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Thursday, January 14, 2010

Exploring the Road Not Taken in Psychotherapy

As a psychotherapist in NYC, I see many clients who come to psychotherapy to explore decisions that they are currently faced with or decisions that they've already made and how those decisions are affecting their lives. These decisions often involve whether to take one path or another in their personal lives or in their careers, whether to stay or leave their relationships, or how to handle a particular crisis in their lives.


Exploring the Road Not Taken in Psychotherapy
One of my favorite poems is "The Road Not Taken" by Robert Frost. I remember first reading this poem in high school. It had meaning for me then, and it still has meaning for me now in my own life as well as in my work as a psychotherapist when it often comes to mind.

The Road Not Taken - By Robert Frost
Two roads converged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down as far as I could
To where it bent in the undergrowth.

Then took the other just as fair
And having perhaps the better claim
Because it was grassy and wanted wear,
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black,
Oh, I marked the first one for another day!
Yet knowing how way leads on to way
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I,
I took the one less traveled by
And that made all the difference.

We all come to forks in the road at different points in our lives where we have to make decisions. At the time, we might not know where our decisions might ultimately lead later on in our lives. We make these decisions with whatever information we have, based on whatever is going on in our lives at the time, as well as our own psychological make up at that point.

The Road Not Taken
The following vignette is an example of a client who comes to psychotherapy to deal with "the road not taken" in his life and the particular dilemma that he faced when he came to therapy. As always, this example is a composite of various clients with all identifying information changed to protect confidentiality:

When Bill first came to see me in my psychotherapy private practice, he was a successful oncologist and surgeon in his late 40s. He was recognized as one of the top oncologists in NYC who specialized in a particular form of cancer. He was well respected by colleagues, sought after by patients, very successful financially, and he loved his wife and children. Yet, he was deeply unhappy.

According to Bill, he originally wanted to be an engineer. He knew he wanted to be an engineer since he was a teenager. But, from an early age, Bill's father let him know that he wanted Bill to become a doctor. Bill's father and mother escaped their country of origin to come to the US when they were first married. Neither of them spoke English when they arrived. But they were both very intelligent and ambitious so they learned quickly, and both of them attended a top Ivy League college. Bill's mother became a scientist and his father became a professor. Both of them were successful, but Bill's father had always wanted to be a doctor. He didn't pursue a medical career due to pressures from his family for him to become a professor.

So when it came time for Bill to make a decision about choosing a major, he felt a lot of pressure from his father to choose pre-med. Bill didn't want to give up his dream to become an engineer, but he wanted very much to please his father. He described his father as a cold, reserved man who only showed any feelings towards Bill when Bill excelled in school. Bill knew that his father would be very disappointed if he didn't pursue a medical career.

So, when faced with the decision about choosing a major, Bill told himself that he would pursue a medical career but, at some point, like the narrator in "The Road Not Taken," he told himself that he would go back to college and pursue an engineering degree after he graduated from medical school. But as in the poem, "way leads to way," and life didn't turn out the way Bill had planned. He never went back to college for engineering. After he graduated from medical school with honors, he was faced with high student loan bills and a new marriage with young children. so Bill had to work hard to establish himself in his medical career and make money. He had no time, energy or money after medical school to go back to college for an engineering degree.

Bill enjoyed performing surgery and getting involved in cancer research projects. Those two aspects of his work were what he enjoyed the most. However, he really disliked the patient contact which, of course, was a big part of his work. He felt ill at ease dealing with patients' and families' emotions. He would usually leave that to the oncology social workers. And in those instances where it was apparent that nothing more could be done for a patient and the patient was facing end-of-life decisions, Bill would begin limiting his contact with the patient and the patient's family He couldn't tolerate what he perceived as a failure on his part to save the patient, and he could not deal with the patient's and family's emotions. So, he relegated that to the oncology social workers as well.

At first, Bill enjoyed the success and recognition that he received in his profession. He also knew that his father was very proud of him and boasted to his friends about "my son, the doctor." This made Bill feel happy at the time. And although Bill's father was never really affectionate with him, Bill felt that they became a little closer after Bill established himself as one of the top doctors in his field. But after Bill's father died, Bill began to feel lost, depressed and irritable. He was snapping at his wife and children, which he had never done before. He was even snapping at his staff.

But the incident that brought him into my psychotherapy office involved a particular interaction with patient and her husband after it became apparent that treatment was not going to save the patient. At first, as usual, Bill instructed one of the oncology social workers to discuss palliative care and hospice with this patient and her husband, as Bill withdrew from the case. However, the patient insisted on speaking to Bill, and she left several messages on Bill's voicemail. At that point, Bill felt it was his "ethical duty" to speak to the patient and her husband, but he felt backed into a corner.

His secretary arranged for a meeting and during that meeting the patient and her husband took Bill to task for his withdrawal at a time when the patient was facing her death. Bill listened to their complaints with increasing anxiety. He felt trapped and wanted to leave the room, but he couldn't. He kept thinking to himself: "What do they want from me? I've done the best I can. I can't do anything else for them!" When he felt he couldn't tolerate listening to them any more, he apologized to them for disappointing them and then cut them short in a curt manner, telling them that he had another patient waiting and they had to leave his office. When he looked up and saw the hurt and shock looks on their faces, he felt deeply ashamed, but he felt too emotionally paralyzed to do anything else so he let them leave.

Afterwards, when Bill got home, he began talking to his wife about what happened. He was in mid-sentence when he felt a profound sadness come over him and he began to cry. He was surprised at the depth of his feelings because he considered himself to be a logical, rational person and he was usually quite unemotional. At that point, his wife told him that she had been fearing for some time that Bill was in crisis, but she didn't think he would be open to talking about it with her. She suggested that he call the patient and her husband, apologize, and seek professional mental health, which he did.

Over the course of the next several months, Bill came to therapy on a weekly basis. The emotional crisis that he faced forced him to be more open than he ever would have been in the past. He admitted that, before coming to psychotherapy, he "didn't believe in" psychotherapy, and he thought that psychotherapy was for people who were "weak."

Over time, Bill realized that when he chose to be a doctor rather than an engineer, he sacrificed his dream, hoping desperately that his father would show him that he loved him. He dealt with his anger, sadness and resentment towards himself as well as his father. He mourned his father in a way that he had not done before. He also mourned the loss of an engineering career because he had no desire to return to college. And by the time he left treatment, he decided to focus on what he liked best, his research projects, and to stop seeing patients because he knew that he was not well suited for this. He also had a new found respect for psychotherapy.

A year after he left psychotherapy, Bill contacted me to let me know that he was doing well. He had transitioned into full time research work and he was much happier in his work life as well as at home.


Exploring the Road Not Taken
Attending psychotherapy with a licensed psychotherapist provides an opportunity to work through personal and career decisions, past and present, in a way that most people cannot do on their own or with loved ones.

If you're faced with decisions in your life and you're standing at a crossroads, not sure which path to take, or if you're not dealing well with the aftermath of decisions that you've already made, you could benefit from seeking the help of a licensed psychotherapist.

I am a licensed psychotherapist and hypnotherapist in NYC. I have helped many clients who are facing tough decisions or who are looking back on past decisions and how they have affected their lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (212) 726-1006.