Client stories and treatment outcomes

About these cases

Below are several examples that further illustrate what I mean by perspective, insight and solutions. Each of these clients came to me with a sense of their problem, but the ultimate resolution involved helping them see aspects of it that they weren’t in a position to recognize on their own.  These are actual cases, but of course I have changed or withheld details to protect my clients’ privacy.  But the fundamental issues in each case are real, and I hope that they clarify how I try to help.

Example 1: Choking on depression, among other things

 A woman came to my office complaining of “choking,” and described the actual physical sensation of struggling to breathe.  She had been hospitalized for depression years earlier, and she was quite depressed now—but not so much in a sad or emotional way, more in a tense and constricted way.  Even so, neither depression nor choking was the main problem: the more significant issue was that she had a great deal of trouble dealing with upsetting emotions.  For example, as a child, her parents had rather blithely crushed her dreams of being a cellist, but she went to her room to figure out a new career without arguing, complaining, or even shedding a tear.  Later in her life, her husband had an affair and had two children with another woman, but my client never told him off or even raised her voice to him.  She had so much pain, rage, and guilt built up over the years, but no idea what to do with them.  Actually, she didn’t even know she had such feelings in the first place.  For example, even though she told me these stories in great detail, and with great seriousness, she spoke in a businesslike manner that did not reflect the pain she must have felt.
We had to work together to help her recognize, understand and integrate these emotions.  Without realizing it, she had taken on her parent’s approach of treating emotions as a nuisance and a waste of time.  Consequently, she had literally been choking difficult feelings back—and choking on them—for years.  But she was fighting reactions that were quite natural and human given the circumstances, and so putting herself in an impossible position.  In contrast, as she started to understand and allow herself to experience these feelings, the sensation of choking stopped immediately, and over time she became much less depressed.  In addition, she became less constricted and more open in general.  For example, she started to play cello again after not having touched one for over forty years. 

Example 2: “I need to be tougher and more decisive.”

A man first came to me anxiously reporting that he was weak, indecisive, and not his “own man.” He had been in a committed relationship since college, and his girlfriend had often indicated that he had to be more driven and decisive. My client himself had been raised in a rather enmeshed family that was part of a small and equally enmeshed religious community. His family culture followed the teachings of “the church” closely, and seemed to be relentlessly upbeat. His girlfriend’s perspective was that he was a “momma’s boy,” and possibly brainwashed by his family and religion. At work, my client had colleagues that he saw as assertive and ambitious, and he tried to emulate them. But at work and with his girlfriend, when he tried to speak up and be more assertive, this only came off as forced and actually made him feel more pathetic.
In reality, my client was not particularly indecisive, but he was quiet and introverted. Soft-spoken, thoughtful and friendly, when he tried to be tough and decisive it was not just forced but false: not only was he trying to feel more confident than he actually felt, he was literally trying to be someone he was not. This is not usually a good recipe for self-confidence. Worse, this approach obscured his natural strengths: at work, for example, even though he didn’t come off as a mover and shaker, his kind and curious approach was actually much more likely to build trusting, collaborative professional relationships than his colleagues’ flashier but more self-serving approaches. In addition, he even failed to recognize when he actually was bold and decisive: for example, he did not see his decision to go to college where he wanted to go—in defiance of his family and the insular community in which he’d spent his whole life—as an act of personal choice and self-direction.
In this case, rather than trying to change who he was as a person, we needed to recognize his strengths and help him develop his own style. As he did so, some interesting things began to happen. He became much more comfortable in his own skin. He also became more aware that the perspectives around him—that he had taken at face value for so long—had some of their own biases. His girlfriend was well meaning, but struggling with some of her own insecurities that also shaped her perceptions of him. Some of his co-workers, while smart and capable, were more interested in image than substance. Ultimately, he also became more decisive, though not in the way he initially imagined: he was able to make choices according to his own inner compass rather than other peoples’ ideas of toughness and assertiveness. 

Example 3: A case of sexual addiction, or is it?

A man came to my office quite distressed about his apparent sexual addiction. Although in a committed relationship and quite in love with his partner, he had arranged several “hook ups” through the internet and now found himself on these websites all the time. He felt like he couldn’t resist. But there were some other clues to his behavior that he didn’t fully recognize, or at least didn’t see as relevant. For example, there had been considerable tension with his partner lately, and he was feeling repeatedly ignored, dismissed and discarded. In addition, his general style was that of a very driven and practical problem solver, as well as quite a private fellow who was not comfortable sharing his personal thoughts and feelings.
Although he didn’t realize it, his “addiction” was actually an attempt to solve another problem: he was feeling quite abandoned and looking elsewhere for the closeness and affection that he couldn’t find in his relationship. In addition, his highly practical approach was not working in this case, and perhaps even obscuring the real issues. For example, he and his partner would discuss various rules—such as establishing a time to return home from work, or not using smart phones at the table—that were designed to address what was coming between them, but which utterly failed to address his feelings of loneliness and rejection. These emotions were at the heart of the problem he was trying to solve. We had to re-conceptualize this problem and consider a new approach, one that acknowledged his needs, feelings and desires.
As he and I began to implement this approach, not only did his “addiction” completely disappear, his relationship started to improve in unanticipated and positive ways. It turned out that his pragmatic, problem-solving mindset was getting in the way of intimacy and understanding in many aspects of his life. Ultimately, he also realized that he was extremely unhappy in his job, but had been trying for years to find a practical solution to this too. He eventually decided to make a career change he had long dreamed about, and today is on the road to becoming a happier and more successful person.