I was the guy on the academic track in my class at the Psychodynamic Psychotherapy Training Program. I was the guy with the asterisk by his name on the attendance sheet. Alas, the eternal asterisk. (Still, there’s pride in being marginal.) I was the non-clinician in a room of practicing therapists. As such I couldn’t contribute case material, unless I made it up.
I fairly loved the PPTP. I say “fairly” because love is a worrisome word to me and usually needs a modifier. But the truth is the Program is a fabulous education―perhaps the best education I’ve ever had, and I’ve been through some pretty darn good schools. But the caveat here (like the eternal asterisk) is the danger for the academician to get bitten by the clinician bug. Because then each week, without clinical material to share, each week can become a tiny torment, a slight castration (slight?) metaphorically, and that’s what happened to me. I wanted the theory and abstraction to be reified. I wanted to be where the rubber meets the road. I wanted to be onstage with actual patients, to feel the experience, and I was fortunate enough to meet Chuck Giannasio who connected me to Larry Real at Belmont, who told me to phone Nancy Beck―director of volunteer services there.
I met with Nancy and told her my background. I’m a teacher and writer. For twenty years I’ve run the Rittenhouse Writers’ Group―a series of fiction writing workshops. I taught at Penn for fifteen years. I’ve published a bunch of stories. I told Nancy that I approach writing analytically, critically; I think about characters on the page in a psychodynamic way; I push students to hone their writing. She told me that wasn’t what she wanted. She wanted to use writing therapeutically, not in an analytical way. Perhaps people wouldn’t tolerate the criticism. I felt balky at first; this wasn’t what I taught; this wasn’t what I was learning at the Psychoanalytic Center. But I wanted to have the clinical experience, and so of course I made the change. Nancy decided to put me with the mood-disorder patients.
So, last January, I began participating in an hour-long Friday group therapy session using writing as therapy. The group is coordinated by a terrific occupational therapist, Stacey Saleff. It’s her group. I’m the hired-gun, though I’m a volunteer.
Stacey and I established a framework: we’d give a writing prompt, then the participants would write for fifteen minutes, then they’d read aloud and we’d discuss their pieces. I’d make some comments about how to sharpen their writing. We’d look for common experiences that people could share.
The first day I was nervous (though I’m usually nervous before a new class). But this was different. I wanted to really embrace the experience. I wanted to be helpful to the folks. I didn’t want to embarrass myself after so much analytic theory. I felt…uncertain. But then I’ve learned: one must tolerate the uncertainty; one must sit with one’s disturbing emotions.
There were eight people in a common-room when we arrived. Everybody seemed downcast, gloomy. One man looked furious. The gloomy mood hit me―my first clinical countertransference. Of course, I thought, these are the mood-disorder folks: teary-eyed, anxious, angry, depressed.
Stacey gave me a glowing introduction and I smiled and spoke briefly about myself. Then I gave them our prearranged topic: Write about a memory, a “moment-of-being” (Virginia Woolf)―i.e., a moment where you suddenly understood something differently, something that perhaps a parent or friend had tried to convey to you for years. A change, an insight. Make it a positive change. Put some emotion into it. The people looked nonplused. I repeated what I said, then I added jokingly, “Nobody fails this assignment. Everybody passes or gets an A. Write whatever you want; I don’t care. Just make it sincere.”
So they wrote for fifteen minutes. Most people. A couple just stared into the winter sky.
There are windows looking out on Monument Avenue with an American flag pulsing in the breeze. There are windows facing the main corridor. I studied other accouterments in the room. The walls are putty-hued; call it hospital chic. There’s a TV, exercise bike, upright piano, a big clock on the wall, a round table with jigsaw puzzle pieces on it, piles of New Yorkers, and a sarcophagus-like, stand-alone closet in a corner.
I felt the heat in the room as I sat there waiting. I listened to the shuddering, humming radiator. The clock ticked behind me and I wanted to know the time. Sit with the uncertainty and the disturbing emotions. After fifteen minutes I asked the people to stop writing. Then I asked them to read what they had written. They hesitated a bit. I felt sweat start to bead on my neck. Still I pushed them to read or speak about their memories.
A couple people read exquisite, intimate, heartfelt memories, filled with lyrical language (after fifteen minutes!). One young woman talked about how her father finally told her he loved her after his twenty years of being a junkie. Another woman spoke about how she found the right meds that stopped her from hearing voices. Some people didn’t read. I tried to get everyone involved. I learn names fast, so I called on everyone. For the most part everybody got involved and the mood changed, and it became exciting.
For the first few weeks I gave people exercises, always emphasizing the positive in their thoughts, but then I’d get these descriptions of lovely beach scenes―all shiny, glittery, sun-washed sand―but nothing much to discuss afterwards. “That’s nice,” I’d say. “That’s really beautiful. Maybe if you decide to rewrite your piece you can add some more sensory details―the sounds of the gulls, the smells in the air.”
For me, the therapeutic aspect and therefore my assignments felt saccharine and unreal. I wanted to unlock greater emotion. I wanted to balance the positive with the negative, the light with the dark, though the emphasis could be on the light. I asked Stacey if I could make a change. She said okay. Let’s try it―she nodded. Then I started giving people exercises like: write about a person viewing the ocean after something wonderful has happened to him, then contrast it with a description of the ocean after something tragic has happened. Don’t mention the precipitating event. Let the details and how the person feels suggest it. People wrote longer with the oppositional approach. The discussions afterwards became more honest, vigorous.
Then I started reading brief stories to the group―always with a certain theme, say, a father/son disconnection; some argument between a mother and daughter. I talked about the resiliency of the characters in the story. Then I’d ask people to write what the stories inspired in them. I think the fact of reading stories to people can have a calming, nostalgic effect. I takes them back to childhood or an idyllic fantasy of it―the great symbiosis between mother and child. Again I was impressed by the honesty of the writing. I’d comment about how courageous the people were for presenting such poignant, intimate events. I didn’t analyze, though I had many thoughts. Instead I spoke about how people might carry their problems a long time, and it took a long time for people to work them through.
I’m also attentive to the group dynamics―the mood lability―that rolls like a wave. One person starts crying; several people start crying. One person reads an anecdote about his parents teaching him how to tie his shoes, his parents start fighting and leave the room, and he laces his own shoes. He says, “I learned that I could do things for myself. I didn’t need my parents to solve m problems.” Everyone is suddenly upbeat, smiling.
I’ve made mistakes in my efforts to help people. I’ve been ironic and challenging and people have gotten upset. I’ve had to back off, or Stacey has bailed me out. It’s a good thing that we get along. It wouldn’t work if we didn’t get along. I’ve read stories to folks that have distressed them. Then I have to amplify the positivity. One time I read a piece about a little girl skipping through the woods when she suddenly discovers some human bones. I talked about how bold the little girl was, and how this revelation would help carry her to her future. One guy cried, “Bullshit!” He was partly right. But another person disagreed and said, “That was a great story that James read; dark, yes, but I’m tired of having things sugarcoated. That’s how I ended up in here. Everyone was always sugarcoating something.” The majority agreed. The group rallied for me.
At Belmont I see how hurt people are. There are people on the ward with acute problems: a young mother whose child has recently died; an investor who’s lost his money and can’t stop thinking about it; and there are the chronic sufferers, usually undone by a parent’s lack of love for them, or their perception of it, and how they hate themselves but still want their parent’s love.
I think of Fairbairn and how a bad object is better than no object at all. I met one man who, at the age of six, accidentally bumped his brother out an open window and killed him. I listened to a woman who was enduring the first anniversary of her son’s murder. All I could think at that moment was, “Wow.” This was beyond my experience and I wanted to change the subject, move on to another person and hear his or her story. But I remembered my training, and sat with the emotion.
Then I told them that their revelations were another step in their recovery. I emphasized how courageous they were. Not very analytical. But what can I truly say to them in the brief time I’m there? I have to be careful not to unsettle people, leave them upset over the weekend or before they’re discharged. What I do say is how appreciative I am that they allow me to hear such intimate stories. And I mean it.