Not long ago, an editor who had been a patient of mine called to ask if I would write a piece for her magazine about what exactly changes as a result of psychotherapy. She wanted to know how to explain a successful therapy to her readers, many of whom might be reluctant to see a therapist, either because of the stigma attached or because they were unsure of how it could help. Write something about that, she suggested.

I was a little surprised at her request. She had been my patient for close to ten years, completing her work with me three years before she called. She was a very skilled editor and a talented writer. If anyone could talk about what changes in therapy, she would be the one, I thought. Perhaps she was sending me a not-so-subtle message, in line with what the composer John Cage has called his favorite Zen story, about the master who said, “Now that I’m enlightened, I’m just as miserable as I ever was!” Was that what the editor was implying about her work with me?

Nevertheless, after close to a year of procrastination, I gathered my thoughts to write the piece she requested. This same patient used to tell me that she had stayed so long in therapy because I often surprised her. Whenever she thought she could predict how I might respond to a given issue in her life, I would come, mercurially, from an unexpected direction. When she told me this, I felt proud: it signaled something successful about my method. I had not tried to surprise her; I had always just responded honestly to whatever she was telling me. But I did have a secret method, one that derived from my immersion in Buddhist psychology. Tread softly, I would tell myself, remembering the Buddha’s own emphasis on kindness. Dwell in the stillness of mind. And always look for the clinging.

It is a paradox of therapy that although impermanence is one of the fundamental laws of the universe, most people do not want to change. They hold fast to their ideas of themselves, to their interpretations of how things are, to their grievances, their anxieties, their identities, and their pain. Perhaps this is why my editor-patient took such delight in my unpredictability. Even if it might be difficult for her to change, at least she saw that I could change—in my role as a therapist, in any case. Maybe I embodied the principle of “reliable unreliability” that, while it creates anxiety in the outside world, is perversely comforting in the safety of the therapist’s office.

Fear in life is fear of change, John Cage said, in one of his most famous pronouncements. His lifelong friend, the artist Robert Rauschenberg, often repeated Cage’s aphorism, adding his own coda: “Nothing can avoid changing. It’s the only thing you can count on. Because life doesn’t have any other possibility, everyone can be measured by his adaptability to change.”

That is one way to phrase it, I thought. What changes in a successful therapy is one’s adaptability to change. In many ways, just saying this much might be enough. The Buddha framed it somewhat differently, though. Transformation happens, he taught, when suffering is known and clinging abandoned. This can happen through therapy as well as through meditation; it can even happen spontaneously without either one. In the case of therapy, if you’re lucky you stop taking your gripes, your feelings of injustice, and your insecurities as seriously as you did when you began. This relaxation allows a more flexible and realistic attitude toward everything. It permits the self to adapt to the change that it is intrinsically part of, rather than trying to hold itself apart. And it permits a natural compassion to arise, both toward yourself, caught in whatever you still get caught in, and toward others, caught in their own pain.

There is a thread that connects the worlds of therapy and meditation, a thread pioneered by the British psychoanalyst D.W. Winnicott. To Winnicott, the very basis of human nature is a fundamental state of “essential aloneness” that paradoxically exists only “under maximum conditions of dependence.” The psychoanalyst Michael Eigen calls this the “boundless, unknown support” of primary aloneness. “It seems to me,” Eigen writes, “that something like a sense of a boundless unknown is part of the background sense of existence. It provides a basis for a sense of emergent trust and faith. If [we] cannot trust the environment to uphold our beings, we live in jeopardy.” This sense of background support is what a successful therapy makes possible. Its emergence helps make the inevitable changes of life more tolerable, allowing suffering to be acknowledged and clinging observed with something akin to humor. Meditation, too, can bring this sense of boundless unknown support into awareness, but sometimes the personal relationship with a therapist is a particularly helpful means of achieving the same thing.

The model for this process comes from the study of infants and their caregivers. A baby needs the mother or father to be present but not overly interfering so that it can settle into its own mind and body. Knowing that the parent is around, the child can relax. This relaxation permits the child to develop an internal life in which the mind begins a lifelong process of getting to know itself. “If something goes wrong with the support one does not know is there,” writes Michael Eigen, “the growing personality is affected.” Therapists often find themselves resurrecting this sense of background support for patients whose sense of primary aloneness was wounded for one reason or another. Buddhist meditation plays on this same theme. By creating a sense of background support through the calming and stilling of the mind, meditation makes possible the compassionate conditions that allow clinging to be released.

My thinking on this matter opened up in a workshop I taught with Robert Thurman and Sharon Salzberg. Some hours into the workshop, a woman with a worried look on her face raised her hand to ask a question that seemed to have been simmering for some time. “What can I do about my regret?” she began. “I’ve been feeling badly about ways I treated my mother, about things I said to her, and I can no longer apologize to her.” Bob took the question and responded immediately. “She’s not alive, is that what you mean? Because she’s dead you can’t apologize to her?” Bob has long defended the traditional Buddhist view of reincarnation, and it would have been easy for him to go off on a long tangent at this point. But he did not. “She can still hear you,” he said, as he began to explain the Buddhist notion of rebirth and the ways in which people remain connected life after life. Something in the woman’s face relaxed as he spoke, even as it was clear that she did not entirely share his belief in reincarnation. Bob seemed to notice this, and his tone changed. He looked at her directly. “She doesn’t want that apology from you, you know,” he told her. “She just wants you to have that sweet smile on your face that you have now. Go ahead and become a Buddha yourself. That will be better than any apology.”

Although impermanence is one of the fundamental laws of the universe, most people do not want to change.

Everyone in the room could sense the psychological truth of Bob’s response. Although he was answering in a Buddhist context, his reply was very therapeutic. Of course a mother wants nothing more than for her child to be happy. The woman in the workshop, hampered by her regret, was actually blocking this maternal energy in herself. Her contact with unknown boundless support was full of static. Her mother might have dropped her physical body, but, as Bob was pointing out, she was not entirely unavailable. The room seemed to swell with a maternal energy as the woman in the workshop wrestled with his words. The importance of her apology receded amidst the palpable presence of her mother’s love.

Some weeks later, I encountered something similar from another unexpected source—an article in The New Yorker about Paul McCartney. Entitled “When I’m Sixty-four,” it appeared in the June 4, 2007 issue, just as McCartney was turning 65 and launching a new album, Memory Almost Full. The themes of reminiscence and loss running through the songs on the album reflect what the New Yorker writer, John Colapinto, saw as an “unmistakable sadness” in McCartney.

Once, years ago, as a college student, I found myself on the same flight as McCartney and his wife Linda. I snuck up the circular stairs to the First Class lounge, hoping to catch a glimpse of the star, and found him sprawled on a sofa asleep. I was flummoxed. Seeing him sleeping suddenly made him seem human—and vulnerable.

Photography by Megan Bigelow
Photography by Megan Bigelow

I sensed that same vulnerability as I read the New Yorker article. Linda, his wife of 29 years, had died of breast cancer some years before; he was ending, in a well-publicized catastrophe, his marriage to Heather Mills; and he was openly admitting to dyeing his hair. Though still an award-winning megastar, McCartney was now alone. Colapinto described him eating by himself in an Italian restaurant and walking through London, continually accosted by passersby thrusting CDs at him to sign. It sounded grim. But then, as the article continued and McCartney began opening up to Colapinto, a funny thing happened. The same theme that had emerged in our workshop began to pour out of Paul McCartney.

McCartney’s mother, Mary, was a midwife and the main financial support of the family. His father, Jim, was a jazz trumpeter and cotton salesman who had played in clubs in Liverpool in the 1920s. When Paul was 14 he swapped a trumpet his father had given him for his first guitar. That same year, his mother was diagnosed with breast cancer. A mastectomy followed, but she died after suffering an embolism while recovering from surgery. McCartney wrote his first song that year, a love ballad called “I Lost My Little Girl.”

“I didn’t think I was writing anything to do with my mum, but from this perspective I possibly was,” he told Colapinto. “She died when I was 14, so you get that terrible thing of not being able to picture her face after a few years. It’s sort of a horrific feeling of slipping away.”

McCartney’s mother continued to appear and reappear throughout the New Yorker piece. Though she was long deceased, her influence persisted, inspiring some of his most lasting work. Colapinto writes:

The melody to “Yesterday” . . . came to McCartney in a dream. He brought it to Lennon, unfinished, with nonsense lyrics as a placeholder: “Scrambled eggs, oh my, baby, how I love your legs.” The song became a standing joke between them for days while they tried to find words to fit the melody. McCartney finally wrote the lyrics during a three-hour car trip from Lisbon to the south of Portugal [that] he took with Jane Asher, his girlfriend at the time. “The words are quite mature for a kid,” McCartney said. “Rather . . . dark. Yet [the song] doesn’t communicate itself as too dark somehow. But again, I wonder, psychologically, looking at that now, I sort of think of the words ‘Why she had to go, I don’t know, she wouldn’t say. I said something wrong, now I long for yesterday.’ Was that harking back to my mum?”

Reading McCarthy’s words, I couldn’t help but think of the exchange in our workshop. Love for the long-lost parent needs to keep finding new ways to express itself. It is part of the unknown boundless support of the mind. Death of a parent does not mean that the support ceases to exist. I was particularly struck that the melody of “Yesterday” had appeared to McCartney in a dream. Bubbling up from the unconscious, the trace of the mother made itself known. McCartney’s mother was still very present as the article came to a close. Colapinto wrote:

I was curious to know whether he thought of the sixties as a magical time. “I think I remember it that way,” he said, without conviction. “But, like everything, there’s the juxtaposition. When I wrote ‘Let It Be,’ for instance”—a song that begins “When I find myself in times of trouble/Mother Mary comes to me”—“I’d been partying too much. I had a sort of dream where my mum came to me and said, ‘It’ll be O.K. Let it be.’ That’s where the song came from. So I obviously wasn’t doing too great. It was not just the golden memories.”

McCartney’s recurrent encounters with his long-lost mother merged with Thurman’s words to the woman in our workshop who was mired in self-blame. Both of them seemed to be whispering the same advice: “Let it be.”

The therapeutic implication of this advice was not lost on me. It supported the basic premise that John Cage, D. W. Winnicott, Michael Eigen, and the Buddha seemed to agree on. While the human impulse is to search for an answer—for restitution or reparation or repair in the case of early childhood wounds, and for ultimate release into an absolute heaven or God in the case of the spiritual search—these five men saw a different path to healing. In ways that are remarkably similar, albeit expressed in entirely different languages, they laid out a humble prescription: Connecting with the boundless unknown support intrinsic to the mind is the key to psychological balance. 

Ironically, the cover of the New Yorker issue I had been reading shows Tony Soprano looking over his shoulder as he walks out the door of his therapist’s office for the final time. Called “Last Exit,” the illustration foreshadowed the closing episode of The Sopranos, in which Tony looks up from the table at someone entering the restaurant where he’s dining . . . and the television screen abruptly goes to static. We are left to presume that Tony has just glimpsed his assassin.

Death comes to everyone, even Tony Soprano. And therapy, even good therapy, comes to an end. Change is everywhere. Yet the support that has its origins in our most primary relationships need not be forsaken. Our mothers may die, or disappoint, but they still come to us in our dreams.

The editor who asked me to write about what changes in therapy eventually stopped coming to see me. “I feel like I’m just paying for your friendship now,” she told me one day, as she broached the topic that the psychotherapy profession ominously calls termination. I took her comment as a sign of success, although I felt my own pangs of regret upon hearing it. I loved my time with her, and it was not easy for me to let her go, even though I knew she was right: she no longer needed me to remind her of the unknown boundless support that was intrinsic to her nature. In times of trouble, she now found that something ineffable would come to her aid. Whispering its own words of wisdom, the background energy of her being had its own intelligence. She might be just as miserable as she ever was, but she was no longer filled with regret about it, nor was she casting about for someone to blame.

“I said something wrong, now I long for yesterday,” Paul McCartney sang. The woman in our workshop said much the same thing as she reached out, with remorse, for her lost mother. My patient used therapy to navigate these same waters, as she struggled with love and loss, shame and sorrow. Yet her willingness to unburden herself to me paid a dividend: the Buddha’s teachings opened up to her. Not only was she more accepting of change, she was changed. There was a lightness to her, an irreverence, a jauntiness poking through the surface of her serious-editor persona. In fact, her energy reminded me a little of Paul McCartney’s. On his good days.

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