Category Archives: therapy

How Therapy Works — Cinderella Redux

At a friend’s birthday party in third grade, I saw the animated movie Cinderella. I sobbed through the entire film, terrified that the evil cat would devour the mice. When the credits rolled and the beloved rodents triumphed, I was vastly relieved — but also confused. Cinderella’s happily-ever-after finale made no sense. She lost both parents. She suffered emotional abuse and neglect. She survived extreme isolation and had no human friends. Cinderella couldn’t possibly erase her traumatic past with a hasty marriage to a man, flashing epaulettes, who knew her shoe size before her name. Cinderella didn’t need a prince; she needed a therapist.

Fast-forward twenty years.

I completed a doctoral program in mental health and began a career that lasted more than two decades. Along the way, I’ve been asked several times to explain how therapy works, how words can become catalysts for emotional change. I’ve fielded this question at dinner parties, teaching classes, in sessions with clients, supervising trainees. It’s a worthy question, superficially simple, deceptively complex.

I was always annoyed when therapists spoke Jargon rather than English. When I was in grad school, training to work with patients, my role-model mentors conveyed ideas with an artistic simplicity. They helped their patients explore the depths of their emotional worlds, speaking with clarity and heart, in no way sacrificing scientific knowledge or human intricacies. They chose clear words, to show their patients how unresolved issues from the past became superimposed on the present, derailing the ability to make healthy choices. Simple language is our telegraph line into the tangled, layered, lush emotional life we all hold deep within.

Some adults survive backgrounds that match Cinderella’s early trauma, and resist the emotional pathology that seems inevitable. Some of these children (like Cinderella) look unbreakable, immune, invulnerable — which of course isn’t true. In our offices, our patients show us that their survival has rested in part on their ability to manage potentially incapacitating feelings of vulnerability, a vulnerability which often surfaces in the safety of therapy, as a part of healing. These children carry bruises, even scars into adulthood, but they survived because they were, in many ways, healthy. Like Cinderella with her animal friends, these folks figured out ways to interact with the situation at hand, allowing their own psychological development to continue a forward motion.

But what happens to forward motion when that child stumbles over a roadblock? What happens when that young emotional core needs bolstering from a more mature emotional core? And what if that more mature helper is not available? Then, in the service of forward motion, the child skips over that building block in development. It’s those potential but not yet solidified building blocks that our patients present to us, sometimes in the moment, sometimes decades later.

Into adulthood, people can create lifestyles that accommodate those not-yet solidified building  blocks. But if life throws them a curve ball, or if their own emotional needs call for these building books to be cemented into place, then these people bring to us their pain, bewilderment, vulnerability, both past and present. They begin to examine their own youthful coping strategy, a strategy that was beyond their own years at the time, and to initiate the process of psychologically catching up to themselves.

Each person is an emotional tapestry — interwoven threads of strength, weakness, illness, health. The unique blend in each individual forms an emotional fingerprint of textures, colors, patterns. As clinicians, we strive to understand each thread, and how it intertwines with all the others. Therapy helps patients explore their own internal tapestry, and move from images centered around illness and trauma to norms allowing for a more healthy range. In other words, in the course of treatment, patients shed the constraints that, by necessity, they themselves created in order to grow up.

So how does therapy work? Together, the therapist and patient create a safe place to feel vulnerable, which allows the patient to take charge of that vulnerability. The hunger in each patient becomes a measure not only of need, but also of capacity. If both health and illness are vital to this picture, then the patient’s own strength can be enlisted to engage the patient’s potential to heal, which empowers the patient (instead of the therapist) to become the primary agent of change.

Throughout treatment, the therapeutic relationship is essential. Every word, every nuance, every gesture is an opportunity for the therapist to communicate an optimism of repair — an optimism which no amount of drugs, predictable program regimens or technology can replace. Whenever a sign of health emerges, the therapist can reach for it, weaving it into the tapestry of the therapeutic relationship, and into the patient’s core tapestry as well.

If Cinderella, grown up, had entered my office for treatment, I would have listened carefully to the words she chose to tell her story. Together, we would have developed a language to understand her emotional landscape. I would have helped her own the importance of her relationships with the animals — their warmth, their love, their limitations. Layer by layer, we’d walk through her losses, anger, fear — interwoven with her perseverance, tenacity, resiliency. Inevitably, at some point, she’d become upset with me — possibly she’d experience me as mean (like her step-mom); possibly she’d become terrified that I was about to die (like her Dad); I’d point out that her past was shaping her present world view, causing her to relate to me as a stand-in for someone who had hurt her. When the moment was right, I’d comment on her stunningly graceful movements and her unusual gift relating to animals. I’d wonder — did she hold any interest in dance? In veterinary medicine? I’d ask if she liked her glass slippers, or if she preferred Birkenstocks. I’d guide her to redefine her existence as more than an exercise in endurance, her goals as more than escaping from pain. We’d find words to expand her emotional repertoire, as she discovered new frontiers of empowerment. I’d help her become the person who, by her own definition, she was meant to be.

That’s how therapy works. Just that simple. Just that complex.

___

Amy Kaufman Burk is an author and blogger. She graduated cum laude from Yale University with distinction in the major of psychology. She has a masters degree in Health and Medical Sciences from U.C. Berkeley, and a Doctor of Mental Health degree from U.C. San Francisco. Before she became a full-time writer, Amy was a therapist for over 25 years. Her second novel, Tightwire, follows a rookie psych intern through her first year of training, working with a patient who is feisty, brilliant, stormy and troubled. The story portrays a fictional version of the therapeutic process, and the healing potential of the therapeutic relationship. The perspectives of the therapist, the patient and the supervisor are all parts of the plot line. Check out Amy’s Author Page on Amazon.

https://www.amazon.com/Amy-Kaufman-Burk/e/B00R0S66Y4

 

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Reading Guides for Hollywood High: Achieve The Honorable and Tightwire

Dear Readers,

I’ve received emails from members of book clubs who are reading my novels. Some asked for a reading guide, so I created one for each novel.

When I give talks, my favorite part is opening the floor to questions. Your ideas always kick-start new ways of thinking within me – and I’m grateful. If you want to respond to the reading guides, feel free to contact me through my website. I love hearing from readers, and I try to respond to every message. http://amykaufmanburk.com

For those of you who are including my novel in your book club, in your classroom, on your  personal list of books to read – thank you so much.

Best,

Amy

READING GUIDES

Hollywood High: Achieve The Honorable

1. As the book opens, Caroline has just transferred from a private school to her local public high school and she is terrified.  But from the start, she shows signs of being much more than scared and intimidated. What are the first signs that Caroline has hidden strengths? Have you ever felt strong inside in ways nobody could see?

2. This novel has lesbian and gay characters, as well as straight characters. Each character adds a vital piece to the story. Yet, unlike many books in the “Gay And Lesbian Literary Fiction” category, Hollywood High: Achieve The Honorable does not offer explicit details of sex. In writing the story, this was a careful choice I made. What do you think of this decision?

3. A theme of my novel is defying stereotypes. Some of the stereotypes in the story are racial, sexual and gender based. Some are about other kinds of assumptions. For instance, what does it say about a person if he/she is a prostitute, the leader of a gang, a cheerleader, extremely academic? Have you ever felt that others stereotyped you?

4. I wrote my book in reaction to the bullying of gay boys that I witnessed in high school. Have you ever been bullied? Have you ever acted as a bully? Have you ever seen another bullied? How did you handle it? Will you handle it differently next time?

5. A subplot in the book is based on growing up in the film industry. Have you ever been in an environment that was a mismatch for your true self? How did you navigate the situation?

6. From the first chapter, Caroline begins to find friends in her new high school. She builds a friendship group that is racially, sexually and economically diverse. Is that sort of diversity important to you?

7. Several high school characters have secrets – Caroline, The Duke, Valerie. Have you ever held a secret inside, that you were afraid to speak out loud? How does it feel to have a secret?

8. Sexual assault should happen to nobody, but it can happen to anybody. This is a subplot in Hollywood High: Achieve The Honorable. Have you ever been assaulted? Have you known someone who has been assaulted? Do you have the support you need to heal? (If not, please contact a rape crisis center near you, or talk to a therapist.)

9. When I speak to gay/straight alliances, I often hear stories of adolescents coming out to their families, and getting unsupportive, hurtful responses. I decided to include in my novel one family’s journey to support and acceptance. Have you ever felt unsupported by your family when you most needed support?

I wrote the following blog posts to help families stay supportive and bonded.

“They Came Out And Gay Fills The Room” https://amykaufmanburk.wordpress.com/2014/03/28/they-came-out-and-gay-fills-the-room/

“When Your Daughter Or Son Comes Out” https://amykaufmanburk.wordpress.com/2014/02/14/when-your-daughter-or-son-comes-out/

“If My Child Came Out As Trans”     https://amykaufmanburk.wordpress.com/2015/01/29/if-my-child-came-out-as-trans/

10. Homophobia can show itself in many forms. It can be subtle, damaging, hurtful, deadly. Through different characters, I decided to demonstrate different kinds of homophobia, and model different paths to support and acceptance. Have you ever seen someone move from homophobia to support and acceptance? Have you taken that journey to becoming an ally?

11. Readers often tell me they have picked a favorite character in Hollywood High: Achieve The Honorable. Do you have a favorite character from the book? What draws you to that character?

12. Do you have an idea to add to this study guide? I’d love to hear from you! http://hollywoodhighbook.com/?page_id=70

Tightwire

1. Tightwire tracks Caroline Black through her first year as a psychology intern, working with her first patient, Collier. As the book opens, Collier feels hopeless. As the book progresses, he discovers his capacity to heal. Have you ever felt hopeless? Have you found a way to heal? (If you need help, please reach out to the resources in your community.)

2. People have all sorts of ideas about therapy and therapists, and their ideas sometimes include a stigma. I hope this novel shows how helpful a “talking therapy” can be, and helps to diminish the stigma. Did the story make the idea of therapy less “strange,” possibly more comfortable?

3. Sexuality can feel confusing, even terrifying. At one point in the story, Collier (the patient) questions his sexuality. Have you ever questioned your sexuality or your sexual identity? How did you resolve your questions? Are your questions still ongoing? (If you need support, please contact an LGBTQIA center near your home. The Trevor Project is also an excellent organization to offer support. http://www.thetrevorproject.org)

4. Two important characters in Tightwire are Jeanne and Tracy, a lesbian couple with two children, who become role-model-parents for Collier. Have you met a same-sex couple with children? Are you comfortable with that family constellation? Why or why not? (If you’re open to growing more comfortable, maybe Jeanne and Tracy can help!)

5. One theme of this book is that if you’re motivated, it’s never too late to change. Do you have parts of yourself that you’d like to change?

6. Sexual assault can happen in many forms. People can feel a wide range of emotions including violated, betrayed, contaminated, frightened…also guilty, confused, depressed, doubting the validity of their own experience. Sexual assault is a part of this novel, and the survivor’s healing is a central theme. Have you ever had a sexual experience which left you feeling assaulted? Were you able to trust the validity of your experience, even if the assault fell outside the legal definition of “rape”? Have you ever felt safe enough to tell another person? (If you need help healing, please reach out to a rape crisis center or a therapist.)

7. In one session with Collier, Caroline (the therapist) has no idea how to handle the situation, and she makes several mistakes. She is certain that she has torpedoed both the treatment and her career. She expects her supervisor to kick her out of her psych internship, and her patient to quit. But to her surprise, her supervisor is supportive and helpful, and her patient comes back to continue working. What does Caroline do that earns the respect of her supervisor, and allows Collier to return to his treatment? Have you ever made a big mistake, and then been given a second chance?

8. Tightwire is structured with chapters that alternate between Caroline’s sessions with Collier, and Caroline’s life as she grows up. Did you find the structure engaging? Why or why not?

9. Do you have an idea to add to this study guide? I’d love to hear from you! http://amykaufmanburk.com

____

Novels By Amy Kaufman Burk

Hollywood High: Achieve The Honorable

Caroline Black, 15 years old, leaves her college prep academy for the local public high school, which opens her world. Written in reaction to the bullying of gay students I witnessed in high school.

Tightwire

Caroline Black, now a rookie psychology intern, goes through one year of training, working with her first patient – a young man who is stormy, seductive, complex and troubled. Written in support of healthy sex and sexuality, in support of same-sex parents, and as a voice against the stigma of psychotherapy.

http://amykaufmanburk.com

 

 

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Let’s Lose The Stigma Of Therapy

Before I decided to write fiction full-time, I was a therapist for 25 years. With my patients, I didn’t use scalpels or imaging, stethoscopes or bandages. Sometimes medications were helpful, but my primary tool was the spoken word.

In my office with clients, I used language to create a treatment. I chose my words with care, hoping to start a chain reaction which began with curiosity, then led to alternative ways of processing thoughts and feelings, and finally to the potential for different life choices. Words became catalysts for change.

As a therapist then and a novelist now, I’ve chosen careers based on language – first the spoken word and now the written word. With my second novel, my two careers collided. Tightwire is a fictionalized version of my first year of training to become a therapist. The story follows the rookie year of a psych intern (Caroline Black, from my first novel, Hollywood High: Achieve The Honorable), as she works with her first patient – a stormy, seductive, feisty young man who challenges her at every turn. The therapist, the patient and the training program are all entirely fictionalized.

Although fiction, the story’s foundation is “real” — how it feels to be new to the field – what went through my mind as I scrambled to figure it out – the exhilaration of a great session — the immense talent of the teachers who showed me the field – my love for the work. As I wrote, I was careful NOT to use any pieces from my sessions as a therapist, because that will always belong to the patients. The only pieces lifted from actual psychotherapy sessions were taken from my own experience as a patient, working with a gifted therapist.

I hope Tightwire encourages people to let go of the stigma often attached to psychotherapy. The novel describes a treatment in detail, a story of hope – hard work for sure, but nothing bizarre or weird. If therapy is done well, if the match between the patient and the therapist is strong, then words become powerful, productive tools. Together, the therapist and client create a unique path to discovery, insight and healing.

Let’s lose the stigma.

____

Amy Kaufman Burk is a novelist, blogger and mother of three grown children. Amy wrote her first novel, Hollywood High: Achieve The Honorable, in reaction to seeing gay students bullied in high school. Her second novel, Tightwire, follows a rookie psych intern through her first year of training. Amy blogs on a variety of subjects including parenting, LGBTQ+, gender equality and a Rolling Stones concert. She also collaborates with educators who include her books in their curriculum. To learn more about Amy, visit her website.

http://amykaufmanburk.com

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Tightwire, First Chapter

Dear Readers,

Tightwire, my second novel, is available on Amazon (link below). This is the first chapter. Thanks so much for taking a look!

Amy

CHAPTER 1

First Session July 8, 1982

Collier Z. Tratner sat alone in the waiting room, a picture of calm. Six-one, blue eyes, brown curls to his shoulders, strikingly handsome in his jeans and T-shirt. He looked like he’d never had a mentally unsound moment in his life. Caroline Black introduced herself, and waited to see if he’d initiate a handshake. He didn’t. With a curious grace, not quite an athlete and not quite a dancer, he followed her to the office. He took in the windowless cubicle, the tattered lime carpet, the metal furniture. Two posters hung on the scarred stucco walls: Van Gogh’s white roses, and Monet’s water lilies. Caroline’s failed attempt to create a soothing ambiance.

“I almost didn’t show up,” Collier began impassively. “I don’t know what I’m doing here.”

“Well, um, since you’re here, I mean, the next fifty minutes are yours, so you might as well tell me, what brings you here?”

“Already answered. I don’t have a clue.” He watched her carefully. “Am I your first patient?”

“I…what makes you ask?”

“It’s okay,” he nodded coolly. “I’ve never done therapy before either.” To her horror, Caroline blushed, and he grinned. “Relax, Doctor, we’ll just figure this out together.”

“Actually, it’s my legal and ethical obligation to inform you, I haven’t received my Ph.D. I’ve just completed my dissertation, but I won’t be awarded my degree until next July. I’m not a doctor yet.”

“What manual are you reciting from? And more to the point, why didn’t they give you the doctorate? Something wrong with your research? You’ve finished your dissertation, ready to publish, but…wait…hold on…I get it. You have to finish this year of seeing patients. Then they’ll give you walking papers.” She nodded. “So, this–” Collier gestured around the room, “Oasis Psych Clinic, San Francisco County Hospital. This is your last requirement. Then you’re free.”

“That’s how my program works. But truthfully, for me, the dissertation was the requirement. This–” she copied his gesture, “is what I want to do. But I’m still a pre-doctoral intern.”

“So you’re a partial doctor. I’ll call you ‘Doc.’”

She stiffened. Is it okay to acknowledge a joke?  

“Look,” he continued, “I think we’ve got an obstacle to overcome. I’ve traveled all over the world. I’m fluent in French, Spanish, German and Italian. You clearly speak Textbook, but do you speak English?”

He raised an eyebrow, and before she could rustle up neutrality, she began to laugh softly. “How’d you learn to read people so well?”

“Good question. A necessity for survival. This’ll entail a history lesson.” His voice turned sing-song, lulling. “It’s twelve midnight, 1961. Twenty-one years ago. Los Angeles. Hollywood Boulevard. A studio apartment with cold water and a colony of roaches. My mom woke up with contractions. She called my dad, who was pouring drinks at a sleazy bar three streets over. He said he’d meet her at the hospital. Those were his last words to her. I was born fourteen hours later. I’ve never met my father, and my mother never saw him again.” Collier’s speech had become a boring lecture, cultivated to snuff out any interest from his listeners. “He didn’t want a long-term deal with Mom, didn’t want a kid, she refused an abortion, and here I am. End of story.”

“That explains everything except the past twenty-one years.”

He grinned in surprise. “Good, Doc. You’re not as uptight as I first thought.” No pause. “How old are you?”

She stifled the urge to stammer. Thou shalt not answer a patient’s questions. The Psychoanalytic Manifesto. Collier looked her over. Five-four, dark blonde, one-hundred-twelve, no make-up. Long navy skirt, matching jacket with red piping, cream blouse, knee-high boots, no jewelry. Warm clothes for a San Francisco summer. She’d been called pretty by some, beautiful by others, but to the majority she skimmed by unnoticed. Everyone agreed there was absolutely no flash to her presentation.

Now Collier peered at her, not liking what he saw. “Are your eyes blue? No, they’re green.” He relaxed back in his chair. “I’d say twenty-four years, one month, four days.”  

Wrong, five days. Caroline acknowledged his victory with a nod. “You’d rather talk about me than anything that’s happened since you were born.”

“You’re smart,” Collier frowned. “I’m not sure I like that.”

“Why not?”

“I like to be the smartest.”

“Because…”

“It’s safest that way.”

“If I’m smart, I’m dangerous?”

He crossed his legs, outwardly composed. A sexual aura stirred. Sexual, seductive, unreachable. “You want my story?”

“Sure.”

“What do you want? The outline? The first chapter? The whole book so you can tag it, file it in its proper section?”

“I can’t file it until I know whether it’s biography or fiction.”

“The story is fact. My who-gives-a-damn attitude is pure fiction. By the way, your office is awful. Uglier than the last E.R. I visited.”

“Why’d you go to an emergency room?”

“The metal furniture’s a homey touch. Just dial 1-800-HIDEOUS, emergency decorator fashion police.” Caroline held her smile in check, and Collier’s voice turned quiet. “I think the last time was a mild concussion. I’ve had three fractured wrists, a busted nose, two broken ankles, a dislocated shoulder, countless sprained fingers. I might have missed a few, but that’s the general idea.”

“That’s a lot of injuries.”

“Comes with the territory.”

“What territory is that?”

He cocked his head, measuring her. “I get it. You’re asking about child abuse.”

“Actually, I was asking about broken bones.” She steeled herself. “Should I ask about child abuse?”

“I’m not sure,” a dense sadness permeated the office. “But the broken bones are a different issue. The breaks, the fractures, the languages I speak. I was born into the circus. I’ve done the trapeze and the highwire since I was a kid. Falls are a given. I’ve performed, and I’ve fallen all over the world. Anywhere there’s a Club Med. Mom’s a clown, a unicyclist and a contortionist. She’s at Club Med in San Diego, as we speak.”

The circus, ultrahazardous activity? Caroline shook her head slightly, loosening the image of poodles trotting, horses prancing. “Where do you fit into that picture now?”

“In my book, I’m emancipated. In theirs, I’m AWOL.”

AWOL? You ran away from the circus? “Who’s ‘they’?” she asked.

“Mom, and the group we work with. The Club Med Circus Team. Mom and I flew into San Francisco a week ago, to interview a few potential new members. I met this guy in a bar, and he offered me a job at this restaurant he owns in North Beach. Nice part of San Francisco. One of his waiters just quit. Trattoria Anesta. Upscale Italian. Expensive place. Good tips. I’ve only worked there two days, and I’ve opened a bank account. I’m staying at the YMCA. I’ll get an apartment in a few weeks.”

“And the abuse?”

“None of your fucking business.”

Fucking. So it’s sexual, whatever it is. Collier was suddenly breathing hard. Caroline put up her hands, a clear message that she wouldn’t force him to talk. His breathing slowed. Finally, he looked at her curiously.

“You didn’t have a coronary when I said ‘fuck.’”

“No, I didn’t,” she answered evenly.

“Why not? You reek of proper manners, etiquette, crisp navy and tailored.”

“Are you looking for ways to startle me? So I can’t think clearly because I’m too jumpy?”

He nodded, sheepish and impressed. “I guess that’s right.”

“You can just tell me to back off. I’ll listen. Much more straightforward.”

“I’m not a straightforward person.”

“Okay, I’ll remember that.”

Collier glared, suddenly ferocious. “I don’t give a shit if you remember or not. I never said I’m coming back for a second session. You’re obviously a rookie.” Caroline blushed. “Your office sucks. Your waiting room is enough to send Mickey Mouse into a suicidal depression. You could at least have some music for us while we sit in those grey plastic chairs.”

“What song would you choose?” Caroline heard herself ask, both shaken and fascinated by his tantrum.

“That’s easy,” he smiled, as the rage switched off completely. “Tight Rope. Leon Russell. My favorite song.”

“Okay,” she glanced at the clock, “we’ve got a few minutes left. Where do you want to go from here?”

“I’m not making any promises. You’re on probation. Not hired. Do you read me?”

“Loud and clear. You need to figure out if I’m ‘too blind to see.’ Then you’ll decide.” Caroline willed herself to hold his eyes, amazed at how professional she sounded.

“That’s right.” He studied her. “You know the song.” She nodded. “Maybe you’re not a complete loser.”

“I expect that’ll remain an open question for you.” He chuckled, and Caroline allowed herself a small smile. “How about Tuesdays at eleven.”

“One session at a time.” A hard stare, then he stretched. “Are we done for today? You never asked me where I got my name. What the Z stands for. Most people, that’s their first question.”

“Want to tell me?”

“Tratner’s my mother’s last name. Collier’s my dad’s. Z is for Zeus, Mom’s miniature poodle. I’m named after my father, my mother, and her pet.” Now on his feet, firing words down at her. “And no, I don’t give a damn! And no, it doesn’t mean shit! And no, it’s not up for analysis! So leave it alone! Off limits!”

Caroline nodded, rose slowly.

“So, I’ll see you next week. I…why are you staring at me?” She shook her head, palms up. He rolled his eyes. “Order rescinded. It’s not off limits.”

“You just told me why you showed up for this appointment.”

“Brilliant, and why’s that?”

“You’re here to find yourself in the mix of other people’s names.”

He didn’t move for several seconds, standing sculpted, in control of every muscle. “Not just people’s names. There’s even a canine in the cocktail. I’m quite a mongrel.” She waited for him to continue, but instead, he dug into his backpack for a handful of something. He lobbed it onto her desk: an unopened pack of Marlboros. “You can have these.” She looked up at him, and he shrugged. “I gave up smoking a few months ago. I brought them in case I needed to piss you off.” They grinned, and he held up a hand to halt her speech. “I know, your training manual says never accept a gift from a patient. It won’t happen again. But do me a favor and toss the cigarettes. They cause cancer.”

She weighed the pack, then took aim. Bank shot into the trash.

“Thanks,” he said softly.

“Next week, then,” Caroline answered.

He opened the door, then turned back, hand outstretched. They shook.

________

Tightwire is available on Amazon. You can follow Caroline through her first year as a psych intern, and Collier’s first year of therapy. If you want to read about Caroline Black in high school, check out my first novel, Hollywood High: Achieve The Honorable. http://amykaufmanburk.com

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