(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, served as its president in the early 1990s, and chaired its Ethics Committee for from 1995 to 2010. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

Problems of love should be deferred to the poets, or so the French Psychoanalyst Jacques Lacan believed. If you happen to be in the throes of feeling in-love, then you will agree that Lacan was oh-so-correct. Yet the psychoanalytic field of attachment theory – immensely popular during the past 50 years – delves precisely into that realm, and all from the perspective of the white-coated garb of the 20th century Man of Science. Attachment theory started with the work of John Bowlby during 1958. Later, led by Psychologist Mary Ainsworth and others during the 1960s and 1970s, it flourished. She proposed four basic patterns of “attachment:” secure, anxious, avoidant, or disorganized.

When approached from an observational perspective, attachment theory offers useful ideas. Simply by observing the body language, verbalization patterns, and similar phenomena at an airport bar, for example, the trained observer may well be able to discern whether a particular individual enjoys one or another attachment style. If you observe the pilfering of a wallet from an attractive woman’s purse, perhaps you may well be witnessing a manifestation of a disorganized attachment.

These are extremely useful ideas, but only in certain limited contexts. When making a referral to another therapist – let’s say because the psychotherapist’s attachment capacity has so collapsed that she becomes obsessed about retirement or suicide – some information about the patient’s attachment style may well be helpful. Subsequent psychotherapists would then have a response set to guide them in understanding how that person connects to others. Certainly this could be helpful in understanding patients’ interpersonal experiences, and of course even in the way they might form a connection to the psychotherapist.

But from the point of view of the patient, what matters is “love,” not attachment. This is one of the many problems resulting from the famous APA Scientist-Practitioner Model. Scientist-psychotherapists must beware of the immense gap between the external observation of human experience and internal, subjective experience. This massive fissure – between observed psychology and experienced psychology, between the “It” and the “I” – has been haunting professional psychologists since their profession limped away from philosophy during the last century. Descriptions of attachment are all well and good; but from the perspective of the patient with the rejecting mother, for example, or the distant boyfriend, what is missing is ….. LOVE! Real people feel fear, yearning, loneliness, and emptiness; real people do not experience “anxious attachment.”

Further, the training of professional psychotherapists immersed in this and similar 20th century logical positivistic models risks missing the real experiences of real persons. And these can only be ascertained by listening – and listening extremely carefully – to those consulting you. Again, ideas from attachment theory certainly help us to characterize and categorize; they help us to communicate with one another. But they also may interfere with our ability to really hear those seeking our help.

I have long believed that, if you want to work as a psychotherapist, for God’s sake don’t study science or psychology! Study the fields that best capture the human subjective experience – poetry and prose, philosophy and political science, history and anthropology. This is the literature of human subjective experience.

Staring into this immense chasm between objective observation of human experience, and subjective experience itself, poet W. B. Yeats wrote of his despair in ever finding comfort from the categorizations of the natural sciences. His words offer a fitting example of where the rational lexicon of scientific psychology ends and the artistic language of poetry begins. In The Circus’ Animal’s Desertion (1939), Yeats writes in a fashion that speaks to the real human experience:

Now that my ladder’s gone

I must lie down where all ladders start,

In the foul rag-and-bone shop of the heart

(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, served as its president in the early 1990s, and chaired its Ethics Committee for from 1995 to 2010. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

Because it sprung from the loins of psychiatry during the 1950s, clinical psychology, a bastard child, necessarily grew up in the medical model family. Medical discourse has since remained the primary way psychotherapists organize their professional work. But, truth be told, the actual work of most psychotherapists never really fit into this restrictive, logical positivistic viewpoint. Psychotherapists work within a societal medical system in which they don’t belong. As a result, they suffer a certain form of alienation.

As Thomas Szasz argued, medicine is organized around organ systems. Cardiologists focus on the heart, neurologists on the nervous system, and orthopedists on bones and ligaments. Psychotherapists, in contrast, work with persons’ subjective experiences – phenomena that cannot be reduced to physiological classification.  They read between the lines of patient’s concerns, searching for layers of meaning rather than underlying disease. They meet with whole persons – individuals living their lives, making choices, dealing with vulnerability. Their work eschews a focus on symptoms.  The medical model for providing “psychotherapeutic treatment” to persons is, well, a lie.

As I argued in an earlier column, even the word “psychotherapy” is absurd. It implies that a distinct entity – the psyche – has become diseased in some way and therefore in need of treatment – the therapy. This is patently inaccurate. The “psyche” betrays clear definition. Any “therapy” for it, therefore, becomes equally dubious. The term “psychoanalytic” is similarly problematic. In it, that awkward word “psyche” appears again, and is supposedly subjected to “analysis.”  The actual “psychoanalytic” process involves more synthesis and integration. Its essence is relating, not investigating.

If we are to strive for accuracy about so-called psychotherapy, a “procedure” now more than 100 years old, the phrase “transformational encounter” would be more accurate. Psychotherapists meet with real people with real life struggles. “Patients” seek help because, they believe, something needs to change. They may be uncomfortable with certain types of mental pain, i.e. they feel depressed, anxious, or hopeless. But at the same time some aspect of their lives has become untenable: They are dissatisfied with their work; they feel unfulfilled in their marriages; they have become alienated from others; they regret the way they have treated their friends. Even if “patients” complain because something is changing, i.e. they are aging, or their children dislike them, or their husbands have left them, they still seek transformation of some sort. They need help, ironically, with change itself.

Along the same lines, the more accurate word for psychotherapist would be instigator. Psychotherapists create perturbations in their patients’ experiences, facilitating a process that ultimately results in emotional, interpersonal, or cognitive alterations.  They instigate change either passively or actively. An initial session, or even a whole set of sessions, may consist of a grieving wife weeping over the loss of her husband. The psychotherapists’ role may consist of simply listening and facilitating the grieving process. This would be an example of passive instigation of change; it occurs, partially, just by virtue of the psychotherapists’ social role.

Psychotherapists also interpret, clarify feelings, offer empathy, and in similar ways become active instigators of transformation. In the example just given, the psychotherapist might take a more active role further down the road of the grieving process. If the wife is still intensely grieving five years after the loss, the psychotherapist or instigator might confront the woman with the ways that grief may have become a defense against facing certain fears, moving on with life, and so on.

These ideas may help reduce the sense of alienation psychotherapists feel, particularly as their highly complex, humanistic work comes under attack by a society that views humans in an increasingly mechanical fashion. If psychotherapists view their work as instigators of transformation within the broad spectrum of the human experience, perhaps they can begin to enjoy a professional identity more in line with the truth of their work.

(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, served as its president in the early 1990s, and chaired its Ethics Committee for 15 years. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

If you view psychological conditions as distinct “disease” entities, then you likely appreciate the existence of cognitive behavioral psychotherapists. They develop skill in categorizing aspects of human experience that comport with DSM IV disorders. They identify empirically validated mechanisms for treating such psychiatric entities. They research and publish studies on the effectiveness of their interventions. But even the most conservative cognitive behaviorists would not consider their approaches to be holistic, to involve the “whole person.” Instead, although they might use kinder words, they treat their patients like some variation of machines that, after some thought-adjustments, can be returned tranquilly to society.

Psychodynamic practitioners, in contrast, listen to the persons who consult them as whole beings, as sentient subjects. They realize that, whereas persons might seek help for “erectile dysfunction,” psychotherapy sessions may uncover more global relational difficulties. They understand that, whereas other persons might present with “depression,” the therapy encounters might reveal a profound disinterest in their life work, or previously unknown conflicts with their family or friends. Similarly, they might help persons with “anxiety disorders” discover that their nervousness betrays an insufficient sense of identity, meaning, or emotional security. All of these underlying subjective themes can become altered through the structured interpersonal process called psychoanalytic psychotherapy.

Despite their various inter-school conflicts, these psychodynamic practitioners share a focus on individuality. To one extent or another, they find guidance in the pursuit of what psychoanalyst and philosopher Jacques Lacan called the subject (who the person really is) rather than the ego (who the person thinks he or she is). This search for the subject is nothing less than a sacred duty, particularly in view of contemporary society’s near-destruction of individuality.

This threat to distinct personhood becomes readily evident when watching late night television. As you have likely witnessed yourself, television commercials pawn medications for every “ailment” – physical, mental, or cultural. They display actors showing a range of emotion, from sadness to nervousness to excitement to exhaustion; they then name these as depression, anxiety, mania, or fatigue; they then suggest that your doctor can provide you with the Lexapro, Xanax, Lamictal or Provigil to eliminate these “disorders.”

The process of naming various mental states, and even identifying them as abnormal, begins in earliest childhood. We are inculcated into the mythology of our families – regardless of our true natures. If the family values education and we struggle academically, then we are sent to tutors, offered special remedial materials, and shuffled off to private schools. If mild, compliant behavior is sought, and we are intense by nature, then we are referred for special education, or perhaps given psychoactive substances to modulate our passions.

Once we leave the family home, we become immersed in a more intensive, all-encompassing propaganda program. The mass media encourages the atrophy of all critical thinking abilities. We are barraged with information defining our experiences. We are told what bodily smells are bad, what behaviors are problematic, and what habits are self-destructive. These mass informational campaigns severely damage individuals’ capacity for finding themselves.

In contrast, psychodynamic psychotherapists focus more broadly on the search for individuals’ desires, feelings, thoughts, attitudes, memories, and dreams. They help the individuals who seek their assistance to find the meanings contained therein. As such, these practitioners will always be ill-equipped to target “diagnostically regulated groups.” They will always fit poorly into the evidence based medicine model. Their work towards the liberation of human individuality – ironically just like individuality itself – will never be subject to neat packaging comparable to “the little blue pill.” While the clarion calls for scientifically-based approaches dominate the popular discourse, these professionals will quietly continue to pursue meaning and individuality – features of the human experience that defy categorization and therefore measurement.

Confusions of Freedom

April 20, 2009

(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, and served as its president in the early 1990s; he has chaired the SGVPA Ethics Committee for 14 years. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

Although it may sound idealistic or even grandiose, the heart of our work as psychotherapists lies in enhancing freedom. More specifically, it lies in expanding freedom of choice. We help liberate persons from self-deception, from tyrannical internal dramas, or even from painful academic, occupational, or interpersonal situations.

The unfortunate name for our endeavor, “psycho-therapy,” implies a discrete entity, the “psyche,” for which a specific intervention, the “therapy,” is provided. This grossly distorts the truth of the matter. The psyche, unlike any other entity to which “treatment” is applied, arises only partially from the biological substrate; it also emerges from such non-material factors as early social relations, culture, language, and socio-economic status. Therefore, ethics and politics, and therefore ideas like freedom, lie at the core of the psyche. Comparing “therapy” for the psyche to “therapy” for muscle pain is patently absurd. The variables affecting the psyche approach the infinite; biological systems clearly predominate in the case of a strained muscle.

Whether patients are highly regressed or extremely mature, we psychologists strive to increase their autonomy. In cases of acutely distressed psychotic persons, for example, we tend to be more active, focusing on reducing distress and improving coping capacity. We might even work on basic activities of living and medication compliance. But we are still striving to increase their autonomy. With highly functional persons, the “problems” for which they seek assistance, whether depression, anxiety, substance abuse, or whatever, also cause restrictions in freedom. While we are of course working to reduce their pain, we are also helping them to freely be themselves, to get out of their own way, and to take actions like improving friendships, obtaining exercise, seeking spiritual solace – all intended to improve the quality and meaning of their lives. We build autonomy and thus greater freedom of choice.

This focus on freedom creates paradoxical problems for psychotherapists as licensed professionals. Due to the laws governing the practice of psychology, and to our society’s litigation-proneness, excessive responsibility falls on psychologists. For example, in accordance with the Tarasoff precedent, we psychologists must protect potential victims of violence. Since the Goldstein v. Ewing case, we must also now consider not only information from patients, but what we learn from patients’ friends or families. We risk being sued or imprisoned if we fail to do so. We have become agents of the state.

Or consider, more benignly, psychologists whose outgoing voice mail messages instruct callers to phone 911 in case of medical emergency. These messages insult the callers, and treat them as if they have no autonomy. They incessantly remind them of what an average two-year old knows: Call 911 or go to an emergency room if you are acutely ill!

These conflicts between the autonomy-enhancing role of psychologists, and the protection of society as a whole, require ongoing and serious consideration. Psychologists have been mandated reporters of child abuse since the 1970’s – another way they serve as agents of the state. But this is not without other societal consequences. Many child abusers, pedophiles, and others who prey on vulnerable children now avoid seeking help from psychotherapists. They view us, correctly, as informants. State legislators now contemplate making domestic violence a mandated reportable event. Where will it stop? Will we be required to summon the police the next time adolescents advise us they are smoking Marijuana?

This dilemma was brilliantly addressed centuries ago by the motto of the French revolution: Liberty, Equality, and Fraternity. Be all that you can be (liberty), be considerate of others as you do so (equality), and remember that we are all in this together (fraternity). In applying our method of enhancing personal freedom, we psychotherapists will always be emphasizing liberty for individuals, within their particular social context. Certainly we do our work in a broader societal context but, in the final analysis, our loyalty lies to the agency of the person, not of the state.

(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, and served as its president in the early 1990s; he has chaired the SGVPA Ethics Committee for 14 years. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

As if finding true individuality weren’t difficult enough, Derrida, Foucault, and other post-modernists make discovery of the “real you” near-impossible. They suggest that individuality cannot exist free from the influence of the “other.” The search for individuality, however intense, requires an equally passionate understanding of what French psychoanalyst Jacques Lacan terms the “Big Other” – a subtle set of rules, encoded in language, encoded in the culture, that influences how we view self and other. The Big Other manifests like an over-riding internal object, similar to the Freudian superego, but bigger, more diffuse, more subtle, and more a function of culture.

In the world of object relations, the concept of a “dynamic structure” speaks to the same phenomenon, but on a smaller scale. W.R.D. Fairbairn, the Scottish psychoanalyst who proposed this unique idea, believed that representations of self are always linked with representations of other. If we feel proud of our work after a particular psychotherapy session, “internal objects” applaud while parts of our “egos” or selves experience a feeling of success. The concept of the dynamic structure was a key development in the history of psychoanalysis, but does not go far enough because it ignores culture.

The Big Other incorporates culture, or even God, and affects us in any number of positive or negative ways. For example, the Big Other beckons unknowingly when someone reaches out to shake our hand, and we reach out ours in return. The Big Other lies behind any number of ethical behaviors, from making coffee for our suitemates to calling them when patients appear in the waiting room at the wrong time. Derrida considers God to be the “transcendent signifier” or the ultimate “Big Other.” If we resist our impulse to murder our suitemate, we are likely responding to an injunction, as Derrida would say, from the Big Other.

Now the Big Other also influences behavior in less positive ways. It motivates us to purchase unneeded items because of a shared cultural belief that we’ll feel more fulfilled after doing so. It may cause us to feel irresistibly drawn to eat at a new restaurant, or see a particular movie, just because we’ve heard “critics” or friends rave about them. (Critics themselves, who are nothing more than other individuals, serve a powerful if absurd Big Other function).

But the presence of the Big Other may be way more subtle and unpredictable. At a recent holiday open-house, a colleague whom I’ll call Jonah found himself talking to a female of easy wit and sparkle. Despite his staunch commitment to marital rectitude – he is, as some would say, very married – he was irresistibly, passionately, dangerously drawn to this enchanting woman who was not his wife. But suddenly Jonah crashed to earth. Not because he recovered his sense of propriety or moral equilibrium. No. The encounter terminated when the future love of the rest of his life announced that she was building a second home in Boston – a city Jonah despises with mythic, pathological loathing. He clings to this deranged repugnance for a city that’s no more or less hateful than any other city or town. Here the Big Other manifests as Boston, and in an immense way. Reeling with alienation, Jonah abandoned his ex-future-wife and headed for the wine table (which promised yet another Big Other experience).

The Big Other will always exist, in one form or another, and will always play a major role in our behavior. Individuality can only be found nested within it. But interior “Bostons” can also be stifling (even though, ironically, Jonah’s Boston may have saved his marriage!). Such versions of Big Others inhibit us, create anxiety, confusion, ambivalence. They block the path towards authenticity; they prevent us from heeding the Greek poet Pindar’s injunction to “be who we are.” We must keep searching for individuality anyway. After all, no one from the ancient Greeks to those French postmodern guys ever said this crazy search for self was for the faint of heart.

(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, and served as its president in the early 1990s; he has chaired the SGVPA Ethics Committee for 14 years. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

Simply put, psychoanalytic psychotherapists enter into intimate but bounded relationships with the persons consulting them, become embroiled in their internal dramas, and then interpret rather than enact them. Ideally, the process unfolds with both emotion and containment, facilitating a helpful shift in personality. But this requires tremendous self-discipline. Much of the training, personal psychotherapy and continuing education of psychodynamic psychotherapists serves to help them manage these highly intense encounters.

Last Spring, I provided a brief course of psychotherapy during which this dramatic re-enactment process unhappily derailed. I offer this brief and fictionalized recounting in the hope that you can avoid a similar fate. At that time, a gay attorney named Joey consulted me weekly for help breaking a pattern of aborted intimate relationships. He was in his young 40s, and had been in three significant romantic relationships, each lasting more than five years, and each ending in the same way. He would begin the relationship highly idealizing his partners– usually for their occupational achievement as doctor, lawyer, or celebrity actor – and then end with a gradual devaluation of them leading to his termination of the relationship.

By the end of the first session, I was already wondering how and when this pattern would repeat itself in the transference relationship. I actually interpreted this early on. Joey initially rejected the possibility that this idealization-devaluation cycle could be repeated in our work, citing the “outward signs” of my occupational success.

Approximately three months later, and just as I was beginning to experience the excruciating back pain that ultimately led to my diagnosis of endocarditis, Joey left me an angry message immediately after a session. He felt criticized at my having mentioned that he appeared sad. He was furious that I’d made him so aware of his appearance. I had no hint of his having reacted this way during the session. My recollection was that I had offered the observation with great empathy and sensitivity.

Perhaps because of my own vulnerability, I reacted strongly, and with intense concern. I immediately called him, acknowledged that I’d received the message, and invited him to come in before his usual weekly appointment to discuss what had occurred. Over the next few days, as we exchanged messages looking for a suitable extra session time, I felt increasingly anxious myself. Could I have been too aggressive in the way I pointed out the sad facial expression? Could I have been more critical than I remembered? I felt increasingly vulnerable and inadequate myself.

With each message that I left offering alternative meeting times, Joey’s negative responses escalated. This set of interchanges culminated in his ending the brief course of treatment by voicemail message. I left a final message offering a termination session to at least review what had occurred. I never heard back from him.

Now having the benefit of more than six months of retrospection, I view the experience as a painful but enlightening example of transference-countertransference run amok. If I had it to do over again, I would have simply left one message of acknowledgment with an invitation to come in sooner to discuss what occurred. I believed instead – real or imagined – that Joey needed the contact, that he needed a more overt invitation from me. In doing so I may well have initiated the same cycle that had led to his seeking help in the first place. The more vulnerable I became, the more he devalued me, finally leading him to terminate the treatment in much the same way that he’d ended many romantic relationships in the past.

So what lessons can be taken from this sad tale? Never forget the power of the drama of the person consulting you or of your own personal vulnerability to become negatively embroiled in it. Perhaps most significantly, remember the crucial importance – more than maintaining an observing ego, more than carefully managing boundaries, more than remaining emotionally attuned – of this commonsensical trait: Patience.

Obsessive Ruminations #4

(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, and served as its president in the early 1990s; he has chaired the SGVPA Ethics Committee for 14 years. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

As they enter the consulting room for their first meeting with a person, psychotherapists should feel terrified. They enter the room with, well, nothing. They carry no technical devices. Unlike physicians, who have any number of tools from blood pressure cuffs to electrocardiographic machines, psychotherapists have only themselves. Unlike attorneys, who take notes, refer to legal authorities, and compose official documents, psychotherapists offer only ideas and emotional responses. They present in an exposed state; they carry only their inherited or learned psycho-biology and their knowledge of whomever of the various theorists they have found the most influential.

This nakedness notwithstanding, persons seeking the services of psychotherapists arrive with expectations, even demands. They complain of stale marriages, paralyzed employment situations, or painful emotional states. They request solutions and relief. They insist their psychotherapists take action. This combination of demand, on the one hand, and lack of technology, on the other, creates unease if not abject anxiety in psychotherapists – particularly in the early stages of their work.

How do they then cope with such vulnerability? Some psychotherapists take refuge in dogmatic theoretical approaches. For example, if they have the conviction that all psychopathology results from pent-up aggression and envy, they will view problems exclusively through this lens. If they believe that failures of empathy are the cornerstones of psychological difficulties, they will conclude that emotional troubles result solely from interpersonal deprivation. And so on.

At the other end of a continuum, some psychotherapists eschew theory, and practice some variety of “rent-a-friend.” As one colleague put it, somewhat crassly, psychotherapy is “a love affair without the affair.” Perhaps these psychotherapists are helpful, but they run serious risk of violating the patient, crossing boundaries, or otherwise failing to adhere to the fiduciary aspect of the psychotherapeutic contract. “Patients” are paying a fee for a service, and if only love and friendship are provided, their “sessions” smack of a variant of prostitution.

Striving to find the “middle zone” between these two extremes, psychotherapists face incredible complexity and uncertainty. Even within the confines of the psychoanalytic model, for example, wide variance in theory exists. Different theorists hold that psychopathology results from deficits in maternal care, from intra-psychic conflicts, from unresolved Oedipal complexes, from pent-up aggression and envy, from repressed sexual urges, from existential concerns like fear of death, or from primitive mental states characterized by excessive splitting and projective identification.

Ideally, all these variants should not be causes of anxiety but embraced as part of the beauty and fullness of human experience that psychotherapy uniquely mediate. Psychotherapists do face incredible ambiguity. They should feel awed and humble. They err if they are too rigid in theory; they err if they are too loose. They must struggle to find their way between these two extremes – all the while keeping an open a mind.

But keeping an open mind is anything but easy, particularly when feeling uncomfortable. G. K. Chesterson once wrote that “an open mind is like an open mouth, it looks for something hard to bite into.” Psychotherapists must avoid biting into anything hard. In his recent book called The Black Swan, Nassim Taleb describes theory as “like medicine (or government): often useless, sometimes necessary, always self-serving, and on occasion lethal.” He suggested that theory “be used with care, moderation, and close adult supervision.”

Hopefully, psychotherapists cherish the mystery of the persons who sit before them. Hopefully, they strive to understand what they speak, feel, or display, and then respond in a unique fashion. And as they navigate through the clouds on their lonely journey towards helping others, they can ultimately rely only on this: Their own sense of integrity.