The Mythical Therapist

Joseph Burgoin
Detours
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The Psychotherapy Relationship
44

In response to my last post, one reader commented that when therapists come from a position of "bounty", they will be willing to reduce their fees for clients who can't pay.  Whether you agree with this statement, it suggests that the therapist must first have "enough", whatever that may mean in his or her personal circumstances, maybe even more than just enough, in order to feel bounteous. Therapists must feel that their own needs are being met and that they have enough left over to give to their clients.  This seems unquestionably true, although I suspect my views on "enough" and "bounty" differ from this reader's meaning.  I also believe that "enough" will be a different amount for different people; it's not a case of one-size-fits-all.

My decision to become a therapist was not based on a drive to help people, although I enjoy that aspect of it very much.  I pursued training as a psychotherapist because I could think of no other career that would fascinate me so much, hold such personal meaning and also earn a decent living.  I wanted to marry, have children, own a home and provide for my family.  At that time, I lived in Los Angeles on the west side of town; I went to graduate school and built my practice there. Life in West Los Angeles was and still is expensive.  "Enough" to afford those things in that area meant earning quite a lot of money; even if I had charged very high fees with a full practice, I never could have done it alone.  Ours was a dual-income family, as were most families we knew at that time.  A therapist living in a small town in Indiana might need quite a lot less than I did in order to have "enough".

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Good and Bad Reasons to Take an Antidepressant

Joseph Burgoin
Depression and Bipolar Disorder
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Detours
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The Medicalization of Mental Health
69

Thirty-five years ago, I received a phone call from my friend Lily about a car accident involving a mutual friend of ours, Terry.  The three of us had just graduated from UCLA the week before.  Terry, along with her sister, brother-in-law and niece, had gone on a trip to the Colorado River.  En route, along a two-lane highway, another vehicle tried to pass them and the line of cars ahead.  The driver mis-calculated the distance and as a result, a semi-truck coming from the opposite direction swerved to avoid the passing car, struck our friends' car and instantly killed Terry's sister, brother-in-law and niece.  Terry survived but suffered severe and irreparable brain damage.

I had given up my apartment following graduation and was briefly staying with my parents before leaving on a long trip.   When I came out of my room after the call, deeply upset and in tears, my mother immediately went to her bathroom and returned with a blue, 10 mg Valium tablet which she pressed into my hand.  Her response to my grief was to offer me the same medication she used to keep her own pain sedated.  I hadn't thought about that incident in years, but recently, in considering some of the wrong reasons people take antidepressants, the memory came back to me.

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The Mostly-Bad Mother

Joseph Burgoin
Depression and Bipolar Disorder
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Detours
195

During a recent session with a client, she was revisiting some memories about her mother, familiar to both of us since the beginning of her treatment.  Although her parents provided the basics -- food, clothing, a roof over her head -- they were both disastrous on an emotional level.  As the session unfolded, my client repeated many painful details from her childhood, and yet amidst all those memories, I caught little glimpses of the way she had at one time found her mother beautiful.  It made me think about the spots of goodness to be found in the mostly-bad mother, and how hard it is to hang onto them.  It's an issue I continue to struggle with in relation to my own mostly-bad mother.

I could describe my own parents in very much the same terms as my client's:  they fed us, clothed us, gave us a very nice home and bought us used cars once we learned to drive.  In financial and material terms, I had a comfortable, upper-middle class upbringing.  Emotionally, it was fairly awful.  I won't burden you with the details; many people have more horrific stories to tell and entered their teens even more scarred than I was.  Suffice it to say that I suffered from severe bouts of depression and at 18 concluded, on my own, that I badly needed professional help.  Without telling my parents, I went to consult a psychiatrist who was a casual business acquaintance of my father's.  He intervened on my behalf and spoke to my parents.  Later, after an endless and agonizing argument in which my mother and father insisted that either (a) I was making "it" all up; or (b) I was so mentally ill that nothing would help, they finally agreed to pay for my therapy.

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Defense Mechanisms V: Idealization

Joseph Burgoin
Defense Mechanisms
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Depression and Bipolar Disorder
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Detours
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Shame/Narcissism
26

Once again we have a concept familiar to most people.  Idealizing a new love interest, hero worship, excessive and unwarranted optimism -- these experiences all depend upon the process of idealization.  They also illustrate the point I tried to make in my last post, that these individual defense mechanisms we're discussing are to a degree artificially distinct categories and don't occur one-by-one.  Idealizing a loved object involves denial of the parts of reality that undermine perfection.  Extreme optimism involves denial of our doubts or questions about the future.  Both processes involve splitting to some degree, where the perceptions or ideas that might lead to a more nuanced view are projected outside.

The process of idealization may take aim at several different objects:  self, experience or another person.  I'll discuss each one of those processes separately, but first I'd like to say something about what drives idealization.  In graduate school, one of my professors once told us, "The worse the object, the more the need to idealize it."  I don't remember which professor said it, and whether he was quoting from another theorist, but the expression has remained with me for nearly 30 years.  In this sentence, the word "object" is used in its
theoretical sense, to mean another person -- as in, "the object of my affections."  Given the emphasis on the mother-infant relationship in my training, I'm quite sure this professor meant that the experience of having a grossly deficient mother is excrutiating for the infant; the more intolerable that pain, the more likely he or she would be to defend against it either by idealizing the actual mother or escaping from her into a relationship with a perfect one in fantasy.

If you pursued the latter defensive strategy, you might spend the rest of your life looking for a perfect object to love.  As described in an earlier post on love junkies, you might cycle in and out of infatuation, believing you have finally found The One this time, only to succumb again to disillusionment.  I'm sure this phenomenon will be familiar to most of you.  Another way of conceptualizing that process is that the person uses the heady and idealized feeling of being in love as if it were a kind of drug to ward off pain.  Perfect love as the antidote to other unbearable emotions.  (Just don't call it an "addiction"; if you've been reading my site for a while, you know how I feel about the thoughtless way people use the language of addiction to describe everything.)

One of my clients, Kay, for several years dated the same two men in rotation.  She'd spend an idyllic weekend with Rod and decide he must be her soul-mate.  Then a week later, he'd begin to grate on her nerves and she'd "realize" that Danny was the right guy instead.  The honeymoon period with Danny would eventually wear off, of course, and back she'd go to Rod.  And on and on.  Helping her to have a more realistic relationship with a man, and with her own pain, was extremely difficult.  She kept me and our work together at a great distance through her preoccupation with these two men, and the continual dilemma over which one to choose.
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Defense Mechanisms IV: “Thinking”

Joseph Burgoin
Defense Mechanisms
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Detours
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Unbearable Emotion
36

In an early post entitled Breathe More, Think Less, I introduced the idea that thinking, particularly verbal thought, can serve as a type of psychological defense.  I'd like to revisit that subject today and explore it in greater detail as part of this series on the defense mechanisms.  One recent email from a site visitor mentioned non-stop "chatter" in his head; because so many people seem to suffer from an uncontrollable word-flow in their
thoughts, it seems an important subject to discuss.  Much of what I have to say appeared in an overly-condensed way in that earlier post.

As discussed in my piece on post-traumatic stress disorder, when the early experience of helplessness feels unbearable, for whatever reason, we may try to blot out awareness of that experience; that particular defense mechanism would be called denial, or more precisely, denial of psychic reality.  Another response might be to take flight into precocious intellectual development, which also involves a kind of denial:  I am not small, helpess and afraid; I'm really quite highly developed -- just listen to what I can do with words! In such cases, intellectual and verbal ability develop prematurely, but detached from authentic experience as a defense against it; words take on a life of their own and are often felt to have a magical ability to ward off pain.
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