Monthly Archives: May 2013

On Feeling Worthless

Some people know, deep down, they are worthless or “bad.”  This “knowledge” underlies everything they think and do, and everything they think about themselves.

It may not be obvious to others. Because what others will often see is a normally productive, generous, and caring person.  A good friend and a good colleague.

But those who are intimate with them will almost certainly know about this underlying feeling, even if it is never spoken about.  That’s because the knowledge that “I am worthless” is a slow acting poison in a relationship.

Because every appreciative feeling from the other will ultimately be discredited.  And every negative comment remembered and rehashed.

Many people who know “I am worthless” make do and try to manage this feeling by ignoring it or proving it wrong.  Others are driven by a feeling of worthlessness or badness to act it out, or prove it right.  They take drugs, are sexually promiscuous, commit crimes, fail badly, etc.

I’ve always been struck by the enduring power of this “knowledge.”  One reason it is so hard to shift is because everything that happens is interpreted in its light.  If someone tells the “worthless” person they are loved, beautiful, generous, intelligent, whatever – they won’t rejoice.  They won’t regard this as evidence which contradicts and even disproves their “knowledge.”  Rather they will interpret the comment as evidence the person making it is lying, has an agenda, or simply has no taste or judgement.

This is a vicious circle which easily produces despair.  No accomplishment, evidence of value or “goodness” seems to make a dent on the underlying feeling/knowledge.

In therapy, we’d regard this deep down knowledge as a fantasy or defensive structure.  A fantasy because it seems hyper real, more real and certain than any evidence to the contrary.  A defensive structure because we’d regard this understanding – “I am worthless” — as an unconsciously arrived at defence against some greater, earlier painful recognition or feeling.

The action of adopting this understanding made sense at the time – it’s less painful to think “I’m worthless” than say, that my parents have knowingly allowed me to be abused for example.

But like all defences, its costs increase over time.  And as a foundational identification – one which defines one’s very being– it’s difficult to shift – because people will fight when their basic reality, however painful, is threatened.

The first step in the process is for someone to recognize that the knowledge/feeling — “I’m worthless” – is a construction.  A conclusion arrived at in a context in which it made sense – at the time.

This understanding begins to undermine the absoluteness of the knowledge’s hegemony.  If the “worthless” person then starts to put their energy into being curious about how such an idea came about, rather than confirming its truth,  its days may be numbered.

Memory and the Ability to Bear Pain

The other day a patient reported a conversation between his teenage children at dinner.  The topic was how long the baby in the family would remember his parents if they suddenly disappeared/died.

Of course, this conversation, and the reporting of it at the end of a session, was highly overdetermined (psychoanalytic jargon for “had many strands of meaning”).  But I’m not going to address all that here.  Those meanings were particular to the session and the patient.

Rather, I’m going to talk about the very counterintuitive, but I believe profoundly truthful, psychoanalytic understanding of the kind of memory his children were discussing.

To put it simply, we believe that someone’s ability to remember another in their absence is a function of their capacity to bear pain.  If someone you care about and depend on is absent, and you think of them, you experience loss. If this feeling is overwhelming or the pain goes on too long, you might deal with the pain by deleting the painful object from your emotional memory – you “forget” them. Presto!  The pain is gone.

So… what’s the problem?  We’ll talk about this in a moment, but first, let’s backtrack a bit.

Think about a mother and a baby. (Analysts do, all the time!) The mother is everything to a baby, the source of food, warmth, comfort, understanding.  The baby literally can’t live without her.  So when the mother is absent, the baby is flooded with feeling – panic, anxiety, fear of dying, loss, etc. The good-enough mother will gradually acclimatize the baby to their absence, by being away only for short and then gradually longer periods of time. She will also remind the baby of her presence (by singing, talking) when they are out of sight. This mother instinctively understands that if she’s gone “too long,” the baby will cut off, “forget” her, as he will be overwhelmed by feeling and pain. But as she slowly extends her absences, the baby begins to learn that when she is absent, the mother is not gone/dead but simply away.

As no mother is perfect, it is inevitable that the baby will repeatedly break the connection with her, when she is away for unbearably long.  And that the mother and baby will need to re-make the emotional link between them.

The baby’s capacity to bear absence is increased by the acquisition of the ability to symbolize.  Freud observed his grandson (at 18 months) playing with a reel that had a string attached to it.  The young boy would throw the reel over the side of his cot so it couldn’t be seen and say “fort” – gone.  And then he would draw it back using the string, triumphantly saying “da” – here.

Now, back to the problem.

“Forgetting” or breaking the emotional link with the other works like a charm in terms of getting rid of the pain of loss.  But it has serious unforeseen consequences.  To enumerate a few:

  1. It makes it difficult to learn.  Painful lessons you learn from relationships are “forgotten” along with the pain.  So you keep making the same mistakes in life.
  2. It makes it difficult to sustain relationships.  When your partner or close friend hurts you, or is away “too long,” you cut your emotional tie to them. So when you get together again, you are “cold,” “aloof.” In the case of friendship, it might mean you don’t contact them again, or don’t respond to their attempts to understand what has happened between you.
  3. It means you are denied the comfort of being able to remember and think fondly of those who are absent or who have passed on, to reflect on what you’ve shared and learned from them.
  4. It creates “gaps” in your memory, and in your life story.
  5. It keeps you “young” or like a child, at least in certain areas of your life.

For all these reasons, therapists are always concerned with how people deal with absence and loss.   Our clients are often repeating painful situations, seemingly unable to learn from them.  Their early defence of forgetting/cutting off/breaking emotional links which shielded them from unbearable pain when they were young, has become a serious liability to their capacity to form satisfying relationships, or lead fulfilling lives.

This is part of why the relationship between a therapist and a patient becomes so important. Because as a therapist becomes more important to a client, the pain of the end of a session, the weekend, or of a holiday can become unbearable, in the same way as the mother’s, a partner’s, or a friend’s absence.  Naturally, a client will deal with this pain by their old tried and tested method — they’ll cut off. But this will mean that in some way they start each session afresh, needing to re-establish a relationship, before any other work can be done.  And of course, they’ll lose the capacity to reflect on, and learn from what happens in the sessions between them.

But as this is all highlighted by the therapist, the client may find a different way to deal with the pain of absence, by putting it into words.  And as they do this, their ability to recall the past and to learn from it and the present will increase.

It’s slow work.  It’s counterintuitive.  Men, in particular, often find it difficult to see the advantage to experiencing loss/dependence/neediness. Every fiber of their being protests against it.  But as they understand the cost of their “pain free” existence — the absence of intimacy, not being in contact with others, being alone – they may come to make different conscious choices.  And discover that life can indeed be profoundly different when one can bear the pain of keeping in touch.

Good Advice or What do Therapists Know

 The first principle is that you must not fool yourself and you are the easiest person to fool.

I believe that a scientist looking at nonscientific problems is just as dumb as the next guy.

Richard Feynman

That was good advice. Good advice costs nothing, and it’s worth the price.

Alan Sherman

I’m going to try to explain why I try to avoid giving advice. And to do this, I will need to start what may be a blog long meditation on what a therapist truly knows, and what he doesn’t.

First let me be clear about a number of things:

  1. I don’t avoid giving advice because I’d be dispensing my services for free.
  2. I’m not afraid of being sued.
  3. I enjoy giving advice as much as the next person.

In a nutshell, the problem for me is that people think my advice would be “expert advice,” that I somehow, by virtue of my profession, know “more” about people and relationships than other people.

(This is, of course a belief shared by many psychotherapists, psychiatrists and psychologists.)

Here, I’m going to try to explain why the general public, and psychotherapists, are wrong in this shared belief.

To do so, I’ll have to confront the thorny issue of what it is that psychotherapists know, or are good at.  (Because I do believe, and of course perhaps I must, that psychotherapists do have something to offer, are good at something.)

The analytic hour is a very unusual construction.  Two people, in a room, both attending to the words and actions of one of them for 50 minutes.  In a psychotherapeutic relationship, these hours occur regularly, at least once a week, often 3 to 5 times a week.  Inevitably, as a result of this very special and unusual situation, a relationship develops, one which dispenses with much of the ordinary stuff of conversation.

Through their training, therapists learn the idiosyncrasies of this very special situation.  This learning occurs both from their training analysis (psychotherapists usually undergo a long therapy themselves) and from their teachers and supervisors.  The theory they learn (Freud, Bion, Klein, Lacan, etc.) is mainly written by therapists who have spent most of their lives practicing, and who have gained most of their understanding from reflecting on what happens in the analytic hour. It helps give the trainee therapists a language and frameworks within which to understand the phenomena that occur between them and their clients.

(Of course psychoanalytic theorists do not just draw from their experience in the consulting room — they bring ideas from many other disciplines to shape and illuminate their thought.)

So far, so uncontroversial.

Often, the theory is written as though it will help create an understanding of everyone, or as it’s frequently conceived, the human mind.  So, though based on the practice of sitting in a room with someone for an hour (with particular constraints on the therapist, and a very specific take on how what happens should be understood), the knowledge is generalized to all of humanity.  Stages of development, growth, aspects of mind, etc.

This is one reason why psychotherapists are prone to mistake themselves as experts on the human mind, human behaviour, even human being.  The theory they study lends itself to this confusion.

But I don’t believe this is the crucial reason that psychotherapists so often end up “fooling themselves.”  That is to do with another peculiarity of the therapeutic situation. The way in which clients come to regard their therapists as wise, intelligent, exceptional human beings.

Some of this is transference, of course.  (That is, clients project onto therapist the wise, emotionally intelligent parents/mentor/holy man they wish they’d had in their lives.)

And some of it is because in this very particular situation, in which:

  1. they are constrained not to speak of themselves,
  2. all their attention is focused on the other (except as their own responses might illuminate the actions, unconscious or otherwise, of the client)
  3. they have the space and time to be thoughtful, to think before they speak, and
  4. their training and the contractual relationship with the client means they are not relying on the client to satisfy their own needs,

a therapist can be thoughtful, wise and emotionally intelligent.

In other words, in the analytic hour, a therapist can be a true mentor, not because they give advice – therapists are warned against this – but because they help their clients articulate their difficulties, their desires and their goals.

The way Lacan puts it is that the therapist is in the position “of the one supposed to know.”  That is, for the purposes of the analysis, a therapist allows him/herself to stand in the place of the wise/intelligent/holy other, a focus for projection.

The trouble with this position (and this problem is not unique to therapy) is that someone standing in it, can begin to believe they are indeed wise/intelligent/holy, that they truly understand the human mind and human behaviour, rather than, as I would argue, at best, they have a profound understanding of a very particular human situation, the analytic hour.

In the Meno, Socrates talks about the knowledge of virtue, and how, you would expect that if someone truly understood virtue, was truly wise, they would be able to pass it on to their children, or teach it. He concludes that no one truly understands virtue, because even those who are virtuous or wise, have children who are most certainly not.

I believe the same argument applies to therapists. If they did truly understand themselves and others in the way they sometimes imagine, you would expect their relationships with those with whom they are intimate (partners and children) and colleagues would be relatively straightforward, perhaps even virtuous.

This is clearly not the case.  As a field, psychoanalytic organizations are as prone to schism, bullying, arrogance, envy, contempt for colleagues, disregard of inconvenient truths, as any other group of people.  (There is, of course, also generosity, sympathy, respect for true learning and understanding, etc.) Neither is it obvious that the children of psychotherapists are better adjusted than those of say plumbers or policeman.

To return to the question of advice, I would therefore say that outside the area of their expertise, the consulting room, a therapist is in the same position as a scientist looking at non-scientific problems – just as dumb as anyone else.

I know this.  And while I believe I’m competent, even in my more fanciful moments, gifted, in the practice inside my consulting room, I have no illusions about my “expert knowledge” outside it.

That’s why I don’t like to give advice, especially if it is understood to be “expert.” But if you have a problem with Microsoft Word, well, ask away!