I picture Margo sitting on the couch near Wendell, hugging my favorite pillow and telling him how alone she feels in her pain, how she’s bearing it all herself while her husband is in his closed-off world. And then I think about how alone John must feel, watching his wife’s pain and not being able to bear the sight of it.
“I know it looks that way,” I say finally. “But I wonder if part of why Margo is like this is that she’s been doing double duty. Maybe all of this time, she’s been crying for both of you.”
John’s forehead furrows, then he looks down at his lap. A few tears land on his black designer jeans, slowly at first, then quickly, like a waterfall, faster than he can wipe them, and finally he stops trying. These are the tears he’s been holding in for the past six years.
Or maybe more than thirty.
While he’s crying, it occurs to me that what I’d seen as a theme with John—the argument with Margo about letting their daughter have a cell phone, the back-and-forth with me about using it in my office—had far deeper meaning than I’d realized. I remember holding hands at the Lakers game with my son—Enjoy it while it lasts—and John’s comment when he arrived today. “You win . . . the pleasure of my company.” But perhaps he won the pleasure of mine. After all, he chose to come here today and tell me all of this.
I think, too, about how there are many ways to defend oneself from the unspeakable. Here’s one: you split off unwanted parts of yourself, hide behind a false self, and develop narcissistic traits. You say, Yeah, this catastrophic thing has happened, but I’m A-Okay. Nothing can touch me because I’m special. A special surprise. When John was a boy, wrapping himself in the memory of his mother’s delight was a way to shield himself from the horror of life’s utter unpredictability. He may have comforted himself this way as an adult too, clinging to how special he was after Gabe died. Because the one certainty that John can count on in this world is that he is a special person surrounded by idiots.
Through his tears, John says that this is exactly what he didn’t want to happen, that he didn’t come here to have a breakdown.
But I assure him that he’s not breaking down; he’s breaking open.
39
How Humans Change
Theories involving stages abound in psychology, no doubt because their order, clarity, and predictability are appealing. Anyone who has taken an introductory psychology course has likely encountered the developmental-stage models posited by Freud, Jung, Erikson, Piaget, and Maslow.
But there’s one stage model I keep in mind nearly every minute of every session—the stages of change. If therapy is about guiding people from where they are now to where they’d like to be, we must always consider: How do humans actually change?
In the 1980s, a psychologist named James Prochaska developed the transtheoretical model of behavior change (TTM) based on research showing that people generally don’t “just do it,” as Nike (or a new year’s resolution) might have it, but instead tend to move through a series of sequential stages that look like this:
Stage 1: Pre-contemplation
Stage 2: Contemplation
Stage 3: Preparation
Stage 4: Action
Stage 5: Maintenance
So let’s say you want to make a change—exercise more, end a relationship, or even try therapy for the first time. Before you get to that point, you’re in the first stage, pre-contemplation, which is to say, you’re not even thinking about changing. Some therapists might liken this to denial, meaning that you don’t realize you might have a problem. When Charlotte first came to me, she presented herself as a social drinker; I realized that she was in the pre-contemplation stage as she talked about her mother’s tendency to self-medicate with alcohol but failed to see any connection to her own alcohol use. When I challenged her on this, she shut down, got irritated (“People my age go out and drink!”), or engaged in “what-aboutery,” the practice of diverting attention from the difficulty under discussion by raising a different problematic issue. (“Never mind X, what about Y?”)
Of course, therapists aren’t persuaders. We can’t convince an anorexic to eat. We can’t convince an alcoholic not to drink. We can’t convince people not to be self-destructive, because for now, the self-destruction serves them. What we can do is try to help them understand themselves better and show them how to ask themselves the right questions until something happens—either internally or externally—that leads them to do their own persuading.
It was Charlotte’s car accident and DUI that moved her into the next stage, contemplation.
Contemplation is rife with ambivalence. If pre-contemplation is denial, contemplation might be likened to resistance. Here, the person recognizes the problem, is willing to talk about it, and isn’t opposed (in theory) to taking action but just can’t seem to get herself to do it. So while Charlotte was concerned by her DUI and the subsequent mandate to participate in an addiction program—which she grudgingly attended and only after failing to take the course in time and having to hire a lawyer (at great expense) to get her deadline extended—she wasn’t ready to make any changes to her drinking.
People often start therapy during the contemplation stage. A woman in a long-distance relationship says that her boyfriend keeps delaying his planned move to her city, and she acknowledges that he’s probably not coming—but she won’t break up with him. A man knows that his wife has been having an affair, but when we talk about it, he comes up with excuses for where she might be when she’s not answering her texts so that he doesn’t have to confront her. Here people procrastinate or self-sabotage as a way to stave off change—even positive change—because they’re reluctant to give something up without knowing what they’ll get in its place. The hiccup at this stage is that change involves the loss of the old and the anxiety of the new. Although often maddening for friends and partners to witness, this hamster wheel is part of the process; people need to do the same thing over and over a seemingly ridiculous number of times before they’re ready to change.
Charlotte talked about trying to “cut back” on her drinking, about having two glasses of wine each night instead of three or skipping cocktails at brunch if she would be drinking again at dinner (and, of course, after dinner). She could acknowledge the role that alcohol was playing in her life, its anxiety-muting effects, but she couldn’t find an alternative way to manage her feelings, even with medication prescribed by a psychiatrist.
To help with her anxiety, we decided to add a second therapy session each week. During this time, she drank less, and for a while she believed that this would be enough to control her drinking. But coming twice a week created its own problems—Charlotte was once again convinced that she was addicted to me—so she went back to the once-a-week schedule. When, in an opportune moment (say, after she’d mentioned getting drunk on a date), I’d bring up the idea of an outpatient treatment program, she’d shake her head. No way.
“Those programs make you stop completely,” she’d say. “I want to be able to have a drink at dinner. It’s socially awkward not to drink when everyone else is.”