import

as i recall the story, a writer or scientist awakes in the the middle of the night with what seems like a fantastic insight. prudently, he urges himself to write it down lest he forget it. in the morning he recalls the import of his idea, but not the content. he searches eagerly for the note on his bedside table but all it reads is "write it down!"

sasha shulgin, in his book, pihkal - phenethylamines i have known and loved, catalogs a lifetime of research on newly synthesized psychedelic compounds. the diaries of the volunteers recount tale after tale of awe and wonder. i smile fondly in recognition, but as a reader, i don't quite feel the import.

it is easy to satirize stoned experience: just contrast how excited the speaker is with how put-upon the listener feels. "whoa!" yeah, right. or satirize how fleeting the insight is: "i understood everything about the universe! i just can't remember any of it today."

it seems the content of an insight or experience is somewhat independent of the import. we have ready explanations for some of the variation. the first time at a restaurant or a beach seems magical in a way the 10th time does not. we use terms like habit, or being jaded, or beginner's mind to explain the loss of import over time. still, it's odd that i can remember i had a great dream last nite without remembering the content. i can remember the import just as i might recall that i was angry years ago with a friend but no longer remember why. or, conversely i can remember that i was upset but now feel easy. why did i get so mad anyway?

so import seems to be a mental state. like a mood it comes and goes - sometimes in a predictable pattern, sometimes quite arbitrarily. i have found it useful to track import as an independent variable - in meditation, in my life, and in psychotherapy. in the session, do i care about what the patient is saying? if not can i say something kind and skillful that will change the conversation so i will care? first step: is it me, is it the patient, or is it our collaboration? if it's me, is there something i can notice and introduce: "you know, i'm having a hard time listening. i'm still a bit with how late you were this week and last. can we maybe talk about that?" if it's the patient, "are you really into what you're saying? to me it sounds like you've told that exact story a dozen times." if it's the collaboration, "you know, we've talked about your job every session for weeks. maybe we should take some time somewhere else, maybe on something less practical. maybe a dream or your mood or what's going on in your body." when i supervise psychiatry residents, i ask if they are engaged, if they are into the session - and if not, why not.

i track import in the session as often as i track content. if the patient says, "i don't know why i'm thinking about this, but..." i say, i don't know either, but go for it.  if i get an image that feels important, i often introduce it, even if it initially makes no sense: "i don't know why, but i just thought of a book i read." conversely, when the patient says, "i don't remember what we were talking about last week," i may well say, "good, neither do i; let's improvise today: check your body, images, mood; see what comes up right now and go with it."

in depression, sometimes nothing feels important. more commonly, certain thoughts carry too much import, "it's all my fault; i screwed everything up." i may correct the thought once, but mostly i attend to the over-valuing: you really take that to heart, you think about it all the time. when one or a pair of lovers pulls away, the other is often bereft. nothing else in the world matters. the abandoned one checks voice mail or email every 5 minutes. in the zahir , paulo coelho presents a narrator whose wife has disappeared, leaving the message through an acquaintance that she is alive and well, but wishes not to be contacted. over the course of 2 years, the protagonist eventually stops going out with friends because he can see that talking of his wife finally bores others, yet no other topic interests him. i know the experience, so i say to patient who has lost a lover, or the patient whose son has died, "yes, nothing else matters."

coelho frames romantic loss with obsession in general; a "zahir" is a grail. indeed, psychotherapy sessions are filled with obsessions of sorts. this one is obsessed with her weight, that one with a promotion, another with a spouse who doesn't listen. the content is different, but in all cases, something carries too much import.

what is to be done? sometimes it's possible to turn attention elsewhere. i knew that watching the 49ers, with joe montana and jerry rice, would engage me; i know that the current hapless 49ers will not, but that top-ranked stanford women's basketball will. with patients who have been left by their lovers, i see 2 possibilities: in some cases we talk at length about how to speak up to the lover in a genuine, yet endearing or engaging way; in other cases, i ask at length about their other relationships. how can they confide, be real with their other friends to that those friends can become important again. for the loss of a child, i have no easy answer.

sometimes life overall feels flat or meaningless. something big may need to change: a new career, a better relationship or a new one. sometimes adding service works: helping others is usually meaningful. psychotherapy can focus on identifying and cultivating the particular activities and people that give that individual meaning.

on a small scale, sometimes it just helps to realize that import varies from moment to moment and day to day. jogging is tedious one day, then fun again the next.  and that import can be even harder to convey than content. i recall returning from my first 10-day vipassana retreat full of enthusiasm. it was 1977, and i joined a van of friends driving to big sur to a gestalt therapy workshop. on the way, i stayed quiet for a while, then told everyone of all my amazing experiences. they were happy for me, but i didn't exactly hear, "wow, of course, that's incredible." rather, i noticed a tone of, "wow, you sure are excited." i guess you had to be there.