A Person Appears in My Office

It could be a man or a woman. He or she could be suffering from depression, anxiety, or relationship problems. They could have begun a few weeks ago or have existed for many years. What goes through my head as a psychologist?

Parents, school, friends, lovers, careers, all have the potential to offer both. Inside everyone is a vulnerable self. That self is subjected to both affirming and destructive life experience. If the pain is too severe, the vulnerable self automatically begins to seek protection. There are many, many ways of doing this and in large part the methods used are dependent on inborn temperament and defensive patterns. Sometimes these "defenses" work: when they do, emotional pain is reduced, but the protection itself presents obstacles to intimate contact with people. When the defenses don't work" - the result is depression, anxiety, or both--the vulnerable self is simply overwhelmed.

In my office I am intent on finding the vulnerable self, and almost always I can find it during the first session. Usually it is covered over for protection, sometimes by a huge concrete bunker, hardened to resist penetration. What happened in this person's life, I wonder, that made him or her need to hunker down in a nuclear bomb shelter? People are not crazy - that is not why they come to my office, and I do not see them in that way. They have protected themselves for good reason, and it is my job to understand as quickly as possible why.

People are often not aware of these forces themselves.Usually this is not difficult. Asking the right questions about a person's history, recent and past, exposes the damaging forces that they have been subjected to. Here is where therapists need to be talented" - because they have to be expert in both subtext and extrapolation. They must read between the lines of important relationships and life events, and at the same time understand that what happened at age 8 or 15 or even at age 50, sometimes reflects what happened to the vulnerable self in years past. Here's why: If you are in a bunker hundreds of feet deep, the world may seem like a reasonably safe place. Nothing has hurt for a long, long time (of course, you or your partner may be very disappointed in your relationship). Occasionally, someone knows exactly what happened in their life--parents, relationships, career" - they have simply been devastated by destructive forces and failed attempts to overcome them.

It is my job to love and nurture the vulnerable self" - and to demonstrate in my relationship with a client that protection, with me, is not necessary. I do this through insight, understanding, but especially warmth. Initially, there is - lives have revolved around the conflict between protection and yearning. To give this struggle up (and the highs and lows associated with it) requires time and effort. Slowly the vulnerable self has no choice but to accept my love, and it can begin to grow and make decisions about life that are productive and healthy. I watch with joy as depression and anxiety finally lift, and people choose better relationships--or work constructively on the ones they decide to keep. It is often a surprise to the people I see that I end up inside of them: they remember a look, a phrase, a gesture - and they pull it out when they are besieged again (for life is often difficult) or just for pleasure. The end of therapy is bittersweet. When people leave my office for the last time, they know I will be with them for the rest of their life. They may or not know: they will be with me.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

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