Saturday, January 31, 2015


Your children are not your children.
They are the sons and daughters of Life's longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you.
You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them,
but seek not to make them like you.
For life goes not backward nor tarries with yesterday.

Some of you may know these words from a poem by Kahlil Gibran.  Some of you may know the lyrics from its adaptation by “Sweet Honey in the Rock,”  an all-woman, African-American, a cappella, gospel-inflected, ensemble.  Their music was featured in our home (on our record player!)  when my children were growing up in the early 80’s.  They loved the music.  So did I.
The lyrics of this particular song… not so much.
If my children are not my children, then whose are they?  And what do you mean they are not mine?!   Or so it went.
When I first became a parent I found it difficult to let go of my own aims, my own rhythms.  I felt the loss of my unencumbered life, or at least mostly unencumbered life.  The physical demands and the confinement were challenging.   For me, it was a bumpy process becoming a parent, hard work,  and to be presented with the idea that they were not truly mine, I was merely a mid-wife, was not welcome.
 I’ve been thinking about this notion of “possession” of children since I read  Andrew Solomon’s wonderful, door stop-erish tome: Far From the Tree. 
This is a  beautifully written,  compassionate,  tender and nuanced examination of the implications for parental identity  when  offspring are starkly different from their parents, when parents cannot find their own image or influence in the eyes, the bodies, and the values of their children.  Parents of autistic children, transgendered children, handicapped children, criminal children, schizophrenic children, dwarfs and deaf children as well as many others, were interviewed (over 300 families).   Solomon  thinks deeply about their trials and their triumphs.   There are those who reject their “variant” children and those who embrace them happily.
                 I think Solomon would have us think a little harder about the illusion of our children being “our children” in the more ordinary situation. The first sentence of Solomon’s book reads: “There is no such thing as reproduction.”  We call it reproducing—having children.  We search our infant’s faces and cannot resist comparing them to our own, our partner’s or at least great-aunt Bertha’s.  And their sweet temperament must be a reflection of our own.  Their colicky nature, surely from the other side.   Are we reproducing or are we mostly ­­producing? a grand accomplishment  in and of itself.  Maybe in all cases children are not merely a “chip off the old block,” but a completely new, unique, beloved “chip”
As I reflect on the obsessive involvement with my own children in the early years and how alien the idea of their not being “mine,” I see how adaptive it was at the time, to see them as extensions of myself, a more beautiful, perfected, unblemished extension at that.   And I think in the early years, it was highly adaptive to cling to this illusion.  Loving my children was a form of “self-love.”  Not the malignant kind, but the benign and necessary kind. 
Generally we think of  “parental narcissism” (in so far as we think of this at all) as a toxic quality.  We picture characters like the mother in the movie “Ordinary People” (played so expertly by Mary Tyler Moore)  who do not truly see their children as real people but only as characters in a play of  their own design, there to serve the parental hero and heroine’s needs.  There is a ruthlessness about them.
Parental narcissism is natural, ubiquitous and serves a serious purpose.  Narcissism is generally associated with selfishness and associated with a disorder. But there is pathological narcissism and appropriate or healthy narcissism.   Without some degree of self-love we are in trouble.  It is a developmentally necessary quality, both to love yourself and to enlarge the circle of self - love to include your children and others.  Insofar as we see ourselves in their eyes or in their sweetness, their scent we are in love with our off spring.  It is a serious problem when this fails to happen.   
Things go awry when the individuality, the uniqueness of the child is denied in the service of meeting the needs of the parent.  That’s the kind of narcissism we generally think of when speaking of parental narcissism.  The miracle is balancing the enormous gratification of seeing ourselves in our beloved children and restraining ourselves. When I speak of the benign sort of parental narcissism,  I have in mind something less ruthless, more loving, and flexible.  It has lots of room for empathy. 

 As the children grow the illusion of  “they are us”  needs to fade.  If we don’t begin to see them as who they are and not a deep reflection of ourselves we start to do them a disservice.  They may have preferences that are quite alien.
            I think of the child who comes back from camp and wants to be a vegetarian, or now needs Kosher meals to be prepared by their secular parents.  I think of children who choose a different religion, perhaps a fundamentalist religion to follow and observe.  The son of left wing parents who wants to become a marine,  or the daughter of right wing parents who comes out as a lesbian and lobbies for marriage equality.  These are challenges for parents,  challenges that need to be negotiated with a relinquishment of the earlier narcissistic  investment.   We produce,  not reproduce.
You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams

Thursday, August 28, 2014


Many years ago I viewed a documentary, on a PBS channel that addressed the effects of
the Holocaust  on the second generation, children born of concentration camp survivors.    Much has been written and studied on the effects on the second and even third generation of survivors of the Holocaust.  The secondary wounding of  offspring of trauma survivors, whether they be survivors of war, concentration camp or childhood trauma are well documented.

It must have been in the mid 80’s that I watched a PBS documentary on the relationship beween adult children and their parents, Holocaust survivors all.   It was fascinating and heartbreaking.  Engraved on my memory over the intervening decades is one scene in particular.

In the film, adult “children” were discussing with their parents what it had been like for them to be shut out of their parents’ experience and/or to be victimized secondarily by it.  There were poignant dialogues between the generations.  Among other things, the younger adults had felt that their own suffering, their own experiences of pain were never quite as valid, as the horrors and loss that their parents had suffered.  Some felt it fell to them to redeem, to heal their parents.  

The scene that has stayed with me was a unique one.  One daughter, tearfully addressed her mother with her suffering.  The mother, who had been a child during the Holocaust, and clearly unaware of the effect her experiences had had on her daughter, was at a loss, initially, as to how to respond. Finally she said “I’m sorry, I’m really, really sorry.”   More than any other words intoned in those dialogues, those words held the most power.
Viewers witnessed the potential for repair in that very moment.

I’ve held on to this scene in the intervening decades and even shared the story with patients who clearly were in need of having this kind of validation in their own lives.  It is both a phrase that I have not heard enough in my own life, and one that I have employed far too sparingly myself.  Two words that we all long for.

We read and hear a lot about the importance of the balm of forgiveness, how it heals the giver and as well as the given too.  But I think we don’t think enough about the power of of  asking for forgiveness, to knit together what feels irretrievably broken. Forgiveness is a hard nut to crack—that is, offering forgiveness that isn’t a thinly disguised form of denial.   But we can all apologize for wrongs we have committed.   An attuned apology is not  necessarily asking for forgiveness but rather an expression of empathy, compassion, “heart feeling” for the person we have wronged in some way, or at least they have perceived a wrong and have been wounded.

It happens  sometimes in my clinical practice that an angry client confronts me with some way in which I have hurt them.  Maybe I have been too blunt, insensitive, or just plain wrong. My timing has been lousy.  Sometimes I’m not guilty, but more often than not I am.  At least a little.  After years of trying to explain, clarify, interpret, really to defend myself,  I have come to realize that it is all a waste of time.  A simple, but “attuned” apology is what is called for here.  Whatever my motive or the context for my misstep, I have hurt someone.

This is sometimes difficult in the midst of an attack—an angry, no holds bar, maybe even abusive client is not someone easy to apologize to.  But there is always time for the interpretation, the exploration, and the meaning of the attack.  In the moment “I’m sorry” may be the only way to get back on track.

Recently a client shared with me what was a pivotal moment for him.  He was berating me for a misstep, which he had done before, and hinted strongly that he was seriously considering leaving therapy.  I asked: do you want to repair the rent in our relationship?  Stopped in his tracks by the question he had to admit that that was indeed a novel idea, “repair.”  He had never witnessed it within his own family.  Either a violent argument was forgotten, denied, disowned or it “broke” the relationship forever.  The notion of repair was alien.  Eventually he replied in the affirmative, yes he wanted to see if this relationship could be fixed.  I offered an apology and he was able to re-join  the collaboration and let go of the all too familiar role of wounded adversary.

Dan Siegel, the interpersonal neurobiology psychiatrist, clinician, and researcher makes the important point in a recent publication: the ability to initiate repair requires a certain humility, an acceptance that we are inperfect. 

It is part of being human to contribute to disruptions in connections with others.  Yet processes like shame can keep us from freely acknowledging our role and making a repair to reconnect with the other person.  These impediments to repair can severely constrain the health of a relationship (The Pocket Guide to Interpersonal Neurobiology).”

In other words my general tendency to defend my actions was probably rooted in an expectation of myself that I would never wrong a patient.  “Mistakes might be made,” but never by me!

I will let Rumi, the 13th Century Sufi poet summarize for me:

Out beyond ideas
of wrongdoing and rightdoing
There is a field.
I’ll meet you there.

Monday, May 5, 2014



In a few months, I will turn 70.  It will be over 40 years that I have been in clinical practice.

That sentence is actually a pretty shocking one to compose.  It hardly seems possible.  Forty years is a very long time.  So many of my colleagues from the early days no longer practice psychotherapy.  They left the field for various reasons, some very early on.  Being a clinical social worker, or a family and marriage therapist doesn’t pay very well.  The working conditions are not always pleasant, clients are disappointed, they are angry, they lash out, they fire you without notice and sometimes even explanation.  You are sitting still much of the day absorbing the pain, the shame, the trauma, the fury of your clients.  If you work in an agency you can be subject to crushing piles of paperwork and a remarkable lack of respect.

And then there is the weight of responsibility, or felt responsibility, for the well-being of others.  There is always the prospect that you will fail.  There is the dire prospect that the client will harm themselves or others. 

But like the song says, “I’m still here.” 

Quite a surprise.  Starting out I thought I would never make it, that my high level of anxiety would kill me.  But as I client once scolded me, I am persistent, “like a dog with a bone” is the way she put it: not pretty, but apt.
I’ve never been much good at puzzles, either crossword puzzles, picture puzzles, or Sudoku.   You can always have the puzzle page of the New York Times out of my newspaper anytime you want. 

But the puzzle of a personality I find intensely engaging.  Without exception every new client is a new puzzle, an original.  Why this symptom and not that?  What happened? Why (seek treatment) now and not before. Why did he survive and she didn’t?  Why did this sibling make it through an abusive childhood and the other one, not so much?

And the key to the puzzle is not written in a book anywhere, there is no standard protocol, the way I work anyhow.  It’s always a new task to figure it out, how to treat this person.  What’s going to work?

Then there is my fascination with the story, the narrative of a life. I spent a lot of time as a child with the “orange biographies,” biographies of “great Americans.”  Our small town library had what seemed liked hundreds of them.  I took a stack out every two weeks.  I consumed everything thing from the story of Davy Crockett, frontiersman, to Florence Nightingale, Mary Todd Lincoln, Jane Addams, George Washington.  So was it the history that I loved so much, or the prospect of greatness?   Perhaps if I read enough of them, maybe I could join their ranks?   No, I think it was the story of lives, lived.  And I’m still here, with those stories.

It is a privileged perch, the perch of the therapist.  One gets to witness all the lives not lived: what it’s like being related to the mob, or to be the neglected child of great wealth.    I get a taste of growing up in Lake Woebegone, Garrison Keillor’s fictitious small Midwestern town, without having ever been to Minnesota.  I get to talk to the voices that populate the inner world of seriously traumatized individuals.

The “privileged perch” can be hazardous.  There is no doubt that if you work with trauma, as so many of us do, that your world view is darkened thereby.   The tales of ritualistic abuse and sadistic cruelty toward children are often hard for people to believe, even therapists.  A supervisee, new to the treatment of the long term effects of extreme trauma, once asked if I believed the tales of multiple rapes and torture that her patients and mine recalled.    I really cannot, of course, offer a definitive answer in any particular case. No one can. But we did live through a century when state sanctioned murder and torture and rape were applied on a mass scale, so why not? 

Here are a few things I have learned from being a therapist:

1.       Motivation counts more than the extent of pathology. People who desperately want to get better, generally do.

2.      Safety counts more than anything.  Anything one can do to help a client feel safe with you and in your office facilitates the healing.  Maybe it is the healing.

3.      Chemistry counts. Who you are is what counts:  “The person of the therapist is the converting catalyst, not his order or credo…not his exquisitely chosen words or denominational silences” (from A General Theory of Love, Lewis, T.,Amini, F., Lannon, R., p.187).

4.       Spirit often arises from the extremities of suffering.  It’s almost uncanny how those who have survived early and extreme trauma and make it into my office, arrive with rather robust spiritual lives.  Not conventionally religious, they are still believers in the transcendent and credit those experiences with their survival.  These patients have taught me a lot about resilienc, spirit and spirituality.
Over 40 years of almost continuous practice: it is hard to really comprehend that amount of time. I do comprehend, though, what a blessing it is to have been part of a profession that has brought richness and meaning to so many days of my life.  I am grateful.

Saturday, June 22, 2013

New TED Talk blog posting on the Huffington Post.

Dear Readers,

The Huffington Post asked me to write a response to a wonderful Ted Talk, as part of the Ted Radio Hour.
Maybe some of you are familiar with this NPR program?
The talk is wonderful.  By Candy Chang, entitled "Before I Die."
And they were kind enough to select my blog (among others) to post alongside the video, this on their
TED page.  See it at
If you feel like commenting on the Huff Po page, it makes me look good.


Sunday, March 24, 2013

Rehearsing for Life and Death

A little boy of my acquaintance is worried about death and graveyards and ghosts.  I have been thinking of comforting ways to talk to him about this—something that might be accessible to a 6 year old.  In the midst of my musings I awoke to the fact that I am just as afraid as he, although ghosts and graveyards don’t really bother me so much.   It seems that the predations and losses of aging are my own version of his preoccupation.  The inevitable debility in the body, losing loved ones, mourning recent losses,  these are my ghosts.

I think after a year and a half of working at a cancer support and wellness center in the DC metro area, I am just coming to understand what drew me to this work.  I volunteer once a week to lead a mindfulness meditation group.  I have not been officially trained to do so.  This is in itself remarkable.  I am, however, a qualified, trained, and experienced therapist and a fairly long time practitioner of meditation myself, but my teaching experience is not particularly in this genre.  In the group we mix it up with other practices and I am always drawing on my skills and various tools acquired as a therapist, to deepen and broaden the experience for my very enthusiastic group of meditators.    Remarkably, the changes in those individuals who come consistently and even attempt to practice at home are discernible to themselves and to me.
The members of the group declaim rather loudly and proudly about the benefits and positive energy of the group—they testify to and regularly recruit new members.  But I am quite aware that my benefit is at least as great as theirs.  It is the high point in my week.  Really.

There is the pleasure in doing something that is popular, useful, and positive.  But beyond that, I think I benefit greatly from my relationship with members of the group and with the group as a whole
: their optimism, their strength, their ability to grow in the face of terrifying, often painful, and always life threatening conditions. 

Many are dealing with the long term effects of treatment, more than the threat to their lives.  Surgery, chemotherapy, and radiation leave a variety of “gifts” behind.  The hair grows back, but the neuropathy in hands and feet does not necessarily abate.  “Chemo brain” may recede, but memory may never be quite the same for some.  Unanticipated pain may linger for quite some time after radiation.  Anxiety may take up permanent residence, and thin places in the fabric of family may become deep fissures.

I get a front row seat on how individuals are dealing with these challenges to their bodily integrity and mortality.   Mostly what I see are courage, dignity, and grace under fire.  Of course it’s only an hour a week and a self selected group of individuals who are well enough to sit and listen to the sound of my voice directing them to more peaceful places inside of themselves.  And I don’t observe the moments of sheer terror and rage that walk beside them as well.  But these glimpses of resilience in the woman who dons a stylish chapeau to cover her sparse hair, or manages to look fetching in her outfit despite the loss of 25 pounds or so, enrich my spirit.  The man who teaches himself and practices piano to deal with his overwhelming anxiety and depression and the generous cordiality and even gratitude of those who face the final stages of their disease, inspire and soothe me.

This opportunity to bring comforting practices and to learn from my meditators represents for me a kind of rehearsal for what is inevitable in all of our lives.  Unless we die suddenly, we do need preparation for the last chapter and the loss of those close to us.  There are few models available, for most of death and dying are hidden.  We cannot model ourselves on the brave and the resilient if we don’t know them, if we don’t see them.    They are hidden in nursing homes, hospitals, or hidden away at home.  They are for the most part unidentified.   I have the unusual privilege of meeting, working with and learning from many.

I learned to teach graduate students, something I was also terrified of, by “channeling” one of my most admired teachers and then pretending I was him.  I faked it until I made it. 

Sounds like a plan.









Sunday, January 27, 2013


It was probably 1965 when I did my co op job at  Fairfield Hills State Hospital in Newtown, Connecticut.  This was a huge state hospital campus housing thousands of inpatients from all over the state in need of (mostly) long term custodial psychiatric care.  Although this was decades ago, many of my memories of this time are fresh and crisp.  It was one of a few experiences that shaped my interest in becoming a mental health professional.

The setting, a large institution in rural Newtown, Ct.,  was woefully isolated for two young women in their early 20 's dispatched by Antioch college to fulfill their co-op job requirement. We hung out with some other co-op students from Boston and two male psychologists doing their internship at the hospital.   Gimlets at weeks end with the psychologists were all that was available for “partying.”

There was basically no town in Newtown, as I remember it.   We had to catch a ride into NYC if we expected much fun. 

My memories of the facility where we worked, me as an occupational therapy assistant, my friend J. as an art therapist, are quite positivE, however.  The woman under whom I worked was a consummate professional.  She was highly skilled at creating a program for people who were severely mentally ill and compassionate in her attunement to each individual.  I learned a lot from her.   When I wasn’t working directly with patients, she sent me down to read case records.

On one of those occasions I accidentally discovered that one of the in-patients with whom we worked had come to the hospital  voluntarily, for a short period, had somehow gotten lost in the system and was now a long term resident.  Tommy was not psychotic,  he had come to the hospital for the treatment of depression. Over time he had come to look like he belonged there and did not have anyone to advocate for him. He was heavily medicated, and a physical impairment made him look much sicker than he was.

When I shared this with Madelyn, my boss, she got busy, had him re-evaluated and in short order, "sprung" from the hospital.   Tommy was the poster boy, you might say, for “institutionalization.”  The system had swallowed him whole. It was only a lucky accident that freed him.

Madelyn was not alone among the staff of competent and compassionate employees.  This was a good facility.  Some people got stuck, but most were there because they needed the shelter and the supervision.  Many had nowhere to go.  Larry was an example.  He was in the end stages of Huntington's disease,  a neurodegenerative genetic disorder (the disease that Woody Gutherie succumbed to)  with no cure.     The end stage was often characterized by psychosis.

Larry was a very sweet, bright guy.   He had been a working jazz musician in his prime.  Now he had a hard time walking, controlling the jerky movements characteristic of Huntington’s disease.  And he had psychotic episodes.  He needed the  care that the hospital offered and had few or no other options.  Madelyn was very fond of him and took good care of him.

Patients like Tommy inspired the civil rights activists who felt that the mentally ill were unjustly stripped of their legal rights and were often incarcerated against their will.  They became “institutionalized” and were unable to care for themselves out of the hospital only because they had been socialized to the hospital setting.   In Tommy’s case all of this was true.

But they forgot about Larry, and so many other patients who derived protection from the system, not exploitation and abuse. Sadly, Larry needed the care and protection that the hospital provided.

How strange it is for me to meld my memories of Newtown with current events, in which how to care for the mentally ill is heartbreaking front page news.  My  memory is also vivid for the sweeping policy changes and paradigm shifting of the late 60’s and 70’s that emptied the state hospitals, filled the streets with the homeless mentally ill, and made it next to impossible to care for the seriously mentally ill in any viable custodial arrangements. 

In the name of freedom,  we forsook the mentally ill decades and decades ago.  Instead of re-thinking the system, we jettisoned it, de-funded it, and provided nothing to take its place. 

I join my voice to all the others calling for a humane reconsideration of our responsibilities to the seriously mentally ill.

Friday, January 4, 2013

What Good Can It (Psychotherapy) do?

What good can it ( psychotherapy) do?

The  question above is one that I encounter frequently in one form or another from friends, potential clients, close relatives.  It takes various forms:

  1. What can they tell me that I haven’t already thought of myself?
  2. Life will take its course no matter who I talk to.  My partner will die and I will be alone.
  3. I’m going to die anyhow.
  4. Talking won’t bring her/him back.
  5. I’ll still have cancer/multiple sclerosis/end stage heart disease.
  6. There really is no way out of my marital/familial/work dilemma.
  7. My depression is a result of a chemical imbalance.

I’m frequently not quick enough on my feet to respond thoughtfully, so I’d like to take a moment to do so now.

Therapy, at least the kind that I know about, is not chiefly about finding solutions, i.e., problem solving.  Intelligent people are generally quite aware of a range of solutions to their problems.   They just can’t act on them.  They are frozen.

They  think that no potential solutions are really applicable to their situation or relevant or available to them.  Or they feel, and perhaps this is the  most frequent, that in their particular case there are no real solutions.   Its almost reflexive for the listener, the relative, the loved one, the good friend, the clergy person, even some therapists to offer some thoughts as to possible solutions.  Inevitably they fail.  Its not about that.

Within most adult folks there is an inner wisdom that would offer great assist in resolving the impasses of our life. Therapy is about accessing our inner, innate wisdom, not replacing it with someone else’s.  I can think of many instances where I felt that there were no solutions.  I was trapped.  In retrospect I knew the solutions and just found them totally unpalatable.  I could not end that destructive friendship, it was just too important to me.  I could not resolve a domestic or an economic problem, I just wasn’t strong enough.

So what are the elements of psychotherapy that  enable that inner compass.

  1. the magic of relationship.  When researchers have tried to isolate the “active” ingredient in successful psychotherapies, across many theoretical approaches (CBT, psychoanalysis, mind/body  approaches)  they frequently come up with the same answer:  “it’s the relationship, stupid,” the connection between therapist and patient is the key remedial. 

Neuroscientists have a more exact way of stating this, it’s about “limbic (a key brain structure) resonance.”   Simply stated,  therapy is not so much about the rational, linear, thinking mind.  It’s more like music.  In the best situation the therapist hears the particular melodic essence of the individual, playing softly in the background and is able to tune in and hum along, maybe even in harmony.  Just this tuning in is deeply healing.  How many people in your life have actually heard your “melodic essence”?  Do you think even you have heard it?

2.  A therapist listens differently than other people. I heard a story once of a psychotherapist describe his occupation, at a cocktail party, as one of  listening  “I listen for a living.”

A therapist’s training and experience sharpen and educate their musical ear.  It has been called “listening with the third ear, (Theodore Reik)” among other things.   When things go well, a good therapist hears what others do not, even the speaker.

A therapist may hear anger where others only hear hopelessness, fear where others hear anger, shame where others hear belligerence.   Truly thrilling for both the patient and the therapist is the moment when a door opens and the narrator gets a slightly different perspective, a different way of hearing their own feelings/problems.   “Maybe its not my inadequacy, maybe I am feeling truly alone in this intimate relationship.”  “Perhaps my adversary doesn’t hate me, perhaps they are deeply ashamed of their failures in life and feel humiliated.”  And most powerfully, “maybe there is meaning embedded in my confusion and in my unremitting pain.”   Meaning can set one free.

Certainly there is much more to be said on this subject.  But I will pause here and invite readers, both those who have experienced therapy and those contemplating dipping a toe in, to share their thoughts.

Happy New Year to all!!