Twenty Key Concepts from Psychotherapy

Psychotherapy is one of the most valuable inventions of the last hundred years, with an exceptional power to raise our levels of emotional well-being, improve our relationships, redeem the atmosphere in our families and assist us in mining our professional potential.

But it is also profoundly misunderstood and the subject of a host of unhelpful fantasies, hopes and suspicions. Its logic is rarely explained and its voice seldom heard with sufficient directness.

Here are twenty small essays on its key concepts:

Symptoms and Causes

People typically end up in therapy when they are overwhelmed by painful symptoms whose causes they can’t understand. Why are they always so sad? Why – having done nothing objectively wrong – are they so fearful of being sacked? Why isn’t sex possible any more?

The goal of therapy is to go beneath the surface ‘presenting problem’ in order to locate (and treat) what is really at stake. Sigmund Freud, the inventor of psychoanalysis and its twin, psychotherapy, deserves his place in 20th century history because of his immensely subtle grasp on the devilish way symptoms get disconnected from their real causes. We cannot remember or easily imagine what is ailing us and so cannot recover. On the surface, we might be beset by an urge to clean the house with manic intensity, but over many therapy sessions, we may come to realise that we are unconsciously longing to expunge a sense of being unwanted and ‘bad’ bequeathed by a dismissive parent in early childhood.

It is not coincidental that Freud was a medical doctor by training. In physical medicine, the decisive factor behind bodily suffering is often (at first sight) hugely unexpected; a pain in a toe might be linked to a problem with the abdomen. Freud took this model and applied it to mental suffering, proposing that our current emotional troubles are usually symptoms of problems located in the rarely-visited caverns of childhood memory. Psychotherapy is the discipline that promises to guide us back to our troublesome past in order to give us, once we can address the real causes of our sorrows, the chance of a more liberated, less anxious and more hopeful future.

Childhood Trauma

In ancient Greek, the word ‘trauma’ means a physical wound. Psychotherapy is built round the idea that every childhood involves an inevitable degree of emotional wounding. Nothing particularly sinister need have happened at all for us to have ended up traumatised in ways that harm our chances of finding adult satisfaction. Young children are deeply vulnerable around very ordinary things: parents squabble or are bit distracted; it’s terrifying if they get angry; the child can have intense fears of abandonment and helplessness – even when they are objectively safe. Without being a monster, a parent might be fussily over-protective or highly controlling, rather dismissive or just not very interested. The child’s fragile, immature self can be hugely distorted and damaged by these very normal experiences that occur long before they can be processed or properly understood. In his Outline of Psychoanalysis Freud defines childhood trauma as ‘an inability to deal with early emotional challenges that a person could endure with utmost ease later on.’ In other words, a trauma needn’t sound at all bad to our adult selves for it to have had a severe and lasting impact on our development. Maturity means getting to know our traumas before they are able to spoil too much more of our adult lives.

The Unconscious

The idea of the unconscious is central to psychotherapy. The mind is pictured as divided into two zones. A tiny, intermittent area called consciousness and a vast, complicated, obscure, timeless terrain named the unconscious. Because it is in the nature of the conscious mind to be highly squeamish, we constantly forget or ignore crucial incidents that affect our behaviour and moods in the here and now. These nevertheless live on in the dark continuous present of the unconscious. A traumatic episode – a rebuff or humiliation – that took place when we were little will still be fresh in our unconscious as if it happened yesterday and its effect on our current behaviour can be out of all proportion to what we might ordinarily suppose. Our unconscious selves may still be trying to placate an irritated father or escape the censorious prudishness of a mother. A part of us may be continuing to fear a repeat of an incident of humiliation and breakdown (the catastrophes we fear in the future are generally those that have already happened to us in the past). And these battles, directed at the forgotten past, can take a terrible toll on our adult lives.

The central aim of therapy is to properly reconnect us with our unremembered histories: to give us mastery over lost provinces of mental life and extend our knowledge of our unconscious experiences. Therapy seeks to facilitate the intimate rediscovery of apparently distant emotions so that we can rethink them with our adult faculties and liberate ourselves from their frequently mysterious and painful hold on us.

Sexuality

Psychotherapy is deeply alive to how rare and difficult it is to be able to have satisfying genital sex over the long term with someone one loves. Though this is assumed to be a norm by society at large, psychotherapy knows otherwise: it understands the difficult road that our sexual instincts have to travel down from infancy through to adulthood. Psychotherapy insists that children have what we can think of as proto-sexual feelings and that adult sexual health heavily depends on these feelings being appropriately handled in the home environment. Unwarranted degrees of guilt and shame easily get attached to the body, which then makes intimacy impossible. Furthermore, in childhood, we learn about love from people with whom taboo strictly forbids us to have sex, which means that when we come to love someone as an adult, we might also notice a mysterious waning of sexual interest. It seems like we are merely ‘bored’, but in truth, tender feelings are conflicting with our libido in a way that mirrors the early incest taboo. We may find it far easier to be aroused by total strangers about whom we feel nothing and where love is not an option. By explaining soberly and reasonably how we end up here, therapy makes the stranger zones of our erotic life less humiliating and embarrassing. It also allows us to see that a degree of sexual unhappiness may well be an entirely natural and unavoidable part of a good life.

The Fundamental Rule

When he was trying to describe the process of therapy, Freud said that it required really only one thing of patients: that they must ‘say everything that comes into their head, even if it is disagreeable for them to say it’. Freud called this ‘the fundamental rule’ of therapy – and the only route to successful treatment. Of course, the rule flies in the face of all our impulses. Civilised life constantly requires us, in order to be deemed good, to censor what we say. Very little of what we are actually feeling or thinking makes it out into the world, or even into our conscious minds for long. This may help us in certain situations but it can also, Freud knew, make us deeply sick. There are tricky or disagreeable ideas we need to be able to entertain without cleaning them up – in order that we liberate ourselves from their subterranean grip. According to therapeutic theory, we grow sick when we fail to understand our own more troubling desires and fears, when the story we tell ourselves about who we are no longer tallies with the truth – and the consulting room is a unique space where we can, finally, dare to take a look beneath the surface.

For their part, therapists are properly unshockable and without any desire to moralise: they know human nature, and their own minds, deeply enough never to be surprised. As we watch them accept our darkest secrets with calm and patience, we grow more confident about our own acceptability. We no longer have to keep so many things from ourselves and grow at ease with our underlying strangeness and wondrous oddity – which we share with pretty much everyone on the planet.

Parapraxis

‘Parapraxis’ is the specialised, technical name for a bungled or faulty action which nevertheless reveals something fundamental about our deeper selves. More popularly, the concept is known as a ‘Freudian slip’. Freud’s favourite examples include mislaying one’s keys, forgetting a person’s name, knocking over a vase, clumsily bumping into people, spoiling a presentation by jingling coins in one’s pocket as one speaks, missing a train or forgetting the time of an appointment. These may seem very minor matters but occasionally they give us a glimpse of what is happening in someone’s soul. An unconscious hatred of someone may manifest itself in a recurring failure to summon their name; we may hide a secret but risky desire to triumph over a rival by sabotaging our professional performance.

The interest for therapy lies in the way parapraxes offer one access to active, but disavowed, parts of who we are.  Rather than simply being pure mistakes, they are driven by thoughts and feelings circulating deep in the background of our minds. It can be hugely significant when we say ‘bed’ rather than, as we apparently meant to be say, ‘bread’ – or ‘wife’ rather than ‘life.’  Such slips can show us as being more loving, more hostile, more self-destructive, more sexual or more frightened than we typically care to imagine. The aim of studying our slips isn’t to catch us out but to help us recognise the odder, more fragile parts of who we are: the parts that are in need of understanding and assistance. It is part of therapy’s revolutionary generosity to seek to learn something important even from the most seemingly embarrassing trivialities of existence.

Transference

Transference refers to the way that, once we have been in therapy for a while, we begin to play out, or transfer onto the therapeutic relationship dynamics which derive from our own psychological histories. For example, we might feel convinced the therapist is weak or a bit of a failure or that they are very happily (or very unhappily) married or snobbish or distinctly admiring of us or systematically hostile – any or all of which possibly bears little relationship to the actual life or thoughts of the therapist, about whom we are meant to know almost nothing. Rather than try to quash these fantasies, therapy makes use of them. The therapist will signal where we are prone to pin to them attitudes or outlooks that they don’t actually have – and in this way, the therapeutic relationship will be used as a unique vehicle for learning about our more imperceptible emotional tendencies. The therapist will (with kindness) point out that we’re reacting as if we had been attacked, when they only asked a question; they might draw our attention to how readily we seem to want to tell them impressive things about our finances (yet they like us anyway) or how we seem to rush to agree with them when they’re only trying out an idea which they themselves are not very sure of.

The relationship with the therapist becomes a template for how we might form relationships with others going forward, freed from the maneuvers and background assumptions that we carried within us from childhood, and which can impede us so grievously in the present.

Defence Mechanisms

Psychotherapy understands that we like to keep away from ourselves because so much of what we could discover threatens to be painful. We might find that we were, in the background, deeply furious with certain people we were only meant to love. Or we might learn that though we wanted to be decent, law-abiding people, we harboured fantasies that went in powerfully deviant and aberrant directions. In order to hide our thoughts, we make use of a range of what psychotherapy calls ‘defence mechanisms’. We get addicted to something; we are addicts whenever we develop a manic reliance on something, anything, to keep our darker and more unsettling feelings at bay. We lie to ourselves by attacking and denigrating what we love – but haven’t managed to get. We dismiss the people we once wanted as friends, the careers we hoped one day to have, the lives we tried to emulate. We lie through a generalised cynicism, which we direct at everything and everyone so as to ward off misery about one or two things in particular. We say that all humans are terrible and every activity is compromised – in order that the specific cause of our pain not attract scrutiny and feelings of shame. We lie by filling our minds with impressive ideas, which blatantly announce our intelligence to the world but subtly ensure we won’t have much room left to rediscover long-distant feelings of ignorance or confusion – upon which the development of our personalities may nevertheless rest.

A defence is a response to fear, so an important part of the work of therapy is to create an environment in which we feel sure we won’t be attacked in our tender spots so we can finally risk examining our defences – rather than deploying them.

Splitting and Integration

Melanie Klein (1882 – 1960) was a Viennese psychotherapist who studied the deep-seated human tendency for splitting. Throughout life, but particularly in infancy, we’re confronted by frustrations and disappointments. We are let down and hurt by people we long to rely on. These frustrations can feel so intolerable, we defend ourselves by splitting people into the purely good and the purely bad. We denigrate certain characters entirely so as to preserve a pure hope around others. Everyone that annoys us becomes evil, everyone who gratifies us is perfect. The therapeutic response to splitting is to gently move us towards what is known as integration. With the help of a therapist, we learn sympathetically to see why we made a split but then slowly and painfully start to acknowledge a more complex reality. A parent can be annoying in some ways yet loveable in others; someone can criticise us, without being mean or stupid; we ourselves can have many genuine failings and yet still be quite good people. Splitting is often observed in romantic life, where we can move from person to person, always falling deeply in love and then abruptly detaching ourselves when we discover a flaw. Therapy teaches us to tolerate the ambivalent nature of everyone – not least ourselves. We can admit we’re wrong without feeling too humiliated. We can properly apologise and and accept the apologies of others. The world becomes a little greyer, but also a lot more bearable.

Breakdown

Having a breakdown is not, in the eyes of psychotherapy, the problem it often seems like to the rest of the world. A breakdown is not merely a random piece of madness or malfunction, it is a very real – albeit very inarticulate – bid for health. It is an attempt by one part of our minds to force the other into a process of growth, self-understanding and self-development which it has hitherto refused to undertake. If we can put it paradoxically, it is an attempt to jumpstart a process of getting well, properly well, through a stage of falling very ill. The reason we break down is that we have not, over years, flexed very much. There were things we needed to hear inside our minds that we deftly put to one side, there were messages we needed to heed, bits of emotional learning and communicating we didn’t do – and now, after being patient for so long, far too long, the emotional self is attempting to make itself heard in the only way it now knows how. It has become entirely desperate – and we should understand and even sympathise with its mute rage. What the breakdown is telling us above anything else is that it must no longer be business as usual – that things have to change or (and this can be properly frightening to witness) that death might be preferable.

In the midst of a breakdown, we often wonder whether we have gone mad. We have not. We’re behaving oddly no doubt, but beneath the surface agitation, we are on a hidden yet logical search for health. We haven’t become ill; we were ill already. Our crisis, if we can get through it, is an attempt to dislodge us from a toxic status quo and an insistent call to rebuild our lives on a more authentic and sincere basis.

Avoidant Attachment

The English psychotherapist, John Bowlby (1907-1990) was the prime force behind the development of ‘attachment theory,’ the study of the way in which children form an emotional bond with their carers, which becomes the basis upon which they later manage relationships as and with adults. As part of his work, Bowlby identified an ‘avoidant’ attitude in which we habitually push away or act coldly towards people who, in fact, we would very much like to be close to. We do this, Bowlby argued, because our capacity to trust others was damaged in childhood and we learnt a technique of shutting down engagement as a way of preserving our integrity. Without realising we are doing this (because we have forgotten the past), whenever problems arise with a lover, we are so afraid that we may be unwanted, we disguise our need behind a facade of indifference. At the precise moment when we want to be close, we say we’re busy, we pretend our thoughts are elsewhere, we get sarcastic and dry; we imply that a need for reassurance would be the last thing on our minds. We might even have an affair, the ultimate face-saving attempt to be distant – and often a perverse way to assert that we don’t require a partner’s love (that we have been too reserved to ask for).

Therapy offers us the chance to recognise the pathos of what we’re doing and to return and treat the original wound. For Bowlby, the therapist enacts a new and better model of relating: one in which we are carefully listened to and our tentative revelations are warmly received and from this we derive a life-saving lesson: that it is in fact possible to make demands on someone we love.

Anxious Attachment

Anxious attachment refers to a pattern of relating to lovers whereby, when there is difficulty, we grow officious, procedural and controlling. We feel our partners are escaping us emotionally, but rather than admitting our sense of loss, we respond by trying to pin them down administratively. We get unduly cross that they are eight minutes late, we chastise them heavily for not having done certain chores… All this rather than admit the truth: ‘I’m worried that I don’t matter to you…’

The goal isn’t really to be in charge all the time, it’s just that we can’t admit to our terror at how much we need the partner. A tragic cycle then unfolds. We become shrill and unpleasant. To the other person, it feels like we can’t possibly love them anymore. Yet the truth is we do: we just fear rather too much that they don’t love us. If this harsh, graceless anxious behaviour could be truly understood for what it is, it would be revealed not as a rejection, but as a strangely distorted – yet very real and very touching – plea for tenderness.

John Bowlby didn’t see this unfortunate pattern as fixed. In therapy, we can play out our desire to control the therapist, fail at this, and yet still witness that we do, week by week, retain the therapist’s affection – which can lend us a confidence we can take back out into the rest of life. We learn a lesson that our childhoods may have denied us: that someone we can’t control can still be loyal to our needs.

Feeling rather than Thinking 

Thinking is hugely important – but on its own, within therapy, it is not the key to fixing our psychological problems. There’s a crucial difference between broadly recognising, for example, that we were a bit shy as a child and re-experiencing, in its full intensity, what it was like to feel cowed, ignored and in constant danger of being rebuffed or mocked. Or we might know, in an abstract way, that our mother wasn’t much focused on us when we were little. But it’s another thing entirely to reconnect with the horrific feelings we had when we tried to show her something we loved or tell her of a deep upset and she wasn’t interested in the least.

Therapy builds on the idea of a return to live feelings. It’s only when we’re properly in touch with feelings that we can correct them with the help of our more mature faculties – and thereby address the real troubles of our adult lives.  Oddly (and interestingly) this means intellectual people can have a particularly tricky time in therapy.

They get interested in the ideas. But they don’t so easily recreate and exhibit the pains and distresses of their earlier, less sophisticated selves, though it’s actually these parts of who we all are that need to be encountered, listened to and – perhaps for the first time – comforted and reassured. Therapy demands that we not try to be too clever and accept the need to feel lost and confused.

The Super-ego

‘Super-ego’ is an unfortunate sounding translation, made by Freud’s first English translator James Strachey, of the more forthright and elegant German term ‘Uber-ich’, which means quite literally the ‘Over-I’. By the ‘Over-I’, Freud meant an aspect of the mind that sits over our ordinary day to day consciousness, judges our behaviour and is the guardian of social norms and morality.

The Over-I is an internalisation of actual people we’ve encountered in our early lives, typically parents, and especially fathers. Without noticing the process, we incorporate the voices we have heard around us so that we end up speaking to ourselves in much the same way as others spoke to us. Sometimes, the voice of the Over-I can be encouraging and paternal. We tell ourselves to give it another go and that our superiors will understand and forgive us. But then at other points, our Over-I can be utterly ruthless and punitive. It can be moulded by the most impatient, hostile and critical voices we’ve ever heard. In relation to our failures, it will castigate us mercilessly and leave us with a sense that we truly don’t deserve to exist. It can – at the extreme – push us to suicide.

A lot of the time, our Over-I is way more critical than reality would warrant. It can make us feel like the worst sort of criminals, even though our actual errors are relatively minor. It can make us feel disgusting about sex and very guilty around pleasure in general.

One of the large aims of therapy is to re-educate the Over-I. We can replace the hectoring, unfair, crushing Over-I we’ve built up from childhood with the far more judicious voice of the therapist. We learn to speak to ourselves (and by extension others) in the gentle, helpful way the the therapist spoke to us. We retain a conscience, but we no longer have to feel we’re worthless or (a tragically common sensation) should be dead.

The True and the False Self

This psychological theory of the True and the False Self is the work of the English psychoanalyst Donald Winnicott. We are all, in Winnicott’s eyes, born with a true self. The baby’s true self isn’t interested in the feelings of others, it isn’t socialised. It screams when it needs to – even if it is the middle of the night or on a crowded train. It may be aggressive, biting and – in the eyes of a stickler for manners or a lover of hygiene – shocking and a bit disgusting. Winnicott added that if a person is to have any sense of feeling real as an adult, then they have to have enjoyed a period of letting the True Self have its way. Gradually, a False Self can develop, which has a capacity to submit to the demands of external reality (school, work etc.). Winnicott was not a thorough enemy of a False Self; he simply insisted that it belonged to health only when it had been preceded by a thorough earlier experience of an untrammelled True Self.

Unfortunately, many of us have not been given a chance to be our True Selves. Perhaps mother was depressed, or father was often in a rage, maybe there was an older or younger sibling who was in a crisis and required all the attention. The result is that we will have learnt to comply far too early; we have become obedient at the expense of our ability to feel authentically ourselves.

Therapy gives us a second chance. We are allowed to regress before the time when we started to be False, back to the moment when we so desperately needed to be true. In the therapist’s office, safely contained by their maturity and care, we can learn – once more – to be real; we can be intemperate, difficult, unconcerned with anyone but ourselves, selfish, unimpressive, aggressive and shocking. And the therapist will take it – and thereby help us to experience a new sense of aliveness which should have been there from the start. The demand to be False, which never goes away, becomes more bearable because we are regularly being allowed, in the privacy of the therapist’s room, once a week or so, to be True.

Sublimation

The term ‘sublimation’ has it origins in medieval science, where it names the suggestive process in which solid matter is transformed into a gas, as when a heated lump of coal bursts into flame. It was much associated with the idea of something base and unimpressive being transformed into something wonderful and almost spiritual.

In therapy, ‘sublimation’ is extended to cover the way a usually unhelpful impulse can be converted into a noble ambition. So for example, aggressive instincts to kick or hit can be channeled into sporting prowess; the desire to show off can become the basis of a capacity to address an audience on something of real worth to them; a feeling that no one listens can give birth to a literary career. Freud was particularly interested in the way in which artists turn the often chaotic reality of their lives into something of public use. The artist or writer adapts their ‘private flight from reality’ into the creation of public objects that move, interest and inspire other people. The French psychoanalyst Jacques Lacan focused on the sublimation that can turn a thwarted desire for sex into romantic art; the poetry of love, he argued, flourishes when sex is forbidden.

Sublimation is one of the goals of therapy. The therapist knows that not all our wishes can come true, but this doesn’t have to mean despair on an ongoing basis. We can redirect our problematic drives in as constructive a way as possible. It may not be art we’re going to make, but we should, with the help of therapy, find some way of turning disappointment into a consoling, redemptive activity.

Compliance

Compliance, meaning bowing to the demands of someone else, normally has a good name. It suggests a dutiful, pliant nature. It sounds worthwhile having a compliant colleague, friend or lover. We tend to assume all is well with compliant people. They don’t pose immediate problems, they keep their bedroom tidy, do their homework on time and are very polite. But the very real secret sorrows – and difficulties – of the compliant person are tied to the fact that they behave in this way not out of choice, but because they feel under irresistible pressure to do so. Eventually, under pressure, these compliant people may manifest some disturbing symptoms: secret sulphurous bitterness, sudden outbursts of rage and very harsh views of their own imperfections.

The compliant person typically has particular problems around sex. As a child, they may have been praised for being pure and innocent. As an adult the most exciting parts of their own sexuality strike them as perverse and disgusting and deeply at odds with who they are meant to be. The compliant person is likely to have problems at work as well. They feel too strong a need to follow the rules, never make trouble or annoy anyone. But almost everything that’s interesting or worth doing will meet with a degree of opposition and will seriously irritate some people. The compliant person is condemned to career mediocrity and sterile people-pleasing.

The desire to be good is one of the loveliest things in the world, but in order to have a genuinely good life, we may sometimes need to be (by the standards of the compliant person) fruitfully and bravely difficult. Therapy is an arena in which we can safely get in touch with our more usefully rebellious, ‘difficult’ and self-assertive sides.

Mourning

In 1917, Freud published an essay called Mourning and Melancholia. In it he made a distinction between two ways of feeling sad. In the first, mourning, we suffer a loss and consciously recognise that we have done so. We then enter a period where everything seems worthless and deadening and where we think continually of the person, or ambition or hope we have lost. But eventually, mourning comes to an end. We realise that the world, despite the absence of something deeply good we once knew in it, is still worth enduring and exploring.

The second state of sadness, melancholia, is far more open-ended and far more difficult to handle. Here too, we have suffered a loss and the world seems sad and dispiriting. The problem is that we are not consciously aware of what we have lost. The loss is too difficult for us to factor in, perhaps it took place before we understood our situation properly or maybe it feels like an affront to our self image. We might have forgotten how much we miss someone; we might be repressing our love for an ambition we’ve had to surrender; we can’t bear to think how much a parent has hurt us.

In such circumstances, we are no longer merely sad, we are numb. We cannot pinpoint any specific source of grief and therefore everything becomes hopeless and without meaning. We are depressed.

The goal of therapy is to try to reunite our sad feelings with the forgotten events that will, somewhere in the past, have triggered them. With the therapist there to comfort us, we may feel braver to explore tragedies that have hitherto been too large for us to be able to feel. We realise that we aren’t sad about everything; simply about a few things it felt unbearable to confront. Therapy knows that, when we can cry over something specific, we are well on the way to recovery.

‘Good Enough’

The English psychoanalyst, Donald Winnicott, who specialised in working with parents and children, was disturbed by how often he encountered in his consulting rooms parents who were deeply disappointed with themselves. They felt they were failing as parents and hated themselves intensely as a result. They were ashamed of their occasional rows, their bursts of short temper, their times of boredom around their own children and their many mistakes. What struck Winnicott, however, was that these people were almost always not at all bad parents. They were loving, often very kind, very interested in their children, they tried hard to meet their needs and to understand their problems as best they could. As parents they were – as he came to put it in a hugely memorable and important phrase – ‘good enough.’

Winnicott was putting a finger on a crucial issue. We often torment ourselves because we have in our minds a very demanding – and in fact impossible – vision of what we’re supposed to be like across a range of areas of our lives. This vision doesn’t emerge from a careful study of what actual people are like. Instead it’s a fantasy, a punitive perfectionism, drawn from the cultural ether.

With the phrase ‘good enough’, Winnicott wanted to move us away from idealisation. Ideals may sound nice, but they bring a terrible problem in their wake: they can make us despair of the merely quite good things we already do and have. By dialing down our expectations, the idea of ‘good enough’ resensitises us to the lesser – but very real – virtues we already possess, but which our unreal hopes have made us overlook.

A ‘good enough’ life is not a bad life. It’s the best existence that actual humans are ever likely to lead.

The Goals of Therapy

Therapy cannot make us happy every day. But its benefits are tangible nevertheless. After a course of therapy, we’ll stand to feel substantially freer. We’ll realise that what we had believed to be our inherent personality was really just a position we had crouched into to deal with the prevailing atmosphere. And having taken a measure of the true present situation, we may accept that there could – after all – be other, sufficiently safe ways for us to be.

Also: we had learnt to be ashamed and silent. But the therapist’s kindness and attention encourages us to be less disgusted by ourselves and furtive around our needs. Having once voiced our deeper fears and wishes, they can become ever so slightly easier to bring up again with someone else. There may be an alternative to silence.

And we can be more compassionate: we will inevitably, in the course of therapy, realise how much we were let down by certain people in the past. A natural response might be blame. But the eventual, mature reaction (building on an understanding of how our own flaws arose) will be to interpret their harmful behaviour as a consequence of their own disturbance. The people who caused our primal wound almost invariably didn’t mean to do so; they were themselves hurt and struggling to endure. We can develop a sad but more compassionate picture of a world in which sorrows and anxieties are blindly passed down the generations. The insight isn’t only true to experience, holding it in mind will mean there is less to fear. Those who wounded us were not superior, impressive beings who knew our special weaknesses and justly targeted them. They were themselves highly frantic, damaged creatures trying their best to cope with the litany of private sorrows to which every life condemns us.

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