Now and then I have met someone who seems to have grown up, without therapy, into a relatively balanced, contented person, little encumbered by internal conflicts. As a psychoanalyst and psychiatrist, I continue to wonder how to account for this.

Growing up has so many difficulties and challenges that successfully traversing them all on one’s own seems a daunting task. Where is the child’s guide to developing a sense of personal autonomy while also enjoying relationships with others? How does the child of 3 or 13 figure out how to deal with envy, sexual feelings, and vengeful and destructive wishes? How can the child figure out that her stomachache represents anxiety about going to school, or further, that her worry about school may serve to distract her from more serious concerns about events and fantasies at home?

There is a reason why so many movies about or for children (such as E.T. the Extra-Terrestrial ) depict adults as uncomprehending of children’s worlds: There is a certain truth to it. Even the most intuitive and empathic parents can never fully grasp the inner world of a child, even though they were children once themselves. Nonetheless, their efforts are important, and parents routinely help children learn to understand, accept, and regulate their feelings and wishes. But there are always shameful and guilty feelings that children prefer their parents not know, and always feelings and fantasies that parents can’t imagine.

A 4-year-old girl may brazenly tell her mother that she plans to marry Daddy but hide how much she would love to destroy her younger brother – or vice versa. No matter how her mother responds, the little girl still is significantly on her own as she tries to figure out fantasy and reality. With little knowledge or experience, children are called upon to deal with their own imperious wishes, their own self-criticisms, their changing bodies, and parents’ and teachers’ demands, not to mention the existence of gravity, hunger, sickness, sadness, friends’ rejections, baseball strikeouts, and so on. Parents can help and can hurt, but there is always a lot that is beyond their control.

Given their inevitable reliance on their own limited resources, children pass through phases of various fears, quirks, beliefs, rituals, and ways of relating to the world. These adaptations ebb and flow, change, become dormant, and reappear. We all carry at least some of this baggage, some of this crazy-as-it-is-I’m-dealing-with-it-the-best-that-I-can, into adulthood, and we typically want to leave the contents of the baggage unexamined. It’s so hard to see one’s own blind spots and amazing how tenaciously most of us want to hold onto them.

There’s an aphorism that says, “If you think education is expensive, try ignorance.” This is how I feel about psychoanalytic therapy. In my office, I see people all the time who have married so as to avoid deep involvement and then divorce because there wasn’t enough involvement; or who, unconsciously, are trying so hard to marry or to avoid marrying one of their parents, that they can’t make a relationship work with a partner; or who keep playing out, while trying not to, guilty and shameful revenges for childhood traumas great and small. Often they say to me, “I should have come to see you 20 years ago,” and I don’t disagree.

Why didn’t they? Most often it is because the uncomfortable feelings that people tend to have about their emotional struggles are carried forward from childhood into the present. People talk about the stigma of seeking help for emotional problems, but the most important, and overlooked, “stigma” is typically one’s own internal hesitations and self-deprecations. The statement “I need some help, and I’m going to get it” is seldom met with disrespect, but the shame of wanting or needing help with one’s mind is so great that few people are comfortable saying it.

When I was in college, I was as ashamed and scared of needing therapy as anyone else, but there were things troubling me that I couldn’t master. A little bit of psychotherapy at that time helped me recognize how little I understood about myself and my feelings toward my family – a very helpful start. More psychotherapy when I was a medical student helped more. Having a full psychoanalysis as I pursued training as a psychoanalyst provided a tremendously gratifying sense of finally really unraveling the tightest, most hidden emotional knots. How fortunate that I didn’t feel obliged to pretend that I was so grown up as to deprive myself of essential help from others.

Freud suggested it was desirable for people to be able to love and to work, and some might add, to play. These might sound like simple matters – love, work, and play – but they require emotional balance and flexibility, as well as realistic perceptions of oneself and others. Since there is so much of the past in the present, even invisibly, the emotional obstacles to unencumbered work, love, and play are many. Some people do indeed accomplish these seemingly simple but actually very ambitious aims on their own, but it is so much easier when one has help to clarify one’s misperceptions.

It can be difficult at any age to grow up and take the next developmental step forward. And developmental missteps are resolved much more readily, and usually more completely, with therapy than without. Yet so many of us seem to prefer to try to grow up the hard way, stumbling and struggling alone through our own personal obstacle courses. There are other options.

Dr. Blum is a psychiatrist and psychoanalyst in Philadelphia.

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