You Pays Your Money and You Takes Your Choices

We are defined not by our abilities, but by the choices we make.

Posted Jul 30, 2015

After receiving my Masters degree in Social Work in 1987, I went to work as a psychotherapist at an outpatient psychiatric clinic for adolescents and young adults located in a brownstone on 19th Street around the corner from 3rd Avenue in the Gramercy Park section of Manhattan. The model of psychotherapy there was explicitly psychodynamic. The psychodynamic approach is an offshoot of psychoanalysis and psychoanalytic psychotherapy.

As a generalization, this approach is longer-term and therapists at clinic had the luxury (unusual even by the practice standards of the late 1980s) of working with clients on a generous sliding scale without constraints on the number of sessions allowed or the length of stay in therapy. Some clients had been in treatment there for multiple years. Another unusual aspect of this work environment was that it provided an intensive formal training program in psychodynamic theory and practice. The overall attention to clinical supervision and training was extraordinary—it was almost like working at a post-graduate training institute, and it proved to be an ideal incubator to learn the ropes of psychotherapy.

Every therapist was required to have a monthly case consultation with the Medical Director, an eminent psychiatrist, Dr. Eugene Glynn, MD. Dr. Glynn was a brilliant psychodynamic deconstructionist with a quiet but intimidating demeanor. His case critiques were legendary for being sharp and unsparing, and anticipation of these consultations routinely evoked palpable dread, even for the savvy and highly skilled therapists who had worked with him for more than twenty years.

Prior to my initial meeting with Dr. Glynn, a number of them told me grisly anecdotes about having their work ripped apart, experiences akin to verbal evisceration. I braced myself—if this was the experience of people infinitely more experienced & skilled than me, what could I expect? When it came to my psychotherapy knowledge and skills I was still learning how to differentiate my ass from third base.

While his feedback and criticism could be pointed, Dr. Glynn was much kinder and gentler with me. Perhaps his seeming mercy was based on a sense there was little to be gained with harsher criticism. To my surprise, he complimented my apparent ability to engage oppositional adolescents; in the process teaching me that just getting such clients to show up and continue in therapy was a big deal. Sometimes what we anticipate is considerably worse than the reality that unfolds. As Mark Twain put it, “I have been through some terrible things in my life, some of which actually happened.”

Dr. Glynn was also the long-time partner of renowned children’s author and illustrator Maurice Sendak, who’s Where the Wild Things Are, happened to be my favorite book in early childhood. My guess is that Dr. Glynn had some influence on Mr. Sendak’s insightful depictions of the powerful ambivalence & deep intrapsychic conflicts intrinsic to childhood. During my tenure at the clinic, Dr. Glynn articulated many observations and insights that helped to elevate my clinical knowledge and understanding. Often, these were highly complex psychodynamically-oriented formulations, requiring me to strain my cognitive capacity to unpack their meaning.

Yet, the statement that resonated most deeply for me over time was among his most simple—at least on the surface: “You pays your money and you takes your choices.” It was a paraphrase of a line from Mark Twain's Huckleberry Finn.

When Dr. Glynn first shared this with me in the context of a case consultation, I was taken aback because it seemed so elemental. My reaction resembled that of my initial exposure to certain twelve-step recovery sayings that at first glance seemed superficial and trite. However, on further consideration, aphorisms like “One day at a time,” “This too shall pass,” and “Keep it simple,” are succinct statements of universal principles imbued with great depth and wisdom.

Similarly, as Dr. Glynn was communicating to me via the parallel process of clinical consultation, the choices we make are often more important and reveal more about who we are than our particular abilities. Moreover, we can make whatever choices we want or need to—as long as we are willing to accept the consequences of those choices. This equation represents the intersection of awareness, action, and accountability. And, it is applicable to virtually every area of life.

Copyright 2015 Dan Mager, MSW

Author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain