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Here are some reflections on the kind of interesting conversations that psychotherapy makes possible.

A few weeks ago, an adult patient of mine in his forties shared with me an email he’d received from his older sister. Their mother had been mentally ill in an obvious-to-anyone kind of way through much of their childhood. She still is today. Here’s a paraphrase of part of the email from the sister (all names and details have been significantly changed).

Dear Sam, I do not believe Mom’s behavior affects me or how I deal with life. I think trying to blame problems on her is a cop-out. You are a normal person who just hasn’t met the right woman.  Mom’s issues do not affect how you interact with women and won’t get in the way of you meeting someone, getting married, etc..  You have to overcome it, and not be a victim of it.

A few months ago, another patient grew frustrated with me for pointing out that the way she was dealing with a high-stakes decision in her life was very, very similar to the way in which her mother had dealt with a similar matter in her own life. I added that she and her mother had both failed to come to terms with their decisions in a strikingly similar way. This patient resisted talking about her mother and told me emphatically that she was not about to do the typical clichéd psychotherapy schtick of blaming her parents for her problems. She did not disagree with the observation that she was behaving very similarly to her mother. She just declared that it was irrelevant to her difficulties and had no place in her therapy. She wished that I’d stop bringing it up.

I’m sure most psychotherapists have encountered this sort of thing in patients or with patients’ families. Someone wants to take full responsibility for their own life situation and doesn’t want to blame others for their difficulties. Or, someone wants to protect their relationship with their parents (or the parents themselves) from conflict that hurts — and is therefore inclined to overlook their parents’ shortcomings or failures. Lots of folks have a hard time imagining how one could have strong angry feelings and critical thoughts regarding someone they love and still love them.

Many patients want to take full responsibility for their lives while overlooking unpleasant feelings or critical thoughts they might have about others who are important to them. And, as you can see, there’s a problem here: taking full responsibility for what we feel, what we think, what we want, and how we act means we can’t afford to deny or overlook any of those things. I can’t take full responsibility for my thoughts, feelings, and wishes … except for the ones I don’t like.

So, I think it’s useful to have a way of addressing this problem (an anxiety problem, actually) with patients in a simple and direct way. For patients like Sam, in the first situation described, it can also be useful to have a way to coach or equip them to address the anxiety other family members have (in Sam’s case, it’s his sister) to whatever degree is appropriate. I’ll be clear: the appropriateness of a patient’s addressing family members’ anxiety about their being in therapy can range from totally not appropriate to worthy of thoughtful consideration. How to assess that is outside the limitations of this essay.

What I’m inclined to say to someone like Sam or Gwen (name also changed for the second case described) goes roughly like this …

“I’m really not interested in getting you to blame your parents for your difficulties. That’s actually not the point of talking about them, nor is it a reasonable goal for your therapy. I agree with you there. And I am interested in helping you take full responsibility for your situation – anything less would be less then fully empowering for you. But here’s the deal: you have thoughts and feelings about almost everything that’s ever happened in your life. And taking full responsibility for yourself means facing those thoughts, feelings, and whatever desires you have related to those thoughts and feelings and deciding what, if anything, you are going do about them. As you know, you can’t take responsibility for something by ignoring it or pretending it’s not there.”

I told Sam that I agreed with his sister’s admonition, “you have to overcome it, and not be a victim of it.” I said the question then becomes how to overcome it, how to not be a victim of it. I also said that, all said and done, I’d have to agree with his sister that to blame his problems on his mother would be a cop-out. On the other hand, to act like his mother’s plainly disturbing behaviors had had no effect on him or his sister was also a kind of cop-out. Overcoming, to use his sister’s word, would involve taking a thorough inventory of the ways in which his mother’s behavior might still be affecting him and then choosing for himself what he was going to do about it – or not.

Gwen’s situation is different. When I said the “you can’t take responsibility for something by ignoring it or pretending it’s not there” part, she said, “But, it’s really not there! I just don’t have any feelings about my mother like you think I do.”

She declared she was simply not angry or upset with her mother for how her mother had always handled (or mishandled) the particularly high-stakes decision in question (let’s say it involved “other men”). Gwen and I would butt heads a few more times on this – we’d agree to disagree – until I suddenly saw something worth sharing with her. I’d noticed that she was consistently very angry with herself for the way she approached and mishandled the matter in question while she was simultaneously dedicated to not being bothered at all by the same behavior in her mother. I basically said that it seemed weird that she’d be so mad with herself for something that she was not at all mad at her mother for. What could possibly account for that (striking) inconsistency

This got Gwen’s attention in a way that nothing had before. Now she became curious about a topic she’d previously been uninterested in. At this point, I’m not sure where she’ll go with this curiosity, but what I hope for her is that she’ll see beyond the ordinary “daughters-will-behave-somewhat-like-their-mothers” stuff. Even the adage is obviously true, it’s also what kind of bores Gwen and even offends her since it makes it sound like it’s her mother’s fault that she’s behaving in the self-sabotaging way that she is.

What I hope we can get to is that she imitates her mother not only because she grew up under her influence but also (and now, more importantly) as a way of covering up for her mother. If the behavior in question (call it a kind of flaky, obsessed, second-guessing of herself around an important decision to the point of not being able to move on with her life) is “genetic” then no one is really responsible for it. It’s just how some people are, right?

Gwen’s mother is a fragile person. Gwen doesn’t want to stress her. Gwen’s brother is already mad at their mother. She doubts her mother could handle another such “betrayal” from Gwen and she might be right about that. So, imitating her mother’s behavior of second-guessing herself to the point of not being able to lean forward into her life, while acting like she’s motivated by a mysterious genetic compulsion that no one can understand will keep her from being angry with her mother (e.g.,“Oh, mom can’t help it – just like me.  Let’s leave her out of this.”) There’s no difference between Gwen and her mother in this area of their lives, no differentiation, and thus no perspective or point-of-contrast from which to look honestly at her mother’s behavior and, yes, make some judgment about it, or call it like it is – a tragic waste of time and energy (wise judgment).

For Gwen to differentiate herself from her mother, on the one hand she’ll need to choose to be different: “I don’t want to be like her in this: she won’t let go of her past and I am determined to let go of mine.” And this will involve some feeling: “Ugh, thank god I don’t have to be like that!” And on the other hand, she’ll have to find her way to managing any anger or disgust she has in regard to her mother and her behavior so that she doesn’t do obvious injury to her mother.

There’s really no chance for either of those outcomes if she cannot even admit to herself that she has some pretty negative thoughts and feelings about her mother’s behavior. Our challenge as therapists is often to help patients understand that they can’t live well by trying to cut away parts of themselves (memories, thoughts, feelings, wishes) that they don’t know what to do with. The cutting away just won’t work. Therapists can help their patients think creatively and productively about what to do or not do about unwanted realities. Better to learn how to live as well as we can with what we’ve got – the good, the bad, and the ugly – and who we are than to suffer the illusion that we get to erase what we don’t want from our lives.

Perfection is finally attained not when there is no longer anything to add but when there is no longer anything to take away.   –  Antoine de Saint-Exupery

For the purposes of confidentiality, indentifying details have been obscured.