"Here I am..."

I’ve come to understand that one of the most powerful experiences that psychotherapy offers is the opportunity to be seen, understood and accepted. Being seen for who you are—in your deeply complex humanity—is a rare experience, but one that is essential to mental health and well-being. We are rarely seen as whole people. We inhabit social personas, showing the world only those parts of us deemed “acceptable.” Most of us inhabit roles: parent, child, sibling, lawyer, manager, nurse, police officer, designer, student, patient, ad infinitum. If we let them, roles can come to define us and circumscribe our behavior, and those with whom we interact will only know small parts of us.

Similarly, we often refrain from expressing our thoughts and feelings—for many, many reasons: self-protection, the desire to protect others, fear of being perceived as inadequate or uninformed, shame. In addition, our thoughts often have many nuances that remain unspoken, further preventing us from being fully seen.

Indeed, we are complex people—people with passions, needs, aspirations, and wounds that others do not readily perceive. And sometimes we keep some of those passions and needs hidden from ourselves, out of consciousness, tucked away in the recesses of our minds. We do not fully see ourselves; others cannot possibly see us either. The end result is depression, ennui, unsatisfying relationships, a life less than fully lived.

Many people come into therapy with a deeply felt desire to be seen and known in all their complexities. This desire is often not fully conscious and is almost always unarticulated. But we want to be known as people who have lives beyond the roles we’ve been assigned, beyond our social personas. We are not just “mother,” or “husband,” or “nurse,” or “teacher,” or “abused spouse,” or “cancer patient.” We are so much more, and we want to be fully seen and accepted as such.

Yet, it is hard to be seen for who we are, just as it is hard to see others for who they are. There are too many filters: preconceptions and prejudices, early family experiences, traumas, defenses, beliefs, moods, patterns of communication, social rules and expectations all get in the way of our ability to see and be seen.

Although many people enter therapy hoping to address a specific problem or symptom, they also enter therapy with a deeply held, but unspoken desire to be seen and accepted for who they are. Being seen for who you really are is a profoundly intimate experience. As such, being seen requires courage: to be seen is to be vulnerable. Asking another to see you in all your humanity (“warts and all”) is to invite intimacy and risk acceptance. No wonder intimate relationships are so challenging! No wonder many people are ambivalent about going to therapy!

There are too few opportunities to be seen in our world. While Facebook and other social media give the illusion of being available to be seen, they do not require the courage of intimacy. Social media merely offer glimpses into the lives of their users.

One of the many gifts offered by psychotherapy is the opportunity to be seen. However, it is an opportunity most people approach with some trepidation—and understandably so! While it can be a relief to be seen by another person, it can also be terrifying. Being seen elicits defenses, and the impulse to flee is strong, especially since the feelings of vulnerability can seem so raw.

And so it is that therapy also offers another gift: an opportunity to enter a process where it can become safe to be seen. Allowing yourself to be vulnerable—allowing yourself to be seen by another human being—is a process that, with sensitivity, attention and great care, develops over time.

In today’s world, the psychotherapist’s consulting room can be one of the few places where you can develop the courage to be seen—and then be seen! By offering safety and carefully attending to the deepest reality of each client, the therapist invites the client to say, in effect, “Here I am.” When a client can genuinely say this, and then allow him/herself to actually be seen, the work of self-acceptance and healing has begun.

Being Stuck

A recent question was posted on a listserv I subscribe to. The therapist asked for suggestions on confronting a client’s persistent pattern of dysfunctional choices and behaviors—a pattern that apparently had not changed during the course of therapy. The therapist expressed exasperation with his client: his client was “stuck” (his word, not mine) and had been “stuck” for a long time. The question triggered a number of thoughts, most centering on “stuck points” –those periods of time when therapeutic work appears stalled and when therapeutic tools don’t seem to be effective anymore. Interventions aimed at helping the client get “unstuck” seem fruitless. Frustration builds, and the therapist may begin to feel that he or she has “failed” the client, or worse, that the client has somehow “failed” treatment. The client may also feel frustrated and may even consider leaving treatment.

In many ways, “stuck points” reflect ambivalence about change. Let’s face it: when it comes to making changes in our lives, most of us approach change with some degree of ambivalence. We feel distress and perceive the need to change so that the distress will diminish; but we also feel uncomfortable with entering new territory. This can happen with any problem: leaving a dysfunctional relationship, changing a career, dieting, abstaining from tobacco, drugs or alcohol. We can become "stuck", unable to move forward.

Feeling “stuck”—ambivalent—may also reflect deeper issues. Indeed, it’s been my experience that being “stuck” signals that there is deeper work to be done. The salient issue has not been fully identified. Persistently dysfunctional choices or behaviors have meaning—meaning that has not been fully explored.

Until we work through ambivalence, we often persist in dysfunctional behaviors and remain “stuck”. Until we understand the meaning of the behavior—its role in alleviating anxiety, its role as a defense—it will persist. Likewise, we need to understand what may be happening between the client and therapist in the consultation room; transference and counter-transference dynamics are always at work.

Exploring and working through “stuck points” requires time, courage and persistence—as well as a willingness and ability to sit with ambivalence and uncertainty. The roots of ambivalence can run deep, and quite often we are not fully conscious of the dynamics that create “stuck points.” Sitting with ambivalence also provides an opportunity to look at the therapeutic relationship itself where so many dynamics come into play: transference issues and counter-transference responses are always subject to therapeutic attention and exploration.

In short, “stuck points” are opportunities to explore, learn, and perhaps develop insight. While understanding and insight may not always lead to immediate, visible action, it is important to recognize that an evolution is taking place. Most change is incremental. And sometimes the course of change is surprising—to the client as well as the therapist. Therapeutic activity that supports safe exploration and experimentation will also support movement away from being “stuck.”