I saw people in the throes of mania, psychosis and suicidal depression. I still remember the man who asked if I was a witch who would place a spell on him. And the woman who came barreling at me down the hallway, warning, “You best get out of my way, or I’m going to go Ninja Turtle on your ass!” I remember the man who swallowed six bedsprings in a suicide attempt. And countless others with bandaged wrists, bruised necks, and broken souls. I learned a lot about the breadth and depth of human suffering.

One day I was waxing philosophical about suicide with one of the charge nurses who had worked there for more than 20 years. She shared that she had a collection of 350-odd suicide notes that had been collected by a medical examiner over the course of his career. The notes had been collecting dust in her attic for the past 10 years.

She asked if I wanted them.

It’s not everyday that an archive of grief in the form of suicide notes falls into your lap. I hesitated for just a moment before saying, “Sure.” Her gaze settled in the distance as she told me that having the notes had been fascinating and also a terrible burden. The following week I left work carrying a banker’s box full of yellowing scraps of paper, greeting cards, receipts, napkins, and hotel stationery, on which were scrawled a few hundred people’s last words.

The musty smell when I opened the box was overwhelming. All of the notes were written by individuals who completed suicide between the mid-1940s and the mid-1960s, apparently before privacy rules would have precluded their being collected and filed away.

Gingerly picking up the fragile slips of paper, I read the words, in fits and starts. The notes, most of them no more than a few sentences, telegraphed such heartbreaking despair, hopelessness, and grief. And somewhat surprisingly, they also communicated gratitude, warmth, and an unmistakable concern for others. I couldn’t help but wonder about the lives of these individuals who, for one reason or another, had reached the end of their respective paths, and couldn’t see any further.

“I’m sorry to have to do this to you and the children, but I’ve come to the end.”

I eventually used the notes in a qualitative study exploring the interpersonal nature of suicide (Sanger & McCarthy Veach, 2008). My co-author and I focused on the suicide notes as acts of communication that demonstrated a desire to acknowledge and maintain connections with others, even in the face of death.

In their suicide notes, individuals said goodbye, apologized and asked for forgiveness, and attempted to exonerate others from blame. They provided instructions, expressed love and gratitude, and praised others for their upstanding qualities. Sometimes they discussed loneliness, isolation, and lost or unrequited relationships. They very rarely expressed hostility or pointed their fingers at others for their demise.

In simple and poignant prose, the decedents reached out to loved ones, seemingly trying to ease the unspeakable loss associated with suicide:

“You’ve been a sweet, dear, faithful wife. Thank you for that.”

“I’m sorry to have to do this to you and the children, but I’ve come to the end.”

“I hate myself for giving you this shame, but people will understand that none of it is your fault.”

“It is best I go now before things get worse for you and yours. Please forgive me for unknowingly hurting you. I should know by now that people do not want anyone with problems around them.”

Perhaps most striking was the finding that positive relationship themes, such as saying “I love you” and praising others, were more prevalent in the notes than negative relationship themes, including loneliness, isolation, and overt hostility. Expressions of concern for others also implied positive connections in the lives of these suicidal individuals. It was troubling, though, that this concern was sometimes communicated in the form of fears of being a burden or minimization of the impact of the suicide on others.

From birth, we are wired to need other people in our lives. In the study, more people focused on efforts to maintain their relationships or reconcile relationship difficulties (including those anticipated to result from the suicide) than on directly acknowledging the impending end of relationships. To me, this was a reminder of people’s strong needs for social ties, even as they approached an act that would sever all relationships.

By the end of the study, I was immersed in the balance of fascination and burdensomeness that came with owning a collection of suicide notes. I carefully placed the notes, encased in plastic sheets and organized in binders, back into the banker’s box, which has now been sitting in my attic for the past six years. I certainly cannot throw them away, but I also can’t quite bring myself to open the box again. I am quite literally keeping a lid on all of the pain they represent.

Reference

Sanger, S., & McCarthy Veach, P. (2008). The interpersonal nature of suicide: A qualitative investigation of suicide notes. Archives of Suicide Research, 12, 352-365.

Strangers’ responses to learning that I’m a therapist are varied, and it’s not uncommon for them to be loaded in some way or another. “You’re analyzing everything I say, aren’t you?” many people joke. “Mmhmm,” I’m tempted to respond, with a raised eyebrow and Mona Lisa grin. “Oh,” others murmur, before the conversation trails off into stilted silence and the person starts surreptitiously glancing over my shoulder for someone else to rescue them.

The wedding guest’s response to learning I’m a therapist was of the “Oh, that’s cool” variety. I didn’t think anything of it. Contrary to popular belief, I don’t really “analyze” anyone, let alone people I’ve just met.

Later in the evening, after a lovely dinner, people started migrating to the dance floor, and I followed. I love to dance at weddings and I can dance well enough. By which I mean I don’t call attention to myself with my awkward moves. Often.

As the strains of Hava Nagila faded and the music shifted to more contemporary dance fare, the wedding guest I had previously chatted with caught my eye and shouted above the DJ, “I can’t even imagine my therapist dancing!” Incredulity and an afternote of the freely flowing wine (we were in Sonoma, after all) rang through his comment.

I laughed and shouted back, “Yep, we’re people too!”

After the wedding, I smiled to myself again about the encounter. The wedding guest’s exclamation was a reminder that clients vary broadly in their views of my role as a therapist. Some, like the guest, seem prone to thinking of me existing solely within the confines of my office. Like the students who believe their teachers live at school, these clients keep me in a safe box. They don’t imagine me dancing at weddings, or in other “real life” activities because it doesn’t really occur to them to do so. Sometimes it’s easier to disclose vulnerable material to someone whom you imagine, consciously or not, is not quite real.

There are other clients who keep me boxed up, but for different reasons and in a different way. These clients view me as a professional with a capital P, much like they might view their dentist or accountant. In these clients’ minds, I am the keeper of important information about things like how to intervene during a panic attack or how to skillfully communicate with a partner. These clients want to talk about symptoms and solutions. They don’t care about my dance skills or lack thereof, or at least not any more than they care about whether their accountant plays baseball.

There are, however, some clients who are curious about who I am outside of the consulting room. They want to know more about me as a person, apart from who I am as a therapist. Of course these two things are inextricably intertwined, but not often in ways that are clear to clients when it comes to the specifics. These clients want to know if I’m married; they ask whether I have children; they’re curious about whether I like the outdoors or scrapbooking or cooking. Sometimes they want to know if I have struggled in ways similar to them. Probably most important to the therapeutic endeavor, they wonder about how I see them, what I think of them, whether I am judging them.

Like many therapists, I am eclectic in my approach. I believe strongly that therapy is not a one-size-fits-all process, and that I need to tailor not only my technique, but also the therapy relationship to each client based on his or her needs.

Multiple theories inform my practice, one of which is a relational, or interpersonal process approach. One of the philosophical underpinnings of this approach is that the therapeutic relationship is a real one, and that here-and-now interactions between therapist and client can serve as powerful tools for promoting insight and catalyzing change.

The therapy relationship becomes an experimental forum in which I can provide interpersonal feedback to clients, they can process their role in the dyad, and they can test out new ways of relating. Some clients struggle with eye contact. We talk about why. Other clients are hesitant to disagree with me. We discuss what it is like to feel the need to continually acquiesce to others. On the flip side, other clients seem primed for an argument and take issue with just about everything I say. I share my experience of what it is like to be on the receiving end of their unrelenting criticism. And so on.

Over time, clients begin to view their interpersonal ways of being from a new perspective. They translate an increased awareness of thoughts and feelings about how they are in relationships, and new interpersonal behaviors into relationships outside of therapy.

Regardless of how clients initially perceive my role as a therapist, I am bound to reflect out loud at some point about the here-and-now dynamic playing out between us. Whether or not they want to know about my dance skills, clients hopefully learn that they can count on me for honest, genuine feedback about how I (as a therapist and a person) experience them. If they want to continue believing that I sleep on the couch in my office, that’s fine, so long as they take what they have learned in therapy with them into the world at large.

By the time I finished training as a therapist, I had learned to focus on entirely different kinds of magic tricks, or illusions — the kinds that we consciously and unconsciously create all of the time.

The question pressing on me shifted: Why do we do that? Why do we, as seemingly rational, well-intentioned people go around deluding ourselves on a regular basis?

In the 1970′s, Ellen Langer, a researcher from UCLA, demonstrated evidence for a phenomenon she called the illusion of control. Subsequent researchers corroborated this so-called positive illusion across a number of experimental setups.

Participants in a lottery experiment believed they had more control over the outcome if they chose their numbers rather than having them randomly assigned. People believe they are less likely to get into a car accident if they are driving than if they’re riding in the passenger seat. In the game of craps, gamblers tend to throw the dice harder when they need higher numbers, evidencing an implicit belief that with “skill” they can somehow control their fortune.

Time and again, research has demonstrated that intelligence, knowledge, and reason notwithstanding, people often believe that they have control over events in their lives, even when such control is impossible.

Like all research in psychology, there is uncertainty as to how these experimental results translate to real-life scenarios. There is also some dispute about the mechanism underlying the illusion of control. Even so, and taking the research results with a grain of salt, it is probably safe to say that we have less control in our lives than we might like to think.

The issue of control is ubiquitous in my practice as a therapist. Clients wish they could control others, detest feeling out of control, fear being controlled by others. And let’s face it, there are times when my own illusion of control directs fantasies of wielding more influence in my clients’ lives than is surely possible. If only I could wave the magic wand that, spoken or not, many clients seem to long for.

Interestingly, later researchers learned that although most individuals operate under an illusion of control at least some of the time, depressed individuals are much less likely to harbor such illusions. When it comes to accurately assessing control, people who are depressed have a much better grip on reality.

This accurate view is perhaps surprising, given than depressed individuals are prone to all kinds of other cognitive distortions. Not surprisingly, however, researchers have also found evidence of a pessimism bias in depressed people, which is exactly what it sounds like: an Eeyore-ification of the world, a donning of dun-colored glasses.

A perennial theme among my clients involves going beyond a simple wish for more control, and extending into the realm of a driving need for control. The former usually comes with a reluctant sigh of acknowledgment that our spheres of influence are not just finite, they are actually quite small. The latter often comes dished up with a heavy serving of denial and a bad case of the tail wagging the dog. The need for control ends up controlling the individual.

We all know people who hold on tightly to a need for control. Things need to be just so. They panic when circumstances change. “Letting go” is not in their vocabulary. I would imagine that it is these individuals who are most prone to relying on the illusion of control to bolster their hope that holding on tightly will provide the kind of security they crave.

A hallmark of mental health is the ability to be flexible — in behaviors and responses, and in relationship to feelings and thoughts. When you need to have control, you forgo flexibility and place a lower than necessary ceiling on your capacity for engaging in and enjoying life.

Ironically, there can be more “control” in a flexible position than in one marked by efforts to keep everything within a narrowly defined comfort zone. It’s like trying to hold on to a water balloon. The more tightly you try to grasp it, the more likely it is to just burst. If, instead, you gently and flexibly cup the balloon in your open palm, you’re much more able to “control” its movement without getting all wet.

It’s important to remember that control in our lives is often illusory. You don’t need to be depressed to take an honest look at the actual degree of control you have in different areas of your life. Once you’ve determined, “Hey, I really don’t have control over this at all,” you can begin practicing flexibility and conserve your energy for those matters that you really can influence.

“I’m not going to try to learn how to waterski because I know I won’t be any good at it.”

“Anything less than an A is not a good enough grade.”

“I need to punish myself for not being perfect.”

Perfectionists engage in multiple problematic thoughts, feelings, and behaviors. They tend to fear failure, disapproval, and making mistakes. Sometimes they fear success. They overemphasize “shoulds” and engage in all-or-nothing thinking. They constantly pressure themselves to succeed.

A shameful belief about inner “badness” often is at the core of perfectionism. Individuals who struggle with perfectionism strive to push past or compensate for the feeling that no matter what they do, no matter how much they achieve, they will never be good enough.

Instead of looking to the mirror, perfectionists also typically look outside themselves for appraisal and approval. As children, they become accustomed to equating achievement with love. The belief that “I need to do more, I need to do better” begins to grow, until it spirals into “I need to be perfect.”

For the perfectionist, the concept of self-esteem rises and falls on the tide of external feedback. When he hears positive words, he feels good. When she receives criticism or even constructive feedback, she is devastated. The only defense against feeling wounded in this way is to strive harder to be perfect: “I just need to do it ‘right,’ and then I will be loved.” Perfectionists continually ratchet up expectations for themselves. But by setting impossibly high standards, they inevitably set themselves up for future failure. And on and on the cycle goes. Clearly, something has to give.

So how does one begin to let go of perfectionism?

Leonard Cohen, in his iconic song “Anthem,” offers some insight into this question. He sings:

Ring the bells that still can ring
Forget your perfect offering
There is a crack, a crack in everything
That’s how the light gets in.

If the core of perfectionism is a belief in inner badness, then its opposite must contain some form of belief in inner goodness. There is, after all, a crack in everything, as Cohen sings. Rather than fixating on “cracks” as imperfections or blights, it is possible to view them as windows through which one’s “good enough” sense of self is fed and expressed.

There is a difference between healthy striving and grasping for perfection. Letting go of perfectionism is not equivalent to curling up in a ball and admitting defeat (all-or-nothing thinking). It is about setting goals based on your own needs and desires, not those of others. It is about stretching just a little beyond what you have previously achieved. It is about engaging in and enjoying the process, not just the end result.

Perfectionism is born in a relational context. Without others’ expectations and feedback to plant the seeds of perfectionism, it simply would not grow. But once it has sprouted, internal beliefs (“I’m not good enough”) continue the cultivation process. To let go of perfectionism, it is best to go back to its birthplace – relationship – to seek support and accurate feedback. But this time, you get to intentionally pick the relationships that will remind you that there is indeed a crack in everything. The cracks allow light and love to get in. Stop trying to seal them off.

Marriage, divorce, childbirth, graduating college, losing a job, moving back home: whether positive or negative, transitions can be messy. And they can also give birth to previously unforeseen opportunities for growth.

Therapy is, after all, about change, so I guess it is no surprise that as a therapist I should be witness to transitions galore.

William Bridges, author of a book aptly titled Transitions, writes that moving from here to there involves three distinct stages: endings, the middle ground, and beginnings. He emphasizes that it is not until we fully acknowledge and move through endings and slog through the ill-defined and uncertain middle ground that we can move into the realm of beginnings. It is the sometimes-neglected and complicated topic of endings that I want to focus on here.

Each of us has an idiosyncratic way of navigating endings. Whether you tend toward avoidance (ending, what ending?) or dive headfirst into the sturm und drang of grief and loss, you likely will benefit from knowing just where on the continuum you tend to fall. Past behavior is a pretty good predictor of future behavior. Having mined your past for clues as to how you characteristically approach the ending of one thing — your high school days, your first love, that job you hated — you can learn what to anticipate as future transitions approach, and be better prepared to cope.

Beyond anticipating what might be coming down the pike, Bridges also discusses the importance of letting go in successfully navigating transitions. Before we can move on to the future, we need to let go of the past, including its implications about who we are and what we make of the world.

Over the days, months, and years, we become so strongly identified with the circumstances of our lives that it can be easy to forget that to move on to something new is, in some ways, to de-identify with whatever came before. Failing to let go or modify the parts of ourselves that rightfully belong in the past can make the messy process of transitions even messier. And yet we cannot shrug off the entirety of our identities just because a transition has happened its way along our paths.

So how do we choose what to leave and what to bring along? It is at this junction of deciding which parts of us we will carry forward, and which we will leave behind — not in the transition itself — that the greatest opportunity for growth lies.

Packing light allows us to discard emotional and psychological baggage that we may have been unknowingly carrying around for a long time. No wonder I feel so tired, you might say to yourself, toting around this 500-pound suitcase of ideas about myself and the world that are outdated, based on faulty assumptions, or tied up with messages I’ve received from other people.

So here is the challenge presented by endings: As you stand on the cusp between this and that, here and there, make a conscious choice about “former me” and “becoming me,” between who you were and who you would like to be. Sure, you might not be able to fully discard all of the aspects of “former me” that you’d like to. And your notions about “becoming me” might be a tad overblown in the final analysis (New Year’s resolutions, anyone?). But it is the process of reflecting that is important. You are equipping yourself with important self-knowledge that is sure to help you through the current transition — and the next, and the next, and the next.