Therapy: Worth the Investment


I want to start off by saying that I hate lying. Especially as a therapist, I believe all true, healthy relationships need truth and honesty if they’re going to work.

But I balked when they told me the cost of sending my dog, Kurtis, to obedience school. When my family later asked me how much we’d be spending on this 11-day intensive…I could not help it. I lied. I lied because I was embarrassed at how much money I was willing to spend on training a dog they didn’t even want or like, at first. I lied because…what if it didn’t work? What if he came back just the way he was when he left—sweet, but willful and unable to heed the simplest of commands? It would be just another thing I had tried to fix that didn’t work, no matter how much money I threw at the problem.

So, I lied. I didn’t want anyone to know because I was ashamed, embarrassed, and didn’t want to incur their judgment if the whole thing blew up in my face.

But the joy I felt with the Kurtis I got back! It was amazing. He listens to me now. I don’t have to be afraid that he’ll go berserk at other dogs on our morning runs anymore! He heeds every command I give him—and what’s more, he’s a happier dog because he doesn’t get yelled at! The difference between the Kurtis that left and the Kurtis that returned is night and day, and I couldn’t be happier about it. I got the dog I always wanted, and it was so worth what I put into it.

It’s the same with therapy, isn’t it? So many of my clients come in feeling “ashamed” about their need to be there, “embarrassed” about what their friends or family would say to them if they found out, and stressed about finding a way to pay for something that they’re not even sure will work. I reassure them, “Give it time. It…you…are worth the investment. Just be patient.”

In other words, it’s worth the cost. I can say, from personal experience, that the return of the investment in yourself in a therapeutic setting is absolutely worth every penny. It’s nothing to be ashamed of or embarrassed about, because what you get back…the “you” you get back, the “you” you’ve always wanted to be…is priceless. All you have to do is try, knowing you’re worth the cost and the effort.

Revelation while Running

Revelation while Running

I am the first to admit that I am competitive. I like to win—and to be fair, who doesn’t? We all tend to identify with the outcome of the odds. When we win, we’re winners; when we lose…we try to win again.

But I recently had an experience that, surprisingly, did not force me into either of those two camps. I was running one morning, and woman, a young woman, passed me. I watched her. She was definitely younger than me, wearing one of those matching running outfits where her top and pants and shoes all coordinated, and was running with particular dedication, her ponytail swaying in rhythm with her strides. I reflected that there would have been a time when I would have done my damnedest to catch up with her and leave her in my dust—but that’s exactly what I didn’t do. Instead, I trailed her. I kept a brisk pace behind her, maybe lagging by half a block. But I kept my eyes on her, and when I felt myself dragging, my focus shifted again to her, and I was able to keep my pace.

This happened again along my run when her path took her down a street that wasn’t on my route, and I noticed a man up ahead, also running. His run was distinctively different. He ran at full speed for a minute before dropping down to a slow jog before running at full speed again. At first I laughed at how absurd it looked, but realized how much of a workout he must be getting running that way. Again I reflected that there would have been I time when I would have taken it upon myself to compete with him. But instead, I used his run to modify my own. When he ran at full speed, I pushed myself a little harder, and when he fell back into his slow pace, I did as well.

It turns out that competition is not always about winning or losing. Sometimes the purpose of competition is not to pulverize the opposition, but to use them as marks against our own strides. In my experiences above, there was no need to defeat the other runners; I used them to measure against, and improve upon, my own run. What came into focus for me was not the need to be at the top, but to simply exist at my own personal skill level. I did not have to be like them, or beat them. I could simply, and joyfully, run, letting them be my beacons. My competitiveness melted into self-acceptance when I realized I did not have to run in any particular way except my own. I realized that this was true victory, and no matter who passed me on my next morning run, I would be the winner—that in fact, we could all be winners. The finish line is not crossed by being the best compared to everyone else. The finish line is crossed by being the best you.

A Blank Page—Where Transformation Starts

“And we know that in all things God works for the good of those who love him, whohave been called according to his purpose.”  Romans 8:28

A patient was recently expressing how tired and spent she felt—a natural feeling given her upcoming graduation.  The end of her academic career, with all its harried finals and hurried celebrations, was leaving her feeling empty and blank.  With this exhaustion flowing through her, she found herself reaching out for a symbol, something that truly represented this central part of her present story.  At first she struggled to find anything suitable to the task, which frustrated her.  That’s when she noticed a piece of paper in her printer tray.  At the top of the page, the ink was bold, strong—readable.  Every word could be seen, clear and solid.  But as she continued down the page, the ink faded.  The words looked gray; the lines from the ink cartridge’s strain to put the words on the page visible. At the bottom, the page was blank, the paper clean, as though it hadn’t run through the printer at all.

An apt image of how her experience, and how she felt about it.  She too began her academic journey full of gusto and gumption. But now, at the end of it?  She felt as though she was nothing but a blank page.

But as we processed these feelings, something stood out.  Yes, everyone feels this way, drained and dry, but we reflected on how the gung-ho attitudes we have in our lives could leave us closed off to something extremely powerful—transformation. As any writer will tell you, nothing is more exciting than a blank page, because of the limitless possibilities of what can be created there.  Perhaps, despite the exhaustion, feeling like a blank page at this stage in her life is exactly what and how she should feel.  If she embraces it, she could become open to everything that God as planned for her. It’s possible that this emptiness she feels is exactly what is needed to move forward into the goodness awaiting her, a goodness far better and sweeter than she could ever experience in her haze of getting everything accomplished.  Maybe transformation starts right there—in the emptiness.  Because it is there that the possible starts to imprint itself into our lives, and onto us.



What does it take to love another?  This is a question that burns inside all of us at some point.  As I ponder it, I’m reminded of a movie, of all things—a movie that solidified on screen that being seen and loved is possible, and that truly seeing and loving others is possible.  Which brings me to some thoughts on the film, Avatar (Landau & Cameron, 2009). The lyrics of Avatar’s theme song demonstrate what I feel loving another takes—the concept of mutual recognition:

I see you/Walking through a dream/I see you/My light in darkness breathing hope of new life /Now I live through you and you through me/Enchanting/I pray in my heart that this dream never ends/I see me through your eyes…/I live through your love/You teach me how to see…/Now I give my hope to you/I surrender/I pray in my heart that this world never ends/ I see me through your eyes.

Intersubjective theorist Jessica Benjamin defines recognition as “that response from the other which makes meaningful the feelings, intentions, and actions of the self. It allows the self to realize its agency and authorship in a tangible way. But such recognition can only come from an other whom we, in turn, recognize as a person in his or her own right (p.12).” There is no doubt that intersubjectivity will result in an encountering of others who are distinctly different, and some who are similar. Benjamin (1988) goes on to explain that “to recognize is to affirm, validate, acknowledge, know, accept, understand, empathize, take in, tolerate, appreciate, see, identify with, find familiar…love [and] includes …a number of experiences…emotional attunement, mutual influence, affection mutuality, sharing states of mind” (p. 15-16). But, she notes that, “the need for recognition gives rise to a paradox… [and] the inability to sustain the paradox in that interaction can, and often does, convert the exchange of recognition into domination and submission” (p.12).

This is exactly what happened in Avatar. Audiences were introduced to a beautiful world called Pandora, and to a beautiful race of people called the Na’Vi, a ten-foot-tall, blue-skinned species of sapient humanoids who live in harmony with nature. The film depicted a very real, multidimensional need to be seen and understood, and reified the concept and need for mutual recognition in a tangible way. To the Na’Vi, the idea of seeing others is not just an act. “I see you” doesn’t just mean a cerebral acknowledgement of an other; it’s one person saying to another, “my soul recognizes yours.”

The idea of seeing oneself through the eyes of an other is of particular importance to the idea of mutual recognition because it is being able to see yourself as an other sees you.  Without this other, that self-recognition would not be able to exist. It is the other’s thoughts that color how we see ourselves, and often serve to confirm or combat, and challenge our concept of our self.

The plot of the film itself also serves as a manifestation of the concept of mutual recognition. It centers on humans trying to mine a rare mineral on Pandora.  In order to understand Pandora and its biosphere, they place Jake Sully into an ‘avatar’ of a Na’Vi.  While his mission is to learn about them and their culture, he eventually finds that he identifies with them, both through his personal connection with Neytiri, a female Na’Vi, and the education he receives from them about what it means to be a Na’Vi.  Now able to see his human counterparts through the eyes of his teachers, he understands that their machinations are not only destructive to Pandora and the Na’Vi, but self-destructive in how they represent humanity.  Instead of seeing humans as compassionate and empathic beings, the Na’Vi experience them as beings unable and unwilling to recognize any existence except their own.

While I maintain that this movie tangibly manifests the concept of mutual recognition in its plot, I do note that it is an imperfect manifestation, because instead of maintaining a sense of ‘self’ while recognizing his ‘others,’ James Sully leaves self completely and chooses instead to live the life of the ‘other’. Thus, while mutual recognition occurs beautifully in the film, it falls short of correctly holding the tension between the main character’s self and the other selves introduced in the film.

The important aspect of this character’s experience, however, is that it is through incarnation that his recognition of others becomes possible. Marie Hoffman (2010) notes, “discovery proceeds through an incarnational or lived interaction with the patient, made possible through the development of a safe and authentic alliance” (p. 2).  This is something that I feel is crucial to my work with my patients. Without that safe and authentic alliance; without a sense of nurturing and seeing an other’s perspective, I believe patients won’t be able to trust their therapists.  I strive to make this alliance with all of my patients, and feel it is my duty, and joy, to see things from where they stand, so that they will be able to trust me, and our work together.


“There must be something wrong with me.  I’m not praying enough, not in the Word enough.  I’m sure He’s mad at me. I’m afraid that I’m idolizing you and idealizing you. I should only do that with God.”

This is something that I hear from people when they start getting deeper into their therapy/analysis, when they become aware an attachment that goes beyond a professional relationship. When I hear these sentiments, I second-guess myself, wondering if I’m really helping my patients; wondering if therapy/analysis is doing harm or good; and anxious about whether I am negatively impacting my patients’ relationships with God. As a therapist/analyst who actively takes into consideration the faith systems of my patients, and how my faith intersects with theirs, I think to myself: How do I make room for both of our otherness in this realm? How can I help them have a loving God—one who not only forgives, but forgets?

Working from a psychodynamic/relational perspective, I try to guard myself against dismissing my patients’ sentiments as “transference,” which is the internal world of the patient that is evoked or elicited on a constant basis with each interaction.  Often in therapy, the therapist might unwittingly say or do something that resembles or reminds a patient of painful incidents in the past. In other words, experiences with primary caregivers get internalized and can be triggered in day-to-day relationships. My training in psychoanalysis has helped me take into consideration not just transference, but the transference-countertransference matrix (Mitchell ‘88, ‘93, ‘97).  While transference refers to internalized feelings that get evoked in the patient, countertransference refers to the internalized feelings the patient evokes in the therapist.  So, from my relational perspective, I exist as another an other in the room with my patient.  My emotional reactions to what a patient does or says or believes is not only important for me to monitor, will inform treatment (McWilliams, 18).

This is important to remember, especially when it comes to interactions and relationships I have with patients who express their faiths, and struggles with that faith.  After all, “no child arrives at the house of God without his pet god under his arm” (Rizzuto, 8).  Inevitably, this results in ruptures in therapy; the differences between gods (mine and my patients’) can, and has, led to strife and resentment.  These ruptures are not to be fear or ignored; they are to be embraced as differences between to equally subjective people, both with valid viewpoints and feelings of their own.  We both should strive, not for negation of each other, but for healthy respect for our own vulnerabilities.




The Christian tradition contains an interesting basic analogy with the object relations theory…God can love man or hate him… He can demand obedience from man or forgive him. Correspondingly, man can also love or hate God. He can submit to God’s will or rebel against it… trust in God or deny even his existence (Hyrck, 1997, p. 41).

According to Sigmund Freud, the father of psychoanalysis, religion was created by humankind as a coping mechanism to deal with an individual’s infantile wishes.  Religion was an immature form of neurosis, an illusion, and a type of wish fulfillment (St. Clair, 1994). 

There are many varying theories on how the image of God is formed. Many contend that early experiences with primary and significant caregivers not only help in formulating images of oneself, but also his/her image of God. As such, watching, learning, and doing form one’s image of God. DW Winnicott, a British pediatrician and psychoanalyst, in his book Playing and Reality (1971), argues that God is not necessarily created out of thin air, and is not solely created by the infant.  Therefore, according to Winnicott, God exists in ‘the third space,’ “an intermediate area of experiencing to which inner reality and external life both contribute…a resting-placed for the individual engaged in the perpetual human task of keeping inner and outer reality separate yet inter-related” (Winnicott, 1951, p. 230).

In her work The Birth of the Living God, psychoanalyst Ana-Maria Rizzuto (1979) affirms Winnicott’s sentiments, and states that, “no child arrives at the house of God without his pet god under his arm” (p. 8,). In fact, her central thesis asserts that the idea of God is created by the child and resides in the transitional or third space.  God cannot be fully repressed and the child can do what he or she will: accept or reject.

Rizzuto further goes on to state that “this psychic process of creating and finding God . . . never ceases in the course of human life” (p. 177-179).  God’s existence in the transitional space is difficult to grasp because in that space, he can be either seen or unseen, heard or unheard, but is consistently present. One’s conflict arises in allowing Him to be whoever He seems or needs to be on any given day, in any given session. Mutual recognition arises when God is noticed in the space, whether He is talked to (or about) or not.

It is my belief in a transcendent and immanent other that keeps me hopeful in my work with my patients. I hope they can transcend their current circumstances, both tangible and emotional, and reach a place of peace within themselves, in our relationship, and with their own transcendent gods. 

I often hear patients express their belief that God loves them, but believes that God is disappointed in, and angry with, them and not blessing then a result. They simultaneously believe in God’s love for them, but focus on their perception that He is somehow displeased with them.  Many attribute these feelings to their experiences with the church, which to them was punitive and exacting.  In their thoughts, all that matters is how God experiences them. God experiences them in a way that leaves them feeling “less than,” shameful, unworthy and undeserving of anything good. Their God is not “shoring them up.”

Making space for respective experiences of God is crucially important in my work with patients. It could be that our mental and emotional images of God are diametrically opposed. Some seem to have primarily an autocratic and distant God, while some have more reflective of an immanent and experiential God.

My work with my patients offers hope that mutual space for both is possible, not belonging to either of us individually, but belongs to both of us together. Often, while different God-images exist, many faith systems agree that God is not either transcendent or immanent, but rather both transcendent and immanent.  This paradox must be kept in mind in psychoanalytic work, otherwise my patients and I will exist at an impasse, which leaves no room for establishing a connection between each other.



Sometimes the need becomes apparent, in my work with my patients, for them to come in multiple times a week. This is not unheard of; but given the patient and his or her surrounding circumstances, I as a therapist might decide to seek out a clinical supervisor, or “overseer” to the case, if I feel it would be in the best interest of both my patient and myself. In my experience, looking for the right supervisor can be an arduous process, but there are several key traits I always look for. I would like to explore these traits in detail as a tribute to all my supervisors whom I’ve learned from, and who have taken the time to train me in the  way I should go.

First, I look for someone with a spirit of openness—by which I mean someone with whom I could feel truly comfortable with, and feel comfortable enough with to open up my patients to, without fear of judgment or rejection (which is very similar to what my patients look for from me). 

This openness leads me to the next thing I hope to find in a supervisor: recognition, both for my patients and myself, and our accompanying interactions (however colorful they may become).  Recognition is one of the most important aspects in being supervised on a patient case, because it allows for exposure of both triumphs and failures in therapy, both of which are necessary to the therapeutic process.  In fact, without exposure of these processes, a patient’s therapy might never make progress.  Recognition from a supervisor can validate the work between a patient and myself, and provide necessary insight for improvement of shared expectations, known hurdles, and my own feelings, as a therapist and person.

I feel that supervision should provide a nesting place for my relationship with my patients—a place of familiarity, of warmth, where the relationships can gestate under a careful gaze. For me, supervision goes

Beyond basic ideas about the setting and its boundaries…what needs to be learned is not a list of steadfast rules, but an introspective and empathetic sensitivity to the actual sources and actual impact of our actions and non-actions. This is a most personal learning process that requires considerable personal exposure and is strongly influenced by the supervisory climate (Berman 2000, p. 275). 

Supervisors can model for me a deep sense of empathic attunement to my patients’ needs, especially when my patients are take seriously, with a non-dismissive attitude of their thoughts, feelings and actions. A supervisor’s presence can be a comfort, bring an evenly hovering attention to the process of my work, all the while being supportive and nonintrusive. My best supervisors have not been prying eyes critical of every misdeed, but guiding hands on what could have easily been treacherous paths, which have welcomed the meanderings of my relationships with patients, even honored and respected them. In essence, supervision has provided a ‘m’othering presence that comforted me, and comforted my patients through me.  

Another aspect I find comforting about supervision is the ability and willingness to be transparent in thought processes about the work between my patients and myself. At times (and perhaps at best), insights and observations have not been premeditated, but rather a genuine response to what I shared either verbally or to what is heard in audiotaped sessions. (I sometimes choose to record my sessions because I do not want to forget the most important things that occurred between my patients and me).  A non-omniscient supervisor makes room for grace—that is to say, gives me permission to fail and fall without fear of shame.  Without the worry about how my expression of self will be taken; with no judgment of my method, of me as a analyst, and most importantly, of me as a person, I have found the space to flourish with my patients. Knowing intrinsically of a supervisor’s support, I feel recognized and valued, and almost by proxy, so do my patients.

Jessica Benjamin (2004a), gives an example of her work as a supervisor, which I would like to note:

I often find myself helping the analyst create a space in which it is possible to accept the inevitability of causing or suffering pain, being ‘bad,’ without destroying the third…both members become involved in a symmetrical dance, each trying not to be the bad one…yet whichever side the analyst takes in this dance, taking sides itself simply perpetuates complementary relations (p. 27).

Great supervisors have been crucial in helping me understand this point. It is not a matter of patient vs. me (the analyst); such polarization destroys and tears us down, rather than build us up. Benjamin likens it to a dance. I would add that, for some of my patients and myself, it can become more the dance of two boxers, each trying to knock the other off center, and possibly out completely, in order to “win.”  A good supervisor’s careful observations can, and have, shown me that if this dance continued, and my patient and I indeed knocked one another out, no one would win; and in fact, winning isn’t the point. Winning only helps one of us, and therapy and analysis, to me, strives to find a way to help each other if any headway is going to be made. 

In fact, in those times when this “dance” has turned my therapy room into a boxing ring, supervision has allowed me to realize the mistake on my own without intrusion, but with continual glances in that direction.  It has also helped me redeem myself and restore the relationship with my patients by witnessing compassion to them, our relationship, and myself. Benjamin (2004a), would have analysts “fostering a dyadic system based on taking responsibility, rather than disowning it or evading it under the guise of neutrality…that clinical practice…be founded in certain values, such as the acceptance of uncertainty, humility, and compassion…” (p. 34).  Compassion? Humility? Uncertainty? These are the elements of great supervisors, who have ensconced and embodied all of these things; and these honest revelations of themselves in our interactions have shown me vividly and personally how I could, someday, and maybe even someday soon, interact with my patients in the same manner.