David

“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?
Marianne Williamson


David was a prisoner. That was the way he described himself anyway. A neatly-dressed Black man in his 30’s, he was new to therapy and was admittedly a little uncomfortable about the process. He described himself as a prisoner of his own weight, and how it had kept him from being happy for as long as he could remember.

Again a client of mine had hit on a sensitive subject. I had also felt like this from time to time, and could definitely empathize with David’s struggles. The funny thing was he was no more than 15 pounds overweight, and in his well-tailored suit it was hard to tell he was overweight at all.

But I knew that wasn’t my job to tell him that, although that was certainly my first instinct. When I first became a therapist this was a mistake I made often, correcting people’s opinion about themselves and in many ways being a cheerleader.

My training however taught me that this can actually be counter-productive. What someone is looking for is confirmation of their experience. The desire to be understood is one of the strongest wishes we have. That’s not to say that you don’t help people examine their own self-sabotaging ways of talking to themselves, but our first job is always to try and understand a person’s worldview. If you correct someone to fast, or deny some aspect of a person’s experience, you have missed on an empathic level, and this is something I always try to keep in mind.

So David told me about his life as a prisoner. He described being overweight for most of his life, and how he was always the “fat kid” growing up for as long as he could remember. Through High School he described having a lot of female friends, but very few romantic partnerships. This pattern continued on through college, and now into his professional life as well.

Although I am single, and often find the dating world a hazy and confusing mystery, I did think there were ways I could be of service to David. I knew that if he could begin to feel understood, that over time he may develop more confidence which would then seep into other areas of his life. I know how this works because I have been in therapy myself. It was an extremely important piece of my own development as a therapist, and I often left the sessions feeling a lot more confident when I was on the other side of the proverbial couch.

I told David about my ideas on substitute people, and he was immediately taken with the idea. He described being the guy who girls would take to the dance when no one else had asked them out, and how we was always kind of a second tier kind of guy when it came to dating. He described how now as an adult he had experienced so much of this kind of thing that he had in a sense given up on the dating world, as he knew that people were simply not that interested in him.

One of the first steps in therapy is to actually examine the evidence of what people are saying and see if it holds up to scrutiny. I asked David to think about a college educated, well-dressed, polite and kind man, who had a good job and was financially responsible. I then asked him if I described that man to his female friends, how many of them would feel like that kind of man was extremely difficult, if not impossible to find.

He agreed this hypothetical man sounded great, and his female friends often did complain to him that there were no good men around. Still, although he was able to give this imaginary version of David the benefit of the doubt, he could not extend the same courtesy to himself. This is unfortunately a very common trait in people that struggle with depression, and it takes a lot of hard work and time to begin to undo the roots of this self-defeating way of approaching the world.

Something occurred to me with David however, and at about 6 weeks into therapy I decided to take a chance. Although we talked a lot about his childhood, his self-defeating ways of talking to himself, and engaged in a lot of the standard therapeutic conversations, he kept coming back to being a prisoner of his weight.

So, with a very deep breath, I asked him, as gently as I could, if it was possible that he was overweight because he wanted to be overweight. This is a dangerous kind of question for a therapist to ask, as it can be perceived as blaming the victim. On the other hand a large part of your goal is also to promote personal responsibility, and it was in this vein that I decided to ask the question.

David was very offended at first, and got angry which is what I expected. We spent that hour in a kind of uncomfortable silence as I tried to explain what I meant by this, but it was clear his emotions had become aroused, and it was therefore very difficult to continue the conversation. Still, I thought it was important. I provide him with this quote from Marianne Williamson at the beginning of this story to think about when he returned the next week, and asked him to please think about it until I saw him again.

It was a tense week waiting for that next session, but when David did return it was with a smile on his face. He reported he had been up half the night thinking about what I had said, and how that quote had in fact summed up his feelings, which is what I had hoped for. Personally he thought he was capable of a lot of great things, and described how he spent hours daydreaming and visualizing the life that he thought he was capable of living. But he was also afraid, and he wondered aloud if maintaining the little extra weight he carried was his way of keeping himself safe from having to risk rejection if he did chose to follow his dreams.

This blew me away, and reminded me that people are often much more insightful about themselves than we often give them credit for. It has been my experience that really people often have the answers to their own questions if we just give them time and space to explore these questions. David knew on an intellectual level that he could lose 15 pounds easily enough, he was an athlete in High School and had been thinking of joining a gym for years. What he had done however is make a connection between a surface level symptom (being overweight) and a deep-seated fear he had of living the life he was capable of living.

What happens next after such a revelation is reached is always interesting to observe. Some will tell you that insight in therapy is essentially useless, as it simply reveals the problem without providing any tools to change the problem. Regardless of the particular debate, it is always important to take action. A therapist can provide all of the insight in the world, but ultimately it is the client who has to do the heavy lifting.

So in David’s case we set some goals. Along with joining a gym and losing the weight, he had an idea for a small business he wanted to start, so we also set some goals around that. He became a man on a mission, working out and researching, and generally finding a whole new gear in his life that he never knew he had. It was wonderful to observe, and within a month David had his business up and running and was doing well.

Obviously not every case in therapy goes this well, but I wanted to think seriously about what had happened. Somehow having someone actually become interested in his life had made David interested in his life again, and he had tapped into some kind of long dormant desire he had about the kind of life he wanted to live. Somehow as he got older he had moved farther and farther away from this life force, and became content to simply exist on this planet, in his case literally as a “prisoner” in his own body.

I have seen David for over a year now, and yes, he has begun dating again over the period with a lot of mixed results. He told me one of the women he had dated thought he was too “cocky”, and this was really kind of amusing considering where we had started out just a few months before. Over the course of this year we talked a lot about how this “substitute” pattern happened in the first place, and I think it is an important question that I very much wanted to figure out.

P.S. I joined a gym yesterday myself. Physician heal thyself is I think the proper expression.