Here’s a funny thing: real wounds disgust me. Someone suffering physical pain is hard for me to tolerate; the pain gets under my own skin, I feel it and can do nothing about it. But emotional wounds, now, there I have no problems at all. I don’t mind if people cry or whine or panic. I suppose the difference is that I believe there’s something effective I can do, and, well it’s interesting, the way that things upset us. There have been times when I’ve considered training as a therapist, but on the whole, I’d rather remain a curious amateur, reading fascinating books like Rosemary Dinnage’s One to One: Experiences of Psychotherapy. The book is composed of 20 case histories, written from the point of view of the clients rather than the therapists. Dinnage has obviously interviewed her chosen subjects, but in the book the questions are removed, leaving them to tell their own stories, uninterrupted.

And what stories they are! Much as there are wide variations between the people in these studies, there are similarities, too. An intolerable sense of isolation becomes a common theme, the feeling of never being seen as one really is, of having no one who can really hear the depth and extent of their sorrow. Often the move into therapy is motivated by a significant failure –  a breakdown, a collapse in exams, a marriage falling apart, the death of a child. But equally often, there has simply been an ongoing recognition that the person is living a half life, unable to access the full extent of their qualities, a prisoner inside a personality that is not their own.

Some of the stories are very affecting. The case study of ‘Helen’ concerns a young woman from a family of academics and doctors. She was the first born and expected to be ‘Einstein and Isaac Newton rolled into one.’ To add to the pressure, her father was clearly a difficult man: ‘And then days of silence. It was my father’s anger. It held the whole house in thrall. And if he was angry with you, he was angry with everybody and he wouldn’t speak. So everybody was sucked into this vortex and it was terrifying.’ Now whilst some children might not have been affected by this kind of behaviour, Helen’s natural insecurity, and her sense of not fitting in, compounded her anxiety around her father. She describes how ‘I was trying to force myself into the sort of daughter he wanted and please him in the academic field, which was the only way he wanted. And just completely failing, utterly. Because I always thought in the wrong way, in a way that was unacceptable, I just stopped thinking.’ Helen failed to get good qualifications, lost jobs, was unable to hold down a relationship, found herself unable to do any of the usual things because of cripplingly low self-esteem and excessive anxiety.

There are a lot of cases like this, where children have failed to get the approval they needed from parents, sent away to boarding school at very young ages, or left with a manic parent when the stable one has died young. One woman described how her mother had said to her, when her own children were small: ‘When you were two you used to wake me up crying, so I said to you, “You’ll damage the baby if you wake me up, and you’ll damage me, and if you go on, I’ll put you in the boxroom” and you never cried again!’ Great! Implying that’s what I should say to my children.’ It is amazing the things that people will do to their kids, amazing. But then there are other difficulties too, like the poor woman who had lost a child, or the boy who’d dropped out of Oxford, and another young man, extraordinarily arrogant, whose whole family had been in analysis and so it was simply something he knew he would do.

As for what happens in that analysis, well, it’s not always good. There are some real horror stories in here, mostly arising from the therapists who refuse to interact in a normal, human way with their clients. One terribly sad old lady says over and over ‘I was thinking all the time, I’m doing this all wrong. What’s the matter with me? – if only someone would explain it to me.’ And another woman says with humourous disbelief ‘When I first came he would say “Good morning” or “Good day” or something like that but then he stopped. And I asked him why he’d stopped, and he said because it was not necessary, he’d taken the decision that there was more communicated by that than there should be.’ Unsurprisingly, most of these therapies dragged on and went nowhere. It’s difficult for people who have such a lack of faith in themselves to stand up to healers who are doing them no good and to say so. Some clearly should have been drummed out of practice, like the therapist who refused to declare her rates to her client, suggesting she was aware of his financial difficulties, and then clobbered him a few months down the line with a $900 bill.

But there are as many who have experienced a real upturn in their quality of living. ‘I had a prospective self before,’ one man says. ‘I only wanted to be somebody.’ Now he realises, ‘You have your strength, you have order and you have your brains. You have this marvellous palette and everything coming at you at once, and you’ve just got to handle it.’ Another woman said ‘He was able to put to rest this hurt, then this other hurt, then this other one – so, that’s gone, and that’s gone.’ ‘Jeffrey’ said ‘You learn, I suppose, to quite like yourself, and the bits you don’t like, you learn that they’re part of you and that’s that; you get a sort of inner peace from them.’

The key to healing seems to be in the correct match between therapist and client. Sounds simple, doesn’t it, and yet it is not so obvious as all that. One of the most extraordinary cases is the story of ‘Sarah’, a young woman who acted out appallingly in her sessions, smashing up the analyst’s room and refusing to leave when her time was up. The analyst was clearly out of her depth and had to call the police several times to have her removed. Eventually she was moved over to another therapist, one who told her straight up ‘I’m not having any destructiveness. I won’t tolerate messing up of my room; I’ll just call someone to take you into the next room.’ ‘And so in some way it was safe,’ she recalls. The analyst was harsh with her, declared a session over before the time was up if he felt she wasn’t being responsive, asked her to bring him presents at other times. Yet the client loved this behaviour and responded well to it. At other times he’d let her return later in the day if she was really upset, and unlike many therapists he was happy to hold her if she cried. What she needed was someone so real and honest that he let every emotion show, as it were. In this environment, she felt secure and able to access more reasonable patterns of behaviour.

What I found so intriguing across the book was the way that little things can create so much emotion in response. How it’s the simple things, the one plus one of life that refuses to add up to two, that need to be addressed. It’s interesting also how long the process is to normality, and how painful. Therapy is not for the faint-hearted. But if one thing sums the whole business up, points to both the cause of the damage and the solution, it’s encapsulated in the understanding of one of the subjects who’d come out of a painful ménage à trois: ‘We’d had ideological a prioris of one kind or another, about how one should or should feel and behave, you know, which weren’t really rooted in an understanding of how people are.’ That, for me, really nails it. When we are forced into incongruence, obliged to present a façade or act out a role that does not correspond to the way we really are, trouble results. And yet you look about you at society and the sheer volume of rules and regulations, the excessive demands we place upon ourselves and others, to be like this, to act like that, there’s no end to it. Is this the basis of civilisation and its discontents – too may ideals of happiness and stoicism and achievement that simply do not take into account the reality of our limitations?

As I say, fascinating stuff.


11 thoughts on “Incongruence

  1. Ordering this RIGHT NOW. Just received my copies of “There But for the…” (which was released later in the US; just available last week!) and “Ms. Hempel Chronicles.” You are the architect of my book-buying these days…your posts are much appreciated chez Rochester.

  2. These case studies sound fascinating! I agree with your emphasis on incongruence. There is a lot of that in modern life, and a lot of pressure, including the pressure to be happy, all of which leads to problems when we can’t live up to the ideals. I think it’s easy to end up living for the outside world, for what society or friends or parents or others think of you, not what you really want for yourself. I was a corporate banker on Wall Street at one time in my life, believe it or not, and experienced a lot of incongruence. When I left, even though I still had to do not-very-interesting jobs and for a fraction of the salary, I felt much more honest somehow, and certainly much happier. It was always hard to explain, but I think it was the lifting of that facade you mentioned.

  3. I actually ordered this from Amazon last week. One of my writing goals this year is reviewing books on psychotherapy and mental illness from the point of view of someone who is both a therapist and is bipolar and has had some good but mostly bad therapy in my life. I totally agree about the match between patient and therapist and I always tell my new patients about that up front, that if they feel it isn’t working, they should tell me, I won’t be insulted and that everyone working in my clinic is different and I will help them find someone with a different style. Most people who’s therapy isn’t working either stick it out invalidating their perception, or disappear from therapy having given up it can help. The old Freudian concept of Resistance has done terrible damage to generations of people in therapy who weren’t getting better, who may even have been getting worse, yet kept going because they thought it was their fault. Self-blame is a problem common to people seeking out therapy in the first place. I am a very interactive therapist, but not to the point of constant self-disclosure which can be just as bad for a patient as the Freudian Refrigerator Therapist (I take that from the old concept Refrigerator Mother that used to be blamed for autism and schizophrenia in the 1950’s). I have had both types myself. Many patients who settle in with me have come from therapists who gave them no feedback or talked too much about themselves. I also tell them that everyone is different and it is their job to make me the best therapist for them by telling me when I do things they don’t like. As for tolerating emotional but not physical wounds, I’m the same way. I used to work in a medical practice have conversations with my primary care physician friends like:
    Me: I don’t know how you can stand it, touching naked people’s bodies all day
    Physician Friend: I don’t know how you can stand it, listening to people’s problems all day.
    This comment is getting too long. Sorry. This book just touches on ideas central to my life and work. You would have made a great therapist. You have the empathy and insight and problem-solving skills it takes. You are just as great a literature professor. Some of us are just lucky enough to be multi-talented and have to choose since we only have one life (allegedly).

  4. Sounds fascinating! I love reading about therapy and how different people do it. Not because I love to judge them. That’s not the reason at all. It’s all just out of academic interest.

  5. How interesting this sounds. I have fairly limited experience with therapy, but what you say about the correct match between therapist and client rings true. It’s easy to think that doctors (of all types) are magic-workers and will know how to address any situation and make it better. How far from the truth! I suspect finding the right therapist can actually take a lot of work by the patient sometimes.

  6. It does sound interesting especially because we “hear” the patients speak. Usually you get the therapist’s point of view. I’m more interested nowadays in people who go to a therapy because they want to transform their life and not necessarily because they are ill. The stories of illness are so repetitive. Be it abuse or addiction.
    I agree that the success of a therapy will highly depend on whether you find the perosn who is right for you and the right therapy, of course. Unfortunately I see in people who go to therapy a tendency of seeking out the “wrong” therapist, id est someone who will not challenge them. I have a huge respect for therapists who say “no” to a client and will not start therapy knowing it will go nowhere.

  7. I second what David said in the first comment: I am ordering this book this month–and you now strongly influence my book buying (and I don’t even know you!). I looked through your some of your older posts and ordered and read both The Other Side of You as well as What I Loved based on your recommendation of them. Those books were simply amazing–probably the two best books I have read in the last few years! (I literally sobbed through The Other Side of You, but how wonderful it was! And What I Loved was written so well, and I adored how Hustvedt wrote about art, love, and mental disorders so well.) I could not put down either of those books, and I had been stuck in a rut of reading a lot of Victorian literature so you have renewed my interest in modern literary fiction. Please know that I so appreciate what you write here in Ohio across the Atlantic–and I love how you intertwine your personal life with your literary life in these posts. When I read what you write, I don’t feel so bad that I want to spend the majority of my weekends reading, or that I bring books to me when I spend the night at my friends’ houses!

  8. I think not everyone is so patient with those who have emotional issues, it’s so easy to not care or to not want to listen or worse be impatient with it all, so I think in a way you are rare. This sounds like an interesting book and your post has elicited some very interesting comments. I’ve found how hard it is to work through things sometimes without some sort of help, but I think most people don’t seek out help and are left floundering and it’s a really awful feeling–I hadn’t thought of there being a right fit in terms of finding someone who works well with a particular client–like Rebecca mentions most people probably assume doctors can simply fix whatever problem there is. I can totally see why you find this fascinating!

  9. David – bless you, dear friend! What a lovely comment. I do so hope that you enjoy the books. I’d love to know what you think of them all!

    Andrew – I read your comment about having been a banker and I admit, I had never considered you in that light. It was a surprise! And yet, there are so many more obvious routes you are encouraged to go down when you are young – management consultancy, banking, accountancy, goodness, even I worked in manufacturing industry for a while! It takes time to get to those less obvious occupations, like writing, or any creative endeavour. I’m really glad you had the courage and determination to give it up. I remember deciding that I should leave industry sooner rather than later, because if I got used to the pay check, I’d be sunk. It’s not an easy decision.

    Squirrel – I am already champing at the bit to read your post on this book. I can’t wait to hear what you have to say on this and on any other psychobabble books because I’d love to hear your perspective. I’m particularly interested to hear what you think of concepts like resistance, which I feel so ambivalent about. On the one hand I’ve experienced it as true – I do resist going down routes that are painful, even if they are ultimately useful. And on the other hand, I’ve felt very frustrated trying to say ‘no, this is not how I feel/not what I’m interested in/not what I’m bothered by’ and knowing it to be true, while the therapist smirks in a supercilious way. It can be enraging, and then you’ve opened a whole other can of worms! Your term ‘refridgerator therapist’ is excellent and spot on. In the Dinnage it seems to have caused more harm than just about anything else. And so glad to know I am not alone in my absolute divide between the physical and the emotional – thank you for the solidarity! (and for the lovely compliments, too)

    Jenny – lol! I couldn’t agree more. There is just so much academic interest to be had, isn’t there?

    Rebecca – well you put your finger on it – it does require a lot of work, and often it’s work that someone who’s suffering with low self-esteem, say, has no ability to undertake. If only there were a way of matching up therapists and clients. Mind you, having written than I just had a horrific image of a sort of therapeutic match dot com…. it will probably happen eventually!

    Caroline – oh yes, I must admit I have never found a therapist myself who has said no to me. I think what fascinates me about therapy – and indeed about education (of which it is a branch, no?) – is figuring out what people can hear. No matter how clearly you think you are saying something, it doesn’t get heard right unless the recipient is in the right place to receive the message. I’m endlessly intrigued by that. So to some extent, I am interested in the patients with issues of abuse and illness, because similar life circumstances may end up requiring very different treatment. I suppose ultimately I’m interested in what makes us change. It’s so far from obvious.

    Ali – oh your wonderful comment just made my day! well, my entire week! Thank you so very much for that. I couldn’t be more delighted to know that you enjoyed the Hustvedt and the Vickers, both amazing books. And I’m always thrilled to come across other people who can’t think of a better way to spend a weekend than with a book (I am getting to the stage where I wonder whether I dare take a book with me to any social occasion – when I mention it, it makes Mister Litlove that bit more amenable to leaving me at home). Well, I think we are officially virtual friends now!

    Danielle – Aww you are so kind. I think it’s one of the biggest mistakes that contemporary society makes – forcing the assumption on us that we have to be happy all the time, and that we have to cope with anything life throws in our way. It was in fact a real turning point for me when I realised that the normal reaction to dreadful situations is to fall apart. I felt I had to be so strong all the time! No wonder I was exhausted. It’s such a kindness to ourselves to accept whatever we feel and then to deal with that as if it were completely justified (and it is). I do just have a taste for this sort of book, though, because dealing with ourselves isn’t easy, and I never tire of hearing how people manage it!

  10. An interesting sounding book. I used to work at a place that offered mental health counseling and have seen firsthand how important it is for a person to find the right therapist. It makes all the difference.

  11. This sounds so interesting and I want to read your review again–it’s late and I’m too tired to focus properly. But I was behind in my blogs and wanted to make sure I’d read yours before calling it a day.

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