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.

We hypothesize that Ingrid turns separation into abandonment and then seeks connection through sadness. Mitch takes it personally when she does this and then gets angry and feels unappreciated. I want Mitch not to take it personally but to be clear with Ingrid that although she cannot fix Ingrid’s sadness, she can bring her joy nonetheless.

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.

His mother was a compelling figure, the center of the household, who indulged Steve as long as he did not question her, but ignored him when he did. We might say she was there as an “object-mother” but erratic as an “environment-mother.” This created a big problem for him. There was no room for integrating his anger in this relationship, no possibility of Steve’s mom ever admitting a flaw, and no acknowledgment of Steve’s independent point of view. The natural give-and-take of a mother-child relationship, in which both parent and child get disappointed with one another but learn to tolerate, and forgive, on the road to becoming

interpenetrating centers never happened.

Steve, we began to see, was never given the chance to work productively with his own aggression. It was as if he had no guidance through the inevitable disappointments of early life.

He [Winnicott] was by no means a Buddhist, but I believe he, too, healed by modeling being. He mostly used mother/infant vocabulary to describe his mode of relating, but this did not stop him from describing, in disarmingly frank terms, his own internal process:

It is only in recent years that I have become able to wait and

wait . . . and to avoid breaking up this natural process by making

interpretations. . . . It appals me to think how much deep change I

have prevented or delayed . . . by my personal need to interpret. If

only we can wait, the patient arrives at understanding creatively

and with immense joy, and I now enjoy this joy more than I used to

enjoy the sense of having been clever. I think I interpret mainly to let

the patient know the limits of my understanding. The principle is

that it is the patient and only the patient who has the answers. We

may or may not enable him or her to encompass what is known or

become aware of it with acceptance.