At my best, I see psychotherapy in the same light. Many people who come to therapy are disgusted with themselves for one reason or another, much as the Buddha was in his own time and in his own way. This disgust can take many forms: shame, fear, anxiety, or feelings of unworthiness are common expressions of it, but the possibilities are endless. Some people even develop what is called a “reaction formation” and seem the opposite of disgusted. They come across as prideful or conceited and unwilling to admit their faults or self-doubts. But these individuals are often just propping themselves up, creating a false front to mask their vulnerabilities, and somewhere inside they are troubled because they know they are not being real.

Each time I heard it, it seemed so profound! There is so much in life that we cannot control no matter how we try. Circumstances, events, feelings, even our own thoughts! But we can take responsibility for how we relate to what happens. We can grimace with our hands over our ears or we can lift one hand. By now, this has become a refrain in my mind, one that often returns to guide me in my life and in my work with patients.

I have such a hard time relaxing,” she says. “With men especially, and if I’m attracted to them it’s worse.” There is a longing in April to be known, to be reached, and to be seen, but she is frightened of it at the same time and cannot help but throw up obstacles seemingly in spite of herself. She might spill something in such a situation, for instance. When immersed in her work, April is the opposite. She can be funny, irreverent, spontaneous, innovative, and free. We talk about the paradox. When she loses herself, she is being herself.

But, as important as it is to understand the sources and details of one’s pain, understanding is rarely enough. My patients come to therapy wanting the burden of their accumulated experience lifted. Yes, they want to make sense of their lives, but that is not usually their fundamental or exclusive aim. First and foremost, they are trying to get over their accumulated trauma in order to feel less fearful, isolated, forlorn, helpless, alone, anxious, or depressed. They might not be able to say it so clearly, but they are reaching for things

beyond thought, trying to make contact with essential capacities that have been sacrificed in their efforts to adapt, adjust, comply, cope, or conform.

We are full of preconceptions about ourselves and are limited by them. The actuality of our being is not something we have an easy time making room for.