No More "Same Old"


No More "Same Old"

Young Clients Are Leading Therapists to New Places

November/December 2018


I’m in an overflowing room of therapists at the Networker Symposium to lead a discussion on combating gun violence. The March for Our Lives protest, organized by students from Parkland, is just miles away. As I listen to almost 500 clinicians passionately exchange ideas, I’m struck by how millennials and their younger siblings have begun inspiring sociopolitical change, including the very nature of the therapeutic relationship and our role as therapists.

Ah, millennials. I use the term advisedly, knowing how it rankles many in that approximately 18–35-year-old age group, having been written about endlessly and tied to stereotypes of being whiny and entitled, spoiled by helicopter parents, too sensitive, narcissistic, and selfie-obsessed. But this oft-criticized generation has finally emerged as a force in society that is, by many accounts, the most diversity-embracing, ecologically minded, and philanthropic on record.

At the same time, their vulnerabilities are well documented. They’re experiencing staggering increases in the rates of psychiatric disorders, suicides, and opioid deaths. The great recession affected them far more than any other demographic: one in five lives in poverty, with young African Americans and Latinos having unemployment rates that are double or triple that of their white peers. Student loans approach $35,000 per college graduate, while more than 40 percent of students don’t make it to graduation within six years.

Precisely because of both their intense vulnerability and their emergence as a force to contend with, it’s time to recognize how young people have been quietly changing the world of psychotherapy. I know that I’m not the same therapist I was just a decade ago—few of us are—but it’s not primarily because of any new technique alone: I’m different because millennials, over the past two decades, have pushed me to re­examine my basic assumptions about the therapy relationship.

Today’s teens and young adults are a far cry from the often silent and guarded clients of old. How could they not turn things upside-down, having been raised in mostly nonhierarchical families by parents who encourage children to speak their minds from the get-go? They come into my consulting room so poised I hardly remember that they’re here to be helped with often overwhelming psychological and behavioral issues, almost 50 percent having received a diagnosis by the age of 18. They can be at the edge of collapse, yet as friendly and together as a talk show host. Savvy consumers, they’ve checked me out online and conferred endlessly with their friend group before their appointment. Even the politest don’t mince words. “Given my crappy insurance, we need to make headway fast!” a 23-year-old announced just this week.

I’m often taken aback by how they demand something quite personal of me in the very first session. My wife and I share offices in a suite, and recently a 26-year-old genially asked, before she even sat down for our first meeting, “So how did you meet your wife? I just saw her in the waiting room and I love to hear couples’ meeting stories.” Really, as a therapist, how open am I supposed to be?

My younger clients want to have conversations almost every session about matters other than the therapeutic “work”: politics, sports, streamed shows, video games, you name it. And these dialogues don’t just happen verbally. I’m pulled into relationships with my clients via links they offer me to their blogs, their Instagram accounts, their LinkedIn profiles. They want me to see the concerts they attended, family moments they captured and shared with the world—and, of course, shots of their favorite foods.

And they want answers! Young adults, who have access to endless information, don’t just ask for my personal opinion (which many of us were trained not to give anyway), they demand facts and to be told what to do. “I was snooping through my boyfriend’s phone,” says a 27-year-old. “Does porn impact sex drive? Does it matter what kind? Should I tell him what I found?”

And while therapy is often about tough stuff, they always want to laugh. I need to be funny or at least a “good enough” audience (my apologies to Winnicott). Unless an immediate crisis must be dealt with, there’s a need for fun in the room, as well as the kind of roiling exchange that lives online. And there’s no standing on the sidelines in today’s consulting room: whatever the issue, I’m expected to offer my own views.

WTF is happening? To be sure, we’d made tectonic shifts in our clinical approaches before millennials started coming to our offices, but now these young adults are demanding that we, their therapists, be different. Understanding this transformed vision of the therapeutic relationship required melding my 35 years’ experience in private practice with all I’ve learned while running an urban agency that specializes in young adults. This is the story of that journey and key techniques I picked up along the way, which I hope will resonate with therapists of all ages who work with young adults and teens.


The World is in the Room

“Out of the crooked timber of humanity, no straight thing was ever made.” – Immanuel Kant

In 1990, I started giving talks around the country to help parents become more effective in their roles as the tech revolution and growing academic and social pressures were upending kid-world and creating profound changes in familial organization. By the early 2000s, what struck me most were how these workshops had become exercises in paradox—alternating between parents’ desire for more effective authority and their fundamental belief in the importance of egalitarianism. In this new world of childrearing, they wanted it all; and they taught their kids to expect it all, believing that’s what they deserved in the rest of their lives as well.

In 2006, after a series of these talks in California, I kept returning to a fundamental shift I’d observed: everywhere you looked there was role-fluidity—one minute parent as boss, the next parent as friend, and the next parent as seeker of companionship and even advice from their children. Mothers and fathers had almost totally rejected a “children should be seen and not heard” ethos, instead wanting their kids to feel a sense of power, regardless of how disrespectful it might seem to their “greatest generation” grandparents.

Out of the fluidity of this complex parent–friend–parent dynamic, contradictions in our teens and young adults naturally followed. Millennials can be brutally honest, yet supersensitive to anything perceived as criticism, or even the absence of sufficient praise. They’re astonishingly poised and articulate, yet can fragment within seconds, demonstrating their intense vulnerabilities and struggles with resilience. They’re called the “Me Generation” for their maddening narcissism, yet regularly ask me how I’m doing, and genuinely seem to care about the answer, mirroring data showing millennials to be the most emotionally intelligent, generous generation on record.

At the core of these paradoxes is a millennial truth central to our clinical work: young people live a vertiginous dialectic between a sense of being in control and an increasing economic, psychological, and even physical sense of being out of control. Exponentially fueled by millions of “likes,” every Occupy, Black Lives Matter, Me Too, Never Again, Times Up, and Won’t Be Erased movement represents intense vulnerability and nova-force power intertwined. And every day in our offices, this signature mix challenges and expands the treatment relationship.

Young adults and teens are asking that therapists offer a therapeutic version of the responsive immediacy, personal candor, and role-fluidity they were raised to expect at home and experience online. It’s no wonder that when I inquire of clients why they left their previous therapist, almost to a person they say, in so many words, “She (or he) wasn’t ‘real’ with me, or didn’t go back and forth with me, or answer my questions personally, or give me the advice I needed.”

How, then, do we handle this challenge to our neat theories and protocols? Actually, it’s not such a mystery. Regardless of clinical tribe, most of us bend ourselves into pretzels trying to be both authoritative and deeply collaborative, much like the parents we too often criticize. But we usually think of this fluidity as an add-on, a “besides,” an “in-between,” to be shared privately in peer supervision groups. What if it is the work? What if the palpable spark of personal immediacy and role-fluidity is essential to today’s increasingly outspoken, yet intensely vulnerable teens and young adults? And if the world is in the room, how does it change the therapy relationship?

At the very least, given the constant noise and stimulation of contemporary life, we might begin by learning how to stay remembered between sessions.


Staying Remembered

I referred a 23-year-old patient to a veteran colleague and asked how the first session had gone. “I think it was good,” my colleague said. “She shared way more than I’d expected. But then later, I wondered whether anything had actually happened, or if it was just two strangers talking fast to each other.”

When online communication first exploded about 15 years ago, I began to notice a change in my teen and young adult clients. They’d often start a session by asking me to remind them what we’d talked about last time. At first, I chalked this up to “resistance,” and then I started to worry about myself—was I that bland and unmemorable? Then, as I began hearing similar descriptions from other therapists, I realized that fast-talking and fast-forgetting were a manifestation of light-speed millennial banter, both online and in what I call the “second family” of the peer group.

Anna, a recent college graduate, brought this home for me. Depressed and anxious after relocating to a new city, she was unable to calm herself, which meant ruminative, self-doubting episodes that immobilized her—keeping her up at night and in bed during the day. She always seemed grateful to have someone listen to her, but regardless of a session’s seeming richness, she’d turn to her cell phone the second it ended, and it’d be clear the following week that she’d absorbed almost nothing. “It’s not good,” I’d half-kiddingly say, “when someone with my gray hair remembers more than you do.”

Finally, one session, Anna turned to me and politely said that she’d appreciate my stopping her from “blabbling.”

“What do you mean?” I asked.

“Please make me speak more slowly,” she demanded. “Because I don’t hear a word of what I’m saying to you or what you’re saying to me.” It was true. Speedy dialogue allowed Anna to diffuse into an almost dissociated state—a frazzled groove in her already mercurial temperament. Therapy began to exist in her mind only when I’d created a different kind of space by slowing her down and by making my presence more dramatic.

So I began stopping Anna mid-sentence by saying, “Did you listen to what you just told me? It’s absolutely hilarious!” or “Those words of yours are haunting, I feel like you’re singing a beautiful, sad song to me.”

And key to being surer that my input might have a longer lifespan than a Snap on Snapchat, I now repeat key words and phrases at a session’s end with almost all clients. And I’m not alone. During a recent presentation I gave on treating young adults, many of the therapists described creative tactics they’d dreamed up to stay remembered. One keeps a basket of beautiful, water-smoothed stones by her side. As a session winds down, she asks clients to “name” a stone by writing their version of the meeting’s theme on it, and to take this home with them.

Staying remembered also depends on a client’s learning channels and diagnosis. Many young people love taking notes on their phones. Others, especially those with histories of trauma or anxiety disorders, need session summaries to be metaphorical, so they don’t carry words that may cause greater anxiety.

Twenty-one-year-old Michael was deeply ruminative, for instance, and afraid he couldn’t satisfy anyone sexually. Rather than mentioning anything to do with “performance,” I offered him a calming metaphor. “Your plane doesn’t have to race down the runway,” I said. “You can spend time slowly taxiing, and even decide not to take off. And always listen to your copilot, because you can be guided whether to move ahead at all or approach several landing areas from different directions and speeds. You’ll get better as you log more flying time.”

With 26-year-old Joe, after slowing down his light-speed monologues, I’d offer an almost hypnotically gentle recounting of what we’d gone over. And with Anna, knowing how diffuse she could get, we’d come up with a mantra together: a favorite being “talk slow, breathe slower.”

These days, I no longer grandiosely think that just because I’m the therapist my words will be remembered. Collaboratively, my clients and I create a pacing and drama that preserves what might otherwise vaporize into the cloud. By underscoring our experience, I’m saying, what happened here between you and me today is worth remembering, no matter how busy you are.


The Human Face of Technology

As journalist Thomas Friedman writes, the world changed around 2007. Apple released the first iPhone, Facebook had just opened itself to anyone, the first YouTube Awards were given, Twitter emerged, and the internet crossed well over a billion users.

It’s not surprising that sometime after 2007 the online universe began to find its way into treatment, bringing its combination of control and loss of control. Avery comes in and places her cell phone discreetly next to her leg, anxiously waiting to hear from her girlfriend. Frank wants to answer emails during our meetings about job possibilities, which, in his view, I certainly wouldn’t want to thwart. Justin comes in with Facebook at the ready, to see whether he’d be invited anywhere, to “lessen social isolation,” he says. Now how could I be against that?!

Eventually, I “surrendered to the machines” and began viewing technology as millennials expected me to—an invaluable component of therapy. Freud’s belief that one’s “dream-life is the royal road to the unconscious,” had morphed into its cybercousin: online life is a digital highway to the unspoken self, and a powerful connector between a client and a therapist.

More thoughtful now before speaking, Anna began alluding to tortured relationships. Specifically, she felt angry and helpless about being sloughed off by friends and lovers like some kind of cheap piece of clothing. How did I learn this? Not by asking direct questions, but by Anna showing me YouTube videos of her favorite performers, Goth and punk clips filled with violent images that this politically correct young adult would never own out loud.

Within a few weeks, she began trusting me with a “shameful” secret—several generations of family members had been subjected to drunken threats of violence by parents and siblings, only to be forgotten the day after, dreamlike, as if they’d never happened. The videos she showed me created a shared language between us. A door had opened; trauma-informed interventions were now possible.

Looking back, it was a game-changer in Anna’s trust when I shared with her some of my favorite (admittedly tame classic rock) performers. I almost expected supervisors of old to descend, shouting, “Root him out of the profession!” even as I knew full well how much tech-sharing had become an ordinary, yet still hidden therapeutic tool across the country, making possible a new kind of treatment connection.


“Normal” Substance Use

The Crisis Text Line reports that depression peaks at 8 p.m., anxiety at 11 p.m., self-harm at 4 p.m., and drug or alcohol issues at 5 a.m.—long, ordinary, nights of socializing and substances.

Given the anxieties of a post-9/11 world, the great recession, race and class divides, among a host of frightening sociopolitical developments, it’s not surprising that substance use has increased, especially since 2005. Now include the mounting wreckage in the last few years of drug overdoses amplified by heroin, fentanyl, and opioids, which have claimed almost as many lives as AIDS did at the height of the epidemic. Despite these daunting realities, millennials—paradoxically the most health-conscious of all generations—often present substance use and misuse as an absolutely normal part of everyday life.

How could there be such a profound disconnect? The damage of alcohol alone is astonishing. Each year, approximately 2,000 college students die from alcohol-related incidents, nearly 800,000 are physically assaulted or raped by those under the influence, and more than 100,000 students report having been too intoxicated to remember whether they had consented to sex—and this is just what we know!

These days, stress-reducing substances are so socially embedded in the anxious fabric of daily life, they are, simply, life. Let’s face it, binge-drinking, weed in all its forms, club drugs like Molly, and now opioids (age of first use of painkillers is falling from the 30s into the 20s) are part of just about every social event, from juuling in middle school to pregaming in high school to bar crawls in college to vaping THC at all ages.

These behaviors are so commonplace that I (along with many other therapists) had to change the way I approached them in therapy, especially when they result in days-long, anxiety-laced hangovers. Even if clients weren’t referred for substance-use issues, I regularly began doing a “social-substance review.” And to create the interpersonal immediacy today’s young adults and teens crave, I use my own somatic countertransference responses, a personal and uncannily accurate way of monitoring the unspoken undercurrents in a session.

For instance, when I’d feel my pulse racing a bit faster, I’d wonder out loud whether Jackie’s compulsive behaviors, like shoplifting and cutting, were triggered by a weekend of nonstop bar hopping. My fidgety boredom would tip me off that Armand had been vaping several days in a row and hadn’t gotten off his couch much. My stomach churning about Jama’s latest urinary tract infection would make me wonder about her nights of Molly-fueled hookups while clubbing.

I’ve found sharing somatic countertransference to be an essential part of harm-reduction and of relationship-building in the room. I often say things like, “I’m feeling exhausted listening to you today, how much partying was there this weekend?” or “I’m having a hard time staying with you, but feeling okay otherwise, so I’m wondering what kind of ‘fun’ you had yesterday.”

Anna’s compulsive, self-critical harangues were unbudgeable days after a weekend with the party-hardy college buddies she still saw. I gradually introduced social-substance-use questions: who was there, what time did drinking begin, what kind of drinks? She answered them, but it was only when I shared my own experience—”Anna, this might hurt your feelings, but I feel trapped by your out-of-control self-criticism”—that she seemed relieved, and admitted that she, too, felt trapped. Her drinking, she finally told me, often triggered binge eating, which amplified her feelings of self-hatred and anxious discomfort in her body.

Soon Anna and I discovered a clear pattern: she was recreating the trapped experience she’d had as the neglected, caretaker child in her fragmented family of origin—never the focus, but always responsible. Wanting to change this out-of-control pattern, but not wanting to jeopardize her social life entirely, she chose to avoid the group’s heaviest partiers and hold to a two-to-three-drink maximum.

This was enough to keep her socially connected while reducing alcohol binges and ruminative episodes. With her physiological systems less inflamed and our working relationship more collaborative, previously useless CBT techniques to lessen the social anxiety that had driven her to drink in the first place now had a chance.


The Mindfulness of Texting

In sessions, I sometimes ask adolescents to count the texts they exchange about one evening’s plans. The record so far—234 messages!

There are a lot of myths bandied about around the texting culture, making it difficult to grasp its true clinical implications. However, if you think young people are text driven, you’re right—they typically send more than 70 texts per day, and that number is rising for everyone! You’re also right if you think you’re not getting as many email responses as you used to—it takes the average person 90 minutes to respond to emails, but 90 seconds to texts. Two different surveys also show that about 1 in 5 millennials check their phones during sex. That’s almost twice as often as the rest of the population.

Given these realities, haven’t you found that barely a day goes by without a client demanding that you read a text? Mothers and fathers come in bursting at the seams over being text-ghosted by their kids. Lovers sob and rage over text-fights, drunk-texts, or text-breakups. One young client accidentally sent a “sext” message meant for her lover to her company’s CFO. The sheer intensity of it all can be stunning.

When I realized about five years ago that I could no longer tell from my clients’ stories if they were speaking to someone in person or texting, I finally embraced the clinical relevance of texts as a real-time record of dysregulation and potential healing that could strengthen the vitality of therapy—and allow for systemic interventions with only one person in the room. So I began asking clients to read texts aloud to me.

I wanted us to hear the exact inflections, tones, and pacing, along with the undeniable sequence of words exchanged. My goal was to incorporate the intensity of texts into the therapy relationship itself, in order to transform reflexive text-dances into self-reflection and mindfulness.

Just this past week, a mother had been depressed over her college kid’s nasty responses to her texts; but reading them to me, we discovered that every one of her communications to him had included a directive.

A 24-year-old heard his embarrassedly whiny undertone in jokey complaints he sent to the stand-offish boyfriend he longed to get closer to. A father who felt increasingly estranged from his late-adolescent daughter realized that his open-ended question—“How’s it going?”—would always end conversations.

Anna asked that I listen to the multiple texts her mother sent every evening to say goodnight. Anna would feel trapped by this overcommunication and too agitated to sleep. As easy as it might be to think of mom as a helicopter parent and entirely at fault, the texts showed there was more to the story. Spirited arguments followed between Anna and me about her own texts, like “I’m getting recognized at my job like you always wanted, but I’m drowning in work and feel terrible.” Or “My friend didn’t show up for lunch; what’s wrong with me?” This text-drama provoked mom’s guilt, obviously prolonging the enmeshed goodbyes that Anna bristled at.

I then orchestrated a text-intervention, asking Anna to lose mother-blaming phrases in her messages, like “you always” or “you never” or “none of my friends’ mothers.” After a few weeks, as the temperature between them cooled a bit, Anna’s mom dropped a bombshell. She revealed in emails that she’d been sexually abused as a child, leading to lifelong hypervigilance, which had clearly affected her relationship with her daughter. I then got Anna’s permission to invite her mother to a future session. Coexperiencing her texting brought Anna and me closer as well—a far cry from those fast-talking, superficial exchanges at the beginning of treatment.


The Magic of Play

Walk into a living room filled with young people and one rarely encounters baby-boomer mellow. Chilling these days often means a cacophony of play, a wild back and forth between fierce opinion and serious silliness.

As I’ve become comfortable with a more fluid therapy relationship, lively debate and easy openness happen in treatment much as they do around the kitchen table when our kids have friends over. With an ever-watchful eye on client vulnerabilities, I’ve found that unscripted fun and fierceness fosters greater access to therapeutic intuition, “the un-thought known,” as psychoanalyst Christopher Bollas suggests.

These exchanges are usually a kind of “hello ritual.” Selena, a 20-year-old immigrant from Central America, raged and even joked with me about deportations that left her and her family scared every day. Justin and I jousted over the visibility of his Instagram account showcasing the marijuana plants he was devotedly raising. With the mother of a trans teen, we’d marvel at the latest eye-popping outfit they’d decided to wear to school. Marla and I debated her participation in (yes, they exist) a Game of Thrones fantasy league, as she laughingly dismissed my view of the show’s misogynistic sadism.

Anna loved to discuss her passion for sustainable urban farming. This was her chance to teach me about community politics and my eco-unfriendly footprint, as we switched roles for a few minutes each session. Our conversations, which included Anna showing me Instagram pics of parking lots turned into community gardens, were free-form fun. These unscripted exchanges about hard work and steaming compost piles seemed to register in my unconscious, and perhaps Anna’s, as songs about forgiveness incongruously played inside my head.

Suddenly, Anna’s narrative took a not entirely surprising “un-thought known turn.” In the midst of our joking back and forth, she “magically” began empathizing with the incredible hard work her mother had taken on as she was raising her children while holding down two jobs and handling a financially devastating divorce—all after managing to escape a history of family violence. Mom emerged in this new narrative as a working-class hero of sorts, rather than just the cause of all Anna’s problems. Buried beneath resentments, this newfound compassion for her mother, unearthed during our fun exchanges, allowed Anna to find sturdier roots for her own identity.


Beyond Old-School

Watch competitive sports these days: before or after almost every play, hands are outstretched, fists are bumped, and slaps of encouragement are offered.

Given the growing emphasis on teamwork that begins in preschool, it’s no surprise that 21st-century therapy has evolved into a more supportive collaboration. Most individual and systems therapists have, in fact, moved from a one-dimensional Rogerian mirror to a two-dimensional participant-observer; then from a rigid dispenser of techniques to a three-dimensional, relational clinician, and even a multifaceted teammate.

Millennial clients have helped push us in this evolution with appeals to go way beyond old-school therapist parameters. For example, they unexpectedly bring in friends and partners just for me to meet. They share and expect my collaboration on their art, writing, and musical compositions, and lately, they ask me to join their political activities online or in person at marches.

Sometimes I say yes and sometimes no, taking into account where a client is developmentally and in therapy itself, as well as my own time constraints. But no matter how we think about it, our therapist role has expanded to be more of a co-creator in the room and co-citizen in the world.

Out of the blue, Anna asked me to help her with the personal essay required for a humanitarian-relief program she wanted to join. At first, I was reluctant. “Editing applications is not what I do in therapy,” I responded a bit sharply. But Anna was serious, and except for my image of what a therapist does and doesn’t do, I couldn’t come up with a clinical reason not to.

The stories that most surprised us both as we discussed her drive to be of service to others were about her heretofore almost invisible younger sister, who’d been identified with serious learning disabilities, the result of a seizure disorder. At an early age, Anna felt that she was the “normal one,” making her ever more critical of her own flaws and resentful of her mother for putting her in a caretaker role.

“You were trapped in between, so taken for granted as a child, it’s painful for me to hear,” I whisper to Anna. “But I also feel how much your mother loved and trusted you. I would trust you with anyone I cared about too.”

We’d finally moved the spotlight off Mom and learned that much of Anna’s narrative emanated from this shadow-sibling relationship. The more I emerged as a supportive, honest broker in this writing project, the more self-assured Anna became; after all, she was the final arbiter on the essay’s content. As Anna felt strengthened by the give and take of our teamwork, she began to rewrite her life story, both on the page and in her sense of herself. I, in turn, felt further removed from that formalistic clinician who for many of us, regardless of age, still lives deep in our clinical bones.


Addressing Microaggressions

“A key part of what makes [microaggressions] so disconcerting is that they happen casually, frequently, and often without any harm intended.” – Jenée Desmond-Harris, Vox Media.

The requirement many clients these days have for a relationship that’s “real,” warts and all, becomes extremely important in the area of identity-based assumptions and microaggressions inherent in any interaction. We therapists want to believe in our goodness, and as diversity trainings show, it’s almost impossible not to get defensive about our own unconscious biases. After all, many of us entered this field precisely because we had painful experiences as “the other.”

A younger female therapist is frustrated when her low-income, working-class client is guarded about his Appalachian background. A cisgender, male clinician labels it oversensitivity when his gender-nonconforming client is incensed by improper use of pronouns. An African American client is alienated by her secular therapist’s subtle dismissal of her Pentecostal upbringing.

In my own practice, despite having worked in hospitals and agencies treating extremely diverse populations, I was still unconscious about many of the ways I manifested implicit bias. An 18-year-old Latina girl became increasingly withdrawn because she thought that I and the team behind the one-way mirror didn’t grasp how an abortion would destroy her family relationships. A young, observant Jewish man could not accept my dismissal over his need to run our therapeutic conclusions by the rebbe. A 20-something, first-generation woman of Indian descent resented needing to explain to me the subtleties of her country’s traditions.

The permutations, as we increasingly realize, are endless. So while almost every training program has added implicit-bias modules, we’re only beginning to understand how unintended insults make a thousand cuts, even in the consulting room. And this is another millennial challenge: unless we increase our ability to be honest about our own biases and privilege, secure attachment in treatment is at risk.

Some years ago, Kim, an Asian American client, responded to my offhanded comment about her “obvious” intelligence by gritting her teeth and demanding to know why I’d said that. When I asked what was disturbing her, she shot back, “You wouldn’t understand.”

“Why?” I replied, thinking I’m on to something. “Is it because we’re so different?”

“Obviously, we’re different,” Kim said with annoyance. “You have white hair; I have black hair. We’re different races, ages, and genders.”

“Well, that’s a lot to contend with,” I said.

“Yes,” Kim snapped, “but mainly you wouldn’t understand because you’re a therapist and you only asked that question because it’s your job, not because you actually care.”

“That’s really unfair!” I responded with atypical anger. “Now you’re just assuming things about me.”

We were at an impasse and stared at each other in stone-cold silence for a few minutes.

Then Kim said, “In my culture I’m supposed to respect elders, but I don’t respect you yet. You don’t understand the way I hear things as hurtful, or you’d never have assumed I was so intelligent. That’s what white people think of all Asians.” I was about to defensively review my progressive values, but I’d heard Kim’s hurt and stopped myself, struck by her sensitivity and candor. Not for a moment could I imagine young clients of the past being so nondefiantly confrontational.

From that point on, our relationship changed. My well-intentioned belief about our similarities (my parents had been poor immigrants, too) was replaced by a sharper focus on our unspoken differences. Kim and I slowed down the process whenever an identity-based assumption got in the way, no matter how uncomfortable, giving me, and sometimes Kim, time to self-reflect. My whiteness and its privilege in the power relationship that is therapy was now explicitly open for discussion; in true millennial fashion, Kim helped me open a door to even greater transparency in the therapeutic relationship.


Getting Personal

“What happened with your previous therapist?” I ask 24-year-old Franklin in a consultation. “He wasn’t very dynamic,” he replies, “I went to him because I have trouble getting close to people, and then he wasn’t personal with me.”

Nurtured by a generation of more open parenting, the millennial expectation that we self-disclose is perhaps the most difficult demand for therapists to embrace. After all, many of us get confused by countless theories about what constitutes healthy engagement. The age-old myth of neutrality, misconceptions about Winnicott’s “container,” narrow evidence-based protocols, concerns about our clients’ and our own vulnerabilities—it all makes this issue exquisitely complex. And not sharing enough with other therapists what we really do in our clinical work doesn’t make it any simpler.

I’d known Anna for almost a year, and despite the multifaceted ways we’d worked together, she still exhibited a painful sense of insecurity in some sessions. One day, I mentioned my own family’s insecurity as immigrants, and to my surprise, I saw that she was crying. “What’s going on?” I asked, surprised at her tears.

“You told me something personal about yourself,” Anna answered. “Do you realize how little you do that?” I paused. “And while we’re on this subject,” she continued, “what are these pictures around your office? I’ve always wanted to ask you about them.”

I saw her point. A dozen pictures representing parts of my life lined my walls and shelves, but while few were of people, they were from people extremely meaningful to me. Like therapy, they were me but not me, and I was finally willing to discard this veil. One by one, we talked about the pieces of art behind their respective pieces of glass, until finally we settled on a street-scene postcard my father had sent me from Europe, literally hours before he died.

“He had a stroke that night, Anna,” I told her.

Then she asked more questions. “Was it hard because he was far away? What did you feel, besides shock, when you heard the news?

I was way out of my league now; close-to-the-bone self-revelation was nowhere in my wheelhouse back then. But since she seemed so engaged, I answered her. “Anna, I’m embarrassed to say this to you, but I didn’t feel anything. It was so surreal and far away that I was numb—numb at the funeral and for months after. But then, one night several months later, I had a dream in which my father came to me with clay in his hands. He’d sculpted circus animals for me as a child, and in the dream he handed me a piece of clay, saying, ‘Here, Ronnie, you can do this too.’ He touched my face tenderly, and then he disappeared. I woke up sobbing and not afraid to feel his death for the first time. You know what I did next? I went out, bought some clay, and sculpted a bust of his head. And then I started to sculpt for real, a passion I never even knew I had.”

Anna had entered that session hunched over, almost crouched in her seat and beyond anxious. Now she sat poised even as her eyes glistened with tears, a full head taller and absolutely contained in herself. “What in the world happened here?” I asked gesturing toward her through my own tears.

Anna said to me, “I love and admire you, Ron, but today was the first time I felt like you were a whole person with me. Thank you for this gift.”

Ironically, the gift of my fuller presence in the room was exactly what we’d both been looking for without quite knowing it.

- - - -

To paraphrase Carl Whitaker, if you don’t feel changed at the end of a session, then you’ve cheated your client.

At this moment, I find myself thinking back to the teens who organized the March for Our Lives in Washington, DC this year and about the astonishing surge in young adults running for office nationally. According to the organization Run for Something, 19,000 millennials signed up to get on ballots; and many of them are women running for Congress and governorships, an increase of nearly 350 percent from 2016.

This largest, most diverse demographic in the country is clearly coming into its own and impacting people of all ages. In the therapy room, as we respond to their expectations, their stark anxieties and vulnerabilities, what will our work look like in the future? I have no more of an idea than you do, but as with so many cultural shifts, this one isn’t without its poetic irony—the younger clients coming to us for help are now leading us to where we’ve never been.

***

Ron Taffel, PhD, is the chairman of the board of directors of the Institute for Contemporary Psychotherapy in New York. He’s the author of eight professional and popular books and over 100 articles on therapy and family life. Contact: Rivervue83@aol.com.

PHOTO © ADAM HESTER




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