Sunday, April 26, 2020

Practicing Therapy under Lockdown?

It took a virus to awaken therapist Gary Greenberg from his Freudian torpor. It took a virus for him to turn his attention away from dreams, fantasies and emotions. It took a virus for him to turn toward a reality, one that did not fit neatly in a Freudian theory. He found himself bereft and powerless to offer anything other than consolation.

For a portrait of a psycho therapist practicing in a time of coronavirus, we cannot do much better. 

So, Greenberg begins with an overview of what therapy is supposed to do. Since he will later pledge loyalty to Freud I feel compelling to notice that this paragraph has nothing to do with Freud. 

For the 35 years I have practised as a psychotherapist, I have discouraged people from seeing themselves as hapless victims of forces arrayed against them. That’s the whole premise – that whatever brought you to my office, it is hampering your ability to direct the course of your own life. So let’s name your pain and then do something about it. Tell off the boss, walk out on the husband, confront the perpetrator, whatever it takes, and then move on, become the agent of your existence.

Don’t just sit there staring; do something. Don’t just sit there complaining; do something about it. This is good advice under any circumstance. To think it does not apply to the time of coronavirus is a bit too facile. For my tastes, at least.

And yet, the types of counsel that Greenberg offers are neither constructive nor useless. We do not want people to tell off their bosses, especially in a time of high unemployment. We do not want to tell women to walk out on their husbands, except under the most dire circumstances. We do not want people to confront their perpetrators-- by which I suppose he means, tormentors-- but rather to neutralize and avoid them.

The problem with coronavirus, Greenberg continues, is that there is nothing we can do. The forces of nature are so powerful and so strong that they reduce us to quivering whiners.

What if it turns out that we are hapless victims of a force arrayed against us, that will mercilessly hijack the machinery of our lives, that is silent and invisible and leaves us with nothing to do but cower in our homes and wash our hands and hope that it will pass us by? Is there a role for therapy in a pandemic?

Aside from the fact that there are many things we are doing to ride out the pandemic, the truth is that therapy has long since taught people to complain about the injustice of it all. So much so that ours has become a nation of complainers. If therapy has not taught people how to whine, what has it been doing. 

But then, Greenberg offers a meditation about Skype sessions. He does not mention that Freud himself liked to have his patients lying on a couch, looking away from him, because he could not suffer being looked at. In the vernacular facing your clients means accepting responsibility for the success or failure of treatment.

We note that Greenberg similarly feels self-consciously uncomfortable at the notion of being looked at by his patients, and vice versa.

But the one thing I can’t get used to, so far anyway, is the way my patients’ faces appear in this simulacrum of intimacy. I may have sat for hours with them, watched their faces contort in anguish, or beam in satisfaction. I may have searched out their eyes, tried to bring them back into contact from their safe haven on the ceiling. I may have thought I knew every inch of these faces, and no longer even needed to ask what their expressions meant.

It is truly astonishing that the most basic aspect of human communication, face-to-face, seems to be a novelty, even a disruption for someone who does not looking people in the eye, or vice versa.

Now that it has been reduced to a flat image in the middle of a flat screen, and I have no easy elsewhere to look, I’m realising that half the work was the struggle to behold those faces, and half the satisfaction was succeeding in wrestling attention to the task at hand. And maybe half the treatment was their observing that struggle, feeling the love in it.

But still, that face. It’s right there. I can’t escape it, as I imagine he can’t escape mine. I keep looking at the postage-stamp version of what he is seeing. It’s vanity that draws my attention back to that corner of my screen, but it’s also curiosity. This hard and wrinkled face, this half-smile, these hooded eyes: this is what my patient sees? So much of my job is making sure I understand what I am conveying, labouring to launch my words across the room with the right inflection, the right expression, the one that carries my concern as well as my scepticism, that challenges and supports in equal measure, and watching myself watching myself, I can see that I haven’t got the slightest idea of how I am coming across – and I am far too interested in finding out. I click off the view of my own face.

Then, Greenberg correctly points out that as you look at an image on Skype, you are not really looking anyone in the eye. You are simulating a connection, not making a true connection. As for the notion that looking people in the eye involves being honest, therapists have never been honest with their patients. They might expect that patients say everything that comes to mind-- Freud insisted on it-- but they certainly do not share everything thought that passes through their minds. 

So we are focused on each other’s faces, but there is still at least one thing missing: that moment when your mutual darting attention comes to rest and you make real eye contact, not the off-kilter kind that comes from peering at a screen located a few inches from a camera, but an actual meeting of actual eyes transmitted through the air of a shared room. You look into each other, and you see, even if you don’t say it out loud (and you rarely do) just how rare and precious this is, this intimacy that you have kindled by agreeing (and again mostly without saying so) to be honest with each other, and to sit with the consequences. Which is the whole point, the reason they pay and I work, and the means, if there is one, of healing, if there is any.

Then Greenberg seems to decide that it’s all about trauma, about releasing people from the hold of trauma. This is standard Freud, but it is incoherent with the notion that we ought to tell people how to manage their everyday lives. He even offers a variation on a theme introduced by Kant. I assume that he does not know the source of the concept: “Out of the crooked timber of humanity, no straight thing was ever made.” But maybe he does and was trying to be clever. If that was his intention, he does not succeed.

Here is the Greenberg variation:

If anything unites the disparate branches of psychotherapy, it is the belief that trauma twists the timber of the self, and determines the precise shape of our suffering. Freud identified this as the “repetition compulsion”, the unconscious tendency to place ourselves in situations that are versions of the past – or to construe them that way. Some traumas are more obvious than others, outright violation easier to identify than the diffuse ineptitude of some parents, or their inability to provide both love and sustenance on a sales assistant’s salary, or the manifold humiliations children suffer at the hands of other children. But as capable as we might be at burying them, our traumas are more capable of haunting us. Therapy is the work of exhuming them, bringing them to light, and then putting them behind us.

Of course, Freud himself largely abandoned the trauma theory, shifting the focus from a real event to the victim’s desire. In traditional psychoanalysis the reason people cannot get over their traumas is that they refuse to admit that they really, really wanted it to happen. 

As it happens, some traumas are best left dead and buried. Obviously, the more time you spend exhuming past trauma, even to the point of wallowing in it, the less time you will have to manage your everyday life, including your handling of the coronavirus social distancing. You cannot simultaneously be gazing into the depths of your soul and be working on the intricacies of a difficult personal relationship.

Happily, Greenberg shares the fact that the theory whereby past trauma shapes present experience is a fiction. No one has ever proved it. It works fairly well as a pivot for certain kinds of psycho narratives. From Alfred Hitchcock to half of the crime stories on Netflix today, the notion that we are going to be released from the grip of trauma by dragging it into the light of day, the better to punish the perpetrator, is a dramatic staple. It is also nonsense.

This idea that the pain of the past shapes our present experience has never been scientifically proven, but it is very likely that this idea is part of how you understand your own history, whether or not you ever enter into therapy. And if you do come into my office, we will ferret out the trauma at the source of your discontent, and, having found it, if our work is successful, you will recognise it as the moment that turned your life, and as the moment that you must leave behind.

Again, nothing says that the trauma is the source of your discontent. Sometimes inadequate social skills, poor education, gross inexperience or general anomie is the source of your discontent. In the end two thirds of the people who suffer trauma in childhood recover, without any therapy. 

Greenberg, however, still clings bitterly to the notion that our feelings about politicians are really recycled feelings about our fathers:

Complain to me right now, in the middle of this video therapy session, about that president or the masks or the guy who touched the apple and put it back, and am I really going to tell you that your outrage is about your father – even if, in some ineluctable way, it is?

Now, Greenberg enters into yet another meditation about his own fears. Don’t you know, he has feelings too. In truth, therapists would do well to keep their doubts and worries to themselves. No one is going to pay a physician who drones on about his hemorrhoids, or a lawyer who shares his worries about being indicted for fraud. A serious professional might very well share information, because it creates a friendly bond, but he does not whine and complain about how powerless he is before the dread force of the coronavirus:

I’m just as terrified as my patients are, maybe more so – and not just of drowning in Covid-19 or infecting my wife or losing my friends to disease. I’m as afraid of the aftermath as I am of the illness. Police are using helicopters to enforce social distancing. To those who defer to scientists and public health authorities, that may seem like a good idea. To those who crave power and who understand science well enough to know that this virus will be with us for a long time, it may seem like an opportunity.

He feels their pain. He commiserates. Once the focus shifts from infantile trauma to real world crisis, he is exposed as having very little to offer. 

To the man who can’t sleep, to the woman so racked by anxiety that she has begun to pull out her own hair, to the miserable college student whose postgraduate plans have evaporated along with the economy, to the parents of the high schooler who suddenly believes that the furniture in the house in which he is trapped is alive, and who, in less extraordinary times, probably would not have become psychotic, “I’m so sorry” is all I seem to have to offer.

So, if nothing else, we have got good at consolation. We know how to comfort, how to help people speak the unspeakable. Perhaps I will find use for other old tools, or the trauma of this pandemic will not prove as pervasive or persistent as it seems at this moment. But for the moment, this is what I have to offer those expectant, beautiful faces that are far away and so close: help in cataloguing the losses, and at grappling with them even as they mount. I can only hope it is sufficient.

So, the virus has helped us to draw the curtain, only to discover that the wizard is not really such a wizard after all.


whitney said...

After he described himself I felt compelled to go look at a picture of him. Wow. If I have to look at that I would definitely cancel therapy

Sam L. said...

"For a portrait of a psycho therapist practicing in a time of coronavirus, we cannot do much better." A "psycho therapist": should that be a "psychotherapist" or a
"psycho-therapist"? A "psycho therapist" sounds like a crazed therapist; it reads that way, too.

Stuart Schneiderman said...

It was not a mistake. It was an attempt at humor!!!