Some of you easterners probably saw this on Saturday afternoon or Sunday morning already, but if you’ve got a spare 20 minutes and you’re so inclined, take a look at Daphne Merkin’s essay in the New York Times Sunday Magazine called “My Life in Therapy.” She writes really thoughtfully about her experience of therapy, and wonders what (after 40 years) it’s done for her. Part of the problem, she notes, is that psychoanalysis and its offshoots tends to be an end in itself without fixed goals or an endpoint, unlike a consultation with an allopath or a dentist to fix a specific problem. You have a toothache, or a bodily pain? The doctor will diagnose it and make you feel better. The psychoanalyst’s approach isn’t always diagnostic, and even when a problem is identified, what a patient should do about it isn’t always clear. Merkin writes about going to yet another therapist. Would this one help her? And how would she even know if his approach was helping?
And then there was my feeling that I better not get in too deep. I was wary by this point of the alacrity with which I attached to shrinks, each and every one of them, as if I suspended my usual vigilant powers of critical judgment in their presence merely because they wore the badge of their profession. The truth of the matter was that in more than 40 years of therapy (the only person I knew who may have been at it longer than me was Woody Allen, who once offered me his own analyst), I never developed a set of criteria by which to assess the skill of a given therapist, the way you would assess a dentist or a plumber.Other than a presentable degree of intelligence and an office that didn’t set off aesthetic alarms — I tended to prefer genteelly shabby interiors to overly well-appointed ones, although I was wary of therapists who exhibited a Collyer Brothers-like inability to throw anything away — I wasn’t sure what made for a good one. I never felt entitled to look at them as members of a service profession, which is what, underneath all the crisscrossing of need and wishfulness, they essentially were. The sense of urgency that generally took me into a new shrink’s office was more conducive to seeing myself as the one being evaluated rather than the evaluator. Was I a good-enough patient? Would this latest psychiatrist (I saw mostly M.D.’s) like me and want to take me on? Or would he/she write me off as impossibly disturbed under my cloak of normalcy?
I knew I wasn’t the most promising candidate — I was, in fact, a prime example of what is referred to within the profession as a “difficult” patient, what with my clamorous ways, disregard for boundaries and serial treatments — but perhaps this time, after so many disappointments, I would get lucky. Somewhere out there, sitting in a smaller or larger office on Central Park West or the Upper East Side, tucked behind a waiting area furnished with a suitably arty poster or two, a couple of chairs and old copies of The New Yorker and National Geographic Traveler, was a practitioner who would not only understand my lifelong sorrow and anger in an empathic (but not unduly soppy) fashion but also be able to relieve me of them. Just as some people believe in the idea of soul mates, I held fast to the conviction that my perfect therapeutic match was out there. If only I looked hard enough I would find this person, and then the demons that haunted me— my love/hate relationship with my difficult mother (who has been dead now for four years), my self-torturing and intransigently avoidant attitude toward my work, my abiding sense of aloneness and seeming inability to sustain a romantic relationship and, above all, my lapses into severe depression — would become, with my therapist’s help, easier to manage.
Merkin doesn’t address gender issues in her article, but throughout I couldn’t help but see her problem as a gendered one. Why should she feel like her therapist was someone she needed to please, someone from whom she couldn’t demand results, however modestly or vaguely defined? She reflects on the years and years of dredging up childhood memories for one new therapist after another, and wonders what the point is if she doesn’t achieve any sense of resolution and the process doesn’t make her happier. (She has struggled with depression.) Finally, an encounter with a therapist who offers a clear diagnosis of what he sees as her problems gives her the courage to leave therapy:
Dr. F. and I made a fourth appointment for him to give me his impressions as well as his suggestions on what I should do next. Knowing his reputation for being confrontational with his patients, I braced myself for the worst. Even so, I wasn’t prepared for his ruthlessly pragmatic line of thinking, which had less to do with any inner torment I alluded to and more to do with the face I presented to the world, as if I were applying for a position as a flight attendant or a sales rep. He wondered, for instance, whether I thought of losing weight. Dumbstruck, I momentarily lost my footing, and then I answered that I had. He nodded and then coldly observed, “But you lack the motivation.” No, I said, I didn’t lack the motivation forever, I just lacked it for right now. Dr. F. looked entirely unconvinced and went on to ask me if I didn’t long to be part of a couple, to have someone to visit art galleries with. I said I did but that it hadn’t worked out thus far. “You are alone,” he repeated, as if I were in a state of denial. “I know,” I answered. “Many women are alone.” He then noted that I hadn’t written as much as I might have, that I procrastinated and was often late on coming through with assignments. His tone was smug and self-congratulatory, as if he had adduced these aspects of my character on his own when in reality he was simply throwing back at me the bits of incriminating information that I had willingly offered up. I found myself growing ever more defensive, ready to rise up and fight for the rights of unsvelte, unattached and underachieving women everywhere. Who was he to cast me in his patriarchal, bourgeois mold? Sure, I could lose some weight, but how had this come to be the main diagnostic issue? And I wasn’t completely alone: I had a daughter, I had friends, I had had my share of passion, ex-boyfriends and an ex-husband, there were more things in heaven and earth than were dreamed of in Dr. F.’s philosophy.
What was that–a time warp back to the Golden Age of New York Psychoanalysis, ca. 1960? Merkin could have picked that advice up from a waiting room copy of Redbook or Mademoiselle, for cripessakes. All women are warned from the cradle against the two sins against the world we must never commit: fatness and aloneness. Everything must be sacrificed in order to achieve thinness and coupledom! Oh, and telling a writer that she procrastinates? That’s like observing that she breathes. Gimme a break. What a charlatan.
I maintain that feminism is the best therapy of all, and the only kind most women will ever need. (Oh, and maybe a blog, too. That might help.) Seems like it’s worth a try, compared to 40 years of therapists’ bills!
Historiann 
I never developed a set of criteria by which to assess the skill of a given therapist, the way you would assess a dentist or a plumber.
I think the standards we use to assess practitioners are often not the same ones those practitioners use to evaluate each other. We can tell if the dentist or plumber has fixed the problem we consulted them about, but from their viewpoint, they may have just done something easy (“I just cleaned out the trap with a piece of coathanger–easiest ninety bucks I ever made”), or very skillful; we may not have identified the underlying problem as they found it to be; we may have accepted a short-term fix that, to an expert eye, will still leave a bigger problem down the road. There’s survey data to show that most lay people mistrust doctors in general but have high confidence in their own medical care provider; both these opinions are only weakly connected with the kind of evidence that would convince a hospital review board or an insurance company. And I think the same would apply even more in the mysterious world of psychological diagnosis and talk therapy.
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Historiann, I haven’t read the article, but you make a compelling argument for the gendered dimensions of therapy and psycho-therapy work. I also think there are two other aspects to this: class and geography.
The tone of the excerpts you have presented here (and the general tone of the NYTimes Magazine) speaks more to post Reagan Affluenza rather than 1960s Freudian analysis. Forty years of analysis? Really? Who has the bread to shell out for a weekly session for forty years? Even on a sliding scale, that sounds like someone who has a load of disposable income and time on their hands.
Keep in mind that the empirical basis of Freud’s early theories were pretty slender. Most of his case studies were drawn from his treatment of upper middle class and aristocratic women. His male patients (including himself) were from the same pool. So the earliest theories of psychoanalysis were rooted in the experiences and symptoms of a specific socio-economic class.
The second thing is geography. I grew up on the West Coast where we had loads of therapists, analysts and kooky new age spiritual healers. But even the sketchiest of the sketchy never really could argue for more than a couple of years of ‘treatment.’ I think NYC is the last bastion of Freudian analysis (heck they don’t even do that stuff in Vienna anymore!). New York is an intellectual museum where good ideas go to die a slow death. The Freudian notion that treatment is open-ended has really been rejected by most therapists and analysts around the country. (Remember est and scream therapy? Those died out on the west coast. Nobody does that anymore.)
Unless you are a complete basket case, (ie. on the verge of institutionalization under 5150 or your local equivalent), a good therapist is going to ask you two questions: whats bugging you? and what do you want to get out of this treatment? They want to help you so that you can get on with your life and they can move onto the next person in need of assistance. A good therapist/counselor/analyst does not want to talk to you for the next forty years.
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Matt–I think you’re exactly right that this is at least as much a story about the pasttimes and pursuits of affluent New Yorkers from the middle of the 20th C to the present. (And even in the “intellectual museum” of modern day NYC, it seems like it’s on the wane.) Merkin grew up in a fabulously wealthy family on Park Avenue and started analysis in about 1964, so she’s very much a part of this “world we have lost.”
But it was the unreconstructed gendered element that really smacked me in the face. Why should I be surprised? Fortunately, Merkin snapped out of her thrall after hearing such patently boilerplate sexist advice as that last guy dispensed.
Rootlesscosmo–you’re probably right that the hoi polloi have very well-developed criteria for judging the skills of the professionals they employ to solve their problems. But, they are at least capable of saying whether or not the problem was fixed, and for people who want a solution to a problem, they don’t care much whether it was an obvious solution or one that required years of training and expertise. (And I say this as someone who had a plumber in a few weeks back just to fix some leaky sink faucets and a leaky shower! Sure, I could have opened a book and picked up a wrench, but I didn’t want to. I just needed the damn dripping to END.)
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I find that someone telling me (unsolicited) what’s wrong with me or how I’m Doing It Wrong (whatever “it” is) has a marvelously clarifying effect. In that I get pissed off to stand up for myself and say, “You know, I may not be perfect, but I’m actually pretty good in my own way, and I don’t think I’ll be needing your advice anymore.”
But I am a contrary creature.
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I was fascinated by this article because someone close to me has been in therapy (off and on, but mostly on) for about 30 years… and her results are about as good as Merkin’s. I’ve wondered whether the therapy is part of the problem or the solution in her case ~ there is a sense in which she is stalled in a long-ago past, still agonizing over decades-past slights and hurts. I’ve wondered whether the therapy, which keeps that past vividly present and before her eyes at all times, is helpful. There might be something to be said for striving to bracket certain issues sometimes, rather than continually revisiting them.
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This post surprised me. I’m usually the type to see the gendered aspect of everything, but that’s not what struck me about Merkin’s article. Having read her previous account of her depression, I know that Merkin is a lifetime sufferer of severe depression that is only sometimes helped by medication. Feminism might help her leave psychoanalysis (which doesn’t appear to have been very helpful in treating her depression) in favor of a very different type of therapy (mindfulness, dialectical behavior, cognitive behavior, play….), but I highly doubt feminism would be sufficient to keep her out of a mental health institution.
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Squadrato–as a historian, I’m very interested in the newer theories for treating PTSD and other severe trauma, which are exactly what you suggest–bracketing it off and NOT continually revisiting/reliving them. In many respects, then, it may be psychologically healthier and happier to let the past go and forget it as much as possible.
I tend to be a happy person, and I wonder if that’s because I have a pretty poor memory of the not-happy times in my life and of the not-happy things that happened to me (blessedly few in both cases.) When otherwise I have a very clear memory of my life and times, I can’t recall those unhappy things or periods with any clarity. I don’t know if my happiness causes the memory loss of unhappy times, or if my poor memory of unhappiness is what keeps me happy, but it works for me.
JennyRobot–you’re right that Merkin has suffered from depression (as I noted) and in that article she mentions in passing a recent hospitalization. Please note that I didn’t say that feminism would work as a mental health strategy for all women in all cases–certainly not in the case of the clinically depressed. I just said it would probably work for “most women,” if they gave it a try.
And Notorious: I think a therapist would say that you’re just being defensive! Heh. I’m sure that’s what Merkin’s last therapist thought when she told him she didn’t have the willpower to lose weight RIGHT NOW.
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Historiann, I believe there have been studies that show that most people are more like you than not: humans tend to recall happy moments more vividly than unhappy ones, and even to retrospectively “add” a layer of happy to more neutral emotional memories. In some ways, the folks who are categorized as depressive are likely more realistic in their memories — but that nostalgic rose glow most of us give our memories has good adaptive functions.
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Yes–I think I’ve seen that too. I’ve also seen assessments that depressed people have a more realistic view of life overall–i.e., that it’s randomly marked by tragedy and bad luck, and that there’s little we can do to change that, we don’t have any power, etc.. Whereas happy people are the ones who have the unrealistic view of life: we have the power to shape our lives (or so we think), good things will happen to us, etc.
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I dunno, I’m a big fan of cognitive behavioral therapy. Got me through graduate school and natural childbirth and made me a much calmer person overall.
Of course, it has a set goal, a beginning and an end, it doesn’t pretend to do more than it does (treat the symptoms of anxiety), and it’s got scads of solid scientific backing.
Also many of the techniques are ancient and used in religions across the centuries and continents. Probably because deep breathing does calm a person down.
So yeah, there’s a lot of talk therapy that could be replaced by feminism, but there’s good techniques out there to help specific problems, like JennyRobot suggests.
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I can remember every miserable thing that has ever happened to me. I try not to and I have been trying the Draper approach of moving forward and not looking back. Unfortunately, my memory is stronger than my motivation. Without a doubt, I see the glass as half empty and I hate that I do, but I do. Behavior modification has been unable to change this outlook. Intellectually, I say to myself, stop it. But at the end of the day, it is all Life sucks and then you die. Also, I am well aware that people do not generally like people like me. Yet, what can you do?
I’ve not had a life time of therapy as Merkin has, but I’ve had my share. Looking back, I went to therapy when I could no longer find a way to accept my current lot. Each time afterwards, I was renewed. I would get a new job or go back to school.
I did learn early though that I could not have a male therapist. Yes, there are arguments to be made that the same could be said if I had certain female therapists.
My last therapist was a feminist. I had the sense to seek out a feminist because the two male therapists I went to previously, both MDs, repeatedly told me I needed a boyfriend and I knew that could not be the source of all my woe. How could it be?
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I know a lot of people who have been helped by cognitive behavioral therapy. But Merkin’s article is not about that–CBT has clear goals, whereas psychoanalytic therapy doesn’t, and that (it seems to me) is part of Merkin’s dissatisfaction with psychoanalytic therapy.
Dickens reader–good for you for ditching the therapists just telling you to get a boyfriend. Shades of Freud from 120 years ago, as Matt L. suggests above.
On a related topic: Anne Applebaum has an interesting read of Tom Sawyer in the age of ADHD and ODD at Slate today. Pretty good–except for her conclusion that in the past, boys like Tom and Huck Finn who were fidgety and didn’t like school could just unproblematically go out to the “wild west,” to “Indian territory.” (Isn’t that what our wars of empire serve as now? Isn’t that the fate of a lot of men and some women who don’t fit into the great meritocratic educational race?)
I also don’t really get it when people find a similar-looking problem in the past, and are reassured by the knowledge, as Applebaum says she is in this article. Every generation thinks that things are going to hell and their kids will be ruined. Tom Sawyer was already a nostalgia piece for many Americans when it was published in 1876, a tribute to Mark Twain’s boyhood in Missouri in the 1840s. Emancipation and Reconstruction were processes that were feared by whites and sometimes violently resisted by them. Black families were free, but many lived in fear of their white neighbors. Indian families were threatened by the very same fidgety white boys Applebaum is so relieved to see “gainfully employed.” Print culture and the popularity of dime novels (and other “literary trash” that celebrated violence) were seen as the downfall of civilization and the bane of all middle-class, respectable families. The 1870s felt pretty uncertain and terrifying to the people who were alive then.
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H, that hypothetical therapist (mine or Merkin’s) would be CORRECT. The issue is one of interpretation: when one is attacked one time too many, defending oneself will, at some point, make more sense than cowering and whimpering like a whipped puppy.
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It’s important in any therapy to ensure that your philosophy/orientation/worldview align with the type of therapy you are receiving. As you point out @historiann, CBT sounds like it would have been more beneficial to her than neo-Freudian models she was pursuing. The problem isn’t just that she was working with the “wrong” model for her in general but also the assumptions about gender and sexuality embedded in the model she was working in. While I recently blogged about the failing of many therapeutic models to address oppressions in a non-client-pathologizing way, in my mind Freudian models tend to be the most likely to do this especially for female or queer clients. It seems like the assumption is that she is histrionic and neurotic (classic diagnosis for women that amount to … being female and worried about engendered issues in life) and so everything becomes her fault. The fact that, as presented, no one challenged her belief that a heterosexual relationship would solve all her family of origin issues and avoidance-approach issues with work (and therapy) also seems like part of a larger pathologizing of women in certain therapeutic models; she is of the age/stage where she “should be married” “should have kids” and since she does not, she has “failed”. While her fear of judgment is placed on her as another sign that she is pathological, the therapeutic milieu and the theories within which she worked have not only embedded judgment but as described, she had therapists whose confrontations where sexist and therefore judgment as well. The longer this went on the more she seemed to transfer her classic approach-avoidance coping strategies (mentioned when she discusses work and no doubt part of her “difficult relationship w/ her mother”) on to therapy extending out the time and lack of accomplishment in the process.
All this to say, I think you’re right there is a whole lot of gender inequity going on here at just about every stage in the process as reported. Since certain models tend to see women as already pathological the process can be self-reinforcing particularly if the client is combining healthy, tho unnamed, scepticism toward sexism in the process and actual avoidance or resistance.
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Great point about the heterosexism in all of this, in addition to the sexism. I sometimes wonder if being single and not pursuing any kind of sexual relationship is the new queer. My women friends who are single and who aren’t in a hurry to change that have to explain themselves a lot more than my lesbian friends with partners.
Absent coverture and laws preventing women from renting their own apartments or customs forbidding them to take out mortgages on their own, I suppose society has to have some strategies for inducing fear and panic into women who dare to be single after age 30 or 35 (or so.)
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I suppose society has to have some strategies for inducing fear and panic into women who dare to be single after age 30 or 35 (or so.)
It’s funny, I thought that was what Women’s Magazines were for …
Susanna Kaysen’s book Girl Interrupted (not the feminist-light critique-light film) has an interesting analysis of this exact thing but for much younger women not pursuing marriage.
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I’ve been told that classical Freudian psychoanalysis is still thriving in Buenos Aires.
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This is the benefit of a National Health Service; get your mental health fixed in 6 hours or your money back- no wait, or tough, back on the waiting-list.
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Most people in the U.S. opt to self-medicate with drugs and/or alcohol. It’s a lot cheaper than psychoanalysis, and probably makes people happier. (Well, for a few hours, anyway.)
As Homer Simpson once said: “Alcohol: the cause of, and solution to, most of life’s problems.”
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If the other therapists she saw were similar to the one in the vignette you quoted, or the one who made her feel like she needed to please him, then the problem was not with “therapy”; the problem was that she was seeing grossly incompetent therapists. A good therapist can do absolutely amazing things. Sadly, however, I suspect good therapists are relatively rare.
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re The Simpsons
Or as Lenny (or was it Carl?) observed while sitting in Moe’s, “There’s nothing better for depression than a depressant”
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“I sometimes wonder if being single and not pursuing any kind of sexual relationship is the new queer. ”
Megadittoes, Dr. H. I’m now the freak because I’ve never been married and don’t have someone to mention as after-work company.
Spinsters have always been outlaws; the pro-pr0n foofraw only masked the same old hatred for those not sexually useful.
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“Spinsters have always been outlaws; the pro-pr0n foofraw only masked the same old hatred for those not sexually useful.”
Very well said. Two friends of mine are authors of books focused on singlewomen (that is, never married women) in early modern Britain and America. They were both frustrated by the dominance of wife-and-motherhood in the historiography on early modern English and colonial Anglo-American free women, and its attendant focus on heterosexuality in organizing women’s lives:
Karin Wulf, Not All Wives: Women of Colonial Philadelphia (2000)
Amy Froide, Never Married: Singlewomen in Early Modern England (2005)
You won’t be surprised that the roots of fear, blaming, and shaming of singlewomen are long and deep.
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