Jeff Levy, LCSW
Mental Health, Relationships, Trauma, Identity
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, January 2015)
Endings and beginnings serve a purpose. They punctuate change. They allow us to put a hard stop on a process that has been painful. They invite us to start anew with a fresh perspective. They allow us to celebrate accomplishments. They enable us to set goals for further accomplishments.
Still, as I let my thinking wander, I realize that endings and beginnings, despite the externally created structures, are often self-imposed. In fact, it might be equally important to acknowledge that some things shouldn’t or even don’t end. In some instances, in seeking a finite ending, we actually experience even greater distress.
When Will This Be Over?
When I began my work with Alaina, she would ask me in almost every session: “When will this be over? When will I be done?” Answering her with “I don’t know” was never particularly satisfying for her. But answering her with what I believe to be the truth: “We’re never done. It’s never over,” would have been far less satisfying and, at the beginning of our work together, would have fostered a sense of futility and hopelessness.
Alaina had experienced physical and sexual abuse in her family, at the hands of her father, and then at the hands of her brothers, father and two uncles. Her mother was physically present in the home, but her daily alcohol use rendered her absent in all other ways. She was unavailable to protect Alaina and, as the oldest child, there was no one else in the home to whom Alaina could turn as she endured years of abuse.
Alaina’s escape came at school, where she excelled. While some of us struggle with focusing at school when we are experiencing such abuse, Alaina poured her energy and her consciousness into learning. Though she never told anyone at school about the abuse, school became a safe place for her. Eventually, she graduated high school and received a full academic scholarship at a small liberal arts school in the pacific northwest.
When I met Alaina, she had completed her graduate degree and was working in Chicago. She was quite successful at work and received accolades from her supervisor and colleagues. Still, she experienced a deep and pervasive sense of shame. She felt as though all of her accomplishments were not the “real” her; that the real her lurked just below the surface. That“her” was a scared little girl who was ready to bolt at the slightest sense of danger.
We had many discussions about the discrepancy between how she experienced herself at work and how she experienced herself emotionally in almost all other contexts. I’d gently challenge her to acknowledge her strength, and her typical response was to point to her head and say “I know what you’re telling me is true,” followed by her hand against her heart as she followed with “but I don’t believe it.”
As Alaina’s work in therapy deepened, the voice that believed in her competence became louder. Still, she found herself in situations where she was having dangerous and unprotected sex and wandering areas of the city known for high crime rates. The danger she felt in these situations felt more “real” to her than the safety and support she experienced in her rapidly advancing career, or in her day to day personal interactions.
Over time, we identified themes in her life that probably had their origin in experiences of abuse: that danger was more “comfortable” than safety; that shame often felt more real than pride; and that pleasure was often much more scary than pain. Making some of these themes more explicit afforded Alaina the opportunity to examine them in our work together.
Our Themes Are Our Themes
Gradually, she began to live with more daily joy, a sense of pride not only in her work but in the accomplishments she was making in therapy, and by exploring her personal confidence in romantic relationships. Occasionally, as she moved forward, the ghosts of these old themes returned to haunt her. Each time they returned, she was surprised and initially questioned the extent to which she had made any progress.
During one session, I remember using the metaphor of spirals and moving my hand in circles gradually raising them higher and higher. I likened our personal growth to these “healing spirals” where we continue to re-experience our themes throughout our lives. At different points of our own development and at different stages in our lives, these themes manifest differently. And when we hit bumps in the road, our themes are often there to greet us.
It was at this juncture that we began to explore the possibility that our themes will forever be our themes. I invited her to consider that perhaps the goal of our work together wasn’t to eradicate the themes, but to find more and more productive ways to manage them as they manifest. This idea seemed to resonate with Alaina, and she slowly but steadily began to accept all parts of herself with more compassion.
It wasn’t by accident that I also chose to create a workbook for the groups I was facilitating for male survivors of childhood sexual abuse called “Healing Spirals.” On the cover of the workbook was a drawing of these spirals moving across the page. From the start of the group, we discussed how growth and healing are not linear, and that we often return to certain recurring life themes at different places in our lives.
While initially this was disconcerting for some men in the group who hoped that therapy would eradicate all vestiges of trauma, over time, most men took some comfort in knowing that we didn’t need to find a way to forget how our trauma had impacted us. Our challenge was to recognize the themes we hold, to notice them when they resurface, and to gain confidence in managing them as they appear throughout our lives.
Sometimes Our Themes Whisper and Sometimes They Shout
Several weeks ago, I had some unexpected time one morning and I found myself in my basement going through old books. In retrospect, it probably wasn’t an accident, because I found myself pulling out journals I had written from the time I was 13 until the time I was in my mid twenties.
I was transfixed. As I read my own words over the course of 15 years, I found myself writing about the same themes over and over. Of course the circumstances were different and the words I chose varied, but I was struck by how consistently I described my vulnerabilities which, forty years later, remain fundamentally the same.
I had visceral responses to the stories I shared in these journals and images arose from the times in my life I wrote about. A part of me felt great compassion for the teenager and young adult who was writing. My stomach hurt. My breath caught. And I often felt the urge to cry.
And still, despite the repetition of these themes, I also had a sense of pride for how I had managed them over the years. While some of them continue to whisper in my ear (and sometimes yell at me if I’m not paying attention), I feel a greater sense of agency. These themes were and are a part of who I am.
It’s Not Over
I recently finished reading Bessel Van Der Kolk’s new book about trauma: The Body Keeps the Score.” For many years, he has been working with people who have experienced extreme trauma. He challenges the idea that gaining insight about why we feel the way we do, and using language to construct a narrative is what is needed to heal. Language is not enough, he postulates.
While he acknowledges the place for evidence based practices such as exposure therapy and CBT in healing trauma, he questions their long term effectiveness since, like Alaina, our thoughts may change, but our hearts and our visceral reactions might remain unchanged without understanding and fully experiencing the ever-present nature of our themes.
The day I read my old journals and told my partner I had been reading them, he looked at me quizzically and asked: “Why would you want to do that?” In his information technology black and white world, we have problems, we solve them, and we move on. He’s not unique in his belief that there is a beginning when you identify what is wrong, and the ending when what is wrong has been fixed. After discussion though, he also could agree that some of the same themes arise in his work over and over, but require different solutions given their context.
As for Alaina, I’ll still hear from her occasionally. She’ll come in to see me for a few sessions because she’s in a different space in her life or because something in her life has opened her to the voice of her familiar themes. Now though, she doesn’t ask me when this will be over or when she’ll be done. More often than not, she’ll sit down on my couch and before I have a chance to ask what brings her in, she’ll look at me with a sparkle in her eye and a smirk. “It’s those fucking healing spirals…”
“I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end. Life is about not knowing…”
All AIDS Anger Apologizing Asking Questions In Sessions Authenticity Beginnings And Endings Being The Expert Boundaries Boundary Crossing Boundary Violations Breaks From Therapy Collaboration Between Therapists Coming Out Compassion Fatigue Contact Between Sessions Continuity Between Sessions Courage Crying Death Depression Disclosure Disclosure And Technology Dogs Email Emotional Support Animals Emotions Empathy Ending Psychotherapy Endings Expectations Experiments Failure Finances Forgiveness Framing Therapy Fraudulence Gifts Goals Grief Happiness Healing Rituals HIV Holding Back Homework Honesty Hope Human Animal Bond Identity Imposter Injuries Interpersonal Neurobiology Intersectionality Long Term Therapy Loss Loving Yourself Memory Metaphors In Psychotherapy Microaggressions Money Multiple Identities Neurophysiology New Information New Normal Normal Not Knowing Pain Physical Contact Positive Emotions Present Moment Priorities Privacy Questions Rage Real Relationships Resentment Resolution Rites Of Passage Rituals Rupture And Repair Sadness Safe Spaces Safety Safety Plan Safety Versus Comfort Secrecy Session Structure Short Term Therapy Silence Stigma And Mental Health Suicide Survival Strategies Themes In Psychotherapy Therapist Client Relationships Touch Trauma Trigger Warnings Values Vicarious Resilience Vicarious Trauma