In psychotherapy, it can be useful to work from a model. It gives both participants—person in therapy and therapist—a common language and system of references. Naturally, different people are interested in different things. One of my colleagues is very taken with baseball, and derives complex and responsive imagery from that game. Several others get great results making use of popular movies and songs, and folks who work from a religious orientation find that scriptural texts can be applied in profound ways to the material they sit with. For me, mythology and fairy tales frequently provide new ways to think about things.

Because I’m drawn to fairy tales, I tend to notice when I hear one being told by the person I’m sitting with. If it’s one I already know, Cinderella or All-Kinds-of-Fur or the Golden Goose, I’ll point this out. But often it’s one I’d never heard. When that happens, I use a combination of summarization, amplification, and reflection to tell them the tale I’ve just heard them tell.

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These fairy tales or segments of tales are artifacts of this particular therapist’s response to a particular person’s material. They’re subjective. For this reason, I want to be mindful that I’m not telling someone my fairy tale, but that, in fact, it’s theirs. My intention is to always follow up such a telling with questions. Does this feel right to you? Does it seem useful to our work toward your goals? Does it click? And, of course, not everyone likes fairy tales; not everyone has to. As always in therapy, when something doesn’t work we set it aside, and when it does we go with it.

In the discussion that follows, names have been changed and personal identifiers have been screened out in order to protect confidentiality.

The Story of Myra

Many of the people I work with want to change their relationship to alcohol or drugs, or to various behaviors that were originally rewarding but have since become problematic or compulsive. Myra is in her mid-40s, married and with a steady-if-unsatisfying job. She struggles with alcohol and substance use, with initiating numerous affairs, and with impulsive online purchases and debt. She says these behaviors result in significant levels of anxiety, shame, and guilt. For the first many sessions, we sit with the story of what she’s doing, how she doesn’t like it, and how difficult it is to do more than temporarily interrupt it before starting it up again. One afternoon, her material elicited the following fairy tale.

A woman is walking down the road with disappointment. Emptiness follows at a distance. The woman says to disappointment, “I need something. Maybe I’ll start a new affair.” “Another one?” disappointment says with a deep sigh. This isn’t very encouraging. “Well, maybe I’ll stop and have a few drinks,” she suggests. “And after that get some cocaine.” “Great,” says disappointment. “Another weekend down the drain.” “Well, then maybe I’ll go online and do some shopping,” the woman offers. “I’m sure to find something nice.” “You’ll find crap,” disappointment says flatly. “You always do.”

They come to a crossroads. The woman, not sure which road to take, stops. This gives emptiness a chance to catch up with them. By this time, the woman is tired of talking to disappointment. She turns to emptiness and says, “What do you think I need?” “I don’t know,” says emptiness. “But if you can stand my company, I’ll help you look.”

My intention is to always follow up such a telling with questions. Does this feel right to you? Does it seem useful to our work toward your goals? Does it click?

This moves us into a new stage of our work. Myra focuses on her experience of emptiness and the ways in which she had tried to fill it without having to be aware of it. It’s her repeated disappointment that drew her attention to this and originally brought her to therapy. We consider that if she can stay with the unpleasant feeling of emptiness and not do anything about it, she can increase her tolerance of it. Myra is willing—and courageous. She stays with the uncomfortable feelings. We develop a 10-minute meditation practice for her, to make her sitting a little more structured. As her tolerance of it increases, she reports that emptiness acts less like a driver for her behaviors. They seem to become less essential, and she doesn’t turn to them so readily. She begins to count days and then months of sobriety. We note she is not developing new avenues of activity, such as gambling or workaholism. The empty feeling proves to be survivable.

Later on, we notice that because she can tolerate the presence of emptiness, it acts as a support when she begins to identify and find ways to act more in accordance with her values. She begins to consider a career change, recommits to the relationship with her husband, and becomes more available to her family. Later still in our work together, we find that emptiness is not just helpful but essential in helping her explore her authentic spiritual life, which had gotten lost due to an early disillusionment with organized religion. From being an unconscious driver for problematic behaviors, emptiness became something like a sacred space in her life, in which she could consider and then meet with her highest values. It’s not that her life has become perfect. But what was originally a source of suffering, from which she fled, has become a support in making a more meaningful life.

The Story of Bill and Jay

Bill and Jay come for couples counseling. They’re both in their early 30s, employed in different sectors of the film industry. Jay describes Bill as cold, distant, and having a cruel sense of humor that he uses when Jay wants to get close. Bill notes that Jay is needy and uses emotional displays to get what he wants. I notice that Bill is adept at using figures of speech and sliding definitions (giving the same term a different meaning at the beginning of a conversation from the one it is given at the end) to evade threat. He describes being parentified along with his two brothers by their mother following her divorce from their father. He tells me how challenging it was to take care of his mother as a boy and adolescent, that both approaching her for support and not approaching her for support were negatively reinforced, that trying to take care of her and failing and not trying to take care of her were both punished by outbursts of rage. Part of my response to Bill’s narrative is the opening segment of what appears to be a longer fairy tale.

Three brothers once lived in a cottage in the forest. One day the oldest brother said, “I’m going out into the world to seek my fortune.” He set out along the path. He hadn’t gotten far when he found the way barred by an old woman, who said to him, “Shall I help you or shall I not help you?” “I don’t need anyone’s help. Don’t help me,” said the oldest brother. “Then you’ll get no help from me,” cried the old woman, and she knocked him off the path and into the forest.

The next day, the second brother also set off to seek his fortune. He hadn’t gone far when he found the way barred by an old woman, who said to him, “Shall I help you or shall I not help you?” “I need all the help I can get. Please help me,” he said. “Here’s your help then,” cried the old woman, and she knocked him off the path and into the forest.

Finally, the third brother set out. He wondered why he had heard nothing from his brothers. He hadn’t gone far when he found the way barred by an old woman, who said to him, “Shall I help you or shall I not help you?” “What do you think?” countered the third brother. “It could go either way,” said the old woman. “Well then, there you go,” said the third brother. The old woman stepped aside, and he was able to continue on his way.

With Bill’s cautious approval of this tale (“Yeah, sounds a little familiar”), we’re able to use it to identify and articulate his intense ambivalence about relationships. He feels the need for closeness, but no approach to it seems safe. He’s learned to use irony and wordplay to keep his sense of being at risk at manageable levels. These skills allowed him to maintain a relatively stable relationship with his mother, unlike his brothers, who in his words “were always getting eaten alive or eighty-sixed.” But the same set of skills doesn’t seem as useful in his relationship with Jay. Gradually, he becomes better able to take in feedback from Jay about the impact of these once highly useful skills on their relationship. He also begins to develop the ability to set them down when he chooses because he has become more conscious of what and why they are.

I believe in therapy. Yet sometimes, the concepts and the language seem best able to address us at our higher levels of functioning. And that’s not always where the issues that trouble us are found. Fairy tales, perhaps because we first heard them at earlier stages of our development, can engage us at those deeper levels, where we listen to the story in order to find out what happens next.

All of us become distracted sometimes. So many things compete so effectively for our attention. Multitasking is one response to this. But studies find that while multitasking carries an emotional reward—we feel more productive—it’s actually linked to lower levels of accomplishment and productivity. We’re going to look at a practice called bracketing as a more effective response to distraction.

Bracketing is a simple, three-step process. The first step is to acknowledge what’s distracting you. The second is to deliberately set it aside for the moment. And the third is to return to it later in order to address it.

Bob (not his real name) works as a computer programmer. His department is under a lot of pressure. Unfortunately for Bob, his manager makes use of everyone’s anxiety to keep them working hard. People get called on the carpet and sometimes let go. As a result, a lot of Bob’s colleagues are withdrawn and irritable, and work is a lot less safe than it used to be. Bob is frequently engaged in low-level surveillance. It’s a normal response to dangerous surroundings—think of being in the forest at night, where you’re alert to any noise in case it’s a predator. But as a result, Bob is distracted from the very work he’s pressured to complete. Simple problems are hard to solve. He wonders if he’s lost his edge, if he’s even in the right field.

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To make things even rougher, Bob’s 15-year-old daughter, Madison, has started getting into trouble at school and he’s not sure why. She seems like a happy, well-adjusted kid, but maybe he’s missing something? Is it just a phase they all go through or is it a warning sign? Should he schedule a meeting with the school principal, or should he take her to see a therapist?

Bob and Vicky, his wife, have started having arguments about how to respond to Madison, as well as other issues. He’s begun wondering if his marriage is in trouble.

Often when Bob is writing programming code for one of his assignments his thoughts begin revolving around his daughter, especially if he’s happened to hear a story on the news about high school students. He can find himself having a brief fantasy conversation with Vicky about what the family needs, going over their last disagreement. Or he wonders if he’s in the right line of work, if it’s too late to start something different.

These lapses aren’t long, not usually more than two or three minutes. But they’re enough to distract him from what he’s doing. When he notices what’s happening, he makes a partial effort to suppress his thoughts. “I’ve got to focus,” he tells himself sternly. And then he begins thinking about how much pressure he’s under to get this current project to QA for testing, and how he can’t afford to have them send it back to him to fix something.

Bob doesn’t meet the criteria for attention-deficit hyperactivity, according to the Diagnostic and Statistical Manual. For one thing, he’s able to reflect on his own behaviors. For another, his symptoms of distraction didn’t start before he was 12, and they are clearly related to his current situations. Still, it would be helpful if Bob had some way of clearing his thoughts.

This is where bracketing comes in.

As Bob notices he’s become distracted, he briefly acknowledges what’s distracting him. Worry about Madison. The relationship with Vicky. Pressure at work.

Acknowledging—allowing yourself to notice something—is a key component of mindfulness practice. Buddhist nun and mindfulness meditation teacher Pema Chödrön describes this coming back to the present as recognizing what’s true in the moment without judging it.

Having acknowledged these issues, Bob sets them to one side. Sounds easy, doesn’t it? But how do you actually practice it?

When we set something aside, the implication is “for the time being.” We plan to come back to it at some point. My favorite show is about to come on, so I’ll finish doing the dishes after I watch it. It’s starting to rain; I’ll finish the yardwork tomorrow.

How Bracketing Differs from Procrastination

The difference between setting something aside and procrastination is in commitment to the follow-through. I intend to get back to the dishes when my show is over, and when the closing credits have finished I go back out to the kitchen. When the rain stops, next day I resume mowing the lawn.

This temporary setting aside is also different from thought suppression, or “trying not to think about it.” Some studies show that thought suppression actually reinforces the material we’re trying to suppress, which reminds us of the old saying, “Throw the devil out the door and he comes in the window.” Remember that the first step of this practice is to let yourself become fully aware of what’s claiming some of your attention.

This is the heart of this practice. This is what makes bracketing increasingly effective—when we come back to what we set aside. That we make a commitment to completing our own personal work.

Therefore, we schedule a specific time when we can give our attention to what’s distracting us. Bob tells himself, “I’ll concentrate on Madison when I get home from work.” He also decides to think about the situation at work when he takes his break. And he and Vicky can talk over dinner tonight—not just about Madison, but about their own relationship.

At this point, Bob hasn’t solved his problems, but he has scheduled specific times to engage with them.

The third step is to keep these appointments.

On his afternoon break, he strikes up a conversation with a man in the next cubicle. The two of them decide to take a walk and stretch their legs. As they walk, they talk about how tense it’s getting in the office. When Bob gets home, he sits down with Vicky and they decide to schedule a meeting with Madison’s principal before considering counseling. Later that evening, when Madison gets home, Bob makes a point of checking in with her. Nothing too intense—she’s not in the mood to talk. But he establishes that he will sometimes initiate contact for no reason other than contact.

This is the heart of this practice. This is what makes bracketing increasingly effective—when we come back to what we set aside. That we make a commitment to completing our own personal work. Consider that these issues wouldn’t come up as distractions if they weren’t important in the first place.

Bracketing Improves with Repetition

As with any practice, this one becomes more effective the more we repeat it. Put another way, we believe ourselves more as we keep our word to ourselves.

A recent article in the Harvard Business Review notes that the act of keeping promises to ourselves helps us be more fully realized versions of who we are. Carl Jung uses similar language in his concept of self—the organizing principle of both the conscious and unconscious areas of the psyche, or the “blueprint” of identity.

In this sense, keeping promises to ourselves is a way of communicating with the unconscious. The communication is, “You, the unconscious, are worthy of respect and I, the conscious ego, am worthy of respect.” The thought “I will” is increasingly experienced as believable, and the pressure from the unconscious that shows up as a distraction decreases.

Bob gets through the week and now it’s Sunday afternoon. He and Vicky are visiting Vicky’s sister. Everyone’s in the backyard relaxing while chicken sizzles on the barbecue. Sounds like a nice time, doesn’t it?

But Bob’s having trouble enjoying it because he’s thinking about work tomorrow. The thoughts are intrusive and keep pulling him into a fantasy version of tomorrow morning and away from the present moment, even though this moment of ease and refreshment is just what he needs. But it’s almost as if he can feel it all trickling between his fingers and disappearing, leaving nothing but the apparent reality of work.

So he brackets the intrusive thoughts. First he acknowledges to himself what’s distracting him. This time he doesn’t really need to schedule it for later, because tomorrow morning he’ll be on the road to the office by 6:45. But he makes use of the formality anyway. Although there’s nothing he needs to do to prepare for work, he mentally tells the office he’ll see it at 8 a.m., knowing he’ll keep that appointment. And then he returns to attending to the conversation, the sunlight, and the smell of chicken on the grill, which is making him hungry.

Sometimes Bob wakes up in the middle of the night. His thoughts turn to different topics and become more active, so it can be hard to get back to sleep. Rather than trying to distract himself, he practices bracketing. Acknowledging whatever is present in his thoughts, whether it’s a meeting he’s not looking forward to or a medical procedure he’s been putting off, he determines when he will return to it in order to give it his full attention. And in the morning, or later in the week, or Saturday, he follows through. Again, it’s this follow-through that strengthens the practice and increases its effectiveness.

We live in a culture that bombards us with claims. Sometimes the best way to assess such claims is by experiment. Try the three steps of bracketing—acknowledgement, setting aside, and then returning to the issue—as a tool against distraction in your own life.

References:

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington, D.C.: American Psychiatric Publishing.
2. Chödrön, P. (2012). Living Beautifully with Uncertainty and Change. Boston and London: Shambhalla.
3. Gielan, M. (2010). Why Keeping Your Promise is Good for YOU. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/lights-camera-happiness/201005/why-keeping-your-promise-is-good-you
4. Grabmeier, J. (2012). Multitasking May Hurt Your Performance, but It Makes You Feel Better. Ohio State University. Retrieved from http://researchnews.osu.edu/archive/multitask.htm
5. Jung, C. (1966). “Psychology of the Transference,” Collected Works, 16. Princeton, New Jersey: Princeton University Press.
6. Kibler, M. (2015). Treat Promises to Yourself as Seriously as Promises to Others. Harvard Business Review. Retrieved from https://hbr.org/2015/09/treat-promises-to-yourself-as-seriously-as-promises-to-others
7. Wenzlaff, R.M., & Wegner, D.M. (2000). Thought Suppression. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov

What’s sacred for you? Where is it found? For many of us, the idea of sacred space brings up images of cathedrals or mosques, Stonehenge, Angkor Wat, or the pyramids. These can be places separated from us by great distances and steeped in centuries of tradition, so getting to them is a journey. “Next year in Jerusalem,” we tell one another. Or we dream of making the Hajj to Mecca, or going on pilgrimage to Santiago or Lourdes. Such spaces can also be the houses of worship we go to once a week, for which we dress in special clothes, covering or uncovering our heads, possibly leaving our shoes at the door.

For others of us, the sacred is hard to find, or is something we feel we once had access to but no longer do. We get caught up—sometimes for years at a time—in the business of daily life. Technology provides us with increasingly sophisticated means to keep ourselves distracted. Or the practices that once offered access to the sacred may no longer do so.

In the following discussion, names have been changed and personal material has been screened out.

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Sacred space can mean what we set the space aside for, what we do while within it. Jim creates a memorial altar in his home. On top of a bookcase, he puts photos of people he loves who have died—his grandmother, his partner, his best friend. He keeps a candle burning there, and on their birthdays he sets out flowers or a cup of coffee.

Sacred can refer to what we feel when we enter the space. Benjamin, disillusioned with his church, goes into nature in order to feel he’s contained in something larger than he is, that will accept him no matter what. Janice writes her dreams down in a journal. When she sits down in front of her journal and opens it, she experiences feelings of calm and increased focus. Cathy goes on vacation to Istanbul and enters the Blue Mosque. Although a practicing Lutheran, she finds that looking up into the ornately tiled, domed ceilings produces a sense of weightlessness and freedom from worry.

Bob belongs to a writers’ group. Every two weeks, the group gets together at a different member’s home. They read and critique each other’s work. Although “sacred” isn’t the way he describes this (and, in fact, is a term he objects to), Bob says writing is the most important thing in the world to him—“what he was born to do.”

Kyle meditates before coming to therapy. He sees his therapist’s office as the place where he meets what is most true in his life, sometimes for the first time.

For Alice, it’s her mother’s house. For Karen, it’s wherever her 10-year-old daughter is. Both women struggle with recovery, but don’t use in the spaces where they locate the sacred.

If we give the sacred its own space, do we increase the chances we will recognize it when it greets us?

The sacred is what grounds us in meaning. It can include us, as when we recognize that we are part of or one with the universe. And it can gently put us in our place, as when we slowly realize our ego is not the most important content of that universe. It can be deeply personal, as in meeting rooms where we establish or affirm our relationship to a higher power. And it can be an experience of merger, as when we look up and out into the stars at night. Sharon Olds, in her poem Wilderness, describes sleeping in the desert and looking up at the stars. She feels suddenly “… as if/not only the earth while I am here, but space/and death and existence without me, are my home.”

Sometimes we know it for the first time by responses that surprise us. Fran, hiking, comes into a grove of California oaks in the hills over the ocean. She says, “I suddenly heard the silence for the first time. It seemed to go on forever.” For Steve, the experience came as he was driving through Death Valley. “I was going to meet some friends,” he says. “But I drove more and more slowly, until I just had to pull over and stop. I’d never seen anything like it—white sand dunes, colored cliffs that looked like sculptures, and no one else around anywhere. I felt connected to the earth for the first time since I was a kid.”

Our own bodies can provide such a space. Tom describes an experience late one Christmas Eve that the manger where the Christ child was about to be born was his own body. This original intensity faded, but he was left with a lingering and resonant awareness of what he put into his body in terms of food and recreational substances, and of how he took care of his health.

Sacred space can mean leaving room in our lives for something to be sacred—if not now, then someday. Perhaps as simply as by acknowledging we don’t know all the answers. Or that our answers might not be the ultimate answer, might merely be rest stops along the way.

Sacred space can as well act as a holding place in times of uncertainty or transition. It can be a system of meaning, rather than a literal place.

According to Erik Erikson, in the first stages of life we’re engaged in developmental tasks related to basic psychological functions, such as establishing trust and self-efficacy, and in developing a stable sense of identity. Another way of saying this is that we’re involved in consolidating the ego, the sense of “me” present in experience that makes it “my experience.” This time of life is a little like the Ptolemaic view of the universe, where everything—sun, moon, and stars—seemed to revolve around the earth. That’s us at the center of everything, and whatever happens is about us.

Often around the midpoint of life, we start picking up hints that we’re not going to increase and live forever. In Once Upon a Midlife, Allan Chinen describes how shocking this realization can be, accompanied by anxiety and grief. Especially at such a point, a sense of the sacred can act to ground us. As the fact of “me” begins to lose its apparent guarantee of continuance as well as its centrality (because how central to the universe can I be if I’m not going to be around?), the universe is less and less about me. But perhaps I become more and more about something else, something larger than me.

Carl Jung notes that, in this way, the ego becomes relativized and the process of individualization—becoming wholly who we were meant to be—is accomplished. We begin to live in a system of meaning where the earth revolves around the sun, the sun rotates through the galaxy, and the galaxy itself follows its own great attractor. Our experience then seems to participate in larger movements, whether those are our family or a cause in which we believe or humanity in general, a spiritual pathway or the life of the universe.

Ray tells me that if you go to the mosque to pray 40 mornings in a row, you will be able to meet Khid’r, a mystic figure in Islam, anywhere—in the market, on the street. Barbara tells me she sets a place at the Seder table every year for Elijah, who will someday return from his sojourn in heaven, so why not here, why not now? Beth tells me that when you practice Zen meditation, anything—even a drop of water falling into a bucket—can suddenly herald a glimpse into the nature of reality.

Here, we have the idea of ordinary daily space—and that includes the freeway where we’re caught in traffic, or the area where we keep our trash cans—suddenly converting to sacred.

A related idea is that all space is sacred already. Connie tells me a quotation from the Gospel of Thomas, where the figure of Jesus tells his disciples, “The kingdom of the father is spread out on the earth, and nobody recognizes it.”

If I’m already in a sacred space, what happens to my anxiety that is sometimes so intense? My craving for alcohol? The anger I feel at my partner when we disagree over small matters?

Sacred space can mean leaving room in our lives for something to be sacred—if not now, then someday. Perhaps as simply as by acknowledging we don’t know all the answers. Or that our answers might not be the ultimate answer, might merely be rest stops along the way. The possibility that even though something doesn’t seem to make sense to me, it still might make sense. That I am included in a great web of meaning, at home, wherever I am, with no chance of getting lost.

References:

1. Chinen, A. (1992). Once Upon a Midlife: Classic Stories and Mythic Tales to Illuminate the Middle Years. New York: Putnam Publishing Group.
2. Erikson, E. (1980). Identity and the Life Cycle. New York: Norton.
3. Jung, C. (1969). The Structure and Dynamics of the Psyche, Second Edition. Princeton, NJ: Princeton University Press.
4. Olds, S. (2002). The Unswept Room. New York: Alfred A. Knopf.
5. Robinson, J., Editor. (1978). The Nag Hammadi Library. New York: Harper and Row.

In a previous article, we looked at the role initiation ceremonies play in a culture, and how they help us detach from an outgrown identity and move into one more highly adapted to the present.

In traditional cultures, these ceremonies follow a strict protocol. First communion uses a basic format, and so do bat/bar mitzvahs. Even a bachelor stag party follows a certain sequence of ideas.

For most of us, the transition from midlife into old age isn’t provided with much structure. On the downside, this means it might not be observed or navigated. But on the upside, this leaves a lot of room for an individual experience of initiation. Psychotherapy is a practice in our culture that focuses on the individual. In what follows, we’re going to look at one man’s initiation from midlife to old age. (Names have been changed.)

Howard comes to therapy for relief from depression. He’s in his 70s, burly but fit and well-dressed. During the initial interview, he describes feelings of hopelessness, loss of pleasure, and irritability. His affect—the rise and fall of emotion as he speaks—is mild, but his mood (the “background” feeling) is irritable, not bitter so much as sour, with a sense of disappointment. I ask him if there have been any changes in his life recently. For instance, has he lost anyone? No, he says, not lately, though in the 1980s and ’90s his circle was hit pretty hard by HIV/AIDS. Then he laughs humorlessly and says, “I wouldn’t mind a change, though, to tell you the truth.”

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He tells me he neither recognizes nor appreciates the old man he sees in the mirror. He describes his distaste at noticing age spots, at the continuing loss of skin tone. “I know I’m not a kid anymore,” he asserts, as if I’d accused him of this. “But I still feel like I’m in my 50s.” What are his 50s, I ask. “Like I should still be able to do things. Get up and get out. Meet someone new. But whenever I go out, it’s like I’m invisible.”

When Howard says he can’t believe he’s old, he seems to really internalize it. My impulse is to say, “You’re only as old as you feel,” but I don’t. Instead I sit with curiosity about why I would feel impelled to “rescue” him from old age. I ask him what “old” is. He tells me. It’s material I’ve heard before, and perhaps you have, too: old people can’t, old people don’t.

It’s a description of aging that’s prevalent in our culture, almost cartoon-like because it seems to flatten people out so they’re not quite real. Old age is adjacent to death, so it seems. And even though we don’t know what death is, our fear of it informs all of our other fears. No wonder so many of us avoid recognizing ourselves as old, and feel distress when we do. In a culture characterized by a fear of death, old age can be seen as a stigma—a sign that an individual has beliefs, qualities, or behaviors counter to the culture, and therefore threatening to it. Which might account for Howard’s experience of feeling invisible.

We begin by addressing some of the myths of aging. The first one we tackle is about declining sexuality in both men and women. In Geriatric Mental Health Care, Gary J. Kennedy, MD, notes that “the continuance of sexual activity into late age depends on the life pattern of each person.” Acceptance of a perceived inevitability of loss is linked to both loss of libido and even bodily changes. In How We Die, Anne Karpf cites a study on memory function in aging American and Chinese subjects. The study findings indicate that not only did the Chinese subjects do better on memory testing than their American counterparts, but they performed better than young Chinese adults. The researchers associate these findings to the fact ageism is less prevalent in China than in the United States. Howard and I discuss the idea of self-fulfilling prophecies.

Ageism is the idea that old age will be a mirror image of infancy. In the first stages of development, we acquire skills in sequence—language, mobility, continence, to name a few. Ageism suggests that all of us will, sometime before the end of life, lose those skills along with many others, and that anyone displaying signs of age is experiencing this loss of integrity. I find that Howard has a history of resisting prejudices, including internalized prejudices. I enlist this in our work together.

I ask him about meaningful experiences. This starts a life review—piecemeal at first, but gradually we get a chronology established. We don’t hear about the violent disagreements with his father when he was in his mid-teens, and that were the reason he left Illinois for the west coast, right away. Instead we start with his career as a counselor in a parole office that is both a source of pride and loss for him now in retirement. But eventually we come to his partnership with Don, which ended with Don’s death a decade ago, and to his marriage with Karen when they were both in their 20s, and their two children. Over many sessions, we put together a narrative that extends through seven decades, and that despite having some unsolved mysteries to it—what life doesn’t?—holds together so that meaning can be clearly observed.

One of the effects of such a review is that Howard becomes more grounded in his life—not just its events but its duration. There’s not so much of a disconnect between his actual age and his ownership of that age. He’s just a little bit less inclined to wish it away. For better and for worse, he’s related a history that requires 70-plus years for its unfolding.

As well, this life review places Howard’s own life into the context of his age cohort, and the events which shaped them and which they shaped in turn. Some of these he participated in literally, such as protests against the Vietnam war and his advocacy for ACT UP. His participation in others events is more symbolic but no less real, such as the moon landing and reunification of Germany. We find resources of accomplishment and pride here. In Identity and the Life Cycle, Erik Erikson describes the developmental tasks of later adult life as shifting allegiance from self and our small group to a larger field (“mankind, my kind”). As Howard considers the impact on history of his age cohort—whose accomplishments both include and extend beyond his personal ones—he has the opportunity to locate himself inside and identify with larger movements of life.

Old age is adjacent to death, so it seems. And even though we don’t know what death is, our fear of it informs all of our other fears. No wonder so many of us avoid recognizing ourselves as old, and feel distress when we do. In a culture characterized by a fear of death, old age can be seen as a stigma—a sign that an individual has beliefs, qualities, or behaviors counter to the culture, and therefore threatening to it.

During this stage, I encourage Howard to bring in photographs of meaningful others, and especially of his younger selves. As the conversation grows more intimate, we give names to the earlier versions of Howard. The slim, long-haired teenager is the Poet. The mustached thirty-something exploring a new sexual identity is Robert Redford. The bearded man demonstrating with his younger colleagues at an ACT UP protest is Papa. We marvel at the way one identity succeeded another, taking its turn to be lived. We open up and sit with the interesting problem that even though these identities are no longer the case, they will always be true. Howard is no longer the Poet, and yet Howard carries the Poet and all that identity’s youth and passion within him.

We also look at the fact Howard knows the answers to the questions that puzzled each of his “earlier selves.” He knows, for instance, how the struggle to come to terms with his own sexuality turned out—that struggle was difficult but ultimately rewarding—though the 29-year-old in the photo with Karen doesn’t. As he considers this odd fact, I take the opportunity to wonder out loud if there is an older Howard “up ahead” who knows how Howard resolves his conflicts about old age.

I introduce Howard to Carl Jung’s concept of Self. This is the organizing principle of the psyche, one that initially operates on an unconscious level but with which a conscious relationship can be formed. To illustrate this, I tell Howard a person can have a set of values he lives by without stopping to think about them, but if he becomes aware of what his values are he’s able to live them more effectively, relating to them as he would a blueprint or a compass.

The Self is often personified in fairy tales as the wise old man or woman—think Cinderella’s fairy godmother or Obi-Wan Kenobi of Star Wars. In a rational sense, this combination of wisdom and age speaks to our having lived the earlier stages of our lives and learned through them who we are and what the world is. In an intuitive sense, who I am now and how I’ve lived or not lived so far implies who I will be. That “future self” is implicit in who I am now.

Howard is intrigued by this image of an older self, or Self, from whose point of view his present issues are all resolved one way or another. “I don’t feel so lost,” he says. “In a funny kind of a way, it’s like I already know the answers. It’s just a matter of remembering them.” He’s also interested to think that compared to this image of the Self, he’s the younger of the two. That if the Self is the cumulative image of his full life span, Howard is not there yet.

We look at the fact that if Howard had refused to go on to have new and further experience when he was the Poet, then Robert Redford, Papa, and the others wouldn’t have had their times to be lived. He says about the Self, “I feel like he’s waiting his turn. Like he’s depending on me to live him. I don’t want to let him down.” I reflect the positive nature of such a relationship to the Self. Erikson describes “the acceptance of one’s own and only life cycle,” and Jung refers to participating in “the ego/Self axis.” Both ideas act as guideposts to the same fact, that it’s possible to experience old age with integrity and hope.

In The Measure of My Days, a book of reflections written when she was in her 80s, Florida Scott-Maxwell notes, “Personal immortality may not matter at all. Perhaps our long insistence on it has been our need of spiritual value, and a groping conviction that is our central truth; that we have a share in impersonal greatness.”

If he was the Poet when he was in his 20s and Papa in his 50s, I ask Howard who is he now. He thinks about it, then grins and says, “Well, I guess I’m the Traveler now.” On the spur of the moment he asks if I’ll take a picture of him using his Android phone. I do, and Howard has his first photograph of the Traveler, evidence that he passed this way.

References:

1. Erikson, E. (1980). Identity and the Life Cycle. New York: Norton.
2. Jung, C.G. (1966). The Practice of Psychotherapy: Essays on the Psychology of the Transference and other Subjects (Collected Works Vol. 16). Princeton, N.J.: Princeton University Press.
3. Karpf, A. (2014). How to Age. London: Picador.
4. Kennedy, G. J. (2000). Geriatric Mental Health Care. New York: Guilford Press.
5. Scott-Maxwell, F. (1968). The Measure of My Days. New York: Penguin Books.

Most of us take care of others at some point, sometimes putting their needs first or focusing on helping them out of tight situations. In the 1930s, the term “codependent” was introduced to describe the partner of someone who is addicted to alcohol. What constitutes codependency was later broadened to include a wide spectrum of behaviors, from substance use to compulsive gambling to sex addiction. Codependency also expanded to include relationships in which the other person’s needs are always put first, often to the complete exclusion of a person’s own needs. It may be believed that if this is done, self-sacrifice will be recognized, reciprocated, and rewarded by the other person.

In the following fairy tale, titled “The Wife Who Refused to Bury Her Husband,” consider how codependency often plays out:

There was once a woman who loved her husband very much. Her husband became ill, and after a long time he died. The woman didn’t know how she would carry on without him, and the thought of putting him into the cold ground, casting dirt down on top of him, and leaving him all alone in the graveyard seemed unbearable to her.

So she didn’t bury him. Instead, she kept him in their bed, where he had died. She continued to take care of him, bringing him bowls of good, warm broth (for which, of course, he never thanked her), and spending what little money she had on medicine for him (which he never took), and putting bandages on him (which did no good at all). Every night, she slept next to him.

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As you can imagine, the situation became challenging. Insects and other vermin came into the bed where the woman slept each night. As nature took its course, which nature will do, her own health was put at risk. Sometimes as she lay there, trying to sleep, she wept bitterly because it seemed her husband didn’t appreciate anything she did for him. But then she would rally herself: “I just need to take better care of him, that’s all. And besides, I couldn’t live without him.”

The tale opens with the woman’s husband having just died after a long illness. He’s no longer present in the relationship. People we love may become increasingly unavailable when practicing an addiction. Untreated, addictions also tend to get worse over time. William G. McCown and William A. Howatt, in Treating Gambling Problems, describe the phenomenon of “motivational toxicity,” which is the decreasing ability to be motivated by anything other than the addictive experience.

There’s another sense in which a partner or loved one can seem to be “dead.” One aspect of codependency is to always put the other person’s needs foremost and to expect that person to take care of our needs without having to mention them. When this doesn’t happen, people may perceive the other as ungrateful and unresponsive. Another aspect of codependency is the desire to manage and manipulate others. In this sense, one person becomes an object of another person’s management. Rather than experiencing that person as a subject, the way you might experience your own existence in the world, that person experiences the other as something to be controlled and arranged to best protect a sense of safety.

In the fairy tale, the woman is unwilling to bury her husband even though he’s dead. The idea of consigning him “into the cold ground” is unbearable to her.

Being buried is a natural consequence of having died, and so the woman is trying to protect her husband from this consequence. She appears to be confusing her own responses for his. The husband shows no fear or reaction to hot or cold, to loneliness, or company. Sometimes in addiction, nothing impacts the person who is addicted until that person bottoms out—in other words, the addiction no longer protects the person who is addicted from any painful feelings. Hitting bottom is how many people enter recovery.

Sometimes people with codependent patterns of behavior believe that the other person can’t live without them. In a domestic violence situation where an individual isn’t yet ready to exit, he or she might find grounds for staying with the idea: “I’m the only one who can really understand and help my partner.” This person might think he or she is a partner’s or loved one’s last and only chance for living a good life, or even staying alive. Paradoxically, this seems to make an individual feel very important, essential, almost as if the other person carries him or her as the reason for living.

The woman in the fairy tale cooks her husband nourishing meals and uses her money to buy him medicine and put bandages on him. Jennifer Sowle, in The Everything Guide to Codependency, notes, “If you are codependent, you are not powered from within; your quest for power is through controlling others.” We observe this in the woman in the fairy tale as she attempts to do just that. She tries to control something over which she has no control—trying to make her husband “get better,” although he’s in a state she can’t affect.

This may be reminiscent of some of the arrangements a person experiencing codependency might try to make, at great cost. Sometimes these arrangements are financial—bailing someone out of jail, paying a person’s debts, or providing someone with another stint in detox. Often, it’s in the form of energy someone expends and the wear and tear on his or her heart as the other person says they’ve changed and this was the last time they will strike him or her, or have an affair, or go out on a bender. But the promises an addicted loved one makes aren’t always reliable indicators of change. In the story, the husband is dead. Therefore, he’ll continue as he’s going, and the deterioration will continue as well.

As the woman keeps her dead husband in their bed, in the natural order of things, he begins to decompose. This places her at risk. Addiction often brings chaos, and things can fall apart. Consequences can include legal issues, or What could the woman in the fairy tale or anyone do in order to implement boundaries? She might begin by identifying the needs she has in her relationship and assess whether those needs are being met. She might take a moment to reflect on who she is apart from the relationship—what does she like, dislike, believe in, or do for enjoyment? having people present in the home and in a person’s life who aren’t wanted, from social workers to pushers to other people who are addicted to creditors of past-due debts. These natural consequences will affect the partner who is codependent or family members, as well as the person who is addicted. If the woman was going to do something effective, what would it be? Would it be to focus on her husband, trying to get him to respond and change, or would it be to focus on her own behaviors?

“And besides, I couldn’t live without him,” the wife says, which brings us to the heart of the matter. In Breaking Free of the Codependency Trap, Janae B. Weinhold and Barry K. Weinhold note, “You started out as a helpless infant who could not survive without the care of your parents.” As infants, people depend on their caregivers absolutely. It’s quite possible to love and cherish others, to love life in general, and to value your own life, but for those who experience codependency, the idea may be that their life somehow depends on their partner or loved one’s life, and that their partner or loved one’s life should therefore be responsive to their control, which indicates a confusion of boundaries.

What could the woman in the fairy tale or anyone do in order to implement boundaries? She might begin by identifying the needs she has in her relationship and assess whether those needs are being met. She might take a moment to reflect on who she is apart from the relationship—what does she like, dislike, believe in, or do for enjoyment? She might notice that her husband’s condition is just that—his—and that if she continues trying to rescue him from it, she’s depriving him of the chance to learn from his own life (or death, here).

As she becomes more aware of her own needs, she might notice what she doesn’t want around her. She might say to her husband, “If you’re not going to eat the soup I make for you, then I’m not going to make soup for you,” or, “If you’re going to be in our bed, you may not bring insects and vermin in. If you do, then you’re no longer welcome in our bed.” By setting these boundaries and enforcing the consequences, she may come to a place where she can assess whether she wants to continue with her husband the way things are, or whether she wants to implement change in the relationship.

Meanwhile, the hope is that the woman will begin her own inner work, wake up some morning soon, and realize what she’s in bed with.

We can’t do much about anyone’s addiction because it’s not ours to do anything with. Finally, recovery is a choice for the person who is addicted. It’s a choice that may not be selected, but we can choose a path for ourselves. We can choose to bury the past, mourn for what’s lost, and move on.

One aspect of psychotherapy is that the person in therapy and the therapist participate in a process larger than what either or both can directly observe. Something can be happening in plain sight, but we might not see it because it doesn’t fit into our way of looking at things. But sometimes we fit into its.

Tom—not his real name—was in his early thirties. He was dealing with a number of opportunistic infections that had him confined to a hospital bed in a back bedroom of his family’s house and changed his once-handsome appearance. I saw him through an AIDS service organization that put services into people’s homes, and one of those services was therapy. Tom presented with symptoms supporting a major depression diagnosis, which he wore with a decidedly gloomy air—with anger beneath the gloom.

I’ve never felt as flattened as a therapist as when working with Tom. “What the eff good is this supposed to do me? Pardon my French,” he drawled halfway through our second session. He was always polite, and deeply weary.

He had a point. The infections which had affected his appearance and made movement out of bed virtually impossible had interrupted a life that had always been characterized by independence, a successful career, and enjoyment. I tried bereavement work and adjustment interventions, but Tom only withdrew from dialogue, observing me from across an ironic distance. He also made it clear that he didn’t want to address his health (“I live with this all day, every day. You think I want to spend another hour talking about it?”).

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What he was willing to talk about were his teenage years. He’d been born and raised in the Midwest, and his narrative, once he got going, was vibrant with details. Not just of what he’d done and the people he’d known, but about the landscape, the wildlife, and even the weather.

Tom had a highly developed extroverted sensation function. In depth psychology, this is a way of saying that a person is interested in the physical details of the world, and that these details are a source of deep pleasure. Issues of insight and meaning or even feelings weren’t high on Tom’s agenda. But he could describe the particular quality of the snow the night he and his cousin decided to walk to the corner store half a mile from the house for cigarettes (the flakes were slightly wet, so they tended to stick together, coming down in a spin because the wind kept changing direction, which was why he and his cousin lost their way on the street they’d both grown up on).

To me, this level of detail seemed like concrete thinking. I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was. Early on, I asked him, tentatively, if he would prefer to work with someone else. To my surprise, he told me, “This is working OK. I don’t have any complaints.” I didn’t get it. Gradually, I learned to set aside my own expectations—one of which was that I was supposed to get it, was supposed to get something—and just be available to sit with him.

I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was.

And so, without leaving the back bedroom of the little house in Los Angeles, I went on walks in the Midwest woods with Tom. I learned that the trees were mostly hickory, with a few spruces here and there. They never grew much over 12 feet and weren’t thick-growing, but they had plenty of walking space between them. It was a wet country, and you could usually hear at least one creek, often more, and the katydids. Birds sang around us, warblers and bluebirds, chickadees whistling like they wanted to get our attention. And of course the mosquitos were murder in spring and summer, and that’s one of the reasons he smoked Kools nonstop as we walked, because skeeters don’t like the smoke.

Sometimes we’d go down to his uncle’s for the Fourth of July barbecue. Everybody was there. His uncle used a cut-open water heater for a grill, and there was never any barbecue sauce, just salt and plenty of smoke. It was the best barbecue we ever tasted, and just one of the things lacking in L.A.

Other times, in the season, we’d go chasing storms up on the flatlands with his cousin—when she could be convinced, anyway, and by ourselves when she couldn’t. Yes, it was a pretty stupid thing to do, but when you saw those big, purple storm heads, bigger than anything you see here, and all that lightning, you forgot about everything else. And the tornadoes, when they came, were the best thing in the world. You never forgot those. And when you were stuck laying in a bed all the time, you dreamed about them and wished one would come out this way and take you back home.

Tom’s health went up and down—down most often. Eventually, he was hospitalized. Part of what I did was to follow people and keep meeting with them when they went into the hospital or nursing facility or hospice. The first week, Tom was in the ICU and not receiving visitors except family. When his mother told me it was OK, I went to sit with him.

“I haven’t slept in days,” he grated miserably. “I can’t sleep here. It’s too noisy, and they’re always coming into the room for something.”

I asked him to close his eyes. We went on a guided imagery walk out in the Midwest countryside. I knew the way. The hum of the air conditioner was the breeze through the tops of the hickory trees. That beep of the IV monitor—was that a grebe calling out on the pond or maybe a thrasher? The air circulating in the special mattress that reduced the chance of bedsores was the sound of the creek that ran along beside us. In this familiar landscape, we walked on and on, in no hurry, until the end of our visit. The last time I saw Tom, he was sleeping peacefully.

When Tom visits me in my thoughts, he reminds me not to judge the work because it’s not mine to judge. Its fruits might not show up anywhere that I ever see or know about. He reminds me to trust in a process that’s larger than I am, that I’m only part of.

Bereavement, the grief we feel in response to the death of a loved one, is part of our being in the world. It includes different categories of loss. There is the literal loss of the unique and irreplaceable other person. There is also the apparent loss of the functions that person carried in the relationship (he was the one who always filed our taxes; she was the one who held the family together). Here we can find as well the loss of the one who witnessed us (he was the last person who knew me when I was a teenager).

Less conscious is the—again, apparent—loss of self, of who one was in relationship to the loved one who passed.

Who among us wants to go through bereavement? Yet grief is a healthy response, and a necessary one in order to adjust and go on in a world where people die. At such times, our religious, spiritual, and philosophical beliefs can support us. It can also happen that such structures of belief or hope, which were previously unconscious, come forward spontaneously in response to loss. This can happen in the form of highly subjective, deeply personal experiences.

In the discussion that follows, names have been changed and personally identifying material has been screened out in order to preserve confidentiality.

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After the death of his partner, Jim finds himself waiting for him to come home, to hear the jingle of his keys in the door or to share a piece of news with him. Leah hears her husband call her name from the next room as she’s falling asleep at night. It’s not scary for her, but it brings her grief back when she starts to get up to attend him and remembers that he’s gone. Janet feels her husband sit down on the couch next to her when she’s watching television before going to bed. Annie, out on lunch break, has her eye caught by what appears to be a dear and departed colleague, waiting across the street at a bus stop. Mark sees a close friend twice after the friend’s death: once walking down the street “looking like hell,” the second time some months later, standing outside an Alcoholics Anonymous meeting. John rages at God each afternoon for the loss of his wife, and God—silent, invisible, but palpably present—hears him out.

These phenomena form a broad spectrum, from a subjective feeling to transitory perceptions when in a relaxed or distracted state. It’s important to note that none of these folks met the criteria for psychotic, mood, or substance dependence disorders at the time of their experiences. Bereavement, while not a formal diagnosis, can be a time of disruption, during which material that was previously unconscious comes into awareness. Often, the material serves an adaptive function. One way to support that adaptation is to treat it as symbolic rather than literal. As in dreamwork, we’ll look for what the experiences mean to the one having them rather than debating whether or not they “really” happened. When supported with empathy and respect, the events yield meaning and can be integrated into the person’s worldview, enriching it and making it more resilient.

Leah acted as caregiver for her husband in his final illness. As a result of hearing him speak her name, she reconsiders her situation. The role she filled for the last several years no longer has a purpose. The house where they raised a family and lived together is “too big” for her now. She begins thinking about moving into someplace smaller and closer to her adult daughter, so she can help out with her grandchildren. Annie notes that when she looked again “I saw it wasn’t Greg, not even someone who looked like him, really. But for that moment, I got to see him again. It’s like he paid me a visit.” When asked where Greg “was” when he visited, Annie gives a bittersweet smile and says, “In my thoughts.” Both Leah and Annie assimilate their experiences easily.

As in dreamwork, we’ll look for what the experiences mean to the one having them rather than debating whether or not they “really” happened. When supported with empathy and respect, the events yield meaning and can be integrated into the person’s worldview, enriching it and making it more resilient.

Like Annie, Mark sees a dead friend. Richard died of an accidental overdose, and Mark grieves as much for what seems to him the waste of his friend’s life as for his actual death. His two glimpses seem to be sequential and almost tell a story. In the first, Richard looks to be doing badly. Mark’s associations are that he has continued on the downward spiral he was in at the time of his death. The second glimpse, some months later, is of Richard among a group of others apparently taking a break outside an AA meeting place and looking “better than I remember seeing him for a long time.”

Mark doesn’t subscribe to the idea of life after death. But he was raised as a Roman Catholic in a small New England town. He notices that these experiences seem to refer to the idea of purgatory, a place or state where corrective balance takes place. Or as Mark puts it, with some humor, “It’s like Richard had to go to summer school so he could graduate.” Then he adds, “It makes me feel hopeful. I don’t want to make a religion of this, but it’s like the message is it’s never too late to get your act together.” The psyche provides Mark with images that help express and heal his grief.

Like Mark, John is surprised at his experience. He describes himself as “a scientific humanist, like Carl Sagan.” His wife’s death from cancer was drawn out and marked by suffering, both from the disease progress and from the treatment. John suffered with her. In this second month following her death, he tells me that he “indicts God” on his afternoon walks, giving vent to anger and bitterness that “someone who never hurt anyone suffered so much for no reason.” Angie wasn’t just his wife, she was his primary companion, and her loss makes the world an empty place for John.

The image of God, never previously active, becomes so in this crisis. It functions like a container for what might otherwise be overwhelming feelings, which John is then more safely able to identify and express in the form of his “indictments.” And more than an image: somewhat like Janet feeling her husband sit down next to her, John describes feeling God’s presence as an almost bodily sensation. Whether or not he goes on to live a religious life, in this period this experience provides a supportive and adaptive function.

As we see, some of these experiences are perceptual—auditory, visual, sensate. As a therapist, when someone describes such things, I look for some awareness on his or her part that these experiences are unusual. Also, that what’s experienced is characterized by feelings of grief or loss, or conversely by feelings of relief or hope. If the material is held concretely or literally, I would expect to find some cultural support for that. For instance, Kenny, a practitioner of Santeria, tells me that his recently deceased brother has given him some important information during a shell reading, or divination ceremony. Mary, first-generation Italian American, covers the mirrors with cloth so she won’t see her husband and “get taken by him.” Where I might become concerned is when there’s no such cultural cuing, or when the material is characterized primarily by feelings of guilt or worthlessness.

Alice tells me that she’s very distressed over the loss of her mother two years ago. She can hear the voices of the dead, blaming her not only for her mother’s death but for theirs as well. In order to get some relief from the voices, she accesses alcohol on a daily basis. She becomes distraught as she tells me this, weeping hopelessly. I don’t argue the matter with her, nor do I help her open it up for meaning. I tell her that I believe that she’s hearing the dead and it must be very rough. I ask if she’ll sign a release so we can call her doctor together and see if there’s something that might work better than alcohol.

Not everyone experiences these types of phenomena. For many of us, bereavement can be tracked through dreams. David, unable to be present when his father died, describes a dream a few months later in which his father enters the room David is in. After making eye contact with David (“so I could feel that he was at peace”), the father smiles, closes his eyes, and slowly leans back until David is left looking at the soles of his feet. Barbara dreams of her husband several times in the year following his death due to cancer. The dreams seem to form a sequence, in which she observes that her husband recovers from the symptoms of Alzheimer’s that were increasingly present the last three years of his life. “He looks like his old self now,” she says.

This phenomenon, the healing of the deceased in dreams, can generate different meanings. For Ron, his father wanted to come back and show him that he was all right. Bridget experienced this as a promise that our sufferings and their impact on us are reversible, and that there’s mercy operating in the universe. One additional meaning we might consider is that the healing of the image of the loved one corresponds to the healing and adjustment of the dreamer to the fact of loss.

We derive our personal meanings from the common experiences of loss. I expect you to come home because there are corners of the psyche where news of your death hasn’t reached yet. I hear your voice because I’m shocked by the sudden silence. I see you because I’m looking for you, and my eye assembles your lovely face out of whatever the environment provides—a stranger waiting for a bus, or someone smoking outside of a meeting place.

Although we know one another, much of our knowing is activity in our brains. The familiar face is conveyed by light that enters the eye and causes impulses to travel along the optic nerves and stimulate processing in the visual cortex, whose patterns of response are rendered semi-stable in the temporal lobe. Likewise, the voice. And likewise, too, our feeling responses and memories of shared events. The image we form corresponds to the other person, is alive, but is “made” of our own processes. When someone dies, it seems to be essential to successful adaptation to acknowledge and adjust to that fact. And after that adjustment, many of us find that in some very real ways, the image of the other person continues to live in us.

In psychotherapy, the first time a person tells me she dreamed of me, or that when facing conflict he imagined what I would tell him, I smile and say, “Now you have my image, and it belongs to you.” Later on, when working through closure and termination, we return to this idea. Bereavement is about ending. It’s also about ending’s opposite, which is continuation.