No one wants to feel pain.  At least that’s true for most of us.  In fact, a good number of us make the decision to enter psychotherapy to alleviate pain.  As a therapist, I’ve also been in the position of wanting to support my clients in easing the pain they are feeling.  I’m still not so sure that’s an unrealistic goal.  What I have learned, however, is that the way to assuage one kind of pain often requires that we feel another.  No one necessarily signs up for this.

​Trading One Pain For Another
This was the case for Daniel, a 45 year old formerly Catholic man who had spent the last five years coming out as gay, telling his wife and two children, divorcing, and leaving his very strict religious community.
 
Daniel came to see me because he could no longer bear the burden of keeping his identity secret.  He couldn’t sleep.  He couldn’t function at work.  And he said he couldn’t function as a father and husband.  He felt intense shame about letting down those he loved and also intense shame about his identity as a gay man.
 
“I have to tell my family,” he said one day, “because the secrecy and pressure is killing me.”
 
On the surface, it seemed like the solution to Daniel’s dilemma was to relieve himself of the burden he was carrying by telling those close to him about his sexual orientation.  That is where we started our work together; thinking about who he wanted to tell first, what he wanted to say, and his hopes for each disclosure.  Through our conversations, it became clear Daniel expected to feel a great deal of relief in coming out.  And in so doing, he expected he would feel better.
 
What Daniel didn’t fully acknowledge was that in addition to relief, he might experience pain and rejection; that it was possible he might even continue to feel shame based on people’s reactions.  He knew the course of action he wanted to take, but before he began telling people, we spent time considering how any course of action he would take—staying silent about his sexual orientation or disclosing it—-would most likely result in some kind of pain.
 
Feeling Pain In Order to Grieve
Lance’s reason for coming to therapy was different, yet the inevitability of experiencing pain as part of his process was similar.  At the encouragement of his wife, Lance came to therapy to address his relationship with alcohol.  In his first session he talked about a long history of drug and alcohol use, some periods of brief abstinence, but a more recent increase in use paired with blackouts.
 
During the first few months of therapy, Lance shared growing up in a home where he witnessed verbal and physical conflict between his parents.  He talked about his father’s alcohol use, which eventually resulted in his death due to driving while intoxicated when Lance was 16.
 
Despite his father’s belligerence when drunk, Lance felt close to him and remembered going with him to baseball games and on camping trips.  Because his death was alcohol related, Lance’s anger hijacked his sense of loss.  He spent several sessions talking about his father’s alcohol use as a betrayal, but didn’t make a connection between his own use of alcohol and his father’s.
 
As these discussions continued, Lance came to a session clearly under the influence.  We’d had a discussion about the importance of coming to sessions sober, so my instinct was to follow our agreement and send him on his way (on foot, of course).  Still, there was something about his mood and his sadness that caused me to have him stay.
 
It was in that session, that I saw Lance cry for the first time about his father’s death.  And it was in subsequent sessions that we began to explore the way alcohol also helped him manage pain and loss.
 
While Lance came to therapy to change his relationship with alcohol, it became clear that he would continue to face pain if he continued to drink, and he would face pain if he stopped.  He began to ask himself which pain felt more bearable.  While his path was not linear, he made the choice to become sober and feel the pain of loss.
 
The Pain of Acceptance
Not everyone’s decision about pain is as clear as it was for both Daniel and Lance.  Eric is a 70-year-old gay man working as an accountant.  He had been in several long-term relationships, but had been single for the five years leading up to his decision to enter therapy.  He expressed hopelessness about ever being in an intimate relationship again, and jealousy of his friends who seemed to have an easier time finding and maintaining partners.
 
For Eric, finding a partner became his second full-time job.  He placed profiles on every dating app he learned about and spent almost all of his free time either meeting people for coffee or going back and forth via instant messenger with potential dates.  He often came to sessions either extremely excited about an upcoming date or extremely depressed and disillusioned following one.
 
“The men I am interested in aren’t interested in me, and the men who are interested in me I’m not interested in.  Why do I keep picking the men I do?” he lamented during a recent session.  “I don’t know why I keep trying.  This shouldn’t be so hard!”
 
Eric’s sadness was contagious.  I found myself feeling sad and hopeless for him.  In retrospect, I think because of my own discomfort with sadness, I flipped into “cheerleading.”  I tried to point out all of Eric’s positive qualities.  I was encouraging about his continued dating efforts and tried to brainstorm other ways he could meet available men.
 
The more encouraging I became, the more entrenched in hopelessness Eric became.  I started to believe he was continuing to date more to please me than anything else.  And his history of pleasing others at his own expense had been a lifelong theme.
 
Eventually, I asked him what it might be like to stop trying so hard to meet someone.  Because this was so different than how I had been approaching things with Eric, he looked at me incredulously.
 
“Are you saying I’ll never find someone?  So you finally think it’s as hopeless as I do?”
 
It was at that point that I invited Eric’s pain more explicitly into our work.  We began to explore the energy he had been putting into avoiding pain and loneliness—and even how that energy actually magnified his pain rather than diminished it.  He seemed almost relieved for us to be having this conversation.
 
As Eric considered either being alone or seeking a relationship our work shifted from avoiding pain to understanding the inevitability of some degree of pain.  While we continued our work, Eric made the decision to remove his profile from all dating apps.  He even went so far as to remove his data from sites that were more about sex and hook-ups than they were about dating.
 
“I think I need to find a way to accept that I might not have another long term relationship,” he volunteered in a recent session.  I realized my cheerleading wasn’t a useful strategy toward this acceptance, so I asked Eric how he might also accept the sadness that might come with this decision.  He concluded that accepting the possibility of some pain was actually liberating, since he had spent so much of his time and energy scrambling to avoid it.
 
Pain is Inevitable
I don’t know where we would be without pain.  Sometimes pain is a signal to move away from something because of potential danger.  Other times pain is a reminder of an old injury that requires sensitivity and acknowledgment as we move forward.  There is also the pain that is a necessary part of healing. Lance, for example, needed to feel the pain of losing his father in order to grieve.
 
While it may initially feel counterintuitive to be a psychotherapist who sees the value in pain, I’ve come to believe that we can only be effective in our work when we invite pain into the room and accept it as an inevitable part of our humanity, our grace, and our path toward healing.
 
My own journey with pain has been a complicated one.  Both my father and his mother suffered from depression that was pervasive and situationally aggravated.  Very early in my life I tried desperately to help them feel happy.  In part, I’m sure that my experience in my family is what fueled my decision to become a psychotherapist.  I am also sure this history makes it harder for me to be with another’s pain without becoming a cheerleader as I did with Eric.
 
It’s no surprise that it remains a challenge to accept the painful parts of my own life.  I have learned that I am really not a very effective cheerleader for myself.  And despite the knowledge I have about the value of being with pain, my family history shows up with surprising clarity as I unconsciously evoke the cheerleader in my partner when he sees me in pain.
 
And then I almost always chuckle internally when I hear myself say to him:  “Can you please just let me be sad?”

​The process of therapy can be daunting, especially when we don’t really understand what it’s “supposed” to look like or why sitting in a room with another person somehow helps us make lasting changes. Using metaphors as part of the psychotherapy process is not uncommon. Articles and books have been written on the topic with most folks recognizing the utility of metaphors.
 
Merriam Webster defines metaphor as “a figure of speech in which a word or phrase literally denoting one kind of object or idea is used in place of another to suggest a likeness or analogy between them.” Therapists and clients alike may use metaphors to foster increased understanding of an experience or a series of experiences. Shared understanding of experiences allows us to speak the same language, feel heard, experience greater connection, and ultimately, to better explore the changes we seek to make.

​My own practice of psychotherapy is greatly informed by the study of human development and by advances made in the study of the brain, the mind/body/brain connection, and interpersonal neurobiology. While I might not use all of these terms in my conversations with clients, I try to find ways to share what all of this means through the use of metaphors. In particular, I’ve found four metaphors that have been especially powerful.

Driving a Stick Shift Car
I may be dating myself by using this metaphor since I don’t know nearly as many people who currently drive stick shifts, but I do find when I ask whether or not someone knows how to drive a manual transmission car, many people still say they’ve had some experience with a stick shift, or they learned on a stick shift, or that they have been in cars where others drive a stick shift. describing psychotherapy through metaphors stick shift
 
Learning to drive a stick shift feels pretty awkward—especially if we first learned to drive using an automatic transmission. Driving with a stick requires the coordinated use of both feet; gradually increasing pressure on the gas pedal, gradually reducing pressure on the clutch, and then moving forward. To change gears, we have to put pressure on the clutch again, reduce pressure on the gas, use our hand to “shift” the gears, and then we “rinse and repeat” (another metaphor!) the process all over again.
 
Driving a stick shift initially requires a high level of concentration and thought. Many of us need to talk ourselves through the process each time we drive, over and over, until we’ve done it enough times that it comes to us automatically. We don’t have to consciously think about it because our body goes through the motions easily.
 
This process is similar to many processes of change inside and outside of therapy. In therapy, particularly, we are invited to explore new ways of being in the world. If we are trying to engage in a new way of interacting when we experience stress, we have to consciously think about what we want to do differently. Sometimes, we even have to internally talk ourselves through this new way of being until we practice it again and again and until it occurs automatically.
 
When driving a stick shift car, even when we are able to do so with ease, when we hit a steep hill, the challenge of managing the clutch and gas pedals returns. We once again have to talk ourselves through the process of using the pedals ands shifting gears as we ease ourselves up the hill, with occasional slight backsliding.  And so it is when we hit psychological “hills” in our lives. Newly learned and integrated patterns are more challenging and we’re required to more consciously think about how to navigate this new psychological terrain.
 
What I particularly love about this metaphor is the space it creates for learning and that it allows for change to be a process. Even when we feel we have mastered new coping strategies and made significant changes in our lives, when we experience stressors (or hills), it becomes more challenging to maintain those changes. And even for the most experienced driver of manual transmissions, navigating twists, turns, and hills is also demanding.

Put the Needle on the Record
With the return of an interest in vinyl records, I find myself able to use this metaphor more regularly as we talk about the process of change in psychotherapy. My memories of vinyl records date back to my childhood when I remember my parents and older brothers putting records on our old turntable and watching the needle move from it’s resting place to the first song.
 
Invariably, especially with older records, the needle would skip when it hit a scratch, and what I found particularly interesting is when the needle would get stuck in the groove of a record and continue to play the same music over and over and over again. The only solution to this problem was to walk over to the turntable and physically lift the needle and place it in another groove of the record or onto the beginning of another song.
 
The ways we’ve learned to navigate the world are like the grooves in a vinyl record. If we put more and more pressure on the needle of a record as the music is playing, we deepen the groove the needle creates.  This makes it harder for the music to continue and the song to end.  In fact, sometimes if we press hard enough, the needle remains in that same groove on the record, doomed to repeat the same music as long as the turntable is plugged in.
 
We know from our study of the brain, that it is a use-dependent organ. This means that the more we use certain areas or circuits of the brain, the more developed they become. Infants and developing brains are more sensitive to this dynamic, but even as adults, the more we engage in patterns of being (physical patterns, emotional patterns, thought patterns, etc.), the more developed these patterns become.
 
The brain has neural circuitry, just as the record has plastic grooves. The more we use a neural circuit, the more it is like pressing down on the needle of a record. As we move through the world, we are more likely to get stuck “in a groove” of relating, like the needle gets stuck in a groove of music.
 
As humans, the only way for us to move forward from a neural “groove,” is to first notice that we are repeating a movement, behavior, thought, or an emotional pattern that has been reinforced over time through use, and then consciously make a decision to engage in a different way of being. In a sense, we are picking up the needle and moving it so that we have a chance to experiment with a new “groove” and, if it feels right, continue to engage in these new patterns while they reinforce our neural circuitry.
 
I use this metaphor very frequently in my work, and I find my clients coming back to it when we talk about “getting stuck” and when we talk about making changes. Sometimes I’ll even see a client pantomiming a turntable in a session, lifting the needle, and placing it in a different place on their imaginary vinyl record; sharing an awareness of the process of change through the shared understanding of this metaphor.

Traversing the Jungle Path
Another metaphor I use in talking about coping strategies and neurobiology is the idea of a jungle path. In the jungle, if we are traveling from one location to another, the first time we make this journey, we find ourselves facing lush vegetation and landscape. We may have to take out our machete to cut back plants and trees in order to create an opening for us to walk through.
 
The more we travel between these locations, and the more of us who travel this same journey, the more the pathway is worn down. Over time, because of constant travel, vegetation stops growing and a clear path is visible between our two locations. In fact, we can now travel the path without even thinking about where we are going because the path is so well worn that all we have to do is walk.
 
Like the vinyl record metaphor and being stuck in the groove of a record, the jungle path becomes the only way we know how to get from one place to another because there is no clear “other” way to go. We may find ourselves engaging in certain ways of relating to other people, ways of thinking about problems, or fears/anxieties we experience related to certain situations that feel “automatic;” like there are no alternative ways of being. These become our “jungle paths.”
 
Sometimes we have created these jungle paths—-or neural pathways—based on our individual experiences and the ways we have learned to cope with these experiences. Other times, these jungle paths have been created by our parents, grandparents, or other ancestors and have been passed down to us across the generations. These intergenerational pathways might not even be conscious to us. Because they are so automatic, they feel like they are just a part of how we navigate the world.
 
When thinking about this metaphor, I am reminded of my father and his parents. My grandparents immigrated to this country at the turn of the 20th century to escape persecution and death due to the pogroms of Eastern Europe. When they arrived, they had few belongings and little money to support themselves, living in multi-family tenements in New York City.  My father grew up during the Great Depression, working to help support his family from the time he was a child.
 
I was raised in a middle class home, not having the experiences of my father or grandparents. But growing up, our basement shelves were filled with canned food and supplies. Both directly and indirectly, my family communicated to me “you have to be prepared because at any moment, you could lose everything.” And while these words were never spoken to me, this fear has been a jungle path I have traversed many times in my life.
 
In therapy, our task is often to create new jungle paths.  While the old pathways are worn and familiar, they no longer lead us to the destination(s) we hope for. As we plot our new destinations, there is no clear jungle path to get us there, so we’re required to take out our metaphorical machetes and we begin the process of clearing the brush and debris in order to move forward.
 
It can be challenging and exhausting to forge these new paths, especially when we can see the well-worn old path beckoning us. But as we continue to consciously create the new path, slowly and steadily with use it becomes more worn and open, and the old path, without use, slowly becomes covered with vegetation until it is almost no longer visible.
 

Taking the Developmental Train
In the course I used to teach about trauma, I often used the metaphor of train travel as a way to think of human development, typical developmental challenges, and extra-developmental events. Trains typically have a point of origin as well as a destination, and as humans we too have a point of origin, a developmental trajectory, and a place where our life ends.
 
As a train leaves the station, it traverses a track toward its destination. Sometimes the train stops at various stations, and sometimes it switches tracks in order to ensure it arrives in a timely and accurate fashion. Usually, there is a conductor whose job it is to monitor a train’s travel and to look for any possible danger ahead. If a conductor sees danger, their job is to make adjustments to the train’s journey to avoid or minimize the impact of this danger. An attentive conductor can ensure that a train leaves the station on time and arrives at its destination as planned.
 
There are, of course, times when a conductor may not be as attentive as they need to be. Or in the worst-case scenario, there is no conductor. At these times, if a train experiences some kind of outside impact or engine trouble, the lack of an attentive conductor can cause the train to de-rail—sometimes slightly and sometimes in a more major way. If the derailment is caught by other conductors, it’s possible for the train to be re-railed with minimal impact. If the derailment isn’t caught, however, the derailed train may continue its journey but reach a destination different than originally intended.
 
If we think about conception as the point where our developmental “track” begins, we know that cells start to divide and differentiate from the point of conception to the moment of birth. During this 40-week developmental period, we develop our nervous system, circulatory system, skeletal system and other systems.
 
In the best-case scenario, we have an attentive conductor—initially our mother—who is ensuring our nourishment and looking out for possible danger. When danger, or extra-developmental events occur, an attentive conductor first identifies the danger and then makes the correction to ensure development continues as planned.
 
If our mother and/or other conductors are not available to us, these extra-developmental challenges have potential to de-rail us in small and large ways. We too, can then develop in ways different than originally intended and we are born with pre-existing challenges. Or, if these extra-developmental events occur later in life, without an attentive conductor, we experience additional developmental de-railments that impact the ease with which we reach our intended destination, or alter our destination entirely.
 
As a train experiences multiple and successive uncorrected de-railments, the greater the likelihood it will reach a different destination and/or not reach it’s destination at all. And like the train, as humans, the more we experience extra-developmental events (abuse, neglect, and other traumas) that go unacknowledged and unaddressed, the greater the likelihood we will experience de-railments that leave us vulnerable in all sorts of ways.
 
The good news for trains is that there are usually multiple conductors and others watching while it goes from one station to the next.  And the good news for us is that we too usually have multiple possible conductors to watch out for us as we travel through our lives. The absence of one conductor doesn’t mean a train is doomed because others can step in. As therapists, we often serve as a meta-conductor, working with our clients to identify where de-railments occurred and strategies for successful re-railment.

The Power of Metaphors
We don’t only use metaphors in therapy. They are a part of our everyday conversations with family, friends, and colleagues. They help us describe our experiences for ourselves, and often more common metaphors help others understand and empathize with us. Sometimes we use metaphors so unconsciously that we may not even recognize them as metaphors. For example, when we say we are broken-hearted, we’re actually sharing our sense of sadness or grief.
 
And often we use these same every-day metaphors to describe our experiences to our therapists. Just recently, one of my clients was describing a topic that he and his girlfriend rarely talk about by telling me it is an “elephant in the room.” Here he was conveying to me that both he and his girlfriend know this huge issue is between them, and yet they struggle to bring it into their conversations with one another.
 
I use the four metaphors I’ve shared here with my clients to talk about the process of therapy. When folks are really uncertain of how changes occur in therapy, talking about “the jungle path” or the “needle getting stuck in the groove of a record,” or “learning how to drive a stick-shift” have helped put language to the sometimes frustrating, arduous, and enigmatic process of therapy.
 
These three metaphors also speak to the neurobiology of thoughts, feelings, and actions; that patterns develop over time and are supported by repetition. When we’ve learned a certain way of navigating the world, our neural circuitry is strengthened through use. It only makes sense then, that when we explore making a change, we’re creating new circuitry that also can only be strengthened through increased use. For many of us, it is relieving to know that true and lasting change takes time—scientifically!
 
The conductor and train track metaphor has been particularly helpful in understanding the impact of trauma on our development, whether it be a single trauma, or multiple, cumulative traumas.  Considering the presence or absence of attentive conductors in our lives also helps us understand why certain traumas have more or less impact.  I also invite folks to consider the extent to which they can be their own attentive conductor. By considering our own power to notice the challenges we have experienced means we also have the power to make course corrections, no matter how old we are.
 
Undoubtedly, it’s always important to listen for metaphors our clients create and share with us since these have potential to be the most informative and helpful. The metaphors I’ve shared here can be used as a way to create a shared language about the broader process of therapy.

I was recently thinking about sessions over the course of the last few weeks that went smoothly, and those where I felt like we hit some bumps or that we stalled.   I tried to remember the things I did or questions I asked that I thought helped all of us in the room feel some movement.  There were many ideas and questions I jotted down, but five stood out to me as particularly helpful.
 
While I know there are no quick fixes to change the direction of a session that feels like it is stalled, I still look for strategies to support people in making the changes that bring them to my office, even in the context of a single session.  Maybe it’s unrealistic to think that lasting change can happen in a session.  But I believe there are ways we can invite ourselves and our clients to consider intentional shifts, even in the context of a single session.

What’s happening on the inside?
A few years ago, one of my posts talked about “the weekly report.”  I wrote about those of us that start our sessions by talking about what’s happened during the previous week.  In some instances, this takes the form of a day-by-day description of the week’s events.  Other times, it includes highlights from the prior week.  While there is definitely utility in hearing about the week, it’s inevitable that at some point we will hear:  “Well, nothing new really happened this week.”
 
Nick frequently begins his sessions with a run down of the prior week’s events and activities.  He initially sought therapy to address a 15-year marriage where the romance had disappeared after just a few years.  From the time we began therapy, he told me he and his husband rarely discussed their relationship and had settled into a rhythm of activities that no longer included sex.
 
It soon occurred to me that Nick and I had also settled into a rhythm of discussing the week’s activities without a deeper exploration of his relationship with his husband.  While he often talked about what social activities he and his husband had engaged in during the week, there was no mention of any physical contact—even loving contact that wasn’t necessarily physical.
 
Last week, Nick sat down in my office and looked at me with mild discomfort.  I had a sense that meant that he didn’t know where to start, and sure enough, he began the session with the anticipated:  “Well, nothing new happened this week.”
 
Typically, when our sessions began this way, I wonder if they will feel interminable for both of us.  I feel like an interrogator, asking questions that are answered, followed by long silences that await my next question.  I’d experimented with waiting out the silences and had some instances where ultimately, Nick would continue the conversation, though often his contributions were brief and followed by further silence.
 
On this particular day, I decided to explore a different approach.  After Nick shared he had nothing new to report, I tried something different.
 
“Well,” I started,  “one way we’ve explored what’s going on is to talk about the activities of the week, or what’s been going on ‘outside.’  Could we talk a little about what’s been going on inside?  What you’ve been thinking about this past week and what’s been going on inside your head and heart?”
 
There was a brief pause and I saw Nick exhale.  His body settled back into the couch and his head raised slightly.  “I’ve felt so sad,” he said quietly.
 
We began talking about the loneliness he has been feeling.   And while we have definitely talked about his loneliness on other occasions, I believe that shifting the start of our session allowed us to enter the loneliness sooner—or maybe it allowed us to be with the loneliness that day when we might not have otherwise.
 
What stops you?
Everyone comes to therapy to make a change.  Still, change is not easy, especially when the ways we’ve learned to navigate the world serve an important purpose—albeit a purpose that may no longer benefit us in all contexts.
 
When Carrie came to therapy, she wanted to change a pattern of being in unsatisfying relationships with colleagues at work, with friends, and with romantic partners.  She shared she often felt inadequate and that she was “almost always” the person taking initiative; that if she didn’t make something happen, she was confident it wouldn’t happen at all.
 
One session we were talking about a friendship in which Carrie found herself always initiating plans which left her feeling frustrated and unimportant, especially when she learned about plans this particular friend initiated with other people.  She agreed that prior to her next session, she would have a conversation with this friend about her feelings.
 
When she came to her appointment the next week, she began by telling me I was going to be very disappointed in her.  “I didn’t talk to Joe,” she apologized.  “We talked a few times, but I just couldn’t start the conversation about being disappointed by him.”
 
I felt the words “Why not?” begin to travel from my brain to my vocal chords and almost leave my lips.  And I stopped.  Carrie and I have had this conversation before.  I’ve asked her “why” or “why not” which has typically resulted in her trying to explain herself to me, and I almost always feel as though there is an implicit judgment in my question.
 
I remembered a workshop I’d gone to about addressing communication challenges with couples and the presenter had shared a very simple but powerful reframing when the temptation to ask “why?” felt present.
 
“What do you think stopped you from having that conversation?” I asked her.
 
I know that question is virtually the same as asking “why” or “why not,” and still each time I’ve asked someone “what stops you?” I am surprised by the amount of information I get that might not have come to me as non-defensively or apologetically if I had asked “why?”
 
“What stops you,” often removes any kind of implicit or explicit accusation from the question.  We’re invited to consider the forces that hold us back from change, in some ways externalizing those forces so that they can be examined more closely without shame.  It’s subtle but gentle.  And it opened Carrie to sharing her fears of rejection should she ask directly for her needs to be met.
 
What if you had to guess?
Another session-stopper can be a response of “I don’t know” to one or more of our questions.  I remember a recent conversation I had with Robert, a client with a history of childhood physical abuse and years of addiction as an adult.   Robert has been sober for 5 years, and in therapy on and off for that same amount of time.  Still, he continues to struggle with an awareness of his internal life.  Often in sessions, his first response to a gentle probing question is “I don’t know.”
 
For a while, I took him at face value and didn’t move more deeply into whatever topic we were discussing.  Then, one day I asked him a question about how he had responded to co-worker who had treated him poorly.  After he responded initially with “I don’t know,” I followed up.
 
“If you had to guess, what do you think the reasons were?”
 
He looked perplexed by this question, while at the same time, I could see that he slowed himself down and opened to a bit more introspection.
 
“Maybe it has to do with not feeling like I deserve better?” he responded almost as a question.  “I don’t know if that’s right, but it’s the first thing that came to my head.”
 
The theme of what Robert “deserves” in his life had been one we’d been exploring for weeks.  His “guess” allowed us to explore how internal messages of “deservingness” often stop him from pursuing things that might lead to better health–such as working out, increased financial security—such as saving money, and increased happiness–such as being more direct with his friends and colleagues about what he needs.
 
Does that happen in here?
When I begin my work with someone new, I try to reserve time during the first or second session to share a little about how I think therapy works.  If someone has been in therapy before, I ask about those past experiences.  I’ll also try to weave in some conversation about our relationship in therapy and how it evolves over time as an important part of the psychotherapy process.
 
In a recent conversation with Justine, she was talking about the distance she feels in almost all of her relationships.  She talked about her experience of this distance in her family of origin, in her friendships, in work relationships, and in her current relationship with her boyfriend.  For the past few months, this theme of distance has arisen on multiple occasions.
 
Despite working together for several years, I realized Justine and I hadn’t directly discussed our relationship with one another.  And I realized that I experienced some distance between us; that our sessions were productive and useful, yet I still felt there was something between us—or perhaps not between us—that limited the extent to which we were connected.  On this particular day, I decided to ask Justine if she experienced that same distance she experiences with others in her relationship with me.
 
“You might remember that when we started therapy I talked about how what we walk about is important, but that how we talk about it and how our relationships develops is also an important part of our work together?”
 
She nodded that she remembered.
 
I continued, “So we’ve talked about your experience of distance in so many of your relationships, but we haven’t really talked about whether or not you feel that same distance with me?”
 
What I often notice when I ask a question that brings relational dynamics into the present moment, is an automatic deepening of the session and in the relationship.  With Justine, there was some hesitation after my question, but she haltingly talked about not wanting to get to a place where she depended on me or shared too much with me, only to feel judged or even worse, rejected.
 
While she said she hadn’t felt judgments by anything I said in sessions, she eventually shared that at times she noticed expressions on my face she thought might reflect an underlying judgment.  I wasn’t aware of these moments, but trusted there must have been some subtle shift in my facial expressions and perhaps I was conveying some kind of judgment unknowingly.
 
I asked if Justine might be open to letting me know when these moments arise.  “I’ll try, “ she agreed, “but at those times, it’s sometimes hard for me to say anything.”
 
We then began to talk about how these moments in sessions might also happen to her in her other relationships, and she immediately saw the parallel.  We continued to explore the benefit of engaging in these moments in sessions to see if it helped with feeling closer—less distant.  And if we could explore these moments in sessions, I invited her to consider the possibility she might be able to do the same outside of sessions.
 
How was this session?
While for many of us it is scary to ask for feedback from our clients about how we are doing as therapists or about the process of therapy, research supports that asking for feedback actually improves the therapy experience for most people.  But there is another reason I’ll sometimes ask about a particular session or series of sessions.
 
Michael is someone who self identifies as a “people pleaser.”  Growing up gay in a home with two alcoholic parents and a physically abusive uncle who resided in his home, Michael says he was always trying to figure out how to be “the best little boy” in every situation in which he found himself.
 
Growing up, Michael tried to fly under the radar by never doing anything to make his parents mad, and trying to be as invisible as he could whenever his uncle was home.  In school, he followed all his teachers’ directions and was always identified as the model student.  He got all A’s in high school and went to a prestigious college, following his father’s footsteps by becoming an electrical engineer.
 
Despite all his accomplishments, Michael still struggled with self-worth and entered abusive relationships feeling as though it was his responsibility to meet his partners’ needs, without considering needs of his own.  He focused on pleasing his partners—in fact so much so—that it was occasionally his focus on them that resulted in relationships ending.
 
Pleasing others also occurred in our sessions together.  He’d often answer questions or make comments looking to me to see if he responded appropriately.  We identified how this pattern in our sessions paralleled the patterns he experienced in his relationships with others (e.g. “Does this happen in here?”), and still we struggled with it’s interruption.
 
There was one session where I tried to do something different as we concluded.  I asked Michael:  “How was today’s session?”  He looked at me quizzically.
 
“It was great, as usual!” he responded enthusiastically.
 
I followed with my rationale for asking.  I invited us to consider how we might gradually experiment with giving feedback to me in sessions that he might not be willing to give to people outside of sessions—at least not yet.  I asked if he’d be willing to let me know at the end of each of our sessions, what he found particularly helpful, but also what he experienced as not as helpful or even unhelpful.  The agreement included him identifying things that “worked” for him, as well as things he wished I had done differently.  I also understood that his agreement to engage with me in this way might also be a way to “people please,” so I invited us to consider this as well as we proceeded.
 
Michael quickly understood the purpose of ending our sessions this way, and after several weeks, I no longer had to ask how the session went.  He began to let me know more spontaneously when he found something helpful, and although it wasn’t easy for him, he also let me know when I missed something, or when I said something that was either “off,” or was painful to him in some way.
 
Because we created this experiment, I also believe Michael’s awareness throughout our sessions changed.  I found him listening differently and with more discernment.  Knowing there was an expectation for him to provide feedback, he seemed to be more open to sharing spontaneously throughout sessions when he found something helpful—and equally important—unhelpful.  And as we continue with this, our hope is that he’ll generalize this discernment to his relationships outside the therapy space.
 
Questions Toward Transforming a Session
Each of the questions I’ve shared has multiple possible follow-up questions and multiple directions we can take once the question is asked and answered.  I share these five in hopes that we’ll continue to think of ways we can creatively challenge ourselves when we find ourselves feeling stuck.
 
While thinking about our theoretical underpinnings can be helpful when we struggle, I’ve found that thinking across theoretical boundaries can offer even greater options.  When I allow myself to think more expansively, paradoxically the things I say become more straightforward and less complex.
 
I also want to be clear that when we experience a stalling or stuckness, that doesn’t mean anything is “wrong,” or that therapy isn’t productive.  In fact, I find it is most often those times when we question ourselves or the direction of a particular session, or series of sessions, that we are able to move more deeply into our work, or change directions if necessary.
 
Of course, a single question or statement doesn’t magically transform our work.  But experimenting with asking something in a new way might make a difference.  After all, what stops you?  If you had to guess?  How was this post?

I was reading an article in the Chicago Tribune about Barry Manilow, his recent public “coming out,” and acknowledgment of his marriage to his partner of 40 years.  The article talked about the mixed reactions of the public ranging from support to questions about why Manilow waited so long.
 
What disturbed me most about the article was its implication that coming out means we are finally living authentically.  The author writes, about his own coming out:  “I felt my mind clear and my stomach quiet.  Life was different now.  I knew that.”  And later he writes “but living my truth in public outweighed all that.  I was free to be me at last.”

As a social worker and therapist, I always want to support each person’s lived experience.  And I know that even if one of my identities is similar to or the same as someone else’s, that person’s experience cannot be assumed to be similar to mine.  So I don’t want to discount or dismiss the author’s experience of his own process of coming out.
 
I struggle, however, with the idea that when we come out we are finally living authentically, implying that everything that came before the act of coming out was inauthentic.  And also implying that we are somehow more evolved the more “out” we are.
 
For most of my career, I have worked with adolescents and adults who identify as LGBTQ.  I worked with runaway and homeless teens who were kicked out of their homes when they came out.  I facilitated coming out groups for a number of years, and then I began to do more specific work with men who were coming out as gay or bisexual while married to women; some who were coming out after 20, 30, or even 40 years of marriage.
 
A consistent theme that arose in my work with men coming out while married was around authenticity.  While they were sure that people congratulating them on coming out was meant as a compliment they cringed, however, when that was followed by kudos for finally being able to live authentically; that somehow everything that came before their coming out was inauthentic or, in the worst case scenario, a lie.
 
Raymond came to see me after telling his wife he identified as gay.  They had been married for 10 years, and had two young sons.   While Carolina, Raymond’s wife, felt hurt that Raymond had not shared this with her before they were married or earlier in the marriage, she was most hurt when she heard Raymond talk about finally being able to live “authentically.”
 
To her, his claim of authenticity implied their life together before Raymond’s disclosure was inauthentic.  She struggled with whether this meant he really didn’t love her, didn’t enjoy their life together, didn’t enjoy their sex together, and didn’t love their children.  If he was finally living “authentically,” that meant to her that everything that came before this, was “inauthentic.”   During one couples session, Carolina articulated this clearly:  “Is he saying that everything we had together was a lie?”
 
This became a common theme in my work with men coming out while married.  On the one hand, coming out allowed a long repressed identity to finally live and breathe.  On the other hand, they didn’t feel like their marriages to their wives and histories with their families were inauthentic; that coming out didn’t somehow invalidate who they were before they came out but instead, created an opportunity to live more fully.
 
In addition, it wasn’t always a relief to come out.  For some men, coming out lead to more isolation.  While they were able to tell their wives about their sexual orientation, it wasn’t possible to tell extended family and/or children.  In addition, some men didn’t want to leave their marriages when they came out.  They wanted their wives to know about a long hidden piece of their identity.
 
They felt others pressure them about divorce.  “Now that you’re out,” many friends said, “you can finally leave your wife and be your authentic self.”  Meant as a compliment, the insidious message was clear:  “Your life prior to coming out was not authentic.”  Many men shared with me they felt “too gay” to live a straight life, but “not gay enough” to live a gay one.
 
Recently, I was consulting at a community mental health center and the case being presented was that of Jade, a 16 year old girl who identified as lesbian but was living in a family who belonged to a fundamentalist Baptist church.  The only person she had told she was lesbian was her therapist.  She knew if she came out to her family, she would be judged, shunned, and possibly rejected entirely.
 
During the consultation, her therapist wanted to know how she could help Jade come out.  And how she could support her dealing with her family’s reactions.  “Maybe she could write a letter to her family,” one therapist suggested.  Another had the idea of her coming out during a family session with the therapist.  And still another idea was for her to tell each family member separately.
 
As the group continued to brainstorm, her therapist began to realize that coming out to her family was not necessarily in her best interest and, in fact, might not be safe.  When she voiced this, others in the group immediately challenged her about her client’s right to live authentically.
 
Some of us wondered though, if others were defining authenticity too narrowly.  If she chose not to tell her parents she identified as lesbian, was she not being authentic, or was she making a reasonable (and authentic) choice to think more strategically about when, and to whom, she came out?  We also began to consider that being lesbian was only one identity she held; about one truth about her life but she held multiple identities and multiple truths.
 
Ultimately, the group came up with ideas for how this young woman could continue to explore her sexual orientation in conversations with her therapist; that her therapist could go on the internet with her during sessions and identify resources, read articles, and look for the stories of others who grew up LGBTQ in conservative, religious homes.
 
Living authentically meant balancing being lesbian with other identities and other truths;  acknowledging her circumstances and building her internal and external resources until such time she could safely tell her family about her sexual orientation.  This might occur when she was old enough to leave home or perhaps even after she had left home to go to college.  Maybe, the group acknowledged, she might never choose to tell her family.
 
Another theme that arose in this consultation, and one that I discuss often with many of the people I work with who are in the process of coming out, is the complexity of defining what it means to be “authentic” and/or to “live authentically.”  For so many of us, we’ve learned to define authenticity as a binary concept:  either we are authentic or we are inauthentic.
 
Instead, I believe that authenticity, like so many other constructs we try to dichotomize, exists more on a continuum and is contextual in nature.  Rarely are we fully authentic and rarely are we fully inauthentic.  And what constitutes as authenticity in one setting we may experience as inauthentic in another.
 
For Jade, the task at hand wasn’t how to come out to every possible person in every possible setting.  Her work was around determining to whom she could come out, and in what setting it was reasonable to come out; how she could experience herself as living authentically within these parameters.
 
Her astute therapist also recognized the importance of helping Jade come out to herself, and see herself as holding multiple identities—her sexual orientation being just one of these.  Not sharing her sexual orientation with everyone did not mean she was living inauthentically, but was instead living as authentically as possible given other identities she holds and given the context in which she was living.
 
Older models of coming out—the ones I learned 35 years ago—were developed by white researchers who interviewed exclusively white gay men, retrospectively about their process of coming out.  Like many models of the time, it was linear in nature and implied the more out we are, the more evolved we are and, hence, the more authentically we are living.
 
What these older models do not account for is the non-linear nature of growth and identity development, and factors such as race, religion, culture, and geography; all of which contribute to the way we see ourselves, our relationships, and the world.   While we may have thought coming out everywhere was the “brave” thing to do, we realize more and more that sometimes not coming out to certain people and in certain places is the “brave” thing to do; that for each of us the process of living authentically is complicated and nuanced.
 
I distinctly remember a day in 1987 when my phone rang.  I was living over a thousand miles from my parents and, while I felt close to them, I had not come out to them.  I picked up the phone and heard my mother’s voice.  It was one of those inexplicable moments when hearing the voice of someone you love triggers a swell of emotion and choking sensation to hold back tears.
 
“What’s wrong?” my mother said.  I could not form words or make sounds.  “What is it?” she continued.  Finally, I squeaked out noises that I thought sounded like “It’s nothing.”
 
“I’m getting your father on the phone.”  That rarely happened in conversations with her, and I was confident his presence on the phone would only solidify my silence.  “Ralph, get on the phone.  Something’s wrong with Jeff.”
 
I heard the click of another extension and my father’s voice repeat what my mother had said earlier:  “What’s going on?  What’s wrong?”
 
Still, I could say nothing and there was silence for what felt like hours.  Eventually, my father spoke.
 
“Are you ok?” he asked.
 
“No,” I whispered.
 
“Is it work?”
 
“No,” I whispered again.
 
“Is it a woman?”
 
“No,” even softer.
 
And from what I know came from a long, silent, but intuitive part of my father’s sense of me, he asked:  “Is it a man?”
 
And after 27 years of keeping this secret from my parents, I responded:  “Yes.”
 
I remember at that moment I didn’t feel brave.  I didn’t feel relief.  I didn’t feel suddenly truthful.  And I didn’t feel authentic.  I felt scared, vulnerable, and incredibly surprised by the conversation it seemed we were having.  I was lucky that in that phone call, they couldn’t have responded in a more loving or supportive way.  The next weeks, months, and years though, ebbed and flowed with questions, grief, distance, and closeness.
 
It is only now, in retrospect, I realize that “coming out” to them wasn’t when I said “yes” to my father’s question.  It was and has been the 30 plus years following that conversation, negotiating my many identities with them prior to their deaths, and with others, in a constantly shifting landscape of time and the many other identities I hold.
 
Coming out is not an event.
 
Coming out isn’t always the bravest course of action.
 
Coming out isn’t about telling the truth.
 
And coming out doesn’t mean we are suddenly authentic.
 
For all of you reading this and learning something new about me, I hope you don’t find everything you knew about me prior to be inauthentic or misleading.   Like all of us in all of our relationships, our sense of ourselves and our sense of others is always evolving.
 
Coming out is about telling one truth among the many truths of who we are.  In one way or another, we are all, and always will be, coming out.