Human beings can apparently endure an amazing amount of misery as long as there is hope.

Freud was inclined to call everything that hampered a patient’s progress resistance. But we could hardly regard hopelessness in this light. In analysis we have to deal with a counterplay of retarding and forward-moving forces, with resistance and incentive. Resistance is a collective term for all the forces within the patient that operate to maintain the status quo. His incentive, on the other hand, is produced by the constructive energy that urges him on toward inner freedom. This is the motive power with which we work and without which we could do nothing. It is the force that helps the patient overcome resistance. It makes his associations productive, thereby giving the analyst a change for better understanding. It gives him the inner strength to endure the inevitable pain of maturing. It makes him willing to take the risk of abandoning attitudes that have given him a feeling of safety and to make the leap into the unknown of new attitudes to ward himself and others. The analyst cannot drag the patient through this process; the patient himself must want to go. It is this invaluable force that is paralyzed by a condition of hopelessness.

It is true that the patient’s neurotic development started in childhood and that all the data he (the patient) can provide is relevant to an understanding of the specific kind of development that has taken place. It is true also that he is not responsible for his neurosis. The impact of circumstances was such that he could not help developing as he did. For reasons that will be discussed presently, the analyst must take this point very clear.

The fallacy lies in the patient’s lack of interest in all the forces that have been built up in him on the basis of his childhood. These, however, are the forces that are operating in him now and that lie behind the present difficulties. His having seen so much hypocrisy around him as a child may have played a part, for instance, in making him cynical. But if he relates his cynicism to his early experience alone, he ignores his current need to be cynical- a need that springs from his being divided between divergent ideals and so having to throw all values overboard in an attempt to solve that conflict. Moreover, he tends to assume responsibility where he cannot, and to refuse to assume it where he should. He keeps referring to early experiences in order to reassure himself that he really cannot help having certain failings, and at the same time feels that he should have come out of his early calamities unscathed- a white lily emerging unsullied from a bog. For this his idealized image is partly to blame, since it will not permit him to accept himself with flaws or conflicts past or present. But more important, his harping on childhood is a particular kind of evasion of self which still allows him to maintain an illusion of eagerness for self-scrutiny. Because he externalizes them he does not experience the forces operating within him; and he cannot conceive of himself as an active instrument in his own life. Having ceased to be the propellant, he thinks of himself as a ball that once pushed downhill must keep on rolling, or as a guinea pig, once conditioned forever determined.

LOVE

Need-free love: a relationship, at its best, involves individuals who relate to one another in a need-free fashion.  

Abraham Maslow: an individual’s basic motivation is oriented toward either “deficit” or “growth.” Psychoneurosis, he thought, is a deficiency disease resulting from a lack of fulfillment, beginning early in life, of certain basic psychological needs- that is, safety, belongingness, identification, love, respect, prestige. Individuals who have these needs satisfied are growth-oriented: they are able to realize their own innate potential for maturity and self-actualization. Growth- oriented individuals are far less dependent upon their environment for reinforcement or gratification. In other words, the determinants are inner.

D-love and B-love: by Maslow

D love, deficiency love, is selfish love or love-need, whereas B-love, love for the being of another person, is unneeding love, or unselfish love. B-love is not possessive and is admiring rather than needing; it is a richer, higher, more valuable subjective experience than D-love. B-lovers are more independent of each other, more autonomous, less jealous or threatened, less needful, more disinterested, but also simultaneously more eager to help the other toward self-actualization, more proud of the other’s triumphs, more altruistic, generous, and fostering.

Erich Fromm considered love as a mode of coping, an answer to the problem of existence. Mature love is union under the condition of preserving one’s integrity, one’s individuality…In love the paradox occurs that two beings become one and yet remain two.

Individual transforms the concept of love from “being loved” into “loving.” Fromm equates “being loved” with a state of dependency in which by remaining small, helpless, or good, one is rewarded by being loved.

Fromm’s point that love is an active, not a passive, process has extraordinary importance for the clinician. Patients complain of loneliness, of being unloved and unlovable, but the productive work is always to be done in the opposite realm: their ability to love. Love is a positive act, not a passive affect. It is giving, not receiving.

How to relate to another in a need-free fashion?

1. To care for another means to relate in a selfless way: one lets go of self-consciousness and self-awareness; one relates without the overarching thought, what does he think of me? What is in it for me? In other words, one must relate with one’s whole being.
2. To care for another individual means to know and to experience the other as fully as possible. One extends oneself into the other, recognizing the other as a sentient being who has also constituted a world about himself or herself.
3. To care for another means to care about the being and the growth of the other.
4. Caring is active. Mature love is loving, not being loved.
5. Caring is one’s way of being in the world; it is not an exclusive, elusive magical connection with one particular person.
6. Mature caring flows out of one’s richness, not out of one’s poverty – out of growth, not out of need. One does not love because one needs the other to exist, to be whole, to escape overwhelming loneliness. One who loves maturely has met these needs at other times, in other ways.
7. Caring is reciprocal. To the extent one brings the other to life, one also becomes more fully alive.
8. Mature caring is not without its rewards. One is altered, one is enriched, one is fulfilled, one’s existential loneliness is attenuated. Through caring one is cared for. Yet these rewards flow from genuine caring; they do not instigate it. The rewards ensue, but can not be pursued. 

彼得·阿历山德罗维奇说，“我倒想对诸位另外讲一段关于伊凡·费多罗维奇自己的十分有趣而又别致的故事。约摸五天以前，他在这里的一次大半是女士们在场的聚会上跟人辩论时，郑重声明，世界上根本没有什么能使人们爱自己的同类；所谓‘人爱人类’的那种自然法则是根本不存在的，世界上到现在为止，如果有过爱，并且现在还有，那也并不是由于自然的法则，而唯一的原因是因为人们相信自己的不死。伊凡·费多罗维奇还特别加以补充，说整个的自然法则也仅仅在于此，所以人们对自己不死的信仰一被打破，就不仅是爱情，连使尘世生活继续下去的一切活力都将立即灭绝。不但如此：那时也将没有所谓不道德，一切都是可以做的，甚至吃人肉的事情也一样。这还不算，他最后还下结论说，对于每个象我们现在这样既不信上帝、也不信自身的不死的人，道德的自然法则应该立刻变到和以前的宗教法则完全相反的方向去，而利己主义，即使到了作恶的地步，也不但应该容许人去实行，而且还应该认为这在他的地位上是必要的，最合理的，几乎是最高尚的一种出路。

“难道您果真认为人们丧失了灵魂不灭的信仰后会得到这样的结果么？”长老忽然问伊凡·费多罗维奇。

　　“是的，我曾说过这话。假使没有不死，就没有道德。”

　　“您这样想，是感到愉快呢，或是很不幸！”

　　“为什么不幸？”伊凡·费多罗维奇微笑着说。

　　“因为您大概自己就既不相信自己的灵魂不死，甚至，也不相信您关于教会和教会问题所写的那些言论。”

　　“也许您是对的！……但不管怎样我总不是完全开玩笑。……”伊凡·费多罗维奇忽然奇怪地承认，而且很快地脸红了。

　　“不完全开玩笑，这是真的。这观念在您的心里还没有解决，还在折磨着您的心。但是受折磨的人有时也常爱以绝望自娱，而且这似乎也正是由绝望所驱使。您眼下就正在用给杂志写文章，在社交场合辩论等等的方式，以绝望来自娱，自己却并不相信自己的论证，还怀着痛苦的心情自己暗中笑它。……这个问题在您的心中还没有解决，您的最大悲哀就在这里，因为这是必须解决的。……”

　　“能不能在我心里解决，并且向肯定的方面解决呢？”伊凡·费多罗维奇继续奇怪地问，还是带着一种不可捉摸的微笑望着长老。

　　“假使不能作肯定解决，那么同样也永远不会作否定解决，您是自己知道您的心的特点的，而您的心灵的全部痛苦也就在这里。但是您应该感谢上苍，他给您一颗能以忍受这种痛苦的高超的心，能够去‘思考和探索崇高的事物。因为我们的住所位于天上。’愿上帝赐福给您，使您的心在地上就得到解答，愿上帝祝福您的行程！”

Mindfulness?!

1. You don’t have to react to your thoughts. Your life is a constant stream of thinking and then reacting to the content of your thoughts. Practicing awareness teaches you how to have a thought and just watch it, without doing anything about it. Instead of acting on your thoughts, you’ll notice them, accept them, and watch them vanish as others take their place.
2. All of your thoughts and feelings, no matter how pressing they seem, will come and go. Your thoughts are temporary, and your ability to watch them ultimately means that you are more than everything you think. Therefore, you don’t need to believe in or be driven by your thoughts.
3. you can be comfortable in your own body even when experiencing sensations of fear, anxiety, anger, or any other unpleasant emotion.
4. each of your thoughts, as it rises up and then disappears, brings with it a certain emotional intensity.
5. most of your thoughts focus on one of two categories: what things will make you feel better- how you can get them, and how you can keep them; and what things make you feel “bad” and how you can avoid them, or get rid of them. In essence, everyone spends a lot of time wanting to feel better. This way of thinking is the root of the anxiety you feel. As soon as you think of something you want, you become afraid that you won’t get it. As soon as you get it, you become afraid that you’ll lose it. Or, once you get it, you become afraid that it really won’t fix you up the way you thought it would, and then you’ll have to get rid of it and find something else. We are all so sure that our happiness depends on whether or not we are getting what we want- good grades, the approval of others, nice things, a good job- that we don’t realize we’re really okay, right now, just as we are.
6. fears are, more often than not, based on what you imagine will happen not what will actually happen. The fear reaction that it takes you so much energy to create, maintain, and avoid, is usually a useless protection against something that doesn’t exist.

Staying in an alarmed state, even if that means feeling anxious most of the time, seems much safer than letting down their guard. Most anxious people prefer to stay anxious because anxiety feels safe.

By learning to focus your attention on what your body is feeling and what your mind is thinking as you react to a threatening situation, you’ll be transforming your fear from an unconscious to a conscious activity. When you’re aware of your fear, you can make choices about how you want to behave, instead of automatically reacting in ways that will help you escape from feeling your fear.

Most of the time, we focus our attention on things other than our thoughts and feelings. Our emotions may seem so uncomfortable or overwhelming that we can’t muster the attention it takes to actually experience them. Instead, we occupy the major part of our attention with other things- the ball game, last night’s date, tomorrow’s test, the work fiasco, our best friend’s love life- while many of the fearful thoughts and inner sensations continue just beyond the edge of consciousness. Consequently, we’re often so busy worrying about things that we never truly experience much of the life we are living, right here and right now.

The key to working through test-taking anxiety, or through any anxiety, is to develop awareness of your thoughts and physical sensations moment by moment. When you experience fear with awareness, you’ll be creating a situation in which you can choose what you want to do and how you want to act, instead of reacting in the same old automatic ways.

Suggestions for practicing awareness:

1. Label your thoughts. Labeling your thoughts will help distance you from your thinking, so that instead of getting all wound up in the stories your thoughts are weaving, you’ll be able to stand back and just observe them as they glide by.
2. Pay attention to your physical sensations.
3. Return your attention to your breath.

and (3) how to reach out for help when you need it.

…. A third area in which grief counseling presents a special challenge to the mental health worker

has to do with existential anxiety and one’s own personal death awareness.

In an earlier book, I addressed this issue

and how this type of awareness can make a person more effective or less effective as a human being (Worden, 1976).

Worden, J.W. (1976). Personal death awareness. Englewood Cliffs, NJ: Prentice Hall.

Operational mourning consists of inducing the mourning response

by directly asking one family member about reactions to actual losses they have sustained.

Then the other family members who are present are asked to talk about their feelings,

which have been stimulated by directly witnessing the grief reaction of the first person.

In this way children, often for the first time, observe their parents expressing intense emotions.

This gives the therapist an opportunity to assure them of the normality of these feelings.

It also gives the therapist the opportunity to review the episodic threats of abandonment

by a parent or other family member which have been an important influence in current family life.

During these periods of activated mourning,

family members are encouraged to share their affective experiences

and to react empathetically to affects expressed by each other.

In using this procedure,

Paul finds an enormous amount of resistance and denial on the part of the family,

but if this resistance is overcome, the intervention is very beneficial.

Parents are often surprised at their own needs and responses when a child dies.

The severity of the loss elicits a longing for closeness and intimacy,

but some parents are surprised or feel guilty when they find themselves attempting to meet these needs sexually.

It is important for the parents to recognize and understand these needs and feelings as part of the normal life process.

Many who have not undergone this type of loss believe that the last thing a grieving parent wants to do

is to talk about their child, but this is exactly what most want to do.

It is possible and, for some,

this struggle with repositioning the lost child can lead to important self-awareness and possible personal growth

coming out of this very difficult experience.

Sudden infant death

At the hospital, a sensitive intervention on the part of the hospital staff is

to allow the parents the option of spending time with the dead baby.

This can be extremely important because often the parents want to be near the child,

to hold the child, or to talk to their dead child….

autopsy permission is also important in this type of death and cannot be overemphasized…..

I think that an important part of counseling is to encourage patients to talk to other couples or families involved in similar trauma.

Such sharing helps them develop a growing awareness that it was not their fault that their baby died,

that there was nothing more they could do.

Miscarriages

Generally, in the circumstances surrounding a miscarriage,

the husband feels powerless

and his need to act strong and to be supportive may be misinterpreted by the woman as not caring….

As in other losses, it is very important that people be able to talk openly and honestly regarding their feelings.

Abortion

Abortion is one of those unspeakable losses that people would rather forget.

The surface experience after an abortion is generally one of relief;

however, a woman who does not mourn the loss may experience the grief in some subsequent loss…….

Horowitz and colleagues found that many young women consciously got pregnant a second or third time

as one way to handle their feelings about the first abortion.

To put the experience of abortion “out of mind” is to minimize its importance,

but I do not believe that it can be minimized and adequate grieving is definitely necessary.