Recently I watched the first episode of a Netflix show called “Gypsy.” The lead character, starring Naomi Watts, is a psychotherapist who develops the bad habit of inserting herself into the lives of the people who are in some way involved with her patients. I’m not sure yet if I will commit to watching the rest of this series, but one plot line from the first episode struck me because it caused a flash of recognition in what I have faced many, many times with my patients, as well as with my loved ones and with myself. It has to do with ‘stuckness.’
Above is a section of mural by the Brighton Street beach entrance in Bolinas California. Photo taken May 18, 2013.
In this episode there is an older woman patient who at every session ruminates out loud to the therapist about the pain her daughter, who is in her twenties and who avoids her, causes her. Naomi Watts plays the therapist well by responding to the patient in a sensible way but only after a pause, a pause that’s a small internal eye roll that means, “For heaven’s sake, can you just get over it? This is what happens when kids are in their twenties.”
I don’t know about you, but many times I’ve had a similar reaction: I face a patient to whom I’ve given very good direction, advice and encouragement, and – IMO – the patient ignores it all and keeps perseverating on the same story of woe, seemingly forever stuck in their pain.
What to do?
Today I wish to share some thoughts on how I think and approach these situations. Please note I’m not saying this is the ‘right’ way to do it – there are many right ways and different ‘right ways’ work for different patients. Also, many readers have much more experience in psychotherapy than I do and this may seem obvious or wrong to you. Please consider this simply as an opportunity to think about your own approach to addressing your patients’ ‘stuckness.’
- People often have good, compelling reasons not to ‘let go’ of experiences from the distant or recent past or of current stresses, even if not letting go causes suffering. It’s my job not to do little eye rolls about their recalcitrance, but rather to understand what compels these ruminative thoughts and their current unwillingness to engage in seeking better solutions.
- I conceptualize these ruminations as a person’s compelling need to first address ‘unfinished business.’ First, the person has to face and address whatever thoughts and feelings they’re having about the experiences of which they can’t let go before they are willing to look for a better way.
- I continually remind myself of Marsha Linehan’s motto, ‘acceptance before change.’ It’s my job to acknowledge and validate whatever thoughts and feelings are wrapped in those experiences that keep the patient stuck. And to help the patient make sense of those thoughts and feelings and come to terms with them. Only then will they be freed to move forward.
- Encouraging a discussion of past events is consistent with CBT. Judith Beck, in ‘Cognitive Therapy Basics and Beyond,’ writes, ‘Attention shifts to the past in three circumstances: when the patient expresses a strong predilection to do so; when work directed toward current problems produces little or no cognitive, behavioral, and emotional change; or when the therapist judges that it is important to understand how and when important dysfunctional ideas originated and how these ideas affect the patient today.’
What kind of thoughts and emotions can be wrapped up in these lived experiences, whether they occurred in the past, continue currently, or are of imagined future events? Here are three examples I’ve encountered in my patients.
- Unwillingness to stop thinking of a deceased loved one. Often related to the feeling-belief that letting go means no longer loving the deceased, and disrespecting their memories and their importance in the person’s life, in the past and now into the present and future.
- Fear of letting go of thinking about a past assault. There’s that phrase, ‘Keep your friends close and your enemies closer.’ Persons who lived through an assault wish to maintain their vigilance in order to stay safe. They may resist reframing or cognitive restructuring if they feel they are being asked or cajoled into letting go of their vigilant thoughts.
- War veterans may resist letting go of the trauma of their war experiences, even if thinking about those experiences triggers PTSD symptoms, if they believe they will dishonor their fallen comrades. Veterans have a strong need to ‘bear witness’ to the death and violence they experienced and to maintain the memories and sacrifice of those killed and wounded.
The way out of these dilemmas is to 1) explore the actual thought and emotional content and 2) come to terms with these experiences by accepting them, honoring them, finding meaning in them, and finding a way to move beyond them by incorporating them in a new understanding rather than in rejecting or forgetting them. Painful experiences must be given a place in the ongoing life of a person in a way that allows that person’s growth and attaining a modicum of happiness.
Returning to the fictional character, the older woman patient in ‘Gypsy.”’ I think the way to help this person move beyond her repetitive descriptions of all the ways her daughter ignores and avoids her is to help her focus on the underlying meanings and emotions of that experience. I might say something like, “What you describe, all the ways your daughter ignores you, is a very common experience among parents of twenty-something-year-olds. And, also, it’s unique to you because no one else has had the experiences that you and your daughter together have had. Tell me what makes this experience of her distancing herself from you so difficult for you? In what ways does it hurt you? What thoughts and images come to mind?”
I could imagine that character responding with thoughts such as these:
- “I remember when my daughter was three years old. I was with her at the park, pushing her on the swing. I remember I had the thought that I wish this would never end, that she and I would be close like this forever.”
- “When she was a teenager I was so busy with work, I hardly saw her. I didn’t help her with her homework and I missed a lot of school activities and conferences. And now, she’s gone and doesn’t need me. I taught her not to count on me, I guess.”
- “Maybe I should have expected that an adult child would grow apart from her parent. But I really didn’t realize how hard it would be. I feel so alone now. I’m afraid we’ll never be close again. I don’t want to die feeling so distant from my child.”
So, allowing a person to grieve over what is no more, to articulate regrets over what happened and what didn’t happen, to admit to their guilt and shame over their own behaviors that fell short, and to face their fears, are ways to allow them to find a home for those painful experiences and to free to move forward.
Until next time,
“The pleasure of remembering had been taken from me, because there was no longer anyone to remember with. It felt like losing your co-rememberer meant losing the memory itself, as if the things we’d done were less real and important than they had been hours before.”
– John Greene, The Fault in our Stars
“No one ever told me that grief felt so like fear.”
– CS Lewis, A Grief Observed