The Value of “Having Your Head Examined”


PsychotherapyThe profession of psychotherapy has been around for over 100 years, with less formal versions of personal consultation going back to biblical times.  So why is it that the voluntary seeking of psychotherapy can be such a polarizing issue?   

Skeptics of psychotherapy cast doubts on the effectiveness of “talk” to change anything in a substantive manner.  Human beings are talkative creatures, so what is so special about talking to a psychotherapist rather than to a hairdresser, bar tender, cab driver, or next-door neighbor?  “If all therapists do is talk, then I can get that anywhere, and for a lot less than $150 per hour!”  

But talking is only one part of the picture.  An even more significant aspect of psychotherapy is the therapist’s capacity to hear what is being said—not just with words, but also in a larger implicit sense—hearing the meaning of a person’s truth.

Some advocates of psychotherapy might argue that it has changed their lives, saved their marriages, or even freed them from a life of abuse.  

What does seem clear to me though is that many people are afraid of psychotherapy.  Considering how therapists get portrayed in movies or the embarrassing presentation of media psychologists, there seems to be good reason to fear them.  I am often asked if psychotherapists are motivated by their own deep-seated issues and if they are as “crazy” as the people that they portend to treat?  My answer is simply . . . of course!  Being human is, in itself, a crazy proposition.  We live in an artificial world of our own invention by rules we make up, and we kill ourselves needlessly in wars, with drugs, on highways, in airplanes, and sometimes for pleasure.  There is good reason to think humans are crazy!

Yes, we do good things too, and we invented science and ethics and laws.  But while it is easy to be seduced into exalting the remarkable advances produced by the human race, our fellow (nonhuman) creatures may have a profoundly different opinion of us—if we could only hear them speak!  Humans have one foot in a virtual world of seemingly limitless creativity that seems wonderful, if not artificial, and the other in a biological reality, with specific needs and limitations.  People need to be nurtured, for instance, by another person who will validate their existence and uniqueness.  (Think about how painful it can feel to be ignored, or have your feelings and thoughts dismissed and devalued).  

Perhaps the most valuable contribution made by the profession of psychotherapy has been to create an industry designed to help persons retain their connection to their humanity.  In spite of all we have invented, we remain fragile living organisms, clinging to each other for survival—a reminder that there is no substitute for real human contact.  

With dozens of forms of psychotherapy to choose from, what they all have in common is that they provide a private, protected space, where the challenge of being alive can be acknowledged and supported by another who respects and listens to the struggle for sanity.

A good resource for clinicians for more information on the complexities of the therapeutic relationship is the course Psychodynamics of the Therapeutic Relationship.

An Unforgettable Patient: The “Meerkat Boy”


Child Psychotherapy Case

Child Psychotherapy Case: Meerkat BoyOne of my favorite child psychotherapy cases is that of the “Meerkat Boy.”  He was only 4 ½ years old.  His father had mentioned to his own therapist that the child had rarely (if ever) spoken, was reclusive, and was defecating in the corners of rooms.  The therapist recommended that the child be evaluated.  Hence, my first meeting with the boy. 

The child entered my office alone, apparently uninterested in having his parents join him.  His skittish movements reminded me of a Meerkat, on the lookout for danger but nevertheless engrossed in exploring his environment.  He moved through the room quickly and with curiosity, gently opening and poking through drawers.  What was he searching for? 

Suddenly, he stood straight up and beamed a broad, excited smile.  He had found a treasure!  He swung around and motioned for me to sit down in a nearby chair, positioning me so my face was at his level.  He was about to share his treasure with me!  He held out a roll of transparent tape.  What next?  He gently approached me, but no longer with caution.  He took my head and began to wrap it in the tape.

Should I stop him?  Should I be using this as an educational opportunity to teach him about boundaries?  Should I insist that he put into words what he was demonstrating in action?  The next 10 minutes were painfully long as I wrestled with how to be most helpful to him.  But we’d only just met…  So I said nothing.  And, with both care and determination, he wrapped my head until the entire roll of tape was gone. 

With that, he stood back examining his work with pride, and pronounced, “I wish I could do that to Mommy!”

I soon came to know that he was not on the Autism Spectrum or struggling with intellectual developmental delays, as others outside his family had suspected.  The boy was a bright and curious child, coping with extraordinarily odd and intellectually disabled, although well-meaning, parents.  His parents, after all, had not recognized anything unusual about his lack of language and odd behaviors, but had willingly brought him for therapy when this was suggested by a professional.

In meeting with the child’s mother, I learned that she also had some unusual interests that challenged normal boundaries.  (“I wish I could do this to Mommy!”—that is, containing her with tape.)  Whenever a family member used the bathroom, she would call all others to view the “product” before flushing.  She had also removed all bathroom doors, purportedly due to a fear that her son might drown if allowed to be alone in the bathroom.  The child’s preference to defecate privately in the corners of rooms now made sense to me.  When his need for some privacy was explained to her as developmentally appropriate, she willingly returned the doors and stopped calling for audiences.  He responded positively.

With my encouragement, she also enrolled him in a nearby preschool.  Teachers responded to his intelligence and curiosity, and he thrived.  More clues to his concerns about boundaries came with his first “show and tell” at school.  Children were to bring something from home to share with the class.  The day before the event, the boy came bounding into my office, both excited and anxious, to show me what his mother had prepared for the event.  He pulled a clear plastic bag from his pocket and laid it on the ottoman.  The baggie revealed a multi-year supply of cotton swabs dripping in ear wax.  He announced that his mother had been saving it from before he was born.  I worked hard to maintain my composure (and breakfast) and agreed that this was indeed something the other kids might find really interesting.  Knowing though that some children (and the teacher) might not respond positively, I wondered out loud whether he might want to take something a little less unusual for this first share.  His body language showed great relief and he proceeded to explore my office for something he could take instead.  He decided on some paper clips, which he linked together into a long chain. 

I passed the change in plans on to his mother and, although confused that there could be potential controversy, she complied.  The linked paper clips also appeared to gain special meaning for the child, as thereafter he would ask if he could take two for his pocket whenever there was to be a break between our sessions.

I have had the great fortune to work with this young man periodically through the years, as various issues have arisen for him.  I’m so glad that I’d chosen to observe and listen.    

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