Meeting the Voices in My Head

And Searching for an Inner Adult

Image from Westend61

Introduction

I don’t know about you, but voices are constantly chattering in my head. I don’t mean audible voices. I’m not having hallucinations. I call them thoughts, feelings, memories, cravings, impulses, self-consciousness, and self-criticism. There seems to be more than one person in there because sometimes they talk to one another. I don’t mean there are actual other people residing in my skull and I don’t have what used to be called multiple personality disorder[1]. They are all parts of me, although sometimes they talk about me and judge me as if I were a person they don’t like very much. It’s a strange thing, but it’s the kind of strange thing that’s so ubiquitous, so constant, and maybe so universal that I went through most of my life thinking it wasn’t strange. Sort of like a fish not thinking it’s remarkable to live in water.

When I started thinking about these voices in my head, I wanted to know who was talking, who were they talking to, where they came from, what they wanted, who to trust, and what would make them go away. I started to ask them, but some only said, “I’m you, dummy and I’m talking to you. I’ve always been here. I want what you want. You can trust me, and I’ll never go away.” Other voices disagreed. That’s the first thing I found out. These voices don’t always get along with each other. They represent multiple points of view that are often in conflict.

My Method

I started to study these points of view by creating a new point of view. I imagined a part of myself listening in to a conversation a group of people was having. I wasn’t listening to what they were saying, as much as I was listening to understand who they were and what their overall function might be. I couldn’t see or hear them, but I could infer that some were doing the talking and some were listening. There were some others who were being talked about, and others who made signs that certain members of the group interpreted. I inventoried the points of view, then I classified them according to common characteristics. Finally, I looked back at everything I’ve learned about psychology and human development and saw where they fit in and how they got there. The result is this book, which is all about the inside of my own head; but, who knows, it may also apply to you.

Oh, I missed a step. Because I’m a shrink, I have access to the inside of other people’s heads, or at least what they tell me about what’s in theirs. I compared the results of my study with what they said. When I formed theories about these voices, I applied them to my clients to see if the theory worked for them. Mostly, it did. You’ll have to see for yourself if my account of inner voices works for you, whether it is coherent or illuminates anything you didn’t already know.

In doing this work, I found myself interested in the origin stories of every voice in my head. Maybe it’s the therapist in me. If you came to me to talk about your depression, anxiety, bad relationship, addiction, or what have you, sooner or later we must talk about how you got that way. We may not necessarily find the solution to your problems in your history, but I can’t say I know you until I know it. Consequently, while examining the voices in my head, I tried to inquire where they came from and why they appeared.

Unfortunately, I found I couldn’t always interview them like I interview clients. Instead, I had to rely on conjecture and lean heavily on developmental psychology. I have studied widely; everyone from Freud, Jung, Sullivan, Lacan, and the Object Relations and Ego Psychology theorists, to Erikson, Rogers, Piaget, Schwartz, Bowlby, and Bowen; as well as a bunch of philosophers. Scholars might have a stroke if they see how I’ve put a little bit of this and that together, but I’m only interested in what works. I could care less about maintaining the purity of any brand of psychology. 

Many psychologists have examined these inner points of view and come up with a different company of characters than I have. Freud looked inside and found an Ego, a Super-Ego, and an Id. Jung presented a troupe of dozens of archetypes. The Internal Family System’s model of Richard C. Schwartz identifies exiles, managers, firefighters, and a self. I found every cast of characters lacked something. If you were to look within and learn more about the personalities behind the voices in your head, you might organize them differently. It’s all good. The main point is to appreciate your multiple points of view and be able to assess the wisdom of the parts that hold them.

I wondered which of these voices was my inner child.  I’ve been told I have one. Some shrinks encourage everyone to find their inner child because the kid is said to help you heal from the past and tap into your latent creativity. I had no trouble finding children in my own head. In fact, I soon discovered it was filled with nothing but inner children, squabbling, tattling on each other, bossing each other around, acting petulant, and throwing spectacular fits, as well as healing and being creative. I began to wonder if there was an Inner Adult to take care of them all. Many claimed to be, but inner children like to dress up as adults and assert a maturity they don’t deserve; just as actual children do. Moreover, just as children will regard anyone with a smidgeon more wisdom than they have as grown up, inner children will accept other inner children as caretakers who can barely take care of themselves.

Not finding an inner adult is terrifying. I’m over sixty years old. There’s got to be one, somewhere. How could I survive this long without one? Which of the inner voices I can trust to make good decisions? I don’t think I’m the only one who wonders.

Which one of us has not wanted someone to appear with all the answers, who can take responsibility for our lives and tell us what to do? Please tell me I’m not alone in this. I’ve wanted this when I was a little kid. I still want it now. If I can keep it with me and be able to access it whenever I wanted, all the better. At every stage of my life, I thought I had it, but it always proved to be inadequate. When look back at any part of my life, at some of the decisions I made, I want to kick myself. That doesn’t mean I’ve got it all figured out now. I’ve learned not to trust any part of me that claims to be my inner adult.

My search for an inner adult parallels a longing for God, or a desire that politics, science, or technology can give us the answers. Maybe they’re all looking for the same thing.

The same can be said of this book [2]. It can never be the last word. Meeting the voices in my head is an ongoing process and I can’t ever pretend to have it all figured out. Searching for an inner adult who will explain everything and take charge of the situation is something we do throughout our lives. I’m glad you joined me; perhaps we can find an inner adult together.


Next week: The Innermost Child


1 Now it’s called dissociative identity disorder (DID), which is a name that more accurately captures what can be disorderly about it. The problem with this condition is not the multiplicity of identity, but that one identity sometimes doesn’t know what other identities are doing.

2 I plan for this to be a book someday. Right now, it’s a book in progress. You are reading the draft of the introduction. I plan on posting the book in my blog first, all the way through.

A Good Faith Estimate of What Therapy Will Cost Without Insurance

Image from AAMS

Recently Congress passed the No Surprises Act, which is supposed to correct a wrong that’s committed when a patient enters medical treatment and later finds that not all their health care providers are in-network with their insurance company. These unfortunate souls have been stuck with high bills they had to cover. The act is also designed to facilitate the ability of patients to shop around and get the most cost-effective medical care. I trust the law will accomplish these worthy goals, but in the process, it has mandated that I give clients a document which is impossible to provide.

The document I’m supposed to give is a “good faith estimate” of what it will cost to be in therapy with me without insurance. My clients have always known my per session private pay fee; that’s no secret. But, in addition, this law orders me to state what your diagnosis is, describe the services I’ll provide, the frequency of sessions, an estimate of how many sessions we’re going to need before we’re done, and total it up for you, all within three days of when you set your initial appointment. Not three days after we meet, but three days after you make the appointment.

Here’s the problem. I cannot in good faith give a good faith estimate. But I can explain why.

Diagnosis

Many prospective clients, when they first contact me, tell me the nature of the problem for which they seek therapy. They’ll say they’re anxious, depressed, their wife left, they’re drinking too much, or something like that. This is helpful information, but it’s not a diagnosis. A diagnosis is a label given to a condition that meets a strict set of criteria so that every medical professional can have the same thing in mind when you say you have, for instance, generalized anxiety disorder. Not everyone who says they have a problem with anxiety has an anxiety disorder. It could be a hundred other things in the diagnostic schema. Your anxiety may not even meet criteria for any disorder, but still be very troubling to you.

It’s impossible to give an accurate diagnosis before I meet you and do a thorough evaluation. In some cases, a thorough evaluation could take many sessions. If, for instance, you drink a lot and also have problems with anxiety, we won’t know until you’re sober for a few months if your anxiety is caused by your drinking or the other way around. That, in turn will affect the course of your treatment.

If you want to know your diagnosis, I’ll tell you when I think I know what it is, and you can tell me if you agree; but I cannot in good faith give a diagnosis before I know anything about you. An inaccurate diagnosis is misleading and can stay on your record for years. It can be impossible to get rid of.

The Services I Provide

There are four services I provide. Evaluation, individual counseling, couples’ counseling, and sometimes I write reports to third parties when clients think that will help. Evaluation, individual and couples’ counseling all cost the same rate per hour. I write reports for free if they are not too elaborate. If they are, I charge the same cost per hour as I do for sessions.

Except for the evaluation, there is no way of knowing what you’re going to need when we start working together. Often, when someone comes for individual counseling, I end up seeing family members to involve them in your therapy. When someone comes in for couples’ counseling, I like to have some sessions with the individuals privately, so we can talk about what’s hard to say with the other present. As for the reports, it’s always the client asking me to write the report when they need one. I almost never offer because it’s important to me to keep your confidences.

So, here’s my good faith estimate regarding the services I provide. You will definitely need an evaluation just so we can look at the big picture, but I don’t know how many sessions that will take. We will meet individually if you can profit from having a private place to talk. We will meet with family if that can help. I can write reports if you don’t mind other people knowing what I tell them.

How Frequent Will Your Sessions Be?

I like to meet with clients frequently enough that we don’t forget what we’re doing, but not so often that there’s nothing to do. You always have control of the gas pedal and the brake, so you can start and stop therapy when you want and go as fast as you want to go.

It generally works like this: we meet more frequently at first, to get us going, especially if you’re in distress and need to acquire and perfect new coping skills. As you start to feel better, learn those skills, and resolve the problem that brought you to me, you might stop therapy. I’ll invite you to see me again if you ever need to. I now have hundreds of clients who make an appointment or two every few months or years, whenever they need to talk.

Some clients who find they like therapy and want to deal with the underlying issues that lead up to their problem, meet regularly for longer, but less frequently, giving us time to reflect between sessions.

The point is that the frequency of sessions depends entirely on you and can change from week to week. To ask me to say, before we even meet, how frequent the sessions will be, may cause you to believe you are locked into a plan that should be flexible.

How Many Sessions Will You Need?

Predicting the future is the most difficult part of the “Good Faith Estimate”. I know a therapist is supposed to be an expert and able to predict how treatment is going to go. However, I’m enough of an expert to know our expertise is sketchy. I will not make extravagant claims of understanding something I don’t. Psychological trouble, no matter how mild or severe, is a feline thing. Like a cat, it hides, you never know what it’s going to do, and it never does what you want. I find it best to be adaptable and adjust as we go.

When client first tells me the nature of the problem for which they seek therapy, they seldom tell the whole story. Sometimes they aren’t aware of other factors that turn out to be important; sometimes they’re afraid to say. Very few people end up working only on the issue that brought them into therapy.

The next problem has to do with the concept of being done with therapy. To my mind, you’re never done with therapy in the sense that you will never need to go back and take another look at things. It’s quite all right to take a break from it, maybe for years, but the practice of self-examination must be permanent and sometimes you will need the help of others. Furthermore, if you have a chronic condition, such as an addiction or repeated episodes of depression or psychosis, then your overall success will be directly related to low long you stay in therapy. People who stay are less likely to suffer relapse.

There will be many therapists who can tell you how many sessions they will give you, not how many you need. I used to be one of them. I had a program. I had a set course of treatment that I applied to everyone who came by. There’s a place for that. It imparts basic manualized therapeutic information in what appears to be a cost-effective way. You may want to try it if you never have before. I don’t do that kind of therapy anymore because I think it wastes people’s time. I prefer to provide my therapy tailor made, not ready-to-wear. I want you to have something that fits you perfectly. The thing is, we don’t know in advance what that’s going to be.

The Grand Total

The No Surprises Act requires that I add up all the projected costs and give you the grand total. Even if we knew the diagnosis, the types of services, and the frequency and number of sessions, do you really need me to do the math for you? It’s going to be expensive, frighteningly so, but you should also calculate what it will cost you to NOT go into therapy.

You won’t be able to say for sure what it will cost to NOT have therapy. Now you understand how hard it is to estimate costs.

Not everyone is right for the kind of open-ended, eclectic therapy I offer. I’m OK with that and you need to be, too, if you work with me. If you do work with me, I’ll expect you to take a leap of faith into an unknown future. I’ll go with you. If you can’t take that chance, I understand. However, I do have one question for you.

Does an unwillingness to take a chance have anything to do with the problem that’s troubling you?

The Scab Pickers

Imagine turning on your TV and looking at all the programs, movies, and sports available. You have cable, so you have thirty-four hundred channels to look through. You have Roku and subscriptions to Netflix, Hulu, and Amazon. There’s also YouTube. Despite this bounty, there’s one show you always watch, over and over again. Not just one show, one episode of one show. You could recite the lines and act out all the parts. You know what’s going to happen, but you see the show to the end anyway. That’s what it’s like to be a Scab Picker. It’s madness. Continue reading →

The Righteous Idiots

The addiction, the madness, the lying, the cheating, and the selfishness have just done too much damage. Your relationship is crippled and you’re not sure whether it will ever be the same again. You’ve heard enough apologies, forgiven too much. You can’t forget all the things that have happened. You’ve hardened your heart, dug in, and hate.

I will not argue against the justice of your cause. Yes, she did things that were unwarranted, things that hurt. Bad behavior wrecks things and some of those things are your feelings. You probably can’t even count the number of disappointments. It’s your right. Your cause is just, but don’t be an idiot. Don’t be one of those people who think, just because they are right, they can afford to be stupid. Continue reading →

Wreckage on the Road to Reconciliation

Renounce Revenge

Once you’ve gotten in touch with your feelings and values, you realize that you are hurt. The next step, if you took the path towards healing, is to renounce revenge. If you don’t, you are at risk of becoming the next specimen in our menagerie of people stuck on the Road to Reconciliation: The Ax Grinders. Continue reading →

Wreckage on the Road to Reconciliation

Playing the Victim

So far, you’ve been bearing right on the road to reconciliation. There’s a good reason for this. To the left are all the hazards that come from not taking your injuries seriously enough: becoming an Impossible Martyr, a Denier, or a Discount Pardoner. You have gotten in touch with your hurt and insisted your partner do better than he has. Now, if you continue the way you’re going, you’ll head over a sheer cliff. You’ll go from being someone speaking out against injustice to someone who is playing the victim. Continue reading →

Wreckage on the Road to Reconciliation:

Stay On the Road

To stay on the Road to Reconciliation, and not drive off over the cliffs on either side, you first must acknowledge your hurt, then set it aside. You must recognize that you were a victim, but don’t play the victim. Avoid forgiving cheaply, but don’t be such a fool that you never forgive. So, which is it? you ask. Which way do you go? Continue reading →

Wreckage on the Road to Reconciliation:

The Helpless

I’m glad I didn’t decide to be an experimental psychologist. If I had, I might’ve had to lock dogs up in cages and shock them for the sake of science. As it is, others can do it and we can benefit from the things they learned by doing so. Continue reading →

The Discount Pardoners

Once you’ve acknowledged that someone you love has hurt you, next comes the difficult decision of what to do about it. Some of the people you meet in the Road to Reconciliation think they’ve found a short cut. They give pardon away cheaply, believing then everything can just go back to normal. Continue reading →