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Essential Secrets of Psychotherapy: The Healing Power of Clinical Wisdom (Part Two)

What psychotherapy patients know that you don't--but need to.

In my previous posting (Part One), I presented, in no particular order, seven secrets of psychotherapy based on what we call "clinical wisdom." For the field of psychotherapy, clinical wisdom consists of certain existential, archetypal and pragmatic truths concerning the human condition, the dilemmas most commonly presented by individuals seeking treatment--to which we are all more or less susceptible--and the various ways in which psychotherapy can meaningfully address and ameliorate them. Some of these secrets may seem obvious and mundane. Others subtle and esoteric. Hopefully, readers found at least one or two that resonate.

Here, in Part Two of this series, are seven more essential secrets of psychotherapy, condensed and diverse kernels of clinical wisdom. Again, the selection and order is more or less random. In this sense, these various secrets function as a psychological I Ching : Perhaps you will synchronistically stumble upon some particular secret that applies to your present situation or speaks to some personal, spiritual or existential issue you or someone you know struggle with. While reading these secrets is certainly no substitute for psychotherapy, such distilled clinical wisdom may be helpful in providing some new perspectives or possibly lead to deeper exploration through psychotherapy, philosophy or spirituality. Psychotherapists might also find this concise compendium of collective clinical wisdom worthwhile--even when not necessarily agreeing with all of it. And, in some cases, may want to add their own nuggets to this eclectic collection. Which I encourage.

Procrastination and the power of presence. Psychotherapy patients often report problems with procrastination. Avoiding doing what needs to be done. Putting off till tomorrow what can and should be accomplished today. One aspect of procrastination is what I call the Sisyphus syndrome. As punishment by the gods for trying to eradicate and evade death, Sisyphus was fated to eternally roll a massive rock up a hill each day, only to have it roll back down just as he neared the top. We all share a similar existential fate. We are each required to routinely roll our metaphorical rock--whatever that may be--uphill every day, only to do it all over again tomorrow. It is arduous, difficult, tedious, boring and laborious work. But Sisyphus must do it. And so must we. This tedious aspect of life is something many people try to avoid via procrastination. Like children, we would much rather play games than do our math or history homework, or clean up our room. Who wants to wash dishes? Vacuum? Clean the bathroom? Do their taxes? Study for exams? Write their dissertation? We refuse to accept the difficult, dirty, tedious tasks in life, distracting ourselves instead with more amusing activities so as to avoid them. We resist and avoid shouldering the boulder. But it should be remembered that for philosopher Albert Camus, in his famous little book The Myth of Sisyphus (1942), Sisyphus found meaning, contentment and even happiness in accepting his fate. As must we all. As Friedrich Nietzsche put it : amor fati. Love your fate. Tedium is an inescapable part of our fate. And part of becoming an adult, of growing up, is accepting that life will at times be tedious. One secret to accepting the existential fact of tedium is to assert depth psychologist Otto Rank's therapeutic mental maneuver he referred to as "the willing affirmation of the must." We cannot totally eliminate tedium from our lives, but we can consciously will it by choosing to actively engage it. To throw ourselves into the tedious task fully and wholeheartedly, rather than resisting it. This shift in attitude toward tedium can, paradoxically, transform it. Another mythological metaphor for procrastination can be found in one of the Twelve Labors of the Greek hero Hercules. Hercules was assigned the seemingly impossible task of cleaning the Augean stables--where the droppings of hundreds of huge oxen had accumulated over forty years--in just one day. The nasty task had been avoided for decades. Procrastination, when unchecked, creates one's own personal Augean stable. Perhaps you know the feeling. Hercules, using both brain and brawn, cleverly diverts two rivers to get the daunting, dirty job done. What secrets can we learn from mighty Hercules about conquering procrastination? One secret has to do with the conscious channeling and focusing of life force into the immediate task at hand. Another secret is related to the practice of mindfulness. As the old Zen proverb tells us: Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water. Even spiritual enlightenment can't eliminate life's tedious tasks. The tasks always remain the same. What changes is the attitude taken toward these tasks. And the mindful presence with which they are quite deliberately performed. Even banal activities like sweeping or mopping the floor can be enriched, enlivened and made more interesting (therefore, less tedious) by a more mindful approach. Finally, since so much procrastination boils down to anxiety avoidance, overcoming procrastination requires a willingness to tolerate the experience of anxiety-evoking tasks. Not merely commonplace procrastination, but many psychiatric symptoms stem from or are amplified by a lack of presence. So-called ADD (Attention Deficit Disorder) symptoms like distractibility and lack of focus are but one example. In our efforts to avoid anger, pain, boredom or anxiety, we avoid being fully present in the moment. But this avoidance of what we feel in the present actually exacerbates symptoms and diminishes our quality of life. Consider the following traditional tale: When a Buddhist monk's contemplative walk in the woods is rudely interrupted by a ferocious tiger ready to make a meal of him, he runs for his life, the tiger in hot and hungry pursuit. Racing through the treees, the terrified monk comes upon a clearing, and then stops dead in his tracks. He stands teetering at the edge of a precipice, hundreds of feet deep. Still trying frantically to escape the tiger's teeth and claws, the monk hurriedly climbs several feet down the sheer cliff, clinging precariously only to a protruding tree root. The starving tiger looms above him, snarling, salivating and pawing at his potential prey. The slender root to which the frightened monk desperately clings starts to snap. Before it is about to break, in that very moment, he spies a wild strawberry plant growing from the cliffside, just within arm's reach. With his one free hand he immediately plucks the ripest, reddest, juiciest strawberry and very slowly places it in his mouth, savoring the intense aroma, texture and exquisite taste. This is a classic depiction of mindfulness: complete presence, even in the face of imminent annihilation. The secret is to savor each moment as though it will be our last. Like it is all we have. Because, existentially speaking, it may be. Death is an ever-present possibility. There are a thousand ways to die. But we can also learn from the monk the importance of remaining as present as possible in the face of life's constant distractions, demands and crises. Being mindful of what we are doing and how we are feeling or thinking at all times. Cooking. Eating. Exercising. Driving. Making love. Of course, this is much easier said than done. Mindfulness, like meditation, is a skill. And like any other skill, it must be practiced in order to get good at it. So don't expect instant results. Stay with it, however, and soon you too will be savoring strawberries. And doing that next thing that needs to be done. No matter what it may be.

We all have a little boy or girl living within. Not literally, but psychologically. This is something most grown ups never realize. Or lose touch with when becoming "adults." Commonly, destructive behavior in adults bears the impetuous, impulsive quality of childish petulance or narcissistic temper tantrums. Or an infantile neediness, dependency and dread of abandonment. Or an irresponsiblity and angry refusal to be an adult: the "Peter Pan syndrome," or what Jungians refer to as a puer or puella (aeternus) complex. When we ignore, reject or remain unconscious of our inner child, he or she is unhappy, resentful and influences our lives in negative and significant ways. But becoming conscious of and better relating to this same sad, neglected inner child can turn this all around. The secret is to cultivate and maintain an ongoing dialogue and parental relationship between one's adult self and this needy inner child, with the adult taking charge, being the good "boss" and accepting responsibility for taking care of and loving this inner child. Though our inner child is not literal, not physical, it can behave as an entity, at times taking over or posessing the entire personality. Indeed, this is frequently the case with many psychotherapy patients. And sometimes the source of their psychiatric symptoms. But they don't know what exactly is going on within them. Once they can conceptualize the problem in terms of a conflict between the little one within and the often underdeveloped or absentee adult self, some reconciliation, negotiation and cooperation between the two can be established. Then the adult self can deal with adult things, and the valuable and lovable inner child, no longer needing to be in control of the personality or trying to do adult things it cannot, can happily contribute to our playfulness, creativity and innate capacity for wonder, awe and joy. The secret is to spend some quality time each day together, much like a good parent does with their outer child.

Humans have limitations. Most of us hate to admit this. To do so is experienced as an insult to our narcissism. A blow to our egos. Limitations are for others. Not ourselves. Like the now famous "Energizer Bunny," we believe we can "just keep going and going and going." But we can't. There is only so much energy we have to expend. And so much time to expend it. Each day has only twenty-four hours. Each lifetime has some final limitation we call death. The human psyche and physiology requires sleep on a regular basis. Psychotherapy patients often wrestle with this existential question of finitude or limitedness. In a culture that worships productivity, that tells its children that there are no limits to what can be accomplished by just putting one's mind to it, the notion of having limitations seems anathema and antithetical to the American "can do" attitude and self-identity. We delude ourselves into believing life is unlimited. But, obviously, it is not. Death, of course, is the most glaring evidence. But, then, we tend to also ignore the reality and finality of death, either through repression or, in some cases, religion and so-called spirituality. We wish to be as gods: limitless and immortal. As Freud once said, unconsciously, everyone believes they are immortal. But we are mere mortals. Like Icarus, who upon flying too close to the sun on wings fashioned of wax and feathers, tragically crashes and burns into the sea, we continually overextend ourselves in dangerous ways: sleep deprivation, overwork, stress, spending, and sometimes by giving too much of ourselves to others. All because we refuse to accept our limitations. To take the counsel of Clint Eastwood's Inspector "Dirty Harrry" Callahan in Magnum Force: "A man's got to know his limitations." We fear that if we stop constantly pushing ourselves to be more and more productive, successful, active, ambitious, etc., that we will turn into lazy, sedentary, self-centered slugs. The secret is that the opposite is true: One is more likely to break down, burn out, become physically ill, profoundly depressed, debilitatingly anxious, or grandiosely narcissistic or even manic by chronically denying his or her human limitations. We are human beings. Not machines. Not computers, which can continually function without much down time. And as humans, we need regular down time, rest, weekends off, sufficient sleep, play, solitude, socializing, vacations, etc. Paradoxically, the more we respect our own limitations, honor our finitude, the more productive and efficient we become. The trick is to establish the right rhythm between down time and productivity. And to recognize that productivity and creativity can and do continue to occur, inwardly if not outwardly, even during down time. Even as we sleep, the unconscious keeps working, processing, creating and communicating via our dreams. Sure, we need at times to push ourselves past our own limitations. That promotes growth and self-confidence. But ultimately, we can push ourselves only so far before body and psyche start pushing back. As one of my former analysts once put it, "There's only so much tea you can pour into a tea cup."

Selfishness is not necessarily narcissistic. As children, we are taught that to be selfish is sinful, negative, evil. Psychotherapy patients struggle regularly with the issue of selfishness: both with the gluttonous narcissism of excessive selfishness and the soul-starving, saintly rejection of healthy selfishness. Often, they feel conflicted and guilt-stricken about acknowledging and asserting their own selfish needs, feelings, wishes and wants. Is nurturing one's own soul or sense of self selfish? Trying to attain one's innermost needs? Actualizing one's innate creative potential? Constructively expressing one's self and will in the world? And, if so, could this sort of selfishness be positive, beneficial or therapeutic? These are vital questions for both psychotherapy and spiritual development. Because the right kind of selfishness--an honoring of the true Self--is essential to emotional and spiritual healing. And to finding and fulfilling one's destiny. So what is the secret to being selfish in the right way, at the right time, and in the right measure? One of the most difficult tasks for psychotherapy patients is learning to be properly selfish. I call this spiritual selfishness. Becoming more self-ish. Attentive to the self. Selfishness that centers around, attunes to, acknowledges and honors the needs of the self is what is required. Not the selfish, neurotic, childish demands of the ego. That would still be mundane greed, gluttony or narcissism. But the needs of what C.G. Jung termed the Self: the complete person, the whole enchilada, of which ego is only part. The self represents both the center and totality of the personality. Honoring the self is not simple. It requires persistence, patience, humility, courage and commitment. But learning to listen to and obey the needs of the self rather than ignoring or running from it is the key to becoming a more balanced, whole and happy individual.

The importance of knowing your psychological type. And your partner's. Depth psychology, and Jungian analysis specifically, emphasize the importance of understanding, accepting and honoring one's own psychological typology. It can also be helpful to consider the typology of significant others too: spouses, lovers, friends, parents, siblings, co-workers, etc. Jung's central point about typology is that our particular psychological type is a lens through which we view life, and determines how we see, relate to, and interpret reality.What happens when someone either doesn't know what their own typology is, or rejects it? Here is a super quick, easy and, in my view, fairly accurate way to determine your own basic typology: When you're down, stressed, burnt-out, overwhelmed, drained or exhausted, what do you want to do to feel better? What works best to recharge your battery? Typically, there are two kinds of responses to this question. What's yours? Note it now. We'll come back to this shortly. For Jung, there were essentially two types of people; introverts and extraverts. These were Carl Jung's terms, for which he gives specific definitions. While his term introversion is today widely used as a synonym for shyness, introversion is not necessarily shyness. But there is a close relationship between shyness and introversion, which Jung felt (and I fully agree) is largely an innate tendency. (This strongly contradicts a recent post here on shyness claiming little or no congenital influence at all! ) Introversion is a turning inward toward the interior world of ideas, feelings, fantasies, intuitions, sensations, and other facets of subjective experience. The introverted type finds most of his or her meaning and satisfaction not in the outer world of people, objects, things, accomplishments, but rather in the interior life, the inner world. Extraverts, on the other hand, live almost exclusively in and for the exterior world, deriving fulfillment from regular interaction with outer reality. Of course, no person is completely introverted or extraverted. These are two extreme poles on a continuum which we all occupy. A majority of us lean toward the extraverted orientation, placing true introverted types in the statistical minority in most westernized cultures. Indeed, introversion tends to be stigmatized in our culture, pathologized, and deemed abnormal. When introversion is extremely one-sided, it can become pathological shyness, social phobia, schizoid personality, autism or even psychosis: a total detachment from outer reality. Extreme extraversion can manifest in compulsive activity, workaholism, mania and addictive behaviors (e.g., sex addiction) serving the purpose of avoiding introversion or self-reflection at any cost. One secret is that some rhythmic balance between introversion and extraversion is essential for mental health. Introversion and extraversion appear to be innate temperaments or personality traits which can be and are, however, influenced by environment. For example, in a highly extraverted society like the United States, or an extraverted family, introversion is often discouraged starting in childhood, with extraversion being encouraged as the social norm. As a result, many naturally introverted types strive to become extraverts, developing an extraverted persona, but inexplicably, feel chronically anxious, fatigued or depressed. This could also occur when an extraverted type is constrained by a socially or religiously imposed façade of introversion. Sometimes, extreme extraversion or introversion can stem from too much of its opposite, a compensatory reaction of the psyche. Introverts tend to have trouble dealing with the outer world in general. Extraverts have equal trouble dealing with the inner world. And both resist doing so, in what frequently becomes a habitual pattern of avoidant behavior. What is so mind-boggling is how dramatically different extraverted and introverted types truly are! By their very nature, these are radically divergent modes of being-in-the-world, antithetical attitudes toward life. For example, a wife might be an extraverted type, wanting constantly to go out into the world, have adventures, meet people, etc. Her husband, on the other hand, is an introvert, for whom none of that holds much fascination. He wants nothing more than to stay home and think, read, contemplate, dream. His introverted attitude values the inner life over the outer; hers the outer over the inner. You see how this can wreak serious havoc and conflict in relationships? Particularly when neither party understands where the other is coming from, typologically speaking.

Now, to return to the little test you took earlier. If you responded that all you want to do to nurture yourself and recharge your spiritual battery is to stay at home, read a book, take a bath, meditate, listen to music, and to do so mainly solo, you probably tend toward the introverted pole. You are likely at least fifty-one percent an introvert. What do you think the extraverted type says? You are probably extraverted if you gave this classic response: "I want to go out and be with people, go to a party, do something exciting." You see, this is what fills the extravert's tank when its on empty. But for the introvert, this sort of extraverted activity, especially when depleted, is a repugnant prospect. As is the prospect of introspection and solitude for the extravert. Why? Because to rejuvenate themselves, to replenish their energy, the introvert must introvert. And the extravert must extravert. It's in their nature. What if you weren't able to answer the above query because you don't yet know how to recharge your battery, haven't found what works for you? When introverted types try to live like extraverts, they have problems, because they have lost connection to their true introverted selves, the re-energizing ground of their being. The same can be said about extraverted types who, wanting to be more "spiritual" or contemplative, cut themselves off from the material world. They have each lost their touchstone. It is quite true that Jung's idea of individuation--the process of becoming more whole--requires introverted types to develop and integrate what he called their "inferior function," their extraversion; and for extraverted types to cultivate their capacity for introversion. For both types, this is exceedingly difficult work. What comes naturally to the extravert, requires enormous effort for the introvert. And vice-versa. But it cannot be accomplished by denying one's innate typology and attempting to replace it with its opposite. (Though in the individuation process, the pendulum may sometimes swing from one extreme to the other before finding balance.) The introverted type must learn to extravert, honing his or her extraverted skills, but will always remain an introvert. Just as extraverted types need to learn to introvert but will always be extraverts. Balance is the secret: learning to accept and take care of oneself, and recognizing that refusing to honor one's typology--and that of others--is ultimately self-defeating and destructive.

Stress management and the unsung virtues of sleep. Sleep is a highly underrated activity. Sleep is the primal form of introversion (see above), a state in which we temporarily but regularly withdraw almost totally from the external world. (See my previous post on introversion and extraversion.) Living as we do in such an extraverted society, most suffer from a chronic insufficiency of sleep. Some studies indicate that people today are sleeping less than they did several decade ago, and that sleep deprivation is a possible risk factor for serious physical conditions including heart disease, atherosclerosis, obesity, insulin resistance, diabetes, and suppression of the immune system. In addition, sleep deprivation and resulting sleepiness play a part in traffic accidents and other mishaps involving human error. Moreover, lack of sleep can lead to a transitory mental state known as abaissement du niveau mental: a temporary reduction of consciousness, in which ego defenses are weakened, rendering us more susceptible to the unconscious. Sleep deprivation induces this state, sometimes causing or exacerbating symptoms like anxiety, depression, mania, paranoia, irritability, anger and rage. Hence the value, even for hardcore extraverts, of getting enough of the compensatory, restorative introversion sleep provides--especially during times of intense stress. While each person differs in the amount of sleep needed for replenishment, eight hours being about average, it is crucial to get sufficient amounts and adequate quality of sleep, and to do so on a regular schedule. Sleep heals the body, clears the mind, and restores the soul. Recent studies indicate that getting at least 7-8 hours of sleep nightly leads to losing excess pounds. In patients suffering from insomnia or hypersomnia--sometimes secondary symptoms of anxiety and depression--regulating sleep pharmacologically or otherwise can be crucial to successful psychotherapy. Sometimes simply getting sufficient regular sleep can diminish symptoms, stabilize mood, increase resiliency and improve attitude. When it comes to stress management, sleep--along with proper diet, daily physical exercise and some type of meditation--can do wonders.

"Not out, but through." C.G. Jung (see my prior posts) recounts one of his patient's dreams in which he played a central part: There was a very dangerous-looking circle of lions. In the middle there was a pit that was filled with something hot. She knew that she had to go down into the pit and dive into it. So she went in and was somehow burned in the fire. Just one shoulder of her jutted out. I pressed her down and said: "Not out, but through it!" When patients come for therapy, what they typically want is for the doctor to extricate them from some problematic situation, symptom or state of mind. To alleviate their suffering as quickly as possible. To swiftly solve their problem. That is understandable. And this is exactly what contemporary treatment approaches like psychopharmacology, CBT and even DBT (see my prior post) attempt to provide. Symptomatic relief. But these are all forms of what I would call "suppressive therapy." The truth is that, psychologically speaking, suppressing symptoms without addressing the underlying problem is only a temporary fix. Eventually, they return with a vengeance. Or else require stronger and stronger suppression over time. More medication. More treatment. The secret, as Jung (and, unconsciously, his patient) understood, is not to suppress or escape the problem, but being willing to go through it. Not around it. Not over or under it. But right through it. What would that look like? This theme comes up quite often in treatment, especially when patients are feeling resistant to confronting their deepest fears, agonies or concerns. To facing the unconscioius. They instinctively want out. Out of the fire or proverbial "frying pan." Or the "hotseat" of psychotherapy. But it is the therapist's job, like Jung in his patient's dream (and in reality), or like Virgil in Dante, to carefully and compassionately guide and facilitate the patient's full immersion into the flames. Down into their personal inferno. Gradually. In measured, titrated doses. And, finally, through it. Then, and only then, suppression will no longer be necessary. As the ancient alchemists suggested: "Into the destructive element immerse yourself." Only then can you be creatively transformed.

So there you have it: seven additional pearls of clinical wisdom for your consideration. With another seven soon to follow in Part Three.

This series is based on and distilled from Dr. Diamond's forthcoming book, Essential Secrets of Psychotherapy: The Healing Power of Clinical Wisdom. All rights reserved.

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