Verified by 
As a psychotherapist, I listen to the intimate details of people’s private lives and am expected to reflect on them—sometimes in real-time, but always once there is a coherent image of how the person has lived. It’s a pointillistic process since, while not every detail is clear, all of them can make a kind of sense together at a distance. I make mental notes during a session, and sometimes silently scribble a few observations onto an iPad. Transcribing my notes is a challenge, however, since I invariably stop to think “Where is this going?” If the question seems more rhetorical than likely to invite an answer, I feel in need of a revelation: more light, more notes, more work.
There is a delicate balance between listening, taking notes, and reflecting. Funny how it defies the laws of physics to go in three directions at once but, as a psychotherapist, I do it all the time. We practice a kind of mental gymnastics that defies linearity in the interest of figuring out another human being. A complex challenge often demands a complex response. Fortunately, however, I am assisted by technology. I have a computer-based record-keeping system that’s fairly time-efficient and allows me to make cumulative entries sort of like a book-keeper would. It’s funny that a psychotherapist, engaged in plumbing the depths of another human being, would find analogies in accounting (especially after he has just invoked a famous artistic technique). But trying to understand someone is just that complicated—you draw your analogies from wherever you can.
Today, a patient was describing a dream that I wanted to make sure to remember. So, I jotted down some notes as he spoke. He asked what I was doing. I thought to respond by asking, “What do you imagine I’m doing?” or—perhaps by way of coopting that question—“What does my recording your dream mean to you?” But the former seemed too much like a caricature of Sigmund Freud, and the latter just finessed the importance of the dream itself. So, I just said that I wanted to make note of his dream. He seemed impressed by my interest and went on talking about it. But actually, I don’t like refocusing my discussions with patients on the process of their treatment. It’s distracting. That is, note-taking, however inconspicuous, invariably draws attention towards me and away from the seamless give-and-take that I prefer. But sometimes it’s hard to avoid. So, I acknowledge that compromise is necessary if I am to remember anything and, finally, begin to figure things out.
Still, the question this patient raised stayed with me. It caused me to reflect on what I take notes about and on the ways in which I take notes. What is the split-second decision that favors one detail over another? How do I know what’s important, and will I think so later? Do I take too many notes (unnecessarily distracting the patient), only to stave off remorse when I might wish I to recall something that was now gone? Maybe taking notes is as much about me as it is about the patient, at least in the sense that I need to feel that (as a painter, an accountant, a psychiatrist) I am making progress.
When patients used to lie on a couch unable to see the psychiatrist, they had no idea whether what they said was being reduced to notes. But those days are gone. So why not discuss with this patient why I am taking notes. How about “If I am to develop an in-depth understanding of you, I need to record your dreams. It helps me think about you”? I could bring him into the process, make him complicit. After all, it’s his treatment, and he has an interest in my doing my job well, even I have to create slight distractions. Ultimately, all the loose ends will get tied up (oh, another analogy, this time to knitting—well, I think it makes sense). So, I will make a note to myself and maybe bring it up with him at some point.
What matters, finally, is that we work together. When I have a sense that the patient and I are in sync, I experience a kind of professional satisfaction, apart from the feeling that I am actually helping someone deal with their own circumstances. I focus on note-taking here because it’s an element of how I go about reaching a place where I can “Well, I am making progress. This is coming together.” Notice the “-ing” form of the verb, the sense that my achievement (insofar as something that is never finished can be an achievement) is an unfolding. Psychotherapists do not expect miracles of understanding. But we do hope for some continuous elaboration born out of collaboration with the patient. When it occurs, i.e., when it is sustained, we feel good about ourselves.
Feeling effective in one’s profession is a source of happiness. It implies that we have made the right choice of work—or at least a good, practicable choice—and that we are pursuing it towards a socially useful end. We tend to choose some indicia over others, often those that are personal to us rather than those that are external. Thus, if a colleague pays me a compliment, I’m happy—but not as happy if, by my own lights and according to my own measure, I am performing up to the standards that I’ve set for myself. Note-taking, and the gradual understanding that it entails, has come to seem valuable to me as a constant, almost metronome-like feature of my keeping up with the dialogue that I have with a patient over weeks, months, and even years. It is a mark of our progress together.
When I think about “happiness” in a professional context, therefore, it is not something that equates with the type of elation that occurs in a relationship or when some sought-after promotion finally comes through. If it is an ah-ha moment of understanding or, more generally the feeling that I’m getting somewhere, it is more like a reassurance. It’s like I can tell myself that I know what I’m doing. We all worry about whether we’re good problem-solvers, and whether we’ve learned enough to make the right moves. That’s way before we become concerned about making some lasting contribution. It’s the basic stuff—am I doing this right? Am I using my time in ways that make sense? When I see the notes begin to cohere, however indefinite the portrait/account/knitted-up stocking, I think “OK, I am doing good work. I’m pleased.” I’m pursuing happiness.
This kind of happiness is subdued and is never self-congratulatory. It’s more like feeling that some task, some undertaking is turning out more or less the way it should. Psychotherapy is supposed to help people. Psychotherapists are supposed to understand people well enough to help them understand themselves. When that trajectory seems to be apparent, psychotherapists feel the type of happiness that psychotherapists are supposed to feel. It’s a specific type of happiness, which is satisfaction. It’s translatable, but only imperfectly, to other types of happiness—even to the happiness of other types of professionals. But that’s my point. I don’t expect a thrill-a-minute as I might in some other context. This happiness is contextual, defined by my profession and my expectations for how I should perform. It’s still happiness, however. It starts in a few notes and finally emerges—often over a period of time. That’s OK.
Like every type of happiness, it’s liable to get lost. Maybe my sense of progress will fall victim to a patient’s disillusion, or sudden desire to quit just when I think we’re meshing well. It happens. But while I feel good about things, I value the feeling. That’s an important part of happiness—appreciate it while it’s there. Think about why you are happy. Try to replicate the feeling (recognizing, of course, that you’re not always at the top of your game, and that circumstances don’t always break your way). At the very least, make a note of it.
