Something Happened to How I Think About Therapy

Why I watched "Stutz" three times, and why you should too

The easiest remedy to being chronically late was taking a lot of cabs. Heading downtown to work that morning, while outside the window Manhattan revealed itself in a fast-forward motion of infinite frames, I thought about the session I just had with David -- another forty five minutes’ monologue was in the books. When I decided on trying therapy, I knew nothing. Except that I needed to clean up my head. I needed a fix. 

My life was a semi-wreck, or at least I thought it was -- lots of what-am-I-doing-here’s at work, a looming breakup with my fiancée, an energy-depleting conviction of being seriously ill, and a lack of interest in any human interaction. I was constantly preoccupied, anxious, and unable to meet the easiest social challenge. 

Someone suggested therapy. I think it was my dad, a staunch believer in all things psychology, introspection and mental health. An avid reader of these subjects, he one day told me that a shrink might help. “Give it some thought,” he said, “but don’t let too much time pass: these things snowball faster than you think”. 

David came highly recommended, and he was a nice guy. We’d meet once a week in the morning, before work, at his midtown office: a heavily carpeted, grim and silent apartment that brought to mind The Shining’s Overlook Hotel. I’d get in and sit in a waiting area until he’d crack his office door open. That was the signal that he was ready to start. I’d sit in a comfortable, dark green velvet chair, wait for a prompt, and start talking. Our sessions were simple. David would ask a question, something apparently innocuous like “How was your week?”, and I’d talk for forty five minutes. Every now and then he’d interject with no more than a few words, nothing that would steer my rant in a different direction, or correct the way I decided to lay out my thoughts. By and large, though, it was me talking. I talked my life off.

Probably in his sixties (his age was undefinable), impenetrable, with thick glasses and a deep, low-toned voice, David was the quintessential traditional therapist. Something that I didn’t know then, but I do now. Nothing wrong with that, mind you -- he did help me win myself back. And I would have stayed in touch, as he warmly encouraged me to do at the end of our last session, on a late February morning just weeks before I moved back to Europe, if my life hadn’t taken a sharp turn down a path where marriage, children, a brutal work schedule and non-stop traveling pushed therapy to the periphery of my mind. 

So that day, in the cab, on my way to work, I thought that I was starting to feel the benefits of meeting with David. I had more energy, my thoughts were back into positive territory, and I even enjoyed a few minutes’ small talk with the cab driver. Three unequivocal signs that things would be downhill from there.

What the heck was happening? I couldn’t come to terms with the fact that David would just listen to me talking for forty five minutes once a week, for I forget how many weeks; he wouldn’t tell me what to do or what medicine to take, if any. Yet, this was fixing me. Was I, maybe, an easy case? One of those not needing much of an active, serious effort, that would resolve spontaneously? I had always been an introvert, always kept all my intimate thoughts to myself. So maybe talking, getting things off my chest, was the cure. 

But why there, in that psycho/horror movie-like place and not anywhere else? Because there, David was seated in front of me, paying attention to whatever came out of my mouth. Most importantly, David would listen without judging. Occasionally, with what often sounded like a never ending series of “Why?”, he would urge me to go deeper on whatever I was talking about. He would force me to articulate my thoughts until I’d give them an acceptable shape; where by “acceptable” I mean “that would make me understand where my actions were coming from”. That’s what I was paying for. Nothing else.

David never gave me a solution to my problems. He helped me identify their root cause, but that was it. I guess that identification process, in and of itself, represented the solution I needed back then. The rest I did it myself; slowly and at times painfully, but I did it.

--

So time passed, and times changed. 

And the other night I thought that I hadn’t watched anything on Netflix for a while, so I indulged myself. Usually, when this happens, I spend a ridiculous amount of time just browsing, until it’s time to call it a night and go to bed. A classic choice overload thing. But this time, something immediately caught my attention: “Stutz”, by Jonah Hill.

At first, I couldn’t recognize who Jonah Hill was -- I’m terrible at all things movies, Hollywood, Academy Awards, Venice, Cannes, and what have you. Then I realized he was the nerdy assistant to Billy Beane (Brad Pitt) in Moneyball, and that I watched (and remembered) that movie because it was based on a Michael Lewis’ book that I read and loved. 

So Jonah Hill put together this film/documentary on Phil Stutz, his therapist, and I was immediately captivated by the format -- mostly black and white scenes, interjected (and supported) by little drawings that Stutz makes on cards for his patients to keep. In his mid-seventies and with Parkinson’s, Stutz draws on these little cards with a trembling hand, which gives them a fascinating, unique visual impact. They look like drawings retrieved in prehistoric caves, as if made by some mysterious supernatural entity. “The power of the cards is that they turn big ideas into simple images; it’s a way to communicate with the patient that’s more powerful than using words”.¹

The film is one long therapy session where Stutz explains a number of tools that he has developed over time to work with his patients. In Hill’s words, “I have decided to make this because I want to present your tools and the teachings of you, Phil Stutz, my therapist, in a way that allows people to access them and use them to make their own life better”.

I was super intrigued. Mainly for two reasons: 1) I was reminded of my sessions with David, that I hadn’t thought about for years; 2) Stutz’s tool-based method contrasted with traditional therapy, where patients talk and answers eventually reveal themselves through a process of no (or minimal) interference. And my first thought went to the efficacy that David’s (traditional therapy) method had on me, and how amazed I was at this obscure and apparently self-fulfilling process back then. 

But now this guy has tools. And not only do they seem to work, but they make a lot of sense. I watched the film three times, and took some notes because -- as I was going through it -- I thought that these tools and how to apply them would be beneficial to me. In fact, I thought they would be beneficial to anybody interested in making their life better. 

Here’s how Stutz introduces his ideas: “The first question I usually ask my patients is ‘What do you want? Why are you here?’. The average shrink will say ‘Don’t intrude on the patient’s process, they’ll come up with the answers when they’re ready’. That sucks, that’s not acceptable. When I got into psychiatry, the model was ‘I’m neutral, I’m just watching, I have no dog in this fight’. It was a very slow process and there was a lot of suffering”. 

And then: “I want speed in this. Not speed to cure somebody in a week; that’s impossible. But I want them to feel some change, some forward motion. It gives them hope. So I give them tools. A tool is something that can change your inner state immediately, in real time”.

So, what are these tools? 

Life Force

The first big idea that Stutz introduces is what he calls Life Force -- the inner energy that has the power to change our lives by making anything seem possible. This is what makes us shift our focus from what we can’t do to what we can do.

When we lose our sense of direction and don’t know what to do (because our focus is on what we can’t do), we should work on our Life Force. If we think of it as a pyramid, our Life Force has three levels: the bottom layer is our relationship with our physical body, the second layer is our relationship with other people, and the top layer is our relationship with ourselves. Each of these layers incorporates the tools that allow us to access our Life Force and work on it.

Working on the bottom layer means that we get our body to function better through exercise, diet and sleep. And that’s a simple thing that always works: our life improves immediately. 

Working on the mid layer means that we need to keep our relationship with others alive. The key here is that we shouldn’t wait for them, but be proactive and take the initiative: we could invite somebody out to lunch that we don’t find interesting; it doesn’t matter, it will affect us anyway, in a positive way. “That person represents the whole human race, symbolically”. 

Working on the top layer means to get ourselves in a relationship with our unconscious, and nobody knows what’s in their unconscious unless they activate it. One way to do this is writing. By writing, we enhance our relationship with ourselves. It’s like a mirror reflecting what’s going on in our unconscious. 

“If you’re lost, don’t try to figure it out. Let it go. And work on your Life Force first. [...] Anybody can do that”. And everything else will fall into place. 

Part X 

Being unable to solve our problems is a sign that a strong opponent is blocking our access to the Life Force. That’s Part X.

This is the judgmental, antisocial part of us. It’s an invisible impulse that wants to block our evolution, our potential, “it wants to fuck up our shit”. Whatever we think we need to do, Part X is going to tell us that it's impossible; it’s going to tell us to give up. 

We can’t get rid of Part X. In fact, Part X is essential to our growth and development. Stutz says that there are three aspects of reality that we have to live with, no matter what: pain, uncertainty, and constant work. If we want to be happy, we have to learn to love the process of dealing with those three things. 

Adversity is an opportunity for us to face Part X directly. It’s our chance to embrace that process and grow, evolve, create. If we could eliminate Part X, then there’d be no further progress. “We need the negativity of Part X or else we don’t grow”.

The powerful tool here is acknowledging that Part X exists and learning to accept it as the inevitable noise that -- rather than stopping us -- will push us to go forward and create in the face of adversity.  

String of Pearls 

Our aim is to always keep moving, to keep some form of forward motion going. This is arguably the most important motivational lesson that we can teach ourselves -- true confidence is living in uncertainty, and moving forward. “I’m the one who puts the next pearl on the string”. 

Each pearl on the string equals one action, but the key thing is that every action has the same value. Getting out of bed in the morning is a pearl on the string, and completing a difficult assignment at work is another pearl on the string, but they have the same value. Each pearl on the string looks the same, they are all the same size. 

Now, in every one of these beautiful pearls there’s a little dark spot. “That’s a turd”. What it means is that “every effort we make, whatever comes out is not gonna come out perfectly. So there’s gonna be a turd in it”. A reminder that things are going to be flawed and crooked, but we don’t have to worry about that: we only have to worry about forward motion, about putting the next pearl on the string.

--

These are just three of many tools, or ideas or concepts, that Stutz goes over during the film, like The Shadow, The Snapshot (a.k.a. The Realm of Illusion), The Maze, Active Love, Radical Acceptance, The Grateful Flow, and Loss Processing. The common thread for all of them is that they describe situations affecting, to a variable extent, anyone’s life. There’s a lot to learn here.

What left me astounded is not as much the process through which Stutz helps you recognize certain situations and gives you practical tools to tackle them -- as mind blowing as this whole framework is -- as his view of what effective therapy should be about. Therapy should be practical. It shouldn’t limit itself to identify a problem and its root cause, but give guidance on what to do to solve it. I guess in many delicate cases there’s no time to wait for answers to surface spontaneously, like for people in the throes of severe depression, or even suicidal. 

“If I’m dealing with someone with depression who’s afraid they won’t recover I’d say ‘Do what the fuck I tell you. Do exactly what I tell you; I guarantee you’ll feel better. Guarantee. 100%. It’s on me’”, he says in the film, to get the point across. No time to just talk and wait.

Maybe my case was too mild for David to do anything else but let me talk it off on my own. Maybe he could have accelerated my recovery somewhat by being more active with me. Maybe Stutz’s approach is nothing new and exceptional. I don’t know enough about therapy to give definitive answers.

What I do know is that what’s in this film makes sense. It makes sense for everybody, not only for people in therapy. And I couldn’t recommend it enough. 

I think anybody endowed with a mind should watch it.

1. I would have eagerly posted a few screenshots of the cards, but Netflix material is copyright-protected. One more reason to go watch the movie asap!