Tag Archives: psychotherapy

The Paradox of Hope

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HopeAt a recent storytelling event ushering in the New Year, audience members were asked about their resolutions: “To give up hope only to regain it,” one woman said.

This echoed something I’d heard just weeks before at a clinical meeting I facilitate, when I asked the staff to share something they were doing for self-care. A colleague who unfailingly sees the best in everyone surprised us all by saying she had given up hope, and was thus no longer so prone to disappointment.

Hope, we are told, springs eternal, so such dissents from the cultural imperative to uphold it are rare. Nowadays it often seems the more difficult things become, the more we are forbidden to feel hopeless. We are urged to look on the bright side, keep gratitude journals, embrace the lessons of hardship. And no wonder: It is difficult to live in despair.

Exercises cultivating resilience and hope can bring genuine relief, broaden perspective, even pull one back from the brink. They can also preserve relationships. Being around someone who despairs is also difficult, and in lieu of outright fleeing, it is tempting to extend a lifeline. Yet who really escapes—the person feeling hopeless, or the person who cannot bear to listen? Those who are unable or unwilling to be coaxed out of sorrow might soon find themselves alone.

Our clients know this (or at least the lucky ones do). They worry about burdening or alienating others, fear wallowing in hopelessness. So they bravely try to focus on the positive, often with felicitous results. Yet the more people feel compelled through internal or external expectations to disguise despair, the more pinched they become. It is as if they squeeze themselves into emotional Spanx to keep everything contained and looking good.

Psychotherapy offers the relief that comes from shedding such constraints, breathing freely, and being one’s natural self. The terrain of hope and despair is tricky, though: therapists must help clients navigate the depths of unbearable pain without stranding them there. Often we see ourselves as the guardians of hope. Yet we must never impose it. We would do well to remember the famous story of a patient in analysis who said that the only time he felt hope was when his analyst agreed with him that it was hopeless, but that they would carry on together anyway.

It is when we make room for hopelessness that hope, too, might find a little space.

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What are your thoughts on the balance between hope and hopelessness?
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Originally published in Impulse, an online publication of the Northern California Society for Psychoanalytic Psychotherapy

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Talking Cure

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Conversation

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.

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

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

Her/Us

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Her Movie PosterThe movie Her is a love story for our times. People pass one another without interacting, fixated on their electronic companions. Theodore, who writes others’ love letters for a living, is especially disconnected after his marriage breaks up.

Into the void steps Samantha, the perfect partner. Except that she isn’t real. Or is she? Samantha’s an operating system endowed with artificial intelligence. She has a consciousness. But whose? Her own, as it evolves through “lived” experience? The programmers’? Theodore’s? Perhaps Samantha is solely a projection of Theodore’s desires, a fantasy for which reality is no match.

The parallels to psychotherapy are many. How real is the relationship between therapist and patient? The work is intimate, yet we remain hidden. Distance and closeness are carefully titrated. Fantasy and projections–key transference components–abound. The real/unreal paradox is fertile ground in therapy, as it is in Her.

Theodore, meanwhile, turns not to a therapist but to technology. Asked to describe his relationship with his mother in order to personalize his operating system, Theodore says it’s fine, except that everything’s about her. Samantha (or at least her voice) appears, “an intuitive entity that knows and understands” him and anticipates his every need–the ideal mother/lover. Who doesn’t wish for perfect mirroring as an antidote to early wounds when undertaking love–or therapy?

Initially Samantha is all about Theodore. With her help, he starts to feel better. As with the mutual influence of therapy, Samantha, too, grows and changes. All is well, though trouble rumbles in the background. The idealizing transference soon becomes eroticized. Disappointment inevitably follows the intrusion of reality into fantasy. In an echo of how clients are loathe to share their therapists–or children their mothers–Theodore is dismayed to learn that Samantha is not there for him alone; she’s the operating system for over 6,000 people. Like Theodore’s mother, Samantha increasingly develops her own interests. “I’m yours and I’m not yours,” she tells him. Worse, the pain Theodore’s fantasy is designed to defend against is recapitulated: Samantha leaves, just like his ex-wife.

Is it abandonment? Or a developmentally appropriate separation? Samantha may start as an extension of Theodore’s psyche, but, as with healthy infant-mother pairs, they end as two distinct individuals. (Perhaps it’s part of the design!) Coming to terms with disillusionment, Theodore can finally write his own love letter to his ex-wife. He retrieves his projections, fully feels and mourns, and thus moves on from loss. Perhaps Theodore is even ready to try the whole disappointing, glorious mess of human connection again. For only when we can tolerate that the other is not an extension of ourselves, but another full and complete separate person can we risk ourselves for love–for real.

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This piece appeared originally in NCSPP’s “Impulse,” a publication for analytically oriented therapists in Northern California. What did you think of the movie?