Talking Cure


Sherry Turkle, a sociologist and psychologist who studies the impact of technology on relationships, wrote recently about the need for face-to-face conversation in a world increasingly dominated by texting and smartphones. It is through this “talking cure” that we build empathy, intimacy, and self-reflection, coming to know ourselves and others deeply.

Turkle wasn’t talking about Freud, but she was describing the mainstay of psychotherapy.

Soon after Turkle’s essay appeared, new research questioning the efficacy of talk therapy in treating depression made headlines. That same day, I listened to a podcast about Dr. James O’Connell, who has been providing healthcare to Boston’s homeless population since 1985.

O’Connell’s approach is more art than science.  He described having to unlearn the techniques and arrogance he’d perfected as an ER doctor when he took a job at a homeless shelter. The nurses, unimpressed with his skills, advised him to keep quiet about his medical expertise. They instructed O’Connell to spend his first two months doing nothing but soaking the feet of those living on the street.

“Don’t judge, these people have been through hell,” the nurses told him. “You will not gain anyone’s trust without being present.”

O’Connell spoke of the profound isolation and loneliness as well as the tremendous courage and resourcefulness of the men and women he came to know in his decades on the street. He believes the adversity they experienced would have broken him. This knowledge is fundamental to engaging in such hard work:

“We’re all broken in our own way,” O’Connell says. “It’s a connection with that brokenness that actually keeps us going.”

O’Connell’s words took me back to what inspired me to become a therapist: volunteering at a crisis hotline.

I had never before encountered the level of adversity our callers faced—poverty, abuse, addiction, chronic mental illness. Like O’Connell, I was awed by the courage and dignity of those whose lives were unimaginably precarious. The work was hard, but I loved it—the listening, the immediacy of the connection, feeling that my presence made a difference. Nothing much changed in anyone’s life, mine or theirs. Yet everything changed because we mattered to one another.

This is the essence of therapy. Our work is a modest endeavor–a conversation, a space of undivided, unhurried attention and exploration. The talking cure depends on humility and presence. These are the ineffable, unmeasurable things that matter—on the streets, in conversation, and in psychotherapy.


 How do you preserve conversation in a technology-obsessed world? What is the essence of presence for you?


(Originally published in Impulse, the electronic newsletter of the Northern California Society for Psychoanalytic Psychology)


what-if (1)

Phuc Tran, who as a child barely escaped death in the last days before Saigon fell, speaks in a TED talk about how grammar and culture shape one another and create different worldviews. English, he notes, employs the subjunctive tense–the could haves, would haves, and should haves. It communicates hope, imagination, and possibility, but also regret and longing.

Vietnamese, on the other hand, offers no such grammar. Lacking the subjunctive, it traffics in the indicative–how things are rather than how things might be or could have been. Tran credits to this foible of grammar his parents’ resiliency in tackling the survival needs of their transplanted family: “There was no psychic energy drained to focus on what could have been.”

Tran, however, thinking primarily in the English of his adopted country, often imagined the What ifs? of past, present, and future, musings his elders saw as pointless. The subjunctive tense allowed him to dream but also proved a quagmire when life didn’t pan out as he wished it would. “Accepting things for what they are, their indicativeness,” says Tran, “was my first step away from depression and anxiety.”

Tran’s talk led me to reflect upon how often we use the subjunctive in therapeutic dialogue: “What would it be like if you could let yourself ­­­____.” “What could you have done instead?” “How should your mother have responded?” “If you could feel, what might it be?”  The subjunctive softens defenses and helps gain access to feelings, fantasies, and memories, allowing the patient’s experience to emerge without too much interference. Most importantly, it fosters the expansive space in which possibility and creativity thrive.

Yet “the dark side of the subjunctive,” as Tran calls it, can lead to fixation on an unchangeable past. We see the dilemma play out between what we might call the more indicative approaches, like CBT, and the more subjunctive, analytic therapies that plumb the darker recesses of thwarted possibility. Who among depth psychotherapists and their patients has not wondered where the balance lies between past and present, what might have been versus what is? There is wisdom, as well as limitation, in Tran’s father’s outlook.

Mourning what has been lost or never was–and dreaming about what might be–is fundamental. So is acceptance of reality. The psyche, like language, is enriched by both the subjunctive and the indicative.
Where has the subjunctive led you?
(Originally published in the December 2014 issue of Impulse, an electronic publication of the Northern California Society for Psychoanalytic Psychotherapy)



 A client once remarked, in response to another of my misguided attempts to get her to change, “I’m like the goldfish in a bowl of dirty water. Why should I change when it’s the water itself that needs to be cleaned?”

I pondered her words during two excellent recent events: CIP’s “The Neuroscience and Psychology of Resilience,” and TPI’s Fall Symposium, “The Trauma of Everyday Life: Perspectives from Buddhism and Psychoanalysis.” Both helped me appreciate the paradox of the goldfish in the bowl. Can either ever be free of the influence of the other? A pure holding environment is an illusion whose perpetual pursuit leads to misery. Besides, the excreting goldfish always pollutes the water in which it swims. Where, if at all, should we direct our clean-up efforts? My mind leapt from sanitation to sanity to the hyper-sanitization that comes from too much Purell and its psychological equivalent, too much positive thinking. A little murk, like a little dirt, is not only unavoidable; it’s good for us. We suffer less when we relinquish our quest for a world without suffering.

During the Symposium’s lunch break, someone at my table said, “I like this so much better than positive psychology–embracing rather than de-emphasizing darkness in our work.”

A second woman added, “But people shouldn’t brood too long, they need to move forward.”

She went on to tell us about two friends, both highly educated and well-established in their careers and lives until they were wiped out by the recession. Both had lost jobs, all their savings, their homes. One friend accepted what had happened with apparent equanimity, grateful for the $10/hour job he had just found. The other, unwilling (or unable?) to accept a drastically lower income, couldn’t find a job. Our tablemate spoke admiringly of her first friend, reprovingly of the second, whom she characterized as “angry and entitled.”

“Why shouldn’t she be angry?” I asked.

“Mindfulness training and jobs for all!” someone proposed.

We went on to discuss the increasingly toxic and polarized societal waters in which people seem more and more required to swim alone. Clearly the goldfish bowl needs a massive scouring. In light of that reality, better a resilient goldfish than a fish out of water, or out of a job! But how do we bring about enlightened social policy? When is equanimity an exploitable docility, anger the rioter’s rage that destroys one’s own community?