Thoughts After Neurobiology Conference in New York


In October I attended a neurobiology conference that focused on “Attachment.” Neuroscience has shown that a human’s brain, which controls the central nervous system and therefore the entire body, depends upon good, emotionally-responsive human connection in order to develop and thrive. When our deep relationships go haywire, we go haywire. Establishing emotional connection between myself and a client is at the heart of how I work. It comes from years of training as well as an instinctual sense that what people really want is to be understood by another person who cares.

Shortly after I returned from my trip, I stumbled upon a news article about recently-developed androids that are being created to be as human-like as possible. Their “skin” is flexible, they can smile, they blink intermittently, make jokes, etc. Their inventors hope that eventually, these androids can learn new algorithms from human interactions, and communicate these algorithms to other androids through the cloud. The hope is that androids will surpass humans in their sophistication, intelligence, and even compassion!!

Now, of course, I’m impressed by the ingenuity that leads to technological advances, but—sheesh! Everything I hold dear in my heart has to do with emotional connection in relationships. Emotional connection requires animal instincts, which is why I can’t get excited about a world in which my human instincts are forced to look into the “eyes” of an android and interact as if that android were really human. It never will be, in my humble opinion. But I’m pretty sure I’ll have no choice but to interact with androids. Here we go…

Still, I’ll be a “little warrior” for establishing emotional connection based in human (and animal!) instincts so long as I’m here. While relationships hurt more than anything else in life when the go awry, they also bring the most reward. It’s a gamble I’m willing to make each time I try to make contact with another instinctual being.


Showing Up

Woody Allen once said that “Showing up is 80% of life.”

Feel free to take exception with Allen’s choice of sex partners, as I do, but I can’t help but admire this statement. What does it even mean? It sounds easy at first, like all you have to do is show up and not even lift a finger after that.

But actually, showing up consistently is really hard. How many times have I woken up after a horrible night’s sleep, maybe due to some disagreement with my husband or maybe because I’m in a panic about a loved one’s medical issues. Or maybe it’s because I’m overly anxious about a song I’ve written that I’m going to play at a recital or for critique. Regardless of the reason, some mornings I feel like a hot mess and don’t want to show my face to the world; I don’t want to show up. But I do, and I’m always glad I did; it makes me feel better to have shown my fraught little face to the world and not run away from my day’s commitments. It makes me feel proud of myself, rather than still more ashamed and more avoidant.

When in doubt, show up. It gets easier over time.


Shame, Joy and Excitement

My own therapist emphasized to me that underlying feelings of shame, coming from a damaging childhood, colored my psychology enormously. We all have shame, but some of us may be drowning in it. Growing up with a sense of inner defectiveness is excruciating and people usually have no choice but to cover over those feelings both to themselves and to others, so as to to “look good.” Part of the work of therapy is encouraging a client to turn towards these buried feelings of shame and find a better place of acceptance in relation to them so that that person isn’t stuck in a costume of always “looking good” at the expense of feeling fraudulent or empty. 

In preparing for a course to professionals on the importance of shame, I began reading Sylvan Tomkins’ work which makes a connection between shame, joy and excitement. It works like this: If you run up to someone, happy to see him, and he doesn’t respond excitedly, you will immediately feel foolish (shame). Without thinking, you might blush, your eyes will turn downcast, and your shoulders will slump. That’s shame.

Think of the way babies are always smiling and laughing and how toddlers run up to parents excitedly. Then think of how the child must feel when a parent doesn’t respond to that excitement or joy. The child must repeatedly endure the precipitous drop from joy or excitement into shame. Over time, this becomes internalized as a state of being. I wonder how many of you reading this grew up in homes with a parent or parents who didn’t respond to states of joy/excitement. The more I’ve thought about this and done research on the importance of joy and excitement in development, the more I’ve begun to notice that most of my clients were undersupplied with the nourishment of joy and excitement in childhood.

When I’m in session, I pay attention to my clients’ eyes and when I see them light up, mine do too. It’s exciting! It’s fascinating! I unabashedly enjoy revving up a good feeling in my client. I like my work; I like the clients I work with, and it helps both me and my client get through some of the tougher times in therapy and in life to know this. Without the leavening of joy and excitement, life is unbearable.  I’ve come to feel that it’s vital that therapy include these lively experiences! I guess that means that at times I’m having a great time being a therapist! I can’t help it! If you’re looking for a somber therapist a la “The Sopranos” and come to me, you may be disappointed!

While I take a very serious approach to therapy and don’t shy away from helping a client confront and manage painful experience, I’ve also come to feel that amplifying joy and excitement in session is equally important. Joy and sorrow are kindred emotions of great value in responding to life’s ups and downs.


Going Off Insurance Panels

For about sixteen years, I’ve been a “Preferred Provider” with large health insurance companies in Washington, which means I’ve agreed to diagnose, bill and provide other information, according to their terms. The insurance company has paid the majority of the psychotherapy bill to me directly, while the client has paid me a smaller amount. The advantage for a provider in this agreement is that she receives many more referrals from a larger client base than she would have otherwise. The advantage for the client is that he doesn’t have to pay as much for his therapy as he would have otherwise. Up until very recently, Continue reading “Going Off Insurance Panels”