Starting psychotherapy

When people come to see a psychologist/psychotherapist, they have relatively little information as to what to expect, other than what they have picked up incidentally from television dramas and the like.  Some therapists like to provide as little information as possible (a tactic dating back to early psychoanalysis) in order to determine what the assumptions and preconceptions the prospective client may have.
What the patient understands and expects may have little in common with what the therapist understands.  Often patients expect that we will fix something that hurts psychologically, just as they would expect a physician to fix something that is wrong physically.  They may take a passive stance, waiting for the therapist to direct or prescribe just as a physician might.  When the therapist doesn't do that, the client has no clear idea as to what should happen next in their treatment.

Currently I am starting new patients off with a short introduction.  Of course, it begins with some questions intended to get an idea as to what might be wrong.  If the problem is a simple reduction in unpleasant symptoms, such as a recent depression or sudden increase in anxiety, I can tell them what techniques I will be using and about how long it will take.  I can tell them what the financial and personal  costs are likely to be.  I can tell them exactly what I expect them to do and the outcomes they can anticipate.  But if the problem is a more complex one, such as when the symptoms arise from conflicting values and/or a dysfunctional life style, I use a different approach.

I tell them something like the following:  I will work with you to show you how to make changes in your life.  I can't make the changes for you.  You will have to decide what kind of person you wish to become over the years. You are in charge of who you will become, and every choice you make will brings your goal closer or moves it further from you.   Sometimes people make changes quickly;  more often they need more time to make them, so I can't tell you how long this might take.  I believe that is up to you.  My job will be to get you started along that path and show you how to continue it on your own. 

 To help you make those changes, I need to know who and what you are now.  I need to know what you believe and how you behave in accordance with what you believe.   Your part in this process is to demand of yourself uncompromising honesty.  Lies or dishonesty, whether of omission or commision, will stop the process of change.  Begin by telling me about yourself, what is important to you and what doesn't work, and we'll see how it goes. 

Since new patients are frequently uncomfortable with the idea of criticising the therapist, I am hoping that you as a reader will be willing to comment as to how you might respond to this beginning to therapy.

Losing weight

Like most psychologists, I see many obese patients.  They inevitably have the same story of how they have tried to lose weight or actually lost it, only to immediately regain the weight they had so laboriously lost. 

I have come to a working conclusion as to what went wrong and what might be tried to fix the problem.  All these patients had something in common beside their overeating:  what little pleasure they had in their lives came from eating.  They had no real fun or pleasure from other sources, except such passive pleasures as watching television, playing around on a computer or reading.  When they set themselves to losing weight, they became increasingly unhappy.  The primary source of joy in their lives was shut off.  Their only positive rewards were in what seemed a distant future.

The solution to the problem may lie in the following suggestion:  We should not give up eating until we have developed another source of pleasure in our lives that is as frequent and rewarding as food.  Food is easily obtained and is always satisfying.  What will we find to replace it?  Exercising is rarely a source of joy even remotely comparable to food, so that's not going to do it.  No one prescription will suffice, because the source of our happiness and joy is peculiar to us as individuals.  We must have access to this source of satisfaction as readily as we do to food.

It's hard to lose weight.  It becomes harder when our lives are joyless.  And we can't count on joy in the future.

The Price of Personal Freedom

Personal freedom and its costsThe central idea found in Buddhist philosophy (especially in Zen Buddhism) is “enlightenment”, which means (among other things) the recognition of one’s absolute personal freedom.  Freedom, as described by Zen philosophers, arises from full awareness (satori), which in turn arises from the recognition that all human rules and boundaries are essentially self-created and self-imposed.  Freedom thus presents the individual with the possibility of existing in a boundless, open universe which imposes no personal nor moral obligations.

Humans seem to prefer to operate as if they had far fewer choices than in fact they have.  Perhaps we find having essentially limitless choices overwhelming.  Certainly many (or most) of us are more comfortable with a relatively limited outlook, restricted choices, some self-chosen obligations and the like.  Where there is an empty boundless plain, we like to construct fences and to constrict our world to what we have confined inside them.  By doing so we easily may become less aware of the choices that we make every minute.  In a sense we usually prefer to operate on automatic pilot, as if all our choices have already been made and don’t require any further thought.

It’s not very practical or useful, for instance, to try to choose among the hundreds of actual choices available to us each second.  For instance, at every intersection we can choose another direction, or decide to get out of the car and walk, or hitch a ride with a stranger to wherever they may be going, and so endlessly on.  It’s far easier to ignore all the choices that we could make, or to assume that they are already irrevocably made, and just keep on keeping on.  By limiting our awareness of our choices we gain convenience and ease but we lose some of our sense of personal freedom.

Every day I see people who feel “trapped” and powerless, unable to find ways to change their situation or even to see that there might be such ways.   I sometimes remind them that there is literally nothing to stop them from “changing your name and moving to Seattle”.  They tend to treat such a comment as a joke.  Another “joke” I tell people:  A drunk presses up against a light pole on all sides.  After he goes completely around, he falls to his knees and shouts "I'm walled in!". 

Freedom is a very real thing.  Zen literature is full of examples of Buddhist monks demonstrating the abitrariness of their rules:  The student asks the master “What is the nature of the Buddha?” and receives an arbitrary answer:  a dried up stick, or perhaps a slap in the face.   The point is made that although the student is obeying "the rules" as he sees them, the master is demonstrating the triviality of the rules themselves by stepping "outside the box", and it is hoped that the student will awaken to reality.

 It should be clear that freedom is not something we achieve through meditation (or medication) but something that we already have. We already have the capability of acting with freedom, that is, without reference to what we consider to be "the rules".  We can do as we like.  We can go off “automatic pilot” and control our lives directly.  We can move to Seattle and change our name.  Nothing stops us but our unwillingess to act freely. However, what is not clear is that the price for such freedom may not only be the loss of personal possessions but the end of our belonging to others that we love.

No human relationship can survive in the total absence of rules.  We like to be able to predict what will happen at dinnertime tonight, at least to some degree.  We want some stability in our relationships and our lives.  In fact, we are willing to sacrifice some of our freedom in order to obtain stability and predictability.  In that process, however, we may forget that the sacrifice of some personal freedom is a choice, and that we may unmake that choice just as we made it.  

Freedom means no obligations of any kind, given or taken.  We are free to walk away from our job or our marriage, for instance, but we can't take them with us.  It is true that our "obligations" are arbitrary and self-imposed;  at the same time there is a price for discarding them.  Our relationships become unstable or disintegrate entirely.  Who will stay with us and love us if we cannot be expected to repay the gift?  Who will pay us money for work that we may or may not do?  It's not an accident that the wise Masters in Zen stories live alone in the forest, or teach for handouts.  And there seems to be nothing in the stories about them that implies happiness or satisfaction.  Freedom?  Yes indeed, but without the human relationships that give our lives much of their meaning.

It's also the case that we tend to become afraid of freedom.  When choices are actually endless, how do we make one?  Perhaps it doesn't matter what path we choose, but most people don't find the prospect of a trackless, pathless universe very comforting.  We tend to choose the devils we know rather than those we don't know.  We also forget that this act is a choice.  We are not limited unless we choose to be.  There is also a great deal to be said for being limited as long as we do not forget that being limited is a choice.