An Intimate Portrait of the Psychotherapeutic Process

The New York Times features a blog column about the experience of psychotherapy called “Couch.” Recently, they published a very intimately written and because of that intimacy fascinating account of one person’s journey into psychotherapy. The piece, written by Said Sayrafiezadeh, who is himself a writer, is a very personal account of the obstacles he had to overcome in order to enter into a relationship with a therapist and for that matter into any intimate relationship with another human being. At the start of the article, he intimates that that journey has been successful: he notes how his published books have been dedicated to the same two prominent people in his life, his wife and his therapist.

What he reveals is a difficult process, beginning with the fact of his mother’s mental illness when he was a boy and how, threatened by the prospect of losing her therapist when the later was going to retire, she tried to kill herself. The shock and horror of a parent attempting to end her life is bottomless. No doubt the image of a dependent relationship, not just to a therapist but any other person given his mother fragility haunted him and affected his ability to be in relationship. (Sayrafiezadeh’s presenting problem, what brings him into therapy, is a series of failed relationships and the advice of a former girlfriend to seek help). And while most patients do not react as his mother did to the end of a psychotherapeutic relationship, still there is the challenge, as there is in all relationships, of navigating the terrain between dependency on others and one’s own autonomy. We are all threatened by such dependency and at the same time so in need of it, of others to rely on as well as on ourselves.

Sayrafiezadeh has to also surmount his preconceptions about therapy. He writes, “The argument that I honed and offered freely was that therapy was the domain of those too weak to understand their own brains: i.e., the mentally unstable or feebleminded or upper middle class.” The attitude that one should be sufficiently able to overcome all of one’s problems on one’s own remains dominant in our culture today, perhaps some remnant of the rugged individualism and Wild West mentality of early American culture.

And the writer had to overcome his own defenses, chief of which was a strong sense of denial and ability to blame the other: “But when my second girlfriend affirmed my first girlfriend’s appraisal, I knew that there was something deeper at work inside of me, something that I couldn’t solve on my own, and that it would be a fatal mistake to continue laying the blame for every breakup on the fact that the woman was no longer pretty enough or smart enough or talented enough.” To discover, with the help of another human being, just what is that “something deeper at work inside” is the ultimate intent of psychotherapy. Along the way, to see one’s patterns and one’s defenses becomes part of the landscape.

Not only does this piece reflect the challenges that the author faced, but it also illuminates the working gears of the psychotherapy process: that is, two people talking. Sayrafiezadeh of course had his doubts about how it would work. I write “of course,” because such doubts, for the newcomer or the veteran, are intrinsic to the process which, no matter how well studied and allied to science, remains mysterious and allied to the human soul. He writes: “’What are we going to do with all this?’ I asked him one evening, just as our session was ending. By which I meant, how will it ever be possible to alleviate these unhappy memories that can never be undone? ‘Keep coming and talking about it with me,’ my therapist said. And that’s exactly what I did.” I appreciate that description of the process very much. Often when my clients turn to me and ask “But what do I do?” I reply that we talk and we continue to talk. I don’t mean to undermine the efficacy of taking action, of doing. But in this process, as I understand it, doing comes from understanding, and understanding, intellectually, emotionally, deeply, comes from the process of two people talking.

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