Attention
The capacity to focus, to attend fully and closely is a gift. It improves the quality of relationships and the work you do. When it is intense, when we are absorbed, we can virtually lose ourselves. We achieve what Mihaly Csikszentmihaly calls the sensation of “flow,” which is akin to spiritual experience.
But close, obsessive attention can also be destructive. Like when we can only see flaws in ourselves or others and lose sight of our virtues, lose sight of the complexity of people.
Many people who come to therapy are focused this way. Their attention is literally stuck in one place. And the challenge is to help them let go, to see the complexity in themselves and others. This simple act may set them free.
Of course, just telling someone to stop paying so much attention to the negative rarely works. Picture a parent saying to a child, hurt by classmates, “Just don’t pay attention to them.” This is where good therapy comes. We help people to expand their field of attention.
Here’s a story that speaks to this truth.
His Amazing Nose
This is the story of Bernard, who came to see me after years of intolerable sinus pain. Before he sat down, Bernard asked, in a mildly belligerent way, “What can psychotherapy do for me? Is there a chance in the world that you can help me?” Then before I had a chance to respond, he launched into an agonized description of a life dominated by the pain in his nose. He couldn’t work effectively, and his law practice had dwindled to about a third of what once was. So, of course, he couldn’t provide well for his family. Which was humiliating. Wrapped up in his pain and humiliation, he had largely ignored his children, and his wife. She was present, by the way, and seemed ready to strangle him. Then he concluded his agonized and defiant monologue where he began: “Can you help me?”
Parenthetically, I had a group of students located behind a one-way mirror. Later, they told me that the more Bernard talked, the larger his nose seemed to grow. It so dominated the conversation that, after a while, it seemed to them that I was talking to an immense, disembodied nose.
Back to reality: I asked what he had tried so far.
“Everything,” he exclaimed in an exasperated, nasal-tinged tone. “Obviously I tried nasal sprays and corticosteroids and decongestants. You name it, I’ve tried it. And that includes some surgeries. Chiropractics and herbal medicine. Hypnosis, too. I’ve tried everything. And, because my wife, Gloria doesn’t always believe that my pain is real, I’ve tried psychotherapy. Many times, by the way. It was nonsense. But, she’s persistent. So, here I am again.”
“Do you really think you can help me?” he said, in a whisper, as if a full-voiced question would exacerbate his pain. Gloria, who, to this point, had remained silent, turned from Bernard and added her sad second: “Can you help him, Barry? His pain has ruined our lives. I have tried endlessly to pay less attention to his pain and more to the good things in our lives.”
I enjoyed the role of being the clinician of last resort. I felt like there was little for me—or for them—to lose. They could get better, making some people very happy. I could experiment. I could challenge my own practice. And I could surely learn.
“I might be able to help,” I began, “but only if you’re willing and able to follow my instructions.”
Bernard was a little surprised at my response. He’d been to plenty of psychotherapists and none had talked about following their instructions. But, after some hesitance, he said that he had suffered so much that he was willing to try anything. I responded in the same spirit. “Then I’ll try, too.” But I reiterated: “You’ll have to follow my instructions.”
Before providing those instructions, I began a rapid-fire series of questions. Where is the pain located? How intense is it generally? How intense is it now? When? In the morning, the evening, the middle of the night? How frequently has he felt overcome by it and unable to work or be with people? What had he done to relieve himself?
After about 20 minutes of asking, in minute detail, about the pain that had become the center of his life, I gave him an assignment. I instructed him to keep a detailed diary of his suffering. “That’s ridiculous,” he said. “I already pay too much attention to it.” I explained: I want to know when the pain is bad and better, whether there are rhythms throughout the day. Is it better or worse when you’re alone? With some people, not others? We need to figure out what exacerbates and eases the pain. You have described your pain as a single phenomenon—an undifferentiated mass of suffering—but I bet it isn’t always the same.
In this way, I explained, maybe we can figure out how to reorganize your days, when you should work or play, when you should rest, maybe retreat. We might be able to treat parts, if not the whole. We might develop routines throughout the days that ease the pain. In other words, we might develop a more nuanced, a differentiated approach to your pain.
This, at least, is what I say to Bernard to encourage him to keep an accurate diary. But I am also hoping to deluge him with information about his pain and his obsessive attention to it. Eventually, I am hoping that he rejects my assignment—not the diary but the instruction to keep on obsessing about the pain.
Naturally, Bernard tells me that my assignment is ludicrous. He already pays too much attention to the pain. Internally, I agree. Outwardly, I insist that it might seem like we know enough but I don’t think we really understand his pain. Our discussion is getting repetitive but that’s alright with me since I want him to reject it.
Eventually he concedes. The next week he comes in with a diary. It’s not detailed enough for me, I tell him; and it really is very haphazard. He resists, at first, then agrees. “It just seemed like such a silly thing to do. I had better things to do with my time.” Here I see Bernard moving in a positive direction, moving from his obsession but I remain quiet.
The third week, he and Gloria enter my office in the midst of an animated conversation. Not quite an argument but heated and very engaged with an issue other than his nose. I ask how he’s doing with his pain. He says he’s not so interested in discussing that and wants my help with marital problems. “OK,” I say and agree to listen in, see if I can be helpful. But they seem to be doing very well, even when the passions run high. Within about a half hour, they even come to a resolution—with no help from me.
So, I ask again, “What about your pain?” “That’s not the issue,” he repeats. I am about to ask him again when I realize that I have almost been seduced into returning to the old focus on his nasal pain. By doing so, I’d join the family system whose attention is so absorbed in the problem, thus reinforcing it. So, I shut up and help them resolve an issue with their children. They leave that day without ever telling me about the pain.
The next week, Bernard and Gloria immediately name another issue they want to work on: her returning to work. I see this as less focus on his nose but finally understand that I shouldn’t name that direction. Even naming it might rekindle the focus on his pain.
A few weeks later, I am about to give them another assignment. This time, to further improve their relationship. But I stop. I want to see how their system resolves itself. Already there are major shifts. Gloria has, in fact, returned to work. The children have stopped their dull, almost hopeless requests for Bernard’s attention. In fact, he has sought theirs. He has begun to play cards with them, to watch a movie or two, as well. And to plan a family trip. The dam created by the obsessive focus on Bernard’s pain has broken.
Together, we say “Let’s meet in a month.” They happily agree. They feel “quite able” to resolve problems on their own. And this will save them the money they will need for their family vacation.
As they left, I didn’t ask Bernard about his nasal pain. But, according to my students who were happily observing behind the one way mirror, his nose had returned to human size.
Barry Dym 