Fear of Doing Nothing

Notes of a Young Therapist

Valery Hazanov

• Publisher: Sphinx Books
• Year: 2019
• ISBN:
  9781912573530
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

The Fear of Doing Nothing is a critique of psychotherapy through the lens of a young practitioner training in the field. Hazanov recounts the stories of the most moving, challenging, and memorable patients he worked with during his 6 years of training. This book follows him from the beginning of his training, at the peak of his doubt and skepticism, to its end, where he finally starts to believe in psychotherapy.

This is a book for an intelligent and skeptical reader who is not convinced that psychotherapy is a worthwhile endeavor and questions its usefulness and merit. In the book, the author attempts to understand what can and cannot be achieved in psychotherapy and reflects on its place today.

The rock that ties down the balloon

“I can't breathe.”

“Where are you, Ms Johnson?!”

“I can't breathe, Valery! Do you hear me? I can't breathe. I don't…”

“What's going on? Where are you calling me from?”

“From the bathroom. Oh shit, wait! What's that? AH! The cat! The bastard, ‘Come here! Come here, I'm telling you!’”

“Are you alone?”

“Minus the cat, yes.”

“What happened?”

“I don't know. I just…I can't. I'm done, I'm done. I feel like…typical, typical! ‘Here we go, let's go, baby!’ This…What a ride, ah? You must be entertained! Oh, you must be entertained. You're watching a horror movie. You like them, I know you like them—”

“Slow down, Ms Johnson. What's going on?”

“The same. He came, never mind…It's all the same…Closed circuit. Spinning around. What can you tell me? Nothing…I don't expect much.”

“Is there anyone else in the apartment?”

“I don't think so.”

“So you're safe. The door is locked?”

“I think so.”

“Good, you're safe.”

“Hmmm…”

“Want to breathe together?”

“Yes.”

“Put your hand on your stomach. Slow down, take slow breaths.”

“I'm naked and I'm sweating like a pig.”

“You want to take a shower first?”

“No. Let's breathe.”

“I think we need to talk about the fact that Ms Johnson even called you in the first place, Valery. Something about it feels significant.”

“Absolutely. She's in this almost, how should I say, ‘foetal position’, calling you, Valery. It reminds me of Winnicott: she needs a ‘good enough’ mother to hold her.”

“I was thinking about the same thing. There's something so regressive about that image.”

“And you said she was naked, right? A naked baby.”

“When you were reading the notes, something in her tone reminded me of this terrible panic, like a Kleinian terror—of the paranoid position. Dissolved, lacking a core.”

“Yes, yes. Dissolved. In a moment of panic she can't recall your object internally, so she needs to call you, Valery—notice: call, re-call—to make it almost explicit. Hearing your voice makes it real—you become a real object.”

“I completely agree. You can't look at it outside of the dyad—and we've discussed it this year. In terms of her object relations, this is a very early deficiency. I mean it's pre-Oedipal, clearly.”

“You didn't say anything about your countertransference, by the way. Does she make you feel like a saviour? Her mother? Or maybe you were dismayed that she was breaching the boundaries of the setting? I mean, it can all be true.”

“Did you try to reflect that to her in the following session, Valery?”

I saw her for the first time in the waiting room of a training clinic in which I had worked for about a year. She was assigned to me for an initial “intake” session, in which I had to take her history and assess whether she was a good fit for the clinic. It was February. She sat in the corner and looked frightened and disoriented: shivering, wearing a thick grey hoodie that covered her hair, wiping sweat from her forehead with tissue after tissue, then holding them all in her hand. She later told me that the people who came to fix the copying machine scared her while she was waiting, because she thought that they were talking about her and were looking at the forms she was filling out (so she stopped filling them out).

“Ms Johnson,” I said when approaching her, “I am Valery.” Not looking at me, coughing small, incessant coughs, mumbling something that I couldn't comprehend, she slowly, with great effort, got up and stood in front of me. At six foot tall and probably weighing more than 300 pounds, she was almost twice my size. She had a black plastic bag in her right hand and a can of grape soda, with the straw inside, in her left hand. She was shaking slightly and moving from side to side, but she somehow made it to the room and slumped into the chair. “Needless to say,” she said, “life is not going great.”

I was in the second year of graduate school when I met Ms Johnson and she was my fifth psychotherapy patient.

Meeting someone new so early on in training was an enormous event for which I prepared for hours, sometimes days. I read everything available in the file, consulted the supervisor before seeing the person, went over relevant literature, spoke to colleagues in supervisory groups.

The result of my preparations was a bombardment of ideas, bits of theory and research, an ocean of psychological mumbo-jumbo, and many suggestions—you should do this, you should do that. Eventually, there were two rather confused people in the room.

“You feel a little calmer?” I asked her after sitting together for about thirty minutes.

“No.”

“You look calmer, you stopped shaking.”

“It will come back, don't worry.”

“Where did you grow up?”

“You want the whole story?”

“Sure.”

“It will take us a week.”

“We have time.”

“Have you been to our nation's south, Valery?”

“Does Arizona count?”

“Kinda. I'm from Alabama.”

“I like how you say A-L-A-B-A-M-A.”

She laughed. “Foster homes, drunk mother, shelters, no school after sixteen, the whole circus.”

“How did you get to New York?”

“There was a distant aunt in Brooklyn. For some obscure reason, she wanted me with her, maybe because she didn't have her own kids, I don't know. It worked for six months until she kicked me out.”

“How old were you?”

“Twelve.”

“And then what happened?”

“Hell happened. I moved in with my grandfather.”

Like a worn-out toy missing an ear, she was thrown from one place to another, from one family member who did not want her to the next. In the process, there were shelters and temporary homes and many rooms and houses. By the time she was twelve, she had lost her mother, did not have contact with her father, and had lived in three different states.

But that wasn't the worst.

“Things began alright with grandpa,” she recalled. “He was an enormous man, very charismatic. A ‘patriarch’, I think you say—big family, he was the leader.”

There were several grandchildren at his house in Virginia, mostly boys. Things worked in perfect order: the kids would wake up early, brush their teeth together, dress quickly, go to school, come back, do homework. “I felt okay, it was fine.”

About a year after she had moved in and established, for the first time in her life, a routine, grandpa started acting strange: sneaking into her room at night, commenting on her looks, lingering by her bed before she went to sleep. Suddenly, the joy of having her own room, which she had painstakingly decorated with flowers and posters of Disney movies, turned into the terror of having no escape.

One terrible thing led to another, until he started raping her. Two of the oldest grandchildren joined him at some point. It went on for four years, during which she was threatened that she'd be killed if she told anybody. At seventeen, not able to take it anymore, having no one to talk to, she ran away, came to New York City, and became homeless.

“Start working in the transference, Valery.”

“This is not a case for CBT.”

“Maybe a Rogerian intervention? Unconditional Positive Regard?”

“She is clearly schizotypal.”

“You need something targeted and behavioural to work with her.”

“Yes, yes. Dissolved…”

Over the years, Ms Johnson had developed many phobias. Some made sense, given her horrific history. Others were a bit strange, without a clear causal link to her past. She was afraid of buses, for example. Not only the ride itself, but the whole experience was frightening, including waiting for the bus close to our clinic (in a sleepy, safe part of Brooklyn). “What's the chance of someone hitting you at a bus stop down the street?” I asked after she had described her fear.

“Fifty per cent.”

“Fifty per cent? If you wait for it today and tomorrow, on one of them you'll get hit?”

“Yes.”

“But the probability of getting hit at the bus stop downstairs is so much lower…Think about the hundreds of people who wait there every day. We would have heard if someone was hit, and it's never happened—I've been here for three months already.”

“Fifty per cent.”

Instead of riding the bus, she would get a cab to come to the clinic, even though she had almost no money and lived in subsidised housing. In the cab, she would get so panicked that she would lie down on the back seat, cover her eyes, and pray. When she walked in after the ride, she would always look shaken, as if something horrible had happened, although nothing ever did. “I can't take this anymore, Valery.”

Rarely getting out of her house, she spent most of her days watching TV, sometimes in silence and in the dark; almost always by herself.

“Do you go out sometimes?”

“No. Not really.”

“What's your apartment like?”

“It's small and a bit messy. But clean, I keep it clean.”

“That's great. I struggle with that.”

She laughed, then stopped. “I'm a lady of darkness. The window blinds are closed. It's always dark.”

“Sounds depressing.”

“I don't know. I don't like the light, it makes me anxious.”

In the 1990s, following groundbreaking work by Judith Herman, researchers and psychotherapists started talking about complex trauma. Unlike isolated cases of trauma, complex trauma is a compilation of many instances in which a person was severely abused or violated.

After the hell she had experienced at her grandfather's home, things did not exactly go smoothly for Ms Johnson. Arriving in New York at seventeen as a homeless, poor, severely traumatised young African American woman with no family support, she was in chronic danger and was often abused and exploited.

If there is a sort of emotional “organ” in us that allows us to feel safe enough to exit our homes and take on the day with a basic belief that we won't get killed or bullied or raped by the first person we see on the street, then that was the very thing that had been stripped away from her—like epidermis brutally ripped off from the skin. She felt completely exposed and believed that tragedy was just around the corner, because so many times it was.

There are three basic stages in recovery from trauma: SAFETY–MOURNING–RECONNECTION. You can't skip one and go to the other. Only after feeling safe can a person start mourning what has been lost, and only after that can she start reconnecting to other humans, to life.

Ms Johnson was very clearly in the safety phase, feeling unsafe everywhere, at all times: at her home, which was a housing project she had been granted for an unclear period of time and was rife with violence and drugs, on the street, in the park, and on the bus—everywhere.

She smelled strange. Her body odour was very distinct but of unclear origins. Was it a perfume? Something spicy in her food? Some sort of ointment? People around her, not least in the waiting room of our clinic, quite literally pulled away from her—switched a seat, got up a couple of minutes after she would sit next to them. Several of them had come to me and asked me to “address” that. I don't think it would be an extremely deep psychoanalytic interpretation to maintain that the repulsion was intentional, protective—she wanted them away from her. I never said anything, it felt too private.

She liked wearing hoodies that covered most of her face. Her nails were always done and were very long, wi...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Author's Note
• The Fear of Doing Nothing
• The Rock that Ties down the Balloon
• What is Breakfast?
• Snowflakes
• One Day
• Good Mourning Men
• The Dreamer and the Realist
• Gloom and Maserati
• Many a Time
• My First Private Patient
• Acknowledgements