners.

One afternoon I was waiting tables and a bit bored with the tourist crowd, when I suddenly saw a thundering heard walking towards me. I looked up and saw a sea of red hats and was told that they were members of the infamous Red Hat Society. I made some inquiries and found that they visited Mackinac Island every summer, and the result was the herd marching down the street directly towards me.

As a relatively new waiter at this establishment, I didn’t quite know what to expect. Soon everyone on the waitstaff began bitching about the “old ladies” who came in and acted like fools, and arguments ensued about who was going to actually have to wait on them. I knew a little bit about the Red Hat society, and in particular that they were a group of women over 50 who got together to eat drink, travel, and generally beat back the rigors of getting older by having a lot of fun.

I told them to give them all to me. All of them. Every last one of them. I knew immediately that there was something special about these ladies, and soon there were about 40 of them all sitting in my section grabbing my ass and ordering drinks like it was their last day on earth. And you know what? It was one of the funniest afternoons I could ever recall. I talked to a number of the ladies that afternoon, and heard several stories about widowhood, loss, resiliency, adventure, and even romance. It was incredibly insightful actually, and I knew that the events of that afternoon would one day prove to be useful to me at some future incarnation of my life.

So cut to years later and I’m a therapist with a funny, open-minded widow in my office, and the light bulbs started clicking like you wouldn’t believe. I had actually stayed in touch with several of the women I met on that fateful afternoon all those years ago, and I put Susan in touch with them with the hopes that they could share with her what they knew about overcoming invisibility, as it was my experience that these women were anything but invisible.

Susan eventually found that there was a wild, uninhibited woman waiting to get out inside of her, and finding the Red Hat Society helped her begin to develop this long dormant side of her personality. In finding this new gear in her life, Susan eventually became a mentor to a number of other widows that also felt like life had left them behind, and in doing so became empowered in a way that was truly remarkable.

I would like to say that therapy was responsible for helping Susan make this transformation in her life, but it just wasn’t true. She had some amazingly creative potential inside of her that was just dying to come out under the right circumstances, and the one thing I did was share information with her about how to find these circumstances. The Red Hat society speaks to the power of community as an antidote to substitute feelings in such a wonderfully creative way, that I can scarcely do it justice in writing. The sense of fun, adventure and camaraderie that I found these women possessed convinced me that as long as we are drawing breath we have a chance to stand up and give notice that we are here. It’s kind of wonderful actually.

Tuesday, November 17, 2009

The Island of Misfit Toys

I hate those people who love to tell you
Money is the root of all that kills
They have never been poor
They have never had the joy of a welfare Christmas
Everclear- I will buy you a new life

King Moonraiser: Come closer. What do you desire?
Rudolph: Well, we're a couple of misfits from Christmastown, and we'd like to live here.
King Moonraiser: No. That would not be possible. This island is for toys alone.
Yukon Cornelius: How do you like that? Even among misfits you're a misfit.
Rudolph the Red Nosed Reindeer

Nearly every person I have ever spoken to in therapy has strong feelings about Christmas. There really is nothing like the holidays to reopen old wounds, stir up feelings of jealousy, resentment, loss, and sometimes even joy. This sounds cynical, I know, but it is also something I’m sure most therapists can confirm.

The substitute pattern seems to thrive during this season, as it becomes very easy to compare and contrast our lives with virtually everyone we come into contact with, as people strive to put their best foot forward when describing their own Christmas experience.

Why do we lie? What is it that makes us put on the plastic smiles and wax nostalgic about the holidays? Here in America, the forces of consumerism are at their most powerful during this season, and financial posturing and social comparison always create feelings that send a lot of people straight to therapy during the festive holiday season.

One family I saw touched off a number of my own substitute patterns, and really got me thinking about how much Christmas really separates the haves and the have nots in our contemporary American society.

The family in question had a lot of strikes against them. The father had been in a construction accident, and had lost a great deal of his cognitive functioning as a result. The mother had never worked, and seemed overwhelmed and lost trying to keep the family together as a result of her husband’s problems.

They came to me after being referred from the insurance company, and were very unfamiliar with the therapeutic process. The family had a number of problems, but the one that was currently causing them the most distress came from the 12 year-old daughter, who had been throwing terrible tantrums around the house, ostensibly because her parents wouldn’t provide her with a cell phone.

Our first meeting was comical. She laid down on the couch facing the opposite way from me, and waited for me to say something. When I asked her why she was laying like that, she explained that she saw that on TV and thought that was the way she was supposed to do it. I explained to her that she could just sit up and talk to me, and not to be worried or afraid and she begrudgingly fidgeted and squirmed her way into sitting up.

Our first session was awkward. She clearly didn’t want to be there and I couldn’t say that I blamed her. So we played a little Uno and talked about some of her favorite music. I was amazed to find she was a Beatles fan, and when I found that out I knew we had something to talk about. She told me she also liked to read, and particularly liked Tales of a 4th Grade Nothing which was also a favorite of mine growing up. As the hour progressed we made a real connection, and I could scarcely believe this was the same little girl I had heard described as such a terror.

So we saw each other a couple more times and continued to play cards and talk. I found she was quite bright and articulate, and it was actually a real pleasure to spend time with her. Even still, I knew I had to go a little deeper and at least start to try and understand what it was that was making her so angry. It is dangerous to rush children in therapy before you have built rapport, so as we were rapping up, I simply asked her what she would change in her life if I could wave a magic wand and make things different.

Her reaction was not what I expected. A tear fell down her face and she looked up at me with sad eyes.

“I just want a normal life and a normal family,” she said sadly. “and maybe a dad like you."

Wow. She had totally stunned me. I was trained and prepared for what is known as the “doorknob confession,” something that occurs in therapy where a person drops a bombshell on their way out the door as opposed to dealing with it during the session. This was a little different however, as I was the one who had asked the question. Meanwhile her parents were waiting in the lobby and I needed to wrap things up, while also giving her a response to such a powerful revelation.

“Listen Katie,” I explained. “I really enjoy talking to you and hearing a little more about your life. If it’s helpful to you we can set it up so we can talk once a week about whatever it is you want. I can and will be your friend, but I can’t be your dad. Do you still think you might like to come back and talk again?”

Not the greatest intervention I’d ever dreamed up, but it seemed to reach its mark. She agreed that she would like to come back, and after speaking with the parents for a few minutes, we all agreed that this was something we could make happen.

I stayed up half the night thinking about what had just transpired. As happens so often in therapy, Katie had made me think about something in my life that was very much weighing on my mind. I had just returned home from an extended vacation with my family, and spending time with my nieces and nephews had made me seriously question why I had reached this point in my own life without having children. In general I was happy with my choices, but also wondered very much about what the road less traveled might have had in mind. Would I have been a good father? Was I missing an important part of life? Was all this still ahead of me?

All of these thoughts were important to consider, but first and foremost I also had to try and understand how I could be of the most help to Katie. Clearly she longed for a kind of normalcy in her life that was simply not possible right now, and she seemed to be taking out her frustration about this on her immediate family. They described violent tantrums where she would run into the street screaming and crying. Other times she would curl up in the room and not talk to anyone. I knew that if she couldn’t begin to develop ways to soothe herself and find more effective coping methods she was headed for potentially serious trouble.

So what was the best way to go here? I knew that if I could continue to build a trusting relationship with her she would likely continue to open up to me, but on the other hand I didn’t want her to get so attached that she became completely dependent on me and on coming to therapy. It was kind of a tricky road to walk actually, and meanwhile I didn’t want my own pangs of regret over lost fatherhood to interfere with how I conducted myself here.

Was any of the completely possible? I didn’t really know. All we really have as therapists is ourselves, and I had to figure out how to use myself, flaws and regrets notwithstanding, and hopefully find a way for this girl to begin to quiet the distress that was going on inside of her.

So we continued to meet regularly and play cards and talk. I found out that she was being made fun of by the other kids at school because of her clothes, her “weird” family, and the fact that she didn’t even own a cell phone. This broke my heart to hear about, and I continued to think about what it was I could do to help her with the very real problems she had as a result of the realities of her life. She seemed to look forward to coming to therapy, however and, per her parents report, her anger and tantrums were decreasing.

But still there was this sadness about her, and in particular she was dreading Christmas, which was an amazingly heartbreaking thing to hear from a child. Again her story had struck a chord with me, as I too was not excited about Christmas this year, having decided to forgo going home and instead stay in Chicago and celebrate the season essentially by myself. Again, I didn’t want to mix up my problems with hers, but I also thought a lot about how I could use what I felt about the holidays to be of assistance to her. My first instinct was to simply give her a cell phone, but I knew that was not an appropriate ethical solution. Sadly the family’s financial problems were not something I could help with.

So I went home that night and watched It’s a Wonderful Life, and thought about something special I could do for Katie over this holiday. Even as a kid I loved watching Christmas movies, and every year I anticipated getting lost in these stories almost as much as I did the actual Christmas day experience. Somewhere around the time George Bailey was jumping in to save Clarence I got an idea.

What I did decide on was to throw a little holiday party just for Katie and me. I got this idea from thinking about the show Rudolph the Red Nosed Reindeer, and in particular the scenes that took place on the island of misfit toys. For those who remember that part of the show, it was where all of the toys that were slightly broken or damaged in some way went to live, and this part of the show had always had a special kind of meaning for me.

I had always felt like a bit of a misshaped toy myself, never fitting quite right with everyone else around me. I was quite sure from our conversation that Katie was feeling something very similar, and I thought if we could watch this show together, that maybe we could talk about some of the things that were bothering her. I also wanted to create something special for her on this holiday, but knew that buying her something wasn’t exactly appropriate.

So I told her about the idea and she was thrilled, feeling that there was finally something unique for her that she didn’t have to share with her brothers (they shared a room), or that she could be made fun of for by the other kids.

So when the day arrived I bought some popcorn and her favorite drink, (Orange pop) and we had ourselves a little movie night. Was I getting some of my own needs met through this interaction? Absolutely. But I also knew that this may be an important way to get her to talk about some of the things that were bothering her. When we got to the part about the misfit toys, I told her how I always felt like that, and she shook her head and smiled in a knowing way, both of us communicating a kind of understanding that didn’t need elaboration in that moment.

So we continued to meet after that, and she opened up in a completely new way about how hard it was to endure the comments from the other kids about her family, and how angry this made her at the other kids as well as her own parents. Therapy gave her a chance to explore these feelings, and we also began a discussion about ignoring what other people thought, which was admittedly a difficult thing for a 12 year-old girl to comprehend. Still, she was a Beatles fan, and I knew there was something special about her that might begin to get a grasp on this idea.

I saw her for another year after this, and watched her blossom into a beautiful young woman with her own sense of style and confidence. It was a wonderful transformation that was actually kind of startling to watch, and when it came time to part company I was confident she was on her way to becoming a remarkable young woman.

This case was proof to me that therapy can sometimes have an amazing impact on both the client as well as the therapist, but also spoke to me very deeply about the power and resiliency of the human spirit. Someone in Katie’s situation had a great deal working against her, but something inside of her found a way to hold on and rise above some very difficult circumstances. I don’t know how her story ends, but I very much look forward to hearing all about it.

Thursday, November 12, 2009

I'm dancing as fast as I can

Make Them Stop, make them stop!!!
Celine’ Journey to the end of the night

I’m dancing as fast as I can
Barbara Jordan

Sonia was a 45-year old woman who had a couple of tapes that wouldn’t stop playing in her head. That’s what she came in discussing anyway, and she wanted to know if I could hypnotize her and make these tapes stop playing.

From my initial impressions of Sonia, I knew immediately that this was going to be a fascinating case. I have always found that these “tapes”, these little songs and phrases that get stuck in our heads, often provide amazing insight into a person’s inner world. I have had many such tapes playing I my own head, and thinking about where they came from and what message my subconscious was trying to convey to me has always provided me with amazingly instructive information.

To back up for a second, Sonia was a college professor at a local community college who described feeling a “half step behind” her life at all times. She was divorced, had 2 kids, and had arrived at this period having accomplished a lot of what she had set out to do. Yet she was harried and she was frazzled and she couldn’t quite get caught up on all of her various projects and obligations.

In these cases, the therapeutic prescription might be to help Sonia organize her life a little better. Journaling, short-term goal setting, some work on the issue of time-management and mindful living, these were all things that I knew could be of use to Sonia, but I also knew there was more. The difficulty with Sonia is the she wanted a quick fix, and discussed how she really didn’t have time to do more than 10 sessions with me at this time in her life.

So I had to find out about the tapes, and the relevance they may have to the things that were holding her back from living the life she wanted. She was a professor of sociology, a close cousin of psychology, and I hoped that I could help her reach a deeper level of understanding by appealing to her knowledge about people and their inherent need to find belonging.

So we talked about the tapes. The first one, at the beginning of this story, comes from Celine, a French writer known for his book Journey to the end of the night. In this book, a young boy becomes filled with a sense of dread after watching and reflecting on the frenetic pace of the city in which he lived. He had an urge to scream, “Make them stop” at the top of his lungs. It was literally a desire to stop time and make everyone slow down and pay attention to how fast life was passing them by. It was a short little passage in this book, but one that had gotten stuck in Sonia’s head and that she couldn’t seem to shake.

So we talked about what it was she wanted to make stop, and this question released a floodgate of emotion in Sonia that she hadn’t expected. She wanted her kids to stop getting older so fast, she wanted the wrinkles on her face to stop getting deeper and deeper each day, she wanted birthdays to stop reappearing on her calendar so fast, students to stop coming in and out of her life so quickly, and most of all she missed the things that she never gotten to experience in her rapidly fleeting youth.

Here at last was the key. It wasn’t just that she missed her own life, it was that she also felt a kind of longing for all of the things she never got to do. This is a particularly painful kind of nostalgia, as we wistfully miss an imaginary life that we are sure everyone else has experienced but us. This can create a dangerous kind of personal isolation, as we have assigned superior memories to people that we don’t even know to be true. In comparison our own lives look incomplete.

I wanted to know more. What about the other portion of the tape in Sonia’s head? In this case it was a single phrase “I’m dancing as fast as I can,” which was a book from the 70s later made into a movie, about a career woman struggling with an addiction to Valium and her deteriorating mental health.

So now I had two extremely powerful insights to work with regarding the state of Sonia’s inner world. She was in deep pain about getting older, missing a life that never was, while all the time fearing she was going a little crazy in the process. These were powerful pieces of a puzzle that weren’t in her immediate awareness, and weren’t at all visible to the people in her life, who simply viewed her as a successful professor and an amazing woman.

So we began a deep and comprehensive dialogue about what it was that made her feel like this, and the root of it all came back to unfinished business from her childhood. She had been the child of a divorce, felt a tremendous amount of shame from this, and became in effect the “smart’ girl who always had her nose in a book. Meanwhile she missed out on several rites of passage growing up, and had an amazing amount of regret that she never went to her High School prom. Now, with kids who were getting to this age, she was also divorced, and seeing them go through some of the same things she had stirred up some long forgotten feelings of inferiority.

So we began a discussion about this. These long forgotten feelings had somehow surfaced just to the level of her preconscious mind, and sent a message “make them stop, make them stop.” It was kind of fascinating actually, and as we began to explore this issue, Sonia was able to add a number of her own insights as we continued. What was perhaps the most interesting thing, was this woman, who had not been able to find belonging as a child, chose to dedicate her life to the sociology and in particular the study of group behavior. It was a fascinating compensation that had for the most part served her well. She was very well liked by her students, respected by her peers, and was doing very well financially and professionally.

But as is the case with many things we don’t deal with from our pasts, feelings of inferiority from childhood had arisen to cause Sonia a significant amount of distress. The “I’m dancing as fast as I can” tape seemed to indicate a fear that she was slowly losing her own sanity, which Sonia eventually confirmed. Another part of this particular phrase was that she was, quite, literally, intimated by the word “dance.” Seeing her sons navigate the minefields of dances and proms was very anxiety provoking for her, but there was also something in her own life that was provoking this anxiety.

It seemed that once a year her college had a major party for the faculty to drink wine, dress up, and generally rub elbows outside of the school environment. For years Sonia had avoided these things, but this year was a little different. An attractive economics professor had hinted around at taking her to the party, and had mentioned dancing to her a few times as well. The tape in her head got much louder when he was around, and she even found that repeating “I’m dancing as fast as I can” helped quell her anxiety in these situations.

So we broke this down. In her life, quite literally, she was working very hard to simply maintain her home, and her career, with very little time for anything else. She was doing the best she could, sacrificing for her kids, but still dreamed about a life filled with love, adventure, and romance. Yet this was just a fantasy at this point in her life, and now a man had come along and hinted that this life that she had never had could be a reality. It was a recipe for distress, but yet, just out of her immediate awareness. As we continued to talk, Sonia was able to laugh heartily at her own life, and by our 4th month together had made real progress in putting to rest some of her long-forgotten feelings of inferiority.

I’m pleased to report that this story has a happy ending. Finally, and improbably, Sonia got to have her prom experience at the faculty party, where she and her new boyfriend tripped the light fantastic on the dance floor and were the hits of the party. I even saw them as a couple recently, where we all talked about the pressure of balancing dating, raising kinds, work, etc.

“By the way,” he said at the end of the session, “I have this song, I knew the bride when she used to rock and roll, playing in my head, do you think you can help me with this?”

But he already had his answer.

Wednesday, November 11, 2009

Chris Farley

No man, for any considerable period, can wear one face to himself and another to the multitude, without finally getting bewildered as to which may be true.
Nathaniel Hawthorne

In one of my previous books, The Tragic Clowns, I wrote about one of my favorite comedians, Chris Farley. Some my find it odd that a person so well known and famous could be a substitute person, but in Chris’ case this pattern was actually quite pervasive. It’s an important point, as many of us make the assumption that the rich and famous have lives that are free from everyday feelings of doubt and insecurity. We assign qualities to others based on actions we see in movies and television. One of my clients was amazed for instance that a man like Owen Wilson could attempt suicide. My research into the inner worlds of several comedians, including Chris Farley’s, led me to believe that a substitute pattern is often at the very core of what drives many of our most well known comedians.

In Chris’ case this started at a very young age, as problems with his weight made him in immediate target of abuse from the other children. His weight clearly created for Chris a self image where he was separate and different than the other kids. In many cases a child will do anything to be like the other kids, but in Chris’ case he took the exact opposite strategy. Realizing that the other kids found his weight to be a source of amusement, Chris decided to make jokes about it before the other kids got the chance. He in fact got so good at it, that his act made him the star in virtually every environment he was ever subjected to.

But the validation, admiration, and even adoration Chris received for making fun of his weight caused a split inside of him that made him terribly uncomfortable in his own skin. We want belonging, all of us, and Chris had found belonging with the richest and most famous people in the world, but the price tag for this sense of belonging was one that cost him his life.

How does this happen? As is the case with many substitute people, he turned to drugs and alcohol to ease the pain that he felt from being forever just outside the circle of the other human beings. The difficulty in confronting this pattern is that to really be able to find this sense of belonging, we first have to make peace with ourselves, and this is something Chris never came close to doing. Literally sitting alone with himself was something that was uncomfortable for Chris, and he often turned to drugs and alcohol to create a temporary cease fire in the war that was going on inside him.

Chris’ inner turmoil brings to mind a quote from Alfred Adler, “The greater the feeling of inferiority that has been experienced, the more powerful is the urge to conquest and the more violent the emotional agitation.” So although Chris was able to combat his inferiority by compensating with a wonderfully entertaining self-deprecating sense of humor, it was clear that this emotional agitation was a powerful and destructive force in his tragic, abbreviated life.

What lesson can we as substitute people take from Chris’ life, after all his case seems to be an unusual and extreme example of this pattern. Having researched and written a couple of books on the nature of humor and how it may be used for both healthy and unhealthy adaptation, I think it is an important question. This pattern of attacking one’s self before others have a chance to is prevalent in many people with the substitute pattern, and is especially common with people who are overweight and often struggling with this problem very publicly.

Kurt Vonnegut said, “Laughter and tears are both responses to frustration and exhaustion. I myself prefer to laugh, since there is less cleaning up to do afterward.” Although this is a sentiment I certainly agree with, it is also important to note that laughter can be turned excessively against the self, as was the case with Chris Farley. Somewhere along the laughter continuum we have to find the ability to laugh at our shared absurdity as human beings while also balancing our need to take care of ourselves.

A great deal of taking care of ourselves begins with our inner dialogue. Those little things we say audible only in our own heads that judge, criticize, and compare have a tremendous influence on the choices we eventually make, as these thoughts become feelings that then become actions. Over time prolonged negative judgments we make about ourselves take a huge toll, and not only do we begin to believe our self-fulfilling prophecies, we convince others to believe them as well. My guess is we all know someone who seems like they should be in a different station on life, rather it be with a partner who appreciates them or a career that challenges them, who has simply been unable to grasp that those are things they deserve. Perhaps you have been one of these people. I have been as well.

One quote that was of tremendous value to me in confronting this pattern comes from Marianne Williamson, whose books have been an inspiration to many who have struggled to overcome substitute feelings. She says, “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

Very powerful words that might hold tremendous meaning in the struggle to overcome feelings of inferiority. But if we reflect thoughtfully enough, and think about our tendency to judge and compare, and make a thorough and honest assessment of how the way we talk to ourselves contributes to these feelings, it is my believe that we can begin to find our light.

In Chris’ case he reflected a tremendous amount of this light, but ultimately he couldn’t see himself the way the rest of the world experienced him on a daily basis. My guess is that many of us fit into this pattern as well. All of us have gifts to offer, every one of us. Fear seems to be the central thing that prevents us from sharing these gifts, and we have to stare this fear down if we are going to truly have a chance to share the lives we were born to lead. My hope is that by sharing Chris’ story I have shown that all of us, from the wealthiest celebrity to the loneliest recluses, have at times felt like they didn’t belong with the rest of the parade. By talking about and accepting that a part of this is a natural human tendency, we can perhaps diminish its power and begin to reconnect with each other.

Wednesday, November 4, 2009

A Requiem for Eleanor Rigby

Elanor Rigby
Picks up the rich in the church
Where her wedding has been
Lives in a dream
Waits at the window
Wearing the face
That she keeps in a jar by the door
Who is it for?

All the lonely people
Where do they all come from?
All the lonely people
Where do they all belong?

John Lennon & Paul McCartney

Perhaps more than any case I’ve ever had, Sarah made me truly examine what it is I hoped to accomplish by being a therapist, and what this title really means. I met her during a period of my life when I had just come out a difficult relationship, and was in one of those interpersonal vortexes where I just couldn’t seem to connect with another person. This became particularly clear to me on a drive back to Chicago on a long, rainy night, where there was not another car in site for miles. I turned on the radio and heard,

“Never gonna fall in love again
I don't wanna start with someone new
Cause I couldn't bear to see it end
Just like me and you
No I never wanna feel the pain
Of rememberin' how it used to be
Never gonna fall in love again
Just like you and me”

It was a song by a man named Erik Carmen that I remembered from my youth. It was one of those songs that had the double bonus of being both grating as well as terribly depressing. I pulled over to the side of the road and looked into the mirror. I needed to gather myself for a minute. How had I gotten here, on the side of the road next to an Indiana wheat field with rain pounding down and not another person in site. Where had I gone wrong?

I eventually came out of this funk and made it back to Chicago, determined to commit myself to my work as a therapist, where I could focus on other people, something that had always been a wonderful recipe for alleviating my own feelings of loneliness.

An interesting thing that happens when you work as a therapist is that whatever your own personal issues are at the time, you can almost guarantee that one of your clients will have a problem that will pull these feelings out of you even more. This is the strange, synchronistic, dance of energy that takes place between two people in a therapeutic relationship. This dynamic was especially apparent in my work with Sarah, a 35 year-old woman who had found our office in the phone book and innocently scheduled an appointment with me on the Monday following the ride home I just described.

Sarah showed up to her appointment dressed very nicely and laughing and joking in a way that made me wonder what exactly I could help her with. We spent the whole first session engaging in this good-natured repartee, and when she left I couldn’t help but think I had just been on a first date rather than a therapy session.

Careful here, I thought to myself, this woman clearly has some of the exact issues that you do in your life, and this could be a tricky road to walk down. I thought about this a bit when I got home. One technique that is often pretty effective in therapy is to ask a person what advice they would give someone close to them if they described a similar issue that the person has presented. They are often able to come up with effective and creative solutions to this problem, which they are inexplicably unable to apply to themselves. This then can create a kind of cognitive dissonance, where a person becomes uncomfortable with their own illogical thinking, and slowly begin to incorporate changes into their lives.

From a psychological standpoint, I wanted to keep in mind Jung’s idea that “The meeting of two personalities is like the contact of two chemical substances; if there is any reaction, both are transformed.” My own hope for transformation was secondary in this case, as it was my first priority to see Sarah through her difficulties, and help her feel understood and perhaps even reach a new understanding about how she could create more intimate interpersonal relationships.

Sarah came in complaining about exactly that. She was, in her own words, “too picky” about the men she dated, and would often look for the slightest abnormality in a man and then use it as an excuse to cut her ties with them. For ten years she had been going on like this, and now, as she got into her mid-thirties, she had come to believe that she would never find a husband and be a mother, which had created significant feelings of sadness and loss.

All of this took weeks to get to however, as she masked this sadness by making jokes, laughing at herself, and generally changing the subject whenever the conversation would get uncomfortable or hit too close to home. It was a difficult dance, as these were all of my own compensatory patterns, and I had personally used all of them to change the subject when someone asked me about my own single lifestyle.

But this was my job, and, despite any personal shortcomings, I knew I could not allow her to continue to distract me from the issue she had come in seeking help for. I learned to stop laughing at all of her jokes and playing along with the witty banter, as it was a trap we had fallen into too often. I acknowledged that had we met under different circumstances, I would love to sit and talk with her like this, but she had come in with a problem, and that kind of conversation wasn’t helping us solve the problem.

So over time we began to talk more seriously. She attributed many of her problems with intimacy back to her parent’s divorce when she was 16, which had “blindsided” her and made her distrust the outward appearances of happy couples. Her parent’s relationship had seemed perfect to her, and when they hadn’t made it she had begun to question who could. It wasn’t an altogether uncommon response to divorce, and in particular a divorce that occurred at the age of 16, which is an important time in a woman’s life to begin to make sense of dating, relationships, and romance. Our parents are our templates for these relationships, and when their relationship dissolves, it is natural to wonder how one should proceed when their own model has been destroyed.

Over time our therapeutic relationship deepened, and we were in uncharted waters for me in terms of therapeutic intimacy. A companion to me while I thought about Sarah’s case was Irv Yalom’s book The Gift of Therapy, where he made the point over and over again that it was “the relationship that heals” in therapy. I knew that if she could continue to disclose the deepest and most vulnerable parts of herself in the sessions, that it was likely she could learn to develop this same kind of trust outside of the therapeutic office.

So on we went. Her talking all the time about the doubts she felt about herself and whether she would be any good to someone in a relationship given the insecurities she worked so hard to cover up. She made a number of important insights throughout our work together, and as the weeks turned into months, I was pleased at the progress we had made, and patted myself on the back about how neutral I had been able to stay as a therapist, despite struggling with a number of the same problems that Sarah had.

But I was in for a rude awakening. One Saturday about 6 months into our work together, I was out with some friends at an Irish bar, listening to music and having a beer with at least some notion of improving my own social situation. I felt a buzzing in my pocket and looked down. It was Sarah. What was she doing calling me now? I wondered if she had dialed me by mistake, or sat on her phone, or if there was some other such explanation, but when I listened to her message I knew this wasn’t the case.

She had called me sobbing and sounded very desperate, and I knew that I immediately had to snap back into therapist mode for a moment, despite the fact that it was a Saturday night and I was on my own time. I called her back and she explained that she was feeling suicidal and didn’t know if she could make it through the night. I asked her if she had a plan or the means to commit suicide, and she said she did not, but that she was also very desperate and wondered if it was possible if I could come out and talk to her.

This proved to be a serious test of my clinical judgment. I had had a couple of drinks, and knew that driving was not an option. I could call 911, but that didn’t seem to be a great solution either. She seemed to just need to talk to me at this moment, and I began the long and arduous trip on Chicago’s public transportation to go and see her.

When I got there it was midnight and she was sitting in her car. I unlocked the door and we went inside. Her eyes were red from crying and when we got to my office she let it all out.

“I needed you to know.. That for months I have been lying to you.. I have come in here, pretended to be Ok, and that I was making progress. But I’m not” I never told you about Elanor Rigby. You know the song? The song about the woman who dies alone? It has been in my head for months, and it just keeps getting louder. Tonight it got so loud I couldn’t get it to stop. And you know what the funny part is? The only thing that makes it quiet down is coming here. Coming to talk to you. So I guess I wanted to say fuck you.. Fuck you for making me care so much about you and not being available to me. That’s what I wanted to say to you.”

I took a deep breath and thought very carefully about what I was going to say next. Should I tell her about the songs that played in MY head? Tell her about my own dark night of the soul next to an Indiana farm? We were at a very important crossroads here and I wanted to show her how much she meant to me without making it appear like a romantic overture. What I did say is this;

“I care very much about you Sarah. The things you describe are things I have felt myself. A number of times. I became a therapist because I hate to see people in pain. I will give you everything I have as therapist to help you figure out how to get past your own loneliness. That’s how I think we get through pain, by giving what we have to give to others. From what I know you are an amazing, exceptional woman with an incredible amount of this to give to the rest of the world. Maybe we can keep trying to figure this out together.”

She took this all in with a kind of wonder, and slowly but surely stopped crying and began to think. I wasn’t quite sure if I was being tested in that moment, but what I did know is that for that moment at least, the crisis had been averted. We talked a little more and I hopped back onto the train on another rainy Chicago night to go back home. The soundtrack in my own head was playing “Eleanor Rigby”, but I knew it wouldn’t last forever. I had found a way to deal with my own loneliness, and this night had proved to me that I had made the right choice in becoming a therapist.

So Sarah and I continued our sessions, but after that night there seemed to be a whole new level of honesty between us that allowed for some real progress as we worked on the things that Sarah felt were holding her back. The idea of giving love to get love intrigued her, and, to my great surprise and pleasure, one day she marched into my office and told me how she had decided to become a therapist. That was over a year ago now, and I am happy to report that Sarah has now been in grad school for a year, and has also begun dating again.

I include this story because no other therapy case has truly made me think to this extent about why it is I am a therapist, and what it really means to create a healing relationship with someone in this context. When I began my work with Sarah I often felt like an impostor, as the insecurities, doubts, and failures she had experienced were no different than my own. One of my favorite Psychologists, Rudolph Dreikurs, talked about having “the courage to be imperfect” and in this case I found this courage, despite my own substitute feelings that threatened to undermine my confidence and render me ineffective as a therapist. It was a tremendous learning experience, and I have no doubt Sarah will “pay it forward" when it comes to passing on this lesson.

Thursday, October 29, 2009

Where the Sidewalk Ends

There is a place where the sidewalk ends
And before the street begins,
And there the grass grows soft and white,
And there the sun burns crimson bright,
And there the moon-bird rests from his flight
To cool in the peppermint wind.

Let us leave this place where the smoke blows black
And the dark street winds and bends.
Past the pits where the asphalt flowers grow
We shall walk with a walk that is measured and slow,
And watch where the chalk-white arrows go
To the place where the sidewalk ends.

Yes we'll walk with a walk that is measured and slow,
And we'll go where the chalk-white arrows go,
For the children, they mark, and the children, they know
The place where the sidewalk ends.
Shel Silverstein

I came home from this Christmas experience thinking about how I could use what I had learned in my work as a therapist. Part of being a good therapist is continually taking stock of your own life, and how your own state of mind impacts the people who trust you to counsel them about their lives. I thought about how my life had changed since I had officially become a therapist, and how I had lost touch with some of my old friends as I was surrounded with a new group of people. I had been feeling very “grown up” as I made this transition to a new life, and thought that this would also be a gateway to a new state of mind free from the substitute pattern. Then following story explains how I made sense of dealing with this transition, and lessons I learned about the choices I made about how I was going to spend the rest of the time that I had been given.

My mom was a teacher when I was little, and so books were a part of my life for as long as I can remember. The poem at the beginning of this vignette was my favorite poem growing up, and when I was a kid I used to literally search and search for the place where the sidewalk ends.

I never found it growing up, but I did have to analyze my 20 favorite poems when I was first in college, and I chose this as one of them. To me it was about trying to find that childlike sense of wonder in your heart, even as the responsibilities of life begin to creep in as you get older. And I had gotten older, and life didn’t seem as simple as it did when I was a kid. Shortly after that I just kind of forgot about the poem altogether.

Life takes funny turns sometimes though, and cut to many years later I was living in Chicago and had improbably become an avid bike rider. On one particular evening I had found a trail that seemed like it was leading to a beautiful view of the city. I had gone careening down the path, and then, looking up, saw nothing but Lake Michigan and the Chicago Skyline behind it. I slammed on my brakes and nearly went into the water, getting pretty scratched up in the process. And then, strangely, this poem popped back into my head again. This was it!! This was, quite literally, the place where the sidewalk ends.

As I dusted myself off I began to laugh. I was in such a hurry that I had almost died, but here before me lay an incredible gift. I had found it, finally after years of forgetting about it, and I vowed to give this moment its due. I visit this spot a couple of times a week now, usually right around dusk as the sun sets on Chicago and the lights of the city begin to shine.

I think about a lot of things in these moments. Usually it begins with taking a kind of inventory. What are you doing? I often think to myself. Are you a therapist? A writer? A comedian? An imposter? A Buffoon? Some strange hybrid of all of these things? Usually though a quiet kind of calm comes over me, and I sit and enjoy the city from a distance. I think of all of the things I’ve done here, all the adventures, all the people, and I begin to settle down. When I’m particularly stressed I take out a copy of this poem and read it, and think about those last couple of lines, and usually I find my answer to whatever particular worry is on my mind.

The answer is right there. See the world like a child sees the world, and suddenly everything doesn’t seem so bad. That’s how I want to live my life. How I do live my life most of the time. Sometimes the undertow of various pressures threatens to drag me under with it, and in these moments I have to remember to stay true to myself. I will not be a grownup because someone tells me to be. It hasn’t worked for me, and really I’m not sure it works for anybody.

Oscar Wilde said “The soul is born old but grows young. That is the comedy of life. The body is born young and grows old. That is the tragedy of life. That describes it so well for me. Sometimes I look in the mirror and wonder how the hell this happened. I feel younger than I have ever felt, but clearly that’s not what everyone sees. It has really been my experience that one of the biggest mistakes you can make is to judge anyone simply on their chronological age, as this is just not a good barometer of the size of a person’s spirit. Some of the oldest people I know are 25 or so, and some of the youngest are in their 70’s. Age is a dangerous fixation we have in our culture and it is one that never fails to irritate me.

So for me, as I get ready to enter a new phase of my life, I try to remember that really it doesn’t matter what I am. My only real goal is to continue to emphasize how I’m going to choose to live, and I will hope it will always be with the eyes of a child. It took me many years to find the place where the sidewalk ends, and it is a lesson I am not ready to relinquish so easily.