Empathy and mentalization

I have started to be able to recognize affection. I can’t explain to you why I was unable to recognize it before. I think it created so much cognitive dissonance, I didn’t process it. I didn’t realize it was a distinct feeling, with its own facial expression, its own tone of voice, or that it was as evident as happiness or anger.

I am beginning to recognize it because there is one boy in my class who feels it for me and it’s very clear and obvious in his face. I also hear it in C’s dad voice when I talk to him, and sometimes in his older sister’s manner. (She lives in Y-town.)

I was writing last time about mentalization. I read some things that were interesting to me. I am trying to organize them in my mind this morning, because they are lying there in my head in disarray, like loose threads on the verge of tangling.

The first of these threads is that the ability to understand inner states–to make sense of motives and beliefs and feelings–develops over time. Under stress, we tend to lose later-learned abilities.

Our initial ability to mentalize is teleological–in other words, concrete. I know what you are thinking or feeling only from easily recognizable physical actions. If you do things that I understand will bring comfort to me, then I know that you care.

The process of learning to mentalize is disrupted in abused children, because the malignant intentions of the parent are so unfathomable, and it is stalled in neglected children because of loss of opportunity.

Under stress, we are all vulnerable to regressing to this earlier state.

To me, it explains the controlling people I have encountered, as well as C’s tendency to make demands for money or possessions which can feel exploitative to me. If only actions can communicate care, and even then only actions which you have predetermined to be caring actions, then the only way to feel cared about is to control someone’s actions very carefully. It also explains to me why when I first began to work with parts, I needed to find things which were very sensory and physical to help myself calm down. Self-talk had no impact, because I have learned people can lie. I am even capable of lying to myself.

The other strand lying loose in my mind, ready to tangle, has to do with non-mentalizing. Because borderlines hypermentalize (and I think I do too), then trying to make sense of other’s and one’s one mental states can seem impossible or even destructive. I think I ended up in therapy which discouraged mentalization. I and the therapist lived in worlds where attempts to understand motives, especially the motives of others, felt destructive. The only way to stop the spiral of trying to grapple with real or imagined malignancy was to suppress one’s natural attempt to make sense of the world.

My therapy became action-oriented, rather than reflective. “How do you take care of yourself?” stopped me from attempting to make sense of my partner’s motives and encouraged me to stay in a concrete mode, where I could at least act in ways I understood.

The end result of this, however, was to increase my sense of loneliness. Without engaging in the imaginative process of trying to understand other people or find ways to communicate my own inner states to others, the loneliness was unbearable.

In one article I read, it warned clinicians of this: that people form systems, and clinicians can become part of systems along with their clients in which mentalization is no longer engaged in and curiosity about mental states is discouraged.

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Relationships

I had a terrible day and lost it completely in the evening. I have in my head one particular therapist’s repeated advice as I struggle with hurt feelings.

“How do you take care of yourself?”

To me, this means stop expecting care or help from anyone. Do it yourself. I did this, when I was in therapy with her. It used to drive me crazy that my then-partner never cleaned anything. Well, she liked to wait until it felt to me the health department ought to be called in, do a big clear-up, feel good about what a wonderful clear-up she had done, and then let things devolve for another month or three. It was not actually never.

So, how did I take care of myself? I began to do it all myself instead of fighting with her over it. I didn’t like having a dirty house, and my choices were really to clean it or not. You can’t control other people.

I still do this quite a lot. I have accepted that no one particularly cares about me or is obligated to care about me. If I cannot do something, I ask for help and if they agree I consider that to be a lovely thing, and otherwise I just do what needs to be done. I also do not share that much in the way of my own struggles and frustrations, because talking usually makes me feel worse rather than better.

Since I have been single now for many years, it’s been my mess in the house and not the mess of two people’s. I remember how much free time I began to have when I broke up with her. I had so much less work to do and no longer wasted time having arguments I couldn’t understand.

But it seems much easier not to have relationships if they exist solely to make it harder to clean the house.

At the time, it seemed there was something wrong with this construct for how to have relationships, that there be no expectation of self-responsibility or fairness or consideration for other people.

Looking back now, I think there really was something wrong with this. It’s not that you shouldn’t take responsibility for your own emotional well-being nor that you shouldn’t make compromises. (This was someone who had grown up having a maid–I hadn’t.)

The other thing about this, though, is that this was all a very long time ago, and as I struggled with too many feelings last night, this therapist from 15 years ago lingered in my mind. I think I was trying to regulate an impulse to reach out and try to be understood by someone.

At bedtime, I finally lost it with my kids and I gave them a long lecture on how I was (mentally) doing their work for them, because I continually had to tell them things they already knew (like don’t just sweep the middle of the room), that I am tired and I can’t do it all for them. I didn’t feel proud of this later. I didn’t feel proud of it even 30 seconds later. It was just so tempting to let the flow of words go, and I felt asleep both angry at them and ashamed of myself.

The thing is in the morning, still struggling, I didn’t wake them up. I didn’t tell them to study. I didn’t tell them to get dressed. I didn’t do anything, beyond making breakfast for them. They got up, studied, put their clothes on, and came cheerfully into the kitchen. So I suppose they understood something.

But what was in my mind all morning was this former therapist and how do I take care of myself, rather than ask for others to care for me, and I think it was some attempt on my part to regulate this desire to reach out and ask for some degree of care.

I wonder now why she has stayed on my mind for all these years…

The analysis

I finally feel a bit normal.

Dysregulated, but in a way that allows my mind to engage with the dysregulation. I can engage my ability to reason and reflect along with the feelings at the same time, in other words. So that’s nice.

I didn’t really know what to do or how to calm down enough to know what was wrong, if that makes any sense. I was walking home and tried a grounding strategy a commenter suggested, and that sent images through my mind of smashing my own skull. Not pleasant.

I don’t know if that was because I calmed down enough to start to tap into the distress or if it intensified it.

I got home and sent a message to a good friend from a part: “Can we talk to you? It’s loud in here.”

Okay, so that was helpful. Things are too intense. It was helpful to myself to know what the problem seemed to be, and I am sure it was also helpful to feel some connection to my friend (even though she was sleeping at the time).

I have some more reflections on the session with the therapist that I had on Monday. I think there will be more to come, as I am thinking about not just what happened for me in 50 minutes, but what it reminds me of about therapy in general. I haven’t seen a therapist in four years. I can’t remember how long I saw that particular therapist I saw before I left for Country X. It might have been two years. But there was a long gap before that, as I stopped therapy when I went to graduate school and began teaching, because school and work full-time along with a substantantial commute made it impossible to continue. In other words, it’s been quite a long time since I saw a therapist, and I have changed substantially since then.

I hope you won’t get bored.

The therapist asked a lot of questions about what I had discussed or not discussed with a therapist before. Well, it’s been four years. I don’t exactly remember. She wanted to know what I had discussed with therapists prior to the most recent one–what were the goals? Well, that was 12 years ago. She wanted to know what the goals were. Fuck if I know.

Trying to answer those questions, I was acutely aware of how life feels in parts: that it is often authentically experienced as scattered moments rather than as readily identifiable patterns. I thought about one therapist and what I remember most is staring at her rug for long periods of time. She exclaimed once, “You’re individuating!” And I wondered why this felt important to her and what evidence of that happening she was responding to. She used to say I hadn’t had adequate mirroring, and I wondered where one goes with that. It’s not something you can time-travel to fix. She used to tell me as I learned to self-soothe things would get better, and that I needed to stop depending on other people to soothe me. Those are things I remember.

The thing that strikes me is that particular therapist’s assumption that I would understand where she was coming from and that she didn’t need to explain. I also take away from it that when I went into a freeze state–staring at the carpet seems like a freeze state to me–she was patient, and did not push, which was at least not harmful. But she did not know how to help or even that I might need help.

I remember the one I saw after she retired used to ask me, “And how do you take care of yourself?” when I was unable to pin down what was happening during conflicts. Why was my partner responding to me in the way she was? What about her response was upsetting me. The therapist seemed to believe boundaries would fix everything. To me, looking back, her expectations look much more like tit-for-tat. Hurt her the way she is hurting you, and she’ll stop.

She tried to point out “healthy ways” to set boundaries and I now see them as unassailable ways to fight.

That’s my honest opinion a decade or so down the line. Not that boundaries aren’t important or that I shouldn’t stand up for myself in a conflict. It’s just what I see as her motives. Not actually very good. At some point in her life, she had felt given permission to get other people to behave the way that she wanted by punishing them for misbehaviour, and she assumed that I would respond well to the same kind of permission.

What I think now is that people are free to choose and you need to find the strength to accept their choices. My ex was free to choose to intentionally hurt me, and I needed to find the strength to accept that she does that and to her this represents a valid choice. Those aren’t choices I am willing to make and as it turns out I don’t want to be around someone who sees that choice as an acceptable one, but I need to allow her to make that choice. Standing up for myself does not take away her choice to hurt me intentionally. That choice remains hers to make.

What I am getting at is that what was memorable to me about my therapy experiences weren’t the things that interested the therapist I saw on Monday.

She wanted to know what I talked about in therapy when I was in college. I know it had to do then with my family and with sexual abuse, but fuck if I know what the specifics were. It was 25 years ago.

The therapist seemed to be a bit younger than me–I don’t know if she actually was or not. If she were 10 years younger than me, it might be difficult for someone that age to think about what it is like to remember what happened when they were in still late childhood. That’s one possibility.

A lot of the session seemed to hinge on memory and how we experience it and understand it. Early on, something came up and she said the usual thing, I guess, which is that it protects us not to remember. Now, I am aware people think this, but the evidence is pretty strongly against it, that people who don’t remember traumas have more intrusive symptoms, more disruptions in relationships and are generally less happy than people with the same kinds of trauma who do remember.

So I explained why I think people have trouble remembering trauma, or one of the reasons, which has to do with our constructing meaning out of events collectively.  If no one else saw the “ghost,” you start to think there is no ghost. If no else sees you are being harmed, you find yourself unsure that the harm is occurring, even though you seem to be feeling pain.

She said this happens only when you are little.

I looked at her for a minute. She was very sure of herself. “Okay.”

I am not going to argue about this. I said what I think. You said what you think. We have established we disagree about it.

But I can imagine she thought of my attempts to describe previous experiences of therapy and she presumed I am protecting myself from something. I don’t think that necessarily. Get away from the assumption of the need to forget as a dominant motivation, and other things start to crop up as possible explanations: I am a teacher; there are many reasons I have observed that people don’t remember things. Among them, it didn’t seem important or worth remembering in the first place. Or, that information has not been accessed in a long time, and the neural pathway to it is not very strong.

I am reminded of the tissue incident as I write about this, because it seemed to create some confusion. In talking about the therapist handing me tissues, I was pointing out my willingness to see this as rejecting. I don’t know what the therapist intended by it. I am not in her head. I don’t even know what most people intend by it, since I have never done it before. People do cry around me from time to time–students do, parents do more often than I ever expected. Tissues don’t usually cross my mind.

But my thought about what it meant–get yourself together, stop crying, this is making me uncomfortable–told me about the lens through which I was viewing her already. People refer to this as a distortion, but I won’t go that far. It sounds judgmental to me. It’s a lens, a preconceived notion. It’s not possible to go through life without these. We need to have some framework through which to interpret reality, even if that framework may be imperfect or inaccurate.

This is part of the therapist’s lens: Forgetfulness is motivated by a desire for self-protection, to avoid the pain of memory. She probably does not think of this as a lens, nor does she probably wonder periodically, “If I didn’t what I think, how would I understand this? Are there other ways to think about this that are more interesting or that seem to be more accurate?” I don’t think most people do that.

What I think about my own forgetfulness is that it does not protect me, because I already have the fragments within my mind which constitutes memory. I already know. So not thinking about them or reflecting upon them makes my world less comprehensible to me, but it does not protect me from pain. It does, however, protect other people from that pain. They don’t have those fragments, and if I don’t construct a memory out of them, then there is nothing for them to know. I do think people learn forgetting as a coping strategy, because forgetfulness helps other people to cope, but I don’t think it’s as simple as our minds protecting us by not remembering.

There were four points in the session when connection with the therapist seemed to be possible, times when I felt connected to myself. The second was our discussion about memory, because this question of memory interests me. We disagreed. I don’t know if the therapist understood this as disagreeing.

Anyway, we did.

The first time was when she asked me who cared for me as a child, and I thought of who those people were: Aisha, Ksymcia, Nata. Losses. And I began to sob.

She got the tissues. I tried to box it up. I told her about Aisha or at least the fact of her existence. After that, the question of memory came up.

The third time was when I was telling her about trying to put a dismembered corpse back together. I can’t remember how that came up. I told her how distressing it was to be unable to get the pieces to fit.

She said something like, “Do you remember that?” I didn’t somehow quite catch the words. Well, I was telling her what I remembered. I couldn’t understand the question. It seemed to suggest that what I was telling her did not seem to fall under the category of memory for her–“Is there a “real” memory?” she seemed to be asking. What’s a real memory for her?

I think I just said yes. I remember it.

But it was another dysjunction between us.

The last time was when she asked me something to do with trafficking–the answer ought to have been Yuri. I know I mentioned this in my first post about.

I felt suddenly frightened. So, I paused, surprised about it, and told her. She might have asked something about that, or maybe I volunteered. I said I seemed to be afraid of speaking. It might be that Yuri is someone I cannot talk about, or it might be that Yuri did not like when I spoke.

She said, “Let’s leave this for now.”

Later, I came back to it. I just said, “It’s interesting.”

And she said again, “Let’s leave that.”

After that, I checked out and performed.

Now, in retrospect, what I think was so dysregulating about the session was the intensity of my desire to connect, and my inability to do so–the combination of this pain that’s really separation distress and fear.

 

 

 

What I’m Really Afraid of

FreezerI understand now why religion and science have so often been at odds.

The central mode of thinking behind science is you examine the evidence and see what the evidence seems to be saying. You form an idea based on the evidence, design a way to test the validity of your idea, and check that you’re really right. Then other people repeat your tests and make sure you’re really, really right. And then design even more tests. Just to be sure.

The central mode of thinking behind much of religion is you are given an idea and you need to believe that idea despite any evidence to the contrary. This is called faith and considered a virtue.

It is perfectly possible to restrict each mode of thinking to their respective domains and to only have faith when it comes to theological concerns and only look at evidence when engaged in scientific pursuits. But I can see how it might be human nature not to do that. To try to have faith about everything. Or to try to be scientific about everything. Even God.

I was raised to have faith. In theological matters, I still have faith. But it makes much more sense to approach the rest of my life in a different way. Often, I do.

There are pockets though. Little remnants of that old kind of thinking, where I still believe in particular ideas just because I was told to, or it was even just because it was kind of implied. I’ve looked at some of these. I think it’s time I looked at some more.

These aren’t necessarily 2×2 constructs. The fact that I have believed them isn’t directly the legacy of having been raised in that particular cult. But it is an outgrowth of having been raised in a cult that elevated faith to an unnatural degree.

They mostly seem to be an unfortunate side-effect of decades of psychodynamic therapy, I don’t blame anyone for them. Belief is just what I was raised to do. So I kept doing it.

Here they are, along with some of my current thoughts about them. Some of them are repeats. That’s because redundancy makes things clearer.

1) The mind is a treacherous place. It is mostly bent on sabotaging and undermining your consciously articulated goals and desires.

Not true. A traumatized mind really isn’t fun to be in, but 99% of what is going on in there is aimed at furthering my survival. I am just a little misguided at times.

2) The cause of all of my problems is low self-esteem.

Also not true. My problems have multiple and complex causes, most of them having to do with a lack of specific inter and intrapersonal skills, because for the most part I raised myself. And I wasn’t really up to the task. Also, my dad was intent on trying to mould me into a felon, which doesn’t set you up well for being a productive member of society, let me tell you.

What I think of myself is mostly irrelevant so long as what I most want to do is live. Which I do. (See #1).

3) I am deeply afraid of the disapproval of other people.

Sort of. I am afraid other people will kill me or beat the crap out of me or force me to perform oral sex on someone, which is kind of like disapproval. Only different. But I think I often ignore what people seem to think of me because I expect it to either not make sense or be used in an attempt to manipulate me. The rest of the time I feel I have to become whoever they’d like me to be so that they won’t kill me. So mostly I don’t think too much about other people’s opinion of me. It seems better that way.

Except sometimes I feel I should be afraid of disapproval. Something bad will happen if I don’t.

4) Emotions are frightening.

Emotions are pretty much a cake-walk. They also make you feel more alive. What I’m really afraid of is showing my emotions to someone else. Because they might kill me. Or a cat. Or make me kill one.

You probably don’t have the same preconceived notions. But I encourage you to examine whatever yours are. If nothing else, it can be a relief. In the end, it turns out what I’m really afraid of is the freezer. That’s so much easier to live with than being afraid of feelings, which I have every day, or disapproval, which I can be on the receiving end of at any moment. Or low self-esteem. Which I have. Or my own mind.

If you try it, give me a ping back. Let’s compare notes.

Evidence of Life

Back in the bad old days (but not the worst ones), when I spent my days being verbally abused by my narcissistic spouse, we saw a couples’ therapist who used to tell me that I needed to be heard.

I don’t.

I like writing. I like talking. This blog is evidence of the first. My colleagues will bear witness to the second. But I do those things for one or the other of two reasons: a) because I think it will help, or b) because it’s fun.

I suppose it’s nice to have people agree with us. But if it happens too much I get nervous. What happened to your brain, I wonder? Did it fall out? Should I be looking around on the floor for some squishy white stuff because it has all leaked out of your ear.

I do have the expectation that one or two important people in my life will have a genuine interest in what it is like to be me, in my thoughts simply because I have them, and my feelings because they care. I did have that expectation of my partner.

It seemed to be what all the books said your spouse was going to do. And I don’t mean fascination. I don’t mean I expected her to have heart palpitations every time I opened my mouth. Just, you know, interest, and a genuine desire to understand.

It was confusing as hell to me that she didn’t.

I get it now, but I didn’t then.

But what I never understood is what that appearance of needing to be heard really meant. Other than a confusion about what intimate relationships are all about.

I do now. As of today. Yippee.

I need evidence of my right to exist. If I say, I think this or I feel this, and someone else tells me instead, “No, you don’t. You think this. You feel this>” Or even, “Stop feeling that. Stop thinking that.” Then what I have instead is evidence that I should not exist. I should not be.

Being trafficked is about being. It is about someone else owning you entirely–your actions, your words, your thoughts, your feelings, every part of your existence. Independence is an inconvenience to the traffickers, an affront even. And if you are also nearly killed on a regular basis–as I was–then the abuse is not merely about pain, but about the very process of being and whether or not you have a right to it.

Do I have the right to feel pain? Do I have the right to feel despair? Do I have the right to think anything at all?

And I needed to know, after I left that world, that I could be. I could have thoughts of my own, feelings of my own, interpretations of my own. That I would no longer be expected to think and feel only what was convenient for my traffickers and their customers. But whatever came to mind.

So, when my spouse distorted what I said to match something in her own mind, it wasn’t an assault on my need to be heard, but on my need to have an existence beyond her imagination, a reality and a concreteness of my own. When the therapist insisted I had motives I could not sense within myself, I again lost my right to think my own thoughts and to feel my own feelings.

But I kept trying to speak without being told I meant something else, that I thought something else I didn’t think or that I felt something I didn’t feel. I persisted in looking for evidence of my own life and for proof of my right to exist.

I’m still looking for it, but I think it may be close at hand.

Being There

In One Minute Therapy, I suggest trying to tell a few people in our lives what is real for us at that moment for one minute. The thinking behind it–which isn’t my invention, although I’m not sure whose it is–is just that sometimes our most powerful gift to one another is simply being there

Often, when someone confides their struggles to us or their pain, we want to suggest solutions, we want to make things better, we want to say we understand. But we aren’t that person, and much of the time we really don’t understand exactly what it is like to be her. We don’t have any great insight into the problem. We don’t know what the best direction is for anyone other than ourselves–and we aren’t always clear on that.

But we can be there.

When we tell ourselves our own troubles, sometimes we also want to suggest solutions. We want to tell ourselves the precise origin of our problems and how we should go about solving them. But we often don’t know. We have no great insight, only pain.

We can still be there with ourselves, accepting the state in which we find ourselves. We can know that it is not a nice place to be, we don’t like it, and we wish things were different. We can still be there with ourselves, bearing witness.

Treating Torture Survivors

If you work as a therapist or in the field of mental health, I need you to know this: traditional forms of mental health work are not effective for helping survivors of torture and are in many ways counterproductive.

Cognitive behavioral therapy may alter behaviors, but it doesn’t address core problems, therefore keeping the victim mired in the trauma. Psychodynamic therapy relies to some extent on the therapist being able to provide insight and mirroring to the client. Unless you have worked with a great number of torture survivors, you do not understand the dynamic of torture nor what the survivor is feeling or why. You will only rarely be able to provide appropriate mirroring. And you will have no insight to offer. Instead, insight can only come from the client. If you want to help, you will need to learn new strategies, because the old ones simply don’t work.

Torture creates a world for the victim in which they have absolutely no control—neither over their environment, nor themselves. They are not allowed to make decisions about basic physical functions—when to sleep, when to wake, when to rest, when to be active, when to be naked or clothed, or when to use the toilet and they are unable to solve basic problems for themselves, including simple problems, like how to stop being too hot or too cold. They are also not allowed to decide for themselves what they think or believe. All forms of abuse involve control and an imbalance of power, but in the case of torture, the control is almost total.

Surviving torture can involve overt resistance and refusing to tell ones captors what they want to hear, but this creates intense suffering for the victim that is often untenable. More often survival means providing at least the appearance of surrender, so that the victim appears to tell the torturers wants to hear, and appears to be compliant, while attempting to maintain an internal autonomy. Over time, this alters the victim’s view of how the world works, as the rules of the torturer become over-generalized to the world at large, as well as intense confusion over the victim’s view of himself.

As such, there are three core problems that must be dealt with in the course of therapy: the trauma itself, the victim’s distorted views of the world based on the distorted world of torture, and re-forming the victim’s identity.

Methods for treating the survivor’s trauma seems to be fairly well established. An example of it is found in Psychotherapy Treatment of Torture Survivors.

It involves creating a safe place in the mind of the survivor and using this as a way to titrate and control the intensity of the trauma experience as she interacts with the trauma memories. I have found this to be very helpful.

The second problem seems to be more difficult, as the world of torture is one in which the victim has no rights whatsoever: not the right to demand humane treatment, and not the right to autonomously form opinions or make decisions. At issue in every therapeutic exchange is likely to be that underlying question: “Do I have any rights? And, if so, what are they?” The survivor may be unable to substantially more forward until that question is answered.

The assumptions of traditional psychotherapy often place it odds with solving that fundamental problem. It may help here if I provide a specific example. In the course of being tortured, I was forced to do things that I believe were wrong, and I consequently feel guilty about them. This is not uncommon. The goal of torture involves destroying the victim’s entire identity and sense of worth. Forcing them to act in ways that violate the norms of society or the individual conscience of the victim are effective ways to do this.

From time to time, in therapy I have brought up topics I felt guilty about, as a way of approaching that guilt—even though I wasn’t able to bring up the situations directly. It has seemed to me that the assumption of psychotherapy is that I want to be relieved of my uncomfortable feelings, and that that is the purpose of bringing them up. But that is often not its purpose for me. Most often, I am trying to answer that fundamental question: “Do I have rights?”

When the assumption is that I want to be relieved of my guilty feelings, the response is usually to attempt to help me reframe my guilt, so that I no longer need to see myself as having violated my moral precepts. What this unwittingly communicates is, first, that I have no right to feel guilty, and second, that I have no right to construct my own set of moral values and, with that, no right to determine for myself when I have violated them.  It leaves me once again in the world of my captors and in a state of confusion.

Treating the torture survivor, above all, requires the therapist be sensitive to the importance of that question. It is not a small one for the survivor. Everything hangs on it.