When a patient reports their history, we listen for content as well as the emotions associated with their recollections. With a discerning ear, we also consider the reliability of their narrative. Even if a patient is not a good historian, it does not mean they’ve lied. There are many reasons patients don’t report an accurate history.
One reason that I find particularly interesting, which you’ve likely encountered if you’ve worked with long-term psychotherapy patients, is the shifting of narratives, stories that change over time. This is not necessarily unreliable reporting. Emotions associated with narratives change with life experience and with that so does the recollection of the events.
Memories, then, are as much a representation of the present as they are of the past. What we hear when we listen to patients’ reports of their past experiences not only gives us history but also offers a window into present emotional states.
For example, my patient Beth reports depressed mood, anxiety and feeling that her life is harder than everyone else’s. In the difficulties of her present life, she remembers a man from her past who she dated on-and-off for a couple of years. This is a good example, because I was seeing Beth in therapy while they dated, so I’ve been privy to her emotions while she experienced the relationship as well as her retrospective examination.
At the time, she had described constant frustration and upset at his lack of emotional availability. Her sessions were filled with lamentations about him and about the relationship. I had the sense that she was cornering him and being overly demanding, because I also experienced that in our therapeutic relationship. But she was unable to withstand any relational analysis at the time. It was too soon in our therapy, and she did not yet have the self-esteem and emotional resilience to tolerate that level of painful introspection.
But years after their breakup and with continued therapy, looking back, she remembered a different man, one who was kind and generous, and who wasn’t unavailable, but rather one who was focused on building his career. She longed to go back to that man – the one she didn’t date. She believed that man would reduce her life difficulties. The sessions over the last couple of years have been dripping with nostalgia for the life she didn’t lead.
If memories change, then perhaps nostalgia is a longing for the life we only see in retrospect. If so, how do we help patients let go of regrets for things they couldn’t have understood at the time they happened? How do we help them understand the role of the life they didn’t lead? And even deeper, how do the unlived lives of people close to us influence our own journey?
I’d been tossing these ideas around for a long time, especially after working with patients who presented with trauma symptoms who had not experienced any clear traumatic event but whose parents did. Listening to their narratives, I heard a similar theme: they absorbed their parents’ trauma when they were young children, mostly when it was communicated without words, when the heaviness was felt but not discussed.
I decided to write a novel exploring these psychological and philosophical questions using characters to gain insight so as not to be limited by the frame of psychological constructs. The book, called Before the Footprints Fade, explores how our memories change with life experience, how we often long for the life we can only see in retrospect, and how we sometimes want to go back to things that had remained unrealized. It also delves into how the unlived potentials of our loved ones can become part of our own struggles and journeys.
How are we influenced by the roads not taken?
In each of us and all the people we know, there are an infinite number of unlived lives; each choice opens some doors and closes others. I wanted to show how this translates intergenerationally, because sometimes patients’ distress begins with the unprocessed feelings of the previous generation.
So, for one of the characters in my book, the father’s choice to give up the saxophone and take a more reliable career path to raise the family became something he felt responsible for. His father’s unlived life becomes part of his journey. It’s greater than just the unspoken expectations from his parents, too. He then struggled in his personal life to shed what others wanted from him, so he could become who he truly was.
Another example is my patient Damon, whose parents’ implicit statements about his success led him to be an overachiever. When he began therapy, despite his tremendous ambition, he had little emotional connection to his pursuits. “It all felt empty,” he had told me.
Eventually, he was able to recognize that his relentless motivation was fueled by a need for validation and the label of “success” rather than any meaningful connection to the work itself. It became an unconscious quest to live out what was expected of him, rather than what he might have wanted had he felt the emotional freedom to choose. Complicating this was the fact that expectations were not obviously stated, making it hard to separate his unprocessed emotions from those of his parents.
Exploring the unlived lives of our patients’ parents and the implicit communications of these unlived aspirations can be very helpful when stuck with a patient, particularly when there is a lack of vitality connected to how they are living or pressure surrounding imagined expectations.
And as I learned from writing Before the Footprints Fade, “You never go back the way you came.” Once we’ve learned, once we’ve grown through life experience, the road back looks different. We are different.
We spend time with our patients exploring their past in an effort to help them better understand themselves in the present. With insight and ego strength, with psychological growth, the emotions associated with memories change. Therefore, we can also understand present emotions by listening to stories about the past.
Perhaps it’s not quite accurate to say that youth is wasted on the young. Wisdom can only come from making footprints, not from following them. We can only be where we are because of where we have been. We can only see our youth through the eyes of nostalgia. If we want to help patients live fulfilling lives, with meaningful and integrated intentions, with emotional freedom, then we must consider the influence of the roads not taken. We want to explore and understand them, realizing that though they may never have actually happened they still – like footprints – can leave a deep impression.
*Beth and Damon’s names were changed to protect their anonymity.
File under: Musings and Reflections
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One reason that I find particularly interesting, which you’ve likely encountered if you’ve worked with long-term psychotherapy patients, is the shifting of narratives, stories that change over time. This is not necessarily unreliable reporting. Emotions associated with narratives change with life experience and with that so does the recollection of the events.
Memories, then, are as much a representation of the present as they are of the past. What we hear when we listen to patients’ reports of their past experiences not only gives us history but also offers a window into present emotional states.
For example, my patient Beth reports depressed mood, anxiety and feeling that her life is harder than everyone else’s. In the difficulties of her present life, she remembers a man from her past who she dated on-and-off for a couple of years. This is a good example, because I was seeing Beth in therapy while they dated, so I’ve been privy to her emotions while she experienced the relationship as well as her retrospective examination.
At the time, she had described constant frustration and upset at his lack of emotional availability. Her sessions were filled with lamentations about him and about the relationship. I had the sense that she was cornering him and being overly demanding, because I also experienced that in our therapeutic relationship. But she was unable to withstand any relational analysis at the time. It was too soon in our therapy, and she did not yet have the self-esteem and emotional resilience to tolerate that level of painful introspection.
But years after their breakup and with continued therapy, looking back, she remembered a different man, one who was kind and generous, and who wasn’t unavailable, but rather one who was focused on building his career. She longed to go back to that man – the one she didn’t date. She believed that man would reduce her life difficulties. The sessions over the last couple of years have been dripping with nostalgia for the life she didn’t lead.
If memories change, then perhaps nostalgia is a longing for the life we only see in retrospect. If so, how do we help patients let go of regrets for things they couldn’t have understood at the time they happened? How do we help them understand the role of the life they didn’t lead? And even deeper, how do the unlived lives of people close to us influence our own journey?
I’d been tossing these ideas around for a long time, especially after working with patients who presented with trauma symptoms who had not experienced any clear traumatic event but whose parents did. Listening to their narratives, I heard a similar theme: they absorbed their parents’ trauma when they were young children, mostly when it was communicated without words, when the heaviness was felt but not discussed.
I decided to write a novel exploring these psychological and philosophical questions using characters to gain insight so as not to be limited by the frame of psychological constructs. The book, called Before the Footprints Fade, explores how our memories change with life experience, how we often long for the life we can only see in retrospect, and how we sometimes want to go back to things that had remained unrealized. It also delves into how the unlived potentials of our loved ones can become part of our own struggles and journeys.
How are we influenced by the roads not taken?
In each of us and all the people we know, there are an infinite number of unlived lives; each choice opens some doors and closes others. I wanted to show how this translates intergenerationally, because sometimes patients’ distress begins with the unprocessed feelings of the previous generation.
So, for one of the characters in my book, the father’s choice to give up the saxophone and take a more reliable career path to raise the family became something he felt responsible for. His father’s unlived life becomes part of his journey. It’s greater than just the unspoken expectations from his parents, too. He then struggled in his personal life to shed what others wanted from him, so he could become who he truly was.
Another example is my patient Damon, whose parents’ implicit statements about his success led him to be an overachiever. When he began therapy, despite his tremendous ambition, he had little emotional connection to his pursuits. “It all felt empty,” he had told me.
Eventually, he was able to recognize that his relentless motivation was fueled by a need for validation and the label of “success” rather than any meaningful connection to the work itself. It became an unconscious quest to live out what was expected of him, rather than what he might have wanted had he felt the emotional freedom to choose. Complicating this was the fact that expectations were not obviously stated, making it hard to separate his unprocessed emotions from those of his parents.
Exploring the unlived lives of our patients’ parents and the implicit communications of these unlived aspirations can be very helpful when stuck with a patient, particularly when there is a lack of vitality connected to how they are living or pressure surrounding imagined expectations.
And as I learned from writing Before the Footprints Fade, “You never go back the way you came.” Once we’ve learned, once we’ve grown through life experience, the road back looks different. We are different.
We spend time with our patients exploring their past in an effort to help them better understand themselves in the present. With insight and ego strength, with psychological growth, the emotions associated with memories change. Therefore, we can also understand present emotions by listening to stories about the past.
Perhaps it’s not quite accurate to say that youth is wasted on the young. Wisdom can only come from making footprints, not from following them. We can only be where we are because of where we have been. We can only see our youth through the eyes of nostalgia. If we want to help patients live fulfilling lives, with meaningful and integrated intentions, with emotional freedom, then we must consider the influence of the roads not taken. We want to explore and understand them, realizing that though they may never have actually happened they still – like footprints – can leave a deep impression.
*Beth and Damon’s names were changed to protect their anonymity.
File under: Musings and Reflections