After forty-two years I decided to return to psychotherapy. It was not a decision, says the cliché, that was easily arrived at. I can share, which is my nature, some of what motivated me to do so. Some feelings I will keep to myself where they mostly belong. Last year was one of medical awareness, pronounced at risk by one doctor which was not sensitively rendered. A series of physical maladies befell me, a bone spur impinging on my spine was the severest and required a cortisone shot into the spinal area for relief; the agony was bordering 8 on the Richter scale. So one essential reason for therapy was the need for outside assistance for emotional support; I felt the hound of heaven nipping at my heels and at 73 everything related to death and dying is imminent, more so, of course if I were just a mere youngster of 55. I also had issues in my marriage which made me consider treatment as well.
What I am writing here is my first experience as a potential client after four decades plus. I scanned the internet for male therapists, and I realized that Henderson, Nevada and exurbs are predominantly saturated with women social workers, psychologists, et al. My last treatment was with a woman therapist who ultimately proved to be disastrous and had serious psychological disturbances of her own. Treatment was poor. In fact, in my book of essays This Mobius Strip of Ifs I thoroughly explore what that experience was like in the chapter called “A Spousal Interview.”
Consequently I found a therapist who listed “books, movies and travel” as his interests which are mine as well. And he was 63 which meant he knew who Milton Berle was. I could not work with a young shrink; the cultural backstory would be too much to bridge in my eyes. I spoke to him for a few minutes on the phone and he seemed friendly enough, open, and sharing if not talkative. I set up an appointment with some high hopes for the first session.
As I prepared myself for that first session I considered what he needed to hear from me, for this time around I would know what I wanted to work on and I knew who I was as opposed to the dolt who entered treatment at 28, a product of benign neglect and thoroughly unknown to his self. What I am about to share here are three touchstones I felt the new therapist needed to hear, listening with the third ear (Reik) is the operant phrase. I thought that these three touchstones would be an emotional Baedeker to some of the issues in my life. It is important to note that I did state them to the therapist and I will return to what he made of them — nothing verbal, I can say that.
A mentor of mine who I hold in high esteem and the most intelligent man I have ever met, an emotional genius, if you will, supervised me in a psychotherapy center he managed. We became close friends. In passing he once said to me that my life had been a holocaust of a kind and his evaluation was accurate — loss of a mother at 20, loss of a daughter by suicide at 34, loss of a wife, a divorce, loss of another daughter’s boyfriend in an accident that also killed my wife of 29 years, and so on. Much has befallen me, including a childhood often bereft of real, demonstrative affection.
The second touchstone was a comment my mentor made to someone who asked how should she access who I am, as she found it difficult. He replied tersely, “Matt, needs to be felt.” That comment has reverberated in me for years and I find it dead on. I have cogitated over that as I would a biblical commandment. Growing up under benign neglect, being felt was a parental omission. I was never read to. It is not an exaggeration. Rarely embraced or hugged. So whatever self I had was so regressively sequestered into a nether cavernous recess I never made my own acquaintance.
The final touchstone occurred in 1970. I was seeing Rochelle who was to become my wife. We were preparing to go out for the evening and I was trying to make a Windsor knot out of an unruly tie, one of those blaring ties out of the sixties. I asked Rochelle what she made of it. “It’s beautiful, Matt,” she said. Given who I was at the time, I challenged her with some sarcasm, comments such as, “C’mon, cut it out, what do you really think?” Rochelle stepped closer. “Matt, it’s a beautiful tie,” she whispered. And with that the thorn was removed from the lion’s paw, I dropped my lance, and I was disarmed. It was to be the beginning of many firsts with her, for she was teaching me to trust, one of the significant issues I had.
By the time I was in the session three touchstones in addition to the need for support for my aging carcass were mentally in place. I was handing over some of the keys to the kingdom. I was ready to hear any therapeutic reflection if not interpretation about any or all of them. I was prepared not to be smartass retired shrink showing off what he knew. I wanted to be a client. I came for help.
What I am reporting here did, in fact, happen. What I made of it I will offer for your purview.
I was on time, of course, and I was greeted by the therapist who worked for a therapy agency. He brought me into his office, asked me to take a seat on a small couch. Across my way on a somewhat canted angle was what I thought was the therapist’s chair. The therapist who I will call Mr. O (for oblivious) sat at a desk which had a monitor on it and at a 45 degree angle from my seat. He proceeded to work on the computer filling in data about me. The computer had a glitch he could not resolve. He got up and invited a woman in to help him with that. She then left. (As a therapist I would have never allowed that intrusion!)
He continued on the computer for a while longer and then shifted to asking me questions, specific questions, for apparently he was doing an intake on me. Note that he did not make eye contact with me, just asked questions and wrote down my answers. This went on for a few minutes and I was perturbed by this approach if not rudeness. I thought I should get up and leave but I did not want to act out, but I waited to see if there would be a turn of events.
I was keenly aware that I did not like what was happening. I was being objectified. I will explain later on what technical and relational errors he was making with me as a therapist. I recall saying to him words to the effect that I was miffed with what was going on. He replied that he was good at “multitasking.” Now that is chutzpah! He told me that things have changed and that these are requirements for him to do in that agency. I empathize with future and unknowing clients who might experience this and remain silent and eat therapeutic shit. He did at last turn to me for the rest of the session, continued to write down data for the intake which was all right with me, now that he sustained eye contact.
Somewhere in the session I quoted a line from Miller’s Death of a Salesman. Willy Loman’s wife says to one of her sons with reference to her husband, “Attention must be paid.” A listening, a hearing therapist would pick that up and reflect back to me something like, “So, Matt, here is our first session and you believe or feel that I am not listening to you.” A good therapist decodes. And here I will go off on a pertinent tangent.
If I were supervising Mr. O I’d ask him to tell me about the session, and to read his process notes. He probably would say that Freese said something from Miller’s play about attention being paid. The supervisor would ask him to clarify what that meant. Mr. O would say that upon second thought Freese thought I was not listening to him. Is that all? the supervisor might proffer. I think so, Mr. O says. The supervisor might say this: You are also missing the latent message as well. The client is supervising you. All clients supervise, unconsciously so. He, in effect, is telling you to pay close attention now and in the future to what he is telling you; that you are too busy with gadgets and taking notes without focusing on what he has said. Indeed, he begins the session with three touchstones which you never attend to. These are powerful assessments by the client which he gives to you for your input, reflection or interpretation.Where were you, Mr. O? Think about why you were absent to these momentous themes.
I don’t believe I heard anything of interest from Mr. O except for a comment that I may have attachment issues. I followed up on that and he added some thoughts. What I found disconcerting, to say the least, is that you don’t say to a client that he has oedipal issues or attachment issues without much more information to arrive at that assessment and then if you do have the facts, you use it in a way that is meaningful, oh, such as, “Matt, did you find your mother unwilling to be close to you?” Otherwise labeling my “disorder” is useless to me and that is exactly what I felt when he said I have attachment issues. Mr. O may be eclectic, or have a panoply of approaches in his quiver, but for my money being minimally analytic is not one of them, but I am prejudiced at this point. And I decided after a few days to cancel our next appointment. I sensed he knew he had blown it as we went on to discuss the possibility of a second session for by that time he had heard my misgivings.
One other observation. Mr. O disclosed information about himself and his family of origin; that he is the child of Holocaust survivors; that he went to see a Freudian psychiatrist at the age of eighteen; that he had difficulties with his father; that he experienced guilt in that setting. I felt that this intense self-disclosure was not appropriate in the first session, to say the least. When I practiced I was cautious about self-disclosing and when I did so, I tried to make it pertinent to the client’s situation. After all, I could tell my supervising therapist that I felt a need to blab this or that. Self-disclosing has always been a contentious issue among therapists and in the literature, at least when I was practicing. The session should have focused solely on what I was bringing to it. Clearly what I had to say about my own touchstones was never engaged. If Mr. O wanted to relate to me it should not have been through his own self-disclosure but through the content I was offering up for his consideration. I agree this is all debatable.
I will share something of my training so that you can sense what I was expecting, not inordinately so. When I was training in the mid seventies the first thing I learned was that you welcomed a new client to your office as if you were welcoming him or her to your home, asking him to sit, greeting him amiably (he is probably scared shitless, anxious or very nervous; it is the unknown – the new can paralyze) situating everyone comfortably. I learned that the very first client sentences in a therapy session often foretell the theme of the session and to be very alert to that. If the client was quiet, I might say “What has brought you here at this time in your life?” or “Is there something going on that you need talk to someone?” The critical point here is once the client is in your office the entire focus is on him, no working the computer, no taking notes without eye contact, no distractions and no third party allowed to enter. It is sacrosanct territory. If you are feeling compelled to share some intimacy with the client, save that for your shrink. Who’s treatment is it? I am not rigid, as I said about this, but keep yourself out of the first session. The client should experience the therapist as someone who finds him of worth to listen to for 50 minutes.
When I worked in an agency or clinic I was required to do intakes and when I did these clinical tasks I tried to put the client at ease. I might say this: I need to gather information from you. The clinic requires this. I will take notes as you speak but know that I am listening very hard to you (which was true) and what you are telling me are issues that are making you uncomfortable in life. Afterwards I will write up these impressions and the therapist assigned to you will now have a head start of a kind. I hope you will allow me to do this. I hope you understand. (I have never had anyone say no to my earnest plea.)
In private practice I chose not to do intakes. Many therapists do away with them completely. What I did was write out notes, my countertransferential feelings, impressions and possibly theories after session. I discovered that over the weeks a full picture of the client emerged and what I needed to know came out in any case in session. I trained myself to listen with the third ear, to decode manifest messages or themes for their latent value or meaning. I trusted myself and that took a long time as it must for any therapist. Mr. O seemed slightly obsessed with note-taking and while doing that he lost me because he was not attending to what I was saying or the feelings crossing my face for I experienced the way he was doing his intake as insensitive. I am here. Listen. Fuck your notes for now.
When Mr. O said he was capable of multitasking, what he said, in effect, was that he could do two or more things at a time and at my expense. Good for him. However, I am a human being and I want your attention, in part, because you are now a paid friend. I am sure other individuals would not have minded any of this at all. I felt I could not be treated in ways that I did not treat my clients, basic civility, concentrated attention, undivided attention, I say, focused and putting on elephant ears to hear as much as I could. That I have had a bone spur, macular degeneration, et al was met by his self-disclosing which was not what I needed.[By the way he commented on his own recently diagnosed issue when I spoke of my malady, actually giving me a flyer describing his meds for macular degeneration -- sociability has its place, but not now, not here]. Issues in the therapist’s life are not to be divulged in the very first session, rule numero uno for this once practicing therapist.
I sensed that he was trying to share which is human and reasonable, but in analytic psychotherapy he broke the “hold.” In short, the therapist’s task is to contain and hold the client so that he feels safe and secure and when that is established the client will feel secure enough to speak of pressing issues and life long struggles. So you are a good guy and you want the client to know that you have had similar issue in your life; well, we do that all the time in social discourse; my child has the flu and yours too, what did you do to medicate her? Shared suffering is not therapy in my experience. Disclose when it advances the client’s treatment! A good therapist should be quiet for a fair part of the session, assessing, turning what he hears into postulates or hypotheses; reflecting back to the client when he is stuck; or to put it another way, to cite Carl Rogers, one should be client-centered.
I suppose I could go on and on. The point is that Mr. O put me off. I bring him three or four major themes I was thinking about for a week as grist for the mill and he did not touch upon any one of them. He may have written all of them down, but he did not engage me at all. If a client had ever said to me that a significant issue in his life was that he did not feel felt, I would become instantaneously laser focused; pounce like a lion on a zebra’s hindquarters, ask him to put it into others words if he could; to cite a past example in which he experienced that; how did he feel about that self-conclusion? is it really valid?And I would know that in that piece of kryptonite that was slowly killing him in life that I had weeks ahead teasing out, grasping, reflecting, perhaps interpreting what he was telling me. Poor, Mr. O, he lost what could have been a very good client. And lucky Matt, I escaped wasted sessions leading nowhere.