Lessons from the Depths: Scuba Diving and Psychotherapy with Men

Earn CE Credit

• Diving deep
• Probing wishes, intentions and the will
• Using stories to identify and expand narratives
• From the depths
• Armor and metaphors
• Structured education about emotions
• Collaborative therapy groups
• Bringing in loved ones
• The Sea of Cortez

I've had my psychology license long enough to have acquired a reasonable amount of confidence practicing my craft. But as a recently licensed scuba diver, I'm quite conscious of my limitations underwater. When I joined friends last year for a dive in Monterey Bay, I knew I would face cold water, rough surf, a rocky coastline, entangling kelp forests, limited visibility—and the unlikely but nonetheless unnerving prospect of encountering a great white shark. But I didn't predict the exhilarating, challenging and frightening events that would shake up and later clarify my sense of self, my relationship to others, and my goals as a psychotherapist.

Diving deep

Our first dive was beautiful but exhausting. The surf was rough, and we had to swim a couple hundred yards in choppy seas before our descent and after resurfacing. Because of exhaustion and cold, three from our group opted to stop after one dive. The fourth participant said he was "50/50" about doing a second dive. I knew I was tired, and that it would be a challenge to complete another dive. But I also realized that we had a rare opportunity, because we had two highly skilled dive masters who would accompany us (in attachment terms: a very secure base). I let them know I was 60/40 in favor of going, which tipped the scales and off we went.

We navigated through gorgeous kelp beds, dropped down to about 70 feet, saw stunning marine life—and then I got slightly entangled in kelp. After one of the dive masters helped disentangle me, he and I realized we were separated from the other two divers.

After a brief underwater search, we followed protocol and surfaced to look for the others. Then things got hairy. Ironically, diving can be more dangerous at the surface of the water than below it, because it is difficult to stay afloat and breathe in heavy, choppy swells. I switched my breathing source from the regulator to the snorkel, to conserve air in the tank and keep from taking in mouthfuls of seawater amidst the choppy surf.

Unfortunately, it is hard to breathe through a snorkel while dog-paddling in a nearly vertical position. Waves splashed into the snorkel, mixing water into the air I was breathing. I began taking short, quick breaths—which is the opposite of what is desired while diving. The surf and currents were stronger than earlier, and I quickly became exhausted... and cold... and scared.

Then something happened that I've never experienced before: I began to hyperventilate, which made everything worse. The more frightened I felt, the more frantic my breathing became, and the less air I was receiving.

Fortunately, scuba diving has many safety procedures built into it, including considerable dependence upon one's diving partner. In this case, I knew my partner was a highly trained expert. By verbally assuring me, coaching me to relax and breathe deeply, and assisting me in the long swim back, the instructor helped me get ashore.

Initially I felt embarrassed about needing to be assisted, even rescued. I don't like feeling incompetent, particularly in life-threatening situations. I also have decades of experience in being ridiculed or humiliated, generally by guys, when I've tried and failed at one activity or another. But during and after this situation I received not one iota of criticism or ridicule. Instead, my dive masters and friends offered encouraging suggestions about future learning opportunities. Gradually, after I knew I was out of harm's way (physically and interpersonally), I realized that I felt pleased to have experienced the series of events.

How strange: to feel embarrassed, and yet pleased, about taking risks and then struggling, particularly with a group of guys. That encapsulates a combination of thoughts and feelings that I've experienced more and more often in recent years.

My experience diving symbolizes a gradual and critical shift in my experience and conception of being a man. Throughout my adulthood, but particularly in recent years, I've experienced a similar mixture of feelings—embarrassment about struggling, and yet a sense of pride in having taken on a personal challenge—in a wide range of situations with men, including cycling, playing music, raising kids, repairing dry rot at home, mourning the death of friends, and various professional activities. These events were noteworthy in that they lacked the oftentimes ruthless competitiveness and putdowns that permeate so much of a boy's and young man's world. Several such experiences resulted from men banding together with the intention of supporting and inspiring one another. These were, in essence, attachment experiences that altered my perception of the world and of my self.

As I've reflected further about it, the entire diving experience captures a great deal about my values and aspirations as an adult, as a man, and as a psychotherapist.

Probing wishes, intentions and the will

I vividly recall a key statement from my diving instructor when I first became certified. Within the first five minutes, he told us, "If anyone is taking this certification course to please a spouse, parent, child, friend or anyone else, you should leave now. Diving skills can be learned, but only if your heart is in it."

Therapy is an organic process that must be fundamentally linked to our clients' deepest wishes, feelings, and needs. As psychotherapists, connecting with our clients' hearts and wishes is equally critical.

During my initial assessment process with a male client, I ask him about his wishes, intentions and willfulness. While I'm committed to empathizing and hearing about the struggles and sources of pain in a man's life, I find it essential to explore what he would like to be different, what he hopes to get from therapy, and his level of commitment or dedication to this endeavor. This can be a complex and nuanced process, particularly with those men who can't identify wishes, don't know what they are feeling, or don't know what they would like to be different.

In conducting psychotherapy—as with scuba diving—it is important to be realistic in terms of assessing internal and external resources so we don't guarantee failure by establishing unrealistic hopes. I persist in my efforts to tease out a man's wishes, intentions and willfulness, knowing that the ensuing discussions often strengthen the therapeutic alliance and help diminish a man's resistance to "talking forever about my feelings and my childhood." I may inquire, for example:

• "Given the abuse you experienced, what kind of father do you want to be?"
• "Although you feel furious and cynical, what do you need to do to live up to your own integrity as a husband (or manager, father, employee, elder, etc.)?"
• "Although you feel worthless and depressed, how do you think it would affect your children if you moved out of state, quit your job, or killed yourself? Are you interested in learning more constructive alternatives?"

Many men feel shame about being in pain, and even more so about seeking help; I try to appeal to their honor and pride while developing a therapeutic alliance and contract. I also present a realistic description of the personal commitment required, in terms of time, money and heart, if therapy is to be of benefit.

Using stories to identify and expand narratives

Even with a structured buddy system and safety carefully built into the equipment, scuba divers face many dangers. Overreacting in a crisis can be disastrous, for example if someone abruptly drops their weight belt and shoots to the surface without stopping to decompress.

I often explore the manner in which a man relates to the myth of Icarus, the Greek boy whose father, Daedalus, hastily attached wings to their bodies so they could fly away and escape the labyrinth in which they were imprisoned. Icarus, in his excitement and wonder, ignored his father's warnings not to fly too close to the sun, with disastrous results: the wax melted, his wings fell off, and he crashed to his death into the sea below.

Many highly constricted (and shame-filled) men identify with the story of Icarus. They know in their bones about youthful inflation, subsequent failure and the accompanying humiliation, shame and despair; they know about a devastating loss of self-esteem and assertiveness, although they may not use this language. They know about the death of dreams, of hope, of playfulness and spontaneity.

Many driven, highly inflated men relate to the Icarus story from another perspective: their fear is that if they stop pushing so hard, if they let go of their efforts to control their environment, if they stop beating themselves up or if they loosen their perfectionism, they too will crash and burn. Still others convey deep anger, sadness or envy as they describe feeling that there was no one there to help them fly.

I emphasize to these men that in many cultures the death is not the end of the story. Borrowing from the poet Robert Bly, I link the myth of Icarus with the Phoenix story: out of ashes comes not only a rebirth, but potentially a wiser, more compassionate survivor. Soulwork, Bly argued, begins in the ashes. Building upon this, I may talk with men about the difference between "cool" versus "soul," or explore their relationship to "the blues". These references, as well as the use of mythology, help men see the universality of their struggles and thereby help diminish shame.

Hearing the Phoenix story, and sensing my ability to relate to the journey, brings a palpable sense of relief, and sometimes a newfound glimmer of hope, to many men. I inquire about how a man has dealt with risk-taking and struggles. Was he met with derision and humiliation? Can he imagine empathy and compassion? Has he ever experienced resilience and rebirth after failure? I make clear, with my spoken and unspoken messages, that I understand their pain and despair, that I know something about the journey they are undertaking, and that I view risk-taking and failure as essential aspects of being alive. I also try to convey that while I know this intellectually, I have to relearn this lesson repeatedly in order to counterbalance my own inner critic, which evolved in response to experiences of humiliation and shame in my earlier years.

From the depths

I often encourage men to read about other
men's psychological journeys and struggles, and to see movies that explore similar material. My goal here is twofold: to facilitate continued psychological reflection outside of the therapy hour, and to overcome the sense of isolation that plagues so many men. For example, with many covertly depressed men, I recommend Terry Real's I Don't Want to Talk About It, which addresses the cycle of depression that is often passed on from father to son. (Just hearing the title elicits a smile from many men, who immediately feel known in an important way.) For men who are struggling with identity issues, I may recommend Frank Pitman's Man Enough: Fathers, Sons and the Search for Masculinity, or Aaron Kipnis's Knights Without Armor. With men who recall very little about their adolescence, I may encourage them to see Stand by Me, or to read or see This Boy's Life.

I discourage men from trying to read books from cover to cover, and encourage them to see which (if any) vignettes trigger subjective reactions. I'm usually trying to promote a sense of identification, not simply a cognitive grasping of concepts. I also make it clear that it's fine with me if they dislike any given book or movie—but that I'm going to probe a bit in order to understand their reactions. My goal in part is to "prime the pump," that is, to help them reflect upon experiences that may have been buried or dismissed. I sometimes encourage them to discuss their reactions with supportive family members or friends, particularly their spouse or partner.

Armor and metaphors

My experiences diving help me appreciate that masks and armor serve essential functions, yet they can easily be abused. One's protective gear, such as gloves, fins or diving knife, might be helpful, yet at the same time make one insensitive to one's environment. Consequently, knives and even gloves are sometimes outlawed, such as near some coral reefs that are easily damaged by being touched. At times I use these analogies with men regarding dealing with highly sensitive friends or family members. The roughness, even callousness, that men need to survive in some environments can be quite destructive in other contexts.

Boys and young men learn endless ways to armor and defend themselves; as adults, they need to see the psychological cost of wearing armor that no longer serves its intended function. I often borrow a potent analogy from Jim Bugental wherein he described the life-saving function of a spacesuit for an astronaut—and the reality that the very thing that saved his life must be shed when he returns to earth.

Many men who can barely recognize or identify emotions welcome the opportunity to talk about their use of masks or armor. Rather than pathologizing them for not being adept at describing their emotions, I normalize the need to protect oneself during the trials of childhood, adolescence and adulthood. I try to provide men language that helps them see the value of protecting oneself—which sets a stage for later examining the conscious and unconscious uses of such protection. I explicitly address the radical cultural changes in a post-feminist world, including the reality that many men (along with women) find themselves in roles, situations or relationships for which they have had little or no constructive psychological preparation.

Taking this a step further, I've found that many men—myself included—feel liberated by the metaphor of the Wounded Healer. Henri Nouwen, who mentored me when I first seriously considered becoming a psychotherapist, helped me appreciate that by acknowledging and exploring my wounds, I could better appreciate my gifts and strengths. As a therapist today, I continually try to help men understand that as they come to grips with their psychological wounds, they become valuable role models for other men and boys. My clinical work with Carlos exemplified these themes.

Carlos, a 45-year-old refugee from an oppressive Latin American dictatorship, entered my office with a pronounced limp and an enormous chip on his shoulder. The limp resulted from medical neglect during his childhood, and the chip on his shoulder from years of defending himself from hostile putdowns. After initially conveying considerable anger and bluster, Carlos described a series of disappointing relationships with women and a desire to "learn some tips to keep a woman interested in me." He clearly felt humiliation and shame about his physical impairment, as well as self-loathing about his cultural background and lack of formal education.

I was deeply moved by his physical and psychological journey, his resilience, and his determination to provide better opportunities for his children than he had. Over a two-year period, Carlos gradually let go of his shame about his physical impairments and cultural background, developed a sense of pride in his accomplishments, and became an informal historian in his neighborhood regarding oppressive Latin American regimes. As he put aside his armor, he became a warmer and less hostile man. He came to understand the universal aspects of his individual struggles, which helped him take pride in his own psychological growth. When he ended his therapy he had not yet developed an ongoing relationship with a woman, but he had developed a healthier sense of self-esteem and a positive place for himself within his community.

Structured education about emotions

The danger inherent in diving means that the activity often evokes a range of intense emotion, from awe to fear to anger (e.g., when another diver does something irresponsible that jeopardizes others), so I have frequent opportunities to work with these intense emotions.

I directly and explicitly educate men about feelings, particularly in relation to anger, anxiety, guilt, and shame. Numerous men have expressed relief as I've helped them comprehend the distinction between anger versus hostility, and let them know that I don't consider their anger bad—although I emphatically condemn violence in their relationships with spouses, children, or others.

Richard, a partner in a prestigious law firm, entered therapy with only one goal: to reunite with his wife and three children. He had "accidentally" shoved his wife during an argument at home, badly bruising her. She obtained a restraining order and he had to move out of their home. Richard excelled at work, where he could be totally in charge. But he had no close friends, and no one, including family members, sought his company outside of work.

When Richard was angry, he was intimidating. At times in our sessions, I feared that he might become violent. I shared these concerns with him, and he was ultimately pleased to hear them; while I would not tolerate abusive or threatening behavior, it was okay with me if he was pissed off. He had never thought about the distinction between anger and hostility, or about the difference between feelings and behavior. Once we established a mutually safe therapeutic environment, we focused on what precipitated his anger. After many months of hard work, he slowly became aware of a pervasive, previously unconscious fear of abandonment that provoked his rage. He gradually realized that he had never felt safe revealing vulnerability to anyone, particularly his father. He also realized that, although his love for his wife had died, he desperately wanted to nurture his relationships with his children. During a lengthy course of therapy, he went through a divorce, re-established and strengthened ties with his children, and began to have far more fulfilling and respectful relationships with women.

I make a point of exploring whether or not men differentiate between guilt and shame. Addressing this concept is relatively simple, and many highly rational men appreciate hearing about the logical error of jumping from guilt to shame. Teasing this out in terms of their embodied experience obviously requires far more time and effort. Similarly, I educate men about the function of anxiety and its relationship to fight-or-flight. I emphasize that many of us have an anxiety thermostat that goes out of whack from time to time, prematurely triggering one action or another—and that through mindfulness and perseverance, one can fine-tune one's reactivity and impulsivity. I help them see the importance of reality testing prior to withdrawing or attacking. I may recommend forms of body work, daily walks or journaling to help men relate to their bodies and emotions.

I also talk with men about the importance of re-examining one's values in adulthood. For many teenagers and young men, competition was an essential and enlivening aspect of life; defeating someone else, for many men, is the primary source of joy in their lives. Further growth and development in adulthood, however, often entails turning away from competition with others and turning toward the exploration and pursuit of one's own dreams. Facilitating that shift in orientation becomes the core aspect of therapy for many men.

Ironically, competitiveness can be of great value once the aforementioned shift occurs. For example, for 15 years a friend of mine—another psychologist—met me twice a week to play racquetball. In contrast to our typical behavior as therapists, on the racquetball court we frequently shouted and cursed (generally at ourselves) as our competitiveness was let loose. But once the games were over, we typically felt gratitude for the encounter with a worthy adversary who provided additional incentive and support in our efforts to stay in shape and to have some laughs.

Collaborative therapy groups

When I go diving, I occasionally feel competitive with others. But I'm far more interested in collaborating than in competing. Since scuba diving entails potentially life-threatening situations, it highlights the importance of cooperation. Diving demonstrates that "survival of the fittest" has a collective meaning ("The better we function as a team, the safer we are") and not just an individual meaning ("To hell with everyone else, I just have to look out for my self"). The older I get, the more I appreciate this shift in consciousness in many aspects of my life—and the more determined I am to help other men make this shift.

As my clients begin to develop psychological-mindedness or convey a desire to hasten change, I encourage them to join support groups, such as a 12-step group, a men's group, or a process-oriented therapy group. Twelve-step groups and men's groups can serve as powerful antidotes to the isolation and shame that many men experience, yet may not put into words. I find that particularly helpful are groups with the commitment and expertise to address here-and-now dynamics, which is arguably the most critical therapeutic aspect of an ongoing group.

One of the most powerful and rewarding aspects of my practice is leading an ongoing mixed-gender therapy group comprised primarily of men and women whom I also treat in individual therapy. Groups give men countless opportunities to learn about the value of empathy and the (frequently unhelpful) tendency to try to solve others' problems.
It is fascinating, and enormously valuable, to compare how clients behave in the group and in their individual sessions with me. As just one example, a male client declared during his first group session that "men don't cry"—although for two years he began virtually every individual session by reaching for tissues because he knew he would be in tears as he dealt with his grief over his parents' recent deaths. This contrast between how he interacted with me and how he portrayed himself to others provided rich material for his individual sessions.

I encourage men to view the therapy group as a laboratory in which they can experiment with being vulnerable while simultaneously learning about protecting themselves. Individual sessions provide an excellent context to examine and refine these efforts.

A very successful executive I worked with individually and in group therapy suffered from a crippling addiction to pornography. After he gained control of the addictive behavior, it was clear that he continued to feel shame about his sexuality. In his individual sessions, he occasionally informed me of sexual fantasies he experienced about women in the therapy group. We worked on helping him talk about these fantasies in the group, while being sensitive both to his vulnerability and to the feelings of others. His sensitivity and courageous disclosures helped him develop transferable skills for his other relationships, and enriched the therapeutic experiences of the other group members.

Treating someone in individual and group therapy raises many complicated and challenging issues for a therapist. I've made mistakes, such as nudging an individual to join the group when he wasn't ready or motivated on his own; it became apparent, once this man was in group, that he was there to please me rather than to pursue goals of his own, and that guaranteed failure. I've been fortunate to have trained with two individuals—Jim Bugental and Irv Yalom—who are masters at utilizing this powerful combination of therapeutic approaches, and who have helped me on numerous occasions convert what I initially perceived as disasters into growth opportunities. I strongly encourage those therapists who are considering adopting this dual format strategy to get consultation from someone experienced in this approach.

Bringing in loved ones

Diving with my family has not only allowed us to share exciting and amazing experiences, but also to deepen our relationships by taking on new roles. This role shift occurred, for example, when my family and I went diving for the first time, before any of us were certified. I was surprised, when I cautiously reached the ocean floor, to see my son Cody, then 21, doing flips underwater less than five minutes into our dive. He gestured for me to do the same—but I let him know that his old man was content to simply observe his surroundings and keep an eye on his wife and two kids (all of us were closely supervised by an accompanying dive master). In this way I conveyed respect for his autonomy and appreciation for his sense of adventure, while simultaneously asserting my own wishes. Ten minutes later, after Cody took on a less active and more inquisitive role, he encountered a small octopus and his own sense of awe. I doubt that either one of us will ever forget that shared half-hour experience.

On numerous occasions, after extensive discussions with clients, I have conducted conjoint sessions with significant others in their lives. This has included meetings with spouses, partners, fathers, mothers, friends, and children. I will usually suggest such a meeting after a client has conveyed the desire to improve a particular relationship, or if I suspect that my client's psychological growth could be enhanced by improving an outside relationship. I make it clear that the client, not the significant other, is my primary client and as such I will keep their needs and wishes in the foreground. Sometimes clients bring up the wish for such a session, so we explore their hopes and concerns and act accordingly. On rare occasions I've conducted home visits.

My goal for such meetings is to gain a better perspective on key relationships in my client's life. My general intention is to facilitate a deepening of a current relationship, and is definitely not oriented toward allowing my client to dump on or otherwise attack his family member or friend. I try to get a sense of whether a parent is receptive, for example, to addressing issues and feelings from the past. Is a spouse open to the possibility of couples therapy (with a different therapist)? Does a parent, child or spouse have any information they think would be helpful for me to know as I provide ongoing individual therapy? My work with Luke illustrates this process.

Luke, a 35-year-old physician, carried himself with an air of invincibility. I had a difficult time understanding what he wanted from our sessions beyond his occasional statements that his fiancé thought it would be good for him to see a therapist and that he liked having a place to discuss random events in his life. Whenever I tried to get clarity about his concerns, he became evasive. Something, though, kept him coming; he attended sessions regularly and paid his bill promptly.

After a couple of months I raised the possibility of doing a conjoint session with him and his fiancé, in order for me to better understand Luke’s social life and to hear her perspective on their relationship. Luke was quite open to this, and we talked about what he might hope to get from such a meeting. During the conjoint session his fiancé conveyed great love and admiration for Luke, and excitement about them getting married. She let it be known that she had but one complaint, which was what initially led her to encourage Luke to seek therapy: their sex life had greatly diminished during the previous year. (Luke had not previously acknowledged this, despite my specific inquiries about his sexual life.)

Her comments opened up an immensely important aspect of Luke’s therapy. He refused, initially, to participate in couples therapy. However, in his ensuing individual sessions he began to talk candidly about his history of intermittent sexual difficulties, which seemed interwoven with his professional success. We spent considerable time helping him overcome the humiliation and shame which initially prevented him from addressing these issues with me, and which fueled his resistance to couple’s therapy. After several months of exploring his perfectionism and unrealistic expectations of himself, he became more comfortable addressing his sexual difficulties. Eventually he asked for a referral for a couples therapist who dealt with sexual issues. Within a year Luke reported that their sex life had regained its lost glory and he decided to terminate his therapy.

The Sea of Cortez

I've found that the core analytical work of therapy can be enhanced if I continually explore with my clients the intersubjective impact of these types of interventions. I look for opportunities to gently challenge men to explore or create new, less constrictive relationships in their daily lives. Without using the jargon of our profession, I encourage them to seek and promote healthier attachment experiences. I have found this to be a powerful and gratifying aspect of my life and work.

Last summer, while snorkeling with friends in the Sea of Cortez, an older friend hollered and let me know he needed help. We were only 200 yards from shore, in very calm water that was only slightly over our heads. Nonetheless, he panicked, because he had taken a good deal of water into his mask and was having trouble breathing. I grabbed him by the arm and pulled him to shore, similar to the way someone had helped me about a year before. I felt no competitiveness or bravado during or after this experience, but rather a heightened awareness of the risks inherent in the ocean and an appreciation for the caution we had exercised as we snorkeled together. I'm not a foolish daredevil. But I'm determined to sustain a sense of vitality by taking measured risks with cooperative friends.

Note: This article is an expanded version of pieces that were previously published in the May/June 2008 issue of Viewpoint, the newsletter of The Psychotherapy Institute, Berkeley.

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