Recently, one of my clients told me that every item of clothing she was wearing at our session “feels like me”. She added how hard it had been for her to buy each one–indeed, how hard it is for her, generally, to risk reaching for something–even something as mundane as a sweater–that she really, really wants. I pointed out to her that each of those items of clothing was like a metaphor for pieces of her true self that she has been struggling so hard to reclaim. A very young part of her that still lives inside her (a part from the early years of primary school)knows who she is and what her truths and passions are. Our work is to reconnect that little girl with the young woman in my office. We do this by gradually healing wound after wound that the girl-woman incurred in the intervening years. Once all the blocks to natural growth have finally been removed, becoming will resume, and self-comfort and blossoming will follow.
Meaning-making in the Counseling Process
One of the most important functions of counseling is to help people make meaning out of their past and present lives.
Sometimes people come to counseling in a state of existential crisis; something has happened to them (a diagnosis, a relationship breakup) that has made them question their long-held views of themselves and the world. They don’t know what to think anymore. They may be feeling completely at sea. They need someone to help them figure out what they believe now, who they will be now, and how they can move forward from this point on.
Shame, and Its Antidote
From both personal and professional experience, I’m pretty convinced that shame is one of the two most painful human emotions. Shame is the feeling that there is something wrong with us or that we are not good enough or, to put it more strongly and the way clients often do, that we are worthless and unlovable. Shame is usually installed by early personal history (e.g., parental neglect, childhood sexual abuse, growing up with a disability) and, later, becomes a habitual internal process in which part of the adult mind harshly criticizes another part. Viscerally, when shame is triggered, the experience is of a punch in the gut or a knife in the heart. That is why people experiencing shame often visibly cringe.
One problem with shame, aside from how painful it is, is that it stops us from being willing to engage in relationships in an authentic and vulnerable way (who who feels worthless would want to be truly seen?) and therefore people who suffer from shame also suffer from loneliness. Additionally, shame can often lead either to paralysis with regard to life goals (I’m worthless, so why even try?; I’m bound to fail) or unrealistic and exhausting perfectionism (I must ceaselessly prove that I am worthwhile). Paradoxically, despite their intense pain, people who suffer from shame often have very little compassion for themselves, wrongly assuming that their suffering must all be the result of their inherent worthlessness and, therefore, deserved.
Here is a link to an excellent TED talk by Brene Brown that touches on many of these issues:
Brene Brown on vulnerability
I have been consciously working with my own shame for about 20 years and I’m happy to report that I am much less pained by “shame attacks” than I used to be, both because I am less frequently triggered and because I have much more compassion for myself when I do feel shame. Additionally, I’m no longer a perfectionist and my internal critic has softened considerably. This is how I know there is hope for fellow sufferers!
When working with clients on their shame, I (very tenderly) use Emotion Focused Therapy techniques, both to help clients see how their internalized shaming process works so that they can start to dismantle it, and to re-experience with them in a healing way the specific history that installed the shame in the first place. Ultimately, the goal is for clients to start to know and feel that they are lovable and worthwhile in all their imperfection, just the way they are.
Facilitating Grief
After losing a loved one, people can feel as if their world has been turned upside down and they will never get out of the dark, disorienting tunnel in which they now live. Nothing seems worth getting up in the morning for. They cry a lot, they are irritable, they desperately want things to be different from the way they are.
In normal grief processing, whether facilitated by a therapist or not, the mourning person gradually, imperceptibly, begins to accept the reality of the loved one’s death and to imagine a life that will not include him (although it frequently–and healthily–does include an ongoing inner conversation with him). Gradually, gradually, the mourner begins to have some happy moments. Around six months after the death, symptoms like insomnia start clearing up. And, then, in my experience, there is often some kind of an existential or spiritual shift that happens. This may manifest itself as a dream, a change in perspective, a new sense of meaning…. However it shows up, the mourner recognizes it as a kind of grace. I usually don’t tell my grieving clients about this shift in advance because I don’t think doing so would be helpful; nobody in such pain would believe me. But they know it when they feel it. A line of Leonard Cohen’s seems to me to describe both sides of the grief experience pretty accurately: “There is a crack, a crack in everything. That’s how the light gets in.”
Some clients show up for grief therapy many years after a death has occurred. These clients have not gone through a normal grieving process. For a variety of reasons, their grief has been complicated and their healing delayed. This might be because, at the time of the loved one’s death, there was unfinished business between her and the mourner, because the mourner could not afford to grieve in the period following the death due to other obligations such as taking care of small children, because the mourner has really mixed feelings about the person who died, because the loved one died by killing himself, or for another reason. Usually the unresolved grief has been adversely affecting the mourner’s life for some time.
In such cases of complicated grief, healing can still occur, but usually not without therapeutic help. In such cases, I help the client finish her unfinished business with the deceased person by using a variety of therapeutic techniques that allow her to communicate with the person she has lost and to feel feelings that have been repressed. I also help the mourner make sense out of the lost one’s death and develop an ongoing internal conversation with her. Paradoxically, having such an ongoing relationship with the dead is what often allows people to feel safe moving past loss and forward in their lives.
Whatever our grief process, losing a loved one is a watershed event; it changes us forever, often in unexpected, life-affirming ways.
Book Review: How to Be Sick by Toni Bernhard
I just finished reading Toni Bernard’s How to Be Sick: A Buddhist Inspired Guide for the Chronically Ill and Their Caregivers. I read it to see if this would be a helpful book for clients with chronic illnesses to read. And, I think it is–given the right timing of course. Because I am also “Buddhist inspired” and live with a chronic illness and work with clients with chronic illnesses, most of the material in Bernhard’s book was not new to me. However, she brings it together in a user-friendly, personal, believable and non-preachy way that I think both Buddhist-inspired and non-Buddhist-inspired readers would appreciate. The book offers practical tools for dealing emotionally with such difficulties commonly experienced by people with chronic illnesses as people not understanding one’s experience or even believing one is ill, frustrations with the medical system, and social isolation. By using examples from her own experience, Bernhard, who is mostly house-bound and bed-bound by her illness, teaches a variety of Buddhist concepts and techniques that have helped her reduce her emotional suffering and increase her sense of well-being over her decade-long illness. At the end of the book, there is a chapter in which common emotional difficulties are reviewed along with the techniques that Bernhard suggests for reducing the suffering they can entail–kind of a handy crib sheet that readers can pull out when in distress in order to remember what to try.