by Martha Stark, MD / Faculty, Harvard Medical School


The "Good Enough" Self


As we know, Winnicott (1965) writes about the "good enough" mother who is able, reliably and consistently, to meet the needs of her young child; so too he writes about the good enough therapist who is able, reliably and consistently, to meet the needs of her patient.


This object may not be perfect but is presumed to be good enough, even if sometimes flawed, imperfect, or limited.  But that will be OK because the object is, after all, doing the best that it can.  Nobody is perfect.


As a counterpoint to this concept of the good enough object, with inspirational input from my colleague, Dr. Patty Bresky, I have developed the concept of the "good enough" self, a concept that speaks to the capacity to experience the self as not always perfect, as often making mistakes, and as certainly limited in many ways, but as basically good enough, at least as long as one is doing the best that one can.  Central to this concept is the idea of being able to forgive oneself (again and again) for being, sometimes, a disappointment….


Now I do not mean to be suggesting that telling ourselves we are doing the best that we can should be used as a rationalization for not trying hard enough or for not holding ourselves accountable.


Rather, the idea that we really are doing the best that we can is meant to be a story about forgiveness, compassion, acceptance, and self-love, that although (in the best of all possible worlds) we might have wanted to be a certain way or to accomplish a certain something, under the circumstances and for whatever complex mix of reasons, we are truly doing the very best that we possibly can – and that this is truly good enough.



Clinical Vignette:  Struggling to Maintain the Passion


I would like now to present Wendy, with whom I have worked for many years.  She is a 50-year-old woman who is an exceptionally gifted though struggling writer, divorced since 2009, mother of three, and a deeply thoughtful and evolved old soul.


For many years I worked face-to-face with Wendy on a three times weekly basis, and then a dream job opened up for her in Paris.  After much discussion, she decided to move with her children to France – but we agreed to have her write me (journal-style) every month and to return to the States to see me twice a year in person.  We have done it this way since 2010, and it has worked out well.


In 2012, she met James, a university professor of art history and an exceptionally gifted though struggling sculptor, a dashing, handsome, strong, virile man – and they fell madly in love.  Although not without significant challenge, until last summer Wendy had been managing, reasonably successfully, to juggle the numerous responsibilities of her high-pressure job, her burgeoning career as a published author, the demands and joys of being a parent to three awesome children, and the demands and joys of being a partner to a brilliant and wondrously complex man.  But acutely aware of the passing years, Wendy was always in conflict about scheduling time to do her writing.


The End of a Dream

And then, last July, James, 13 years her senior, became suddenly very ill.  James, a good man with a kind soul and a loving heart, James, who had always prided himself on his strength and his potency, developed a bad cancer that began to ravage and weaken his body.  Determined to do the best that she possibly could to be a devoted partner to this dear man whom she had always loved with tenderness and passion, Wendy made the decision to put aside her writing in order to be by his side and to accompany him to his many medical appointments, chemotherapy sessions, radiation treatments, and follow-up visits.


Devastated by the erosion of his manliness, James became quite regressed, despite his desperate effort not to be.  But the cancer had really taken its toll and he was becoming increasingly demanding and dependent, even as he was ever busy apologizing for being that way and for being disruptive to Wendy and her routine.  Committed to her cherished James but also longing to get back to her writing and her deadlines, Wendy found herself torn apart inside.


A Perfect Storm

And then her daughter, by her ex-husband, develops a brain tumor and, very impressively and somewhat surprisingly, handles it like a little trooper.  There is some real concern that Elise might actually die, but the surgery is successful and she survives.  For the time being, the tumor is gone but it could always come back.  At least for now, however, it is in remission.  But Wendy is now in the position of having to take care of both her daughter, who is so very brave, and James, so very not.


Meanwhile James is trying his best but has suddenly become so old, so frail, no longer strong, no longer virile, just skin and bones, no muscle, but always ever so grateful to Wendy, so appreciative of her care, and so adoring of her.  And Wendy is beside herself with the pain of not knowing what to do.


Confronting the Reality of Another’s Limitations

In one of Wendy’s journal entries to me, she writes:  “I don’t know if I even love him anymore – maybe I don’t have enough love in me…  Is there perhaps something wrong with me?  I feel so sad – I feel this deep pain – it’s just that I’m not sure I can keep doing this – I think, O my God, will I have to be caring for him, like this, from here on out?”


Later, Wendy laments:  “James has been so transformed into an old man, shuffle feet, peeing all night long, partly deaf, slow mind, confused – his skin hangs slack on his face, he has no muscles at all – out of breath after a simple staircase – I am finding it hard to think of him as anything but my duty – not my lover or partner – he seems to have become another child – we barely touch each other anymore – I think because he is ashamed of how he looks and because I am so often seething with a kind of inner rage – I know I am selfish and so I try to hide it, but of course what I feel then is – nothing – absolute deadness inside – I don’t want to be his nurse-maid – I don’t want to take care of him – and I don’t want to have to be angry like this all the time and feeling so bad about myself!”


Later still, she writes:  “I keep reminding myself, just row, Wendy, just row – meaning, just keep going and get through this – there is nothing to be resolved or talked about – it just is and I need to accept my duty and row – just keep rowing…”


Tormented and in despair, Wendy writes:  “I wish I could find a way to open my heart up again – James is incredibly kind and grateful to me for everything – he is trying so hard to be helpful when he can and never complains and is so patient with me – he is exhausted and weak and miserable – while I am just grieving for our old love affair – the passionate sexy times we had together…”


A Tormenting Dilemma

One day James asks her:  “Should I go?”  And Wendy doesn’t quite know how to answer.  Does she say, “Well, let’s give it a year and see what happens,” which is what ultimately she does say, or does she suffer through it, resenting his baby-like, regressed behavior and having less time available for her daughter with the brain tumor and for her twins with their college applications and for her writing (the realization of her life-long dream to get her writing really out there).  In total heartbreak and pain, Wendy cries herself to sleep every night, ripping herself apart inside with the thought – “Maybe I just can’t be there for James in the way that he needs me to be – maybe I just don’t have it in me – maybe I’m just not strong enough…”


Wendy writes:  “I’ve heard that the four sentences people who are dying need to say in order to get to the core of their relationships and be ready to say goodbye are – ‘Can you forgive me?’  ‘I forgive you.’  ‘Thank you.’ and ‘I love you.’”


Wendy comes to the States for her semi-annual meeting with me.  It is a powerful session and there are many tears.  But, later, she writes that one of the most healing things for her was my telling her that I thought she was doing the best that she possibly could.  She goes on to write:  “Funny, just that one little sentence – but it really helped to calm me inside and to make me feel less wracked with guilt and shame.”


Some time after her return to Paris, I receive the following:  “Since our session, I have been writing and I feel so much better about everything – I feel like this whole experience with James and Elise was a huge tumultuous way of teaching me to remember mortality and fragility at the core – we are just little specks – that knowledge can be seen as both a terrifying nihilistic nothingness and also this amazing miraculous moment – one can look at it either way – and both are right – we are just tiny bits in the vast infinite emptiness – or amazing that these tiny bits have this one incredible miracle moment of consciousness.”


The Inevitability of Disappointment and Heartbreak

Wendy continues:  “I can go from one extreme to another in a matter of moments – maybe the Buddhist training of mindfulness is just that, trying to train us to stay focused on the miracle of now, instead of collapsing into disappointment that life is so meaningless…”


And in another communication, Wendy writes:  “I have been thinking a lot about the Buddhist idea of disappointment – that ultimately we will all be disappointed by others, betrayed by others, it is part of the human condition, it is an integral part of relationship – sort of the fundamental core – accepting that disappointment  …and accepting that we ourselves will be a disappointment to others – and to ourselves.  A friend of mine, only half jokingly, once told me ‘Life is filled with disappointment – and all the rest is commentary.’”


Confronting the Reality of One’s Own Limitations

In essence, Wendy is running up against the limits of her own capability.  Hers is a poignant and touching story about encountering your own limits / your own limitations – and grieving them.  Not hating yourself for having failed, but evolving ultimately to a place of humble acceptance that you have done the best, truly, that you could, under the circumstances.  We’re not talking about being lazy or not trying very hard or giving up; we’re talking about when you try so hard and work so long at something and, even so, you just can’t quite pull it off.  That’s what we’re talking about here.  That’s what humble acceptance is all about – when you come finally to a place of accepting the reality of your own, very real limitations – knowing that you are truly doing the very best that you can – and that this very best, even if not all that you would have wanted it to be, is indeed “good enough.”


Importantly, as Wendy has become more accepting of her limitations and less relentless in her pursuit of perfection with respect to James, her children, her writing, her job, she has become more humbly compassionate in relation to herself and, even if sometimes impatient or annoyed, better able to be a loving partner to James at the same time that she is better able to channel laser-focused energy into her writing.



Clinical Vignette:  A Haunting Chronicle of Horrific Loss


My second vignette is the published story of a woman, Sonali Deraniyagala, who was visiting Sri Lanka with her family in 2004 when the wave hit, the tsunami that ultimately claimed the lives of some 230,000 people.  Sonali’s 2013 book, Wave (deservedly a New York Times bestseller), is piercingly honest, gripping, vulnerable, and raw.  It is a haunting chronicle of love, horrific loss, unbearable grief, and, and after many years of first avoidance and then gradual revisiting of the trauma and, bit by bit, daring to relive and, even, embrace it, slow, gradual healing and redemption.

Sonali, her husband, their two boys, and her parents were vacationing at a hotel on the beach in Sri Lanka when the wave, more than 30 feet high, suddenly charges inland at a speed of 25 miles per hour and for more than 2 miles before it just as suddenly retreats and heads back out to sea.


It is Sonali who, from her hotel window, first sees the wave approaching.  It is she who mobilizes her husband, grabs their boys, and rushes them all out of their room and down the hall.  Her parents’ room is right next to theirs but, in a “splintered second,” she makes the decision not to stop in order “to bang on their door or shout out to warn them.”  All she can think is “We must keep running.”  Later she learns that her parents have perished.   


And then Sonali, her husband, and their boys are being rushed to higher ground in a jeep driven by somebody who works at the hotel.  But the wave soon overtakes and engulfs them and everyone is suddenly being tossed about relentlessly and propelled forward in the filthy, swirling water.  At some point, disoriented and traumatized, she becomes vaguely aware of the fact that she has become separated from her husband and both boys and, later, she learns that they too have perished.


Miraculously Sonali herself survives by reaching up, at the last minute, to grab ahold of an overhanging tree branch to which she clings for dear life, until she is rescued by a local.


Searing Guilt and Unrelenting Self-Recrimination

During the days, weeks, months, and years that follow, Sonali struggles to manage the searing guilt and unrelenting self-recrimination that haunt her night and day – that as she was reaching up to grab ahold of the tree branch that would save her life, her family was being swept away.  She torments herself with the knowing that “After the water disappeared, I didn’t even look for them – I abandoned them, and that sickens me…  I was in a stupor, true, I was shaking and shivering and coughing up blood but still I berate myself for not scouring the earth for them – my screams should have had no end – I loathe myself for not howling endlessly.”


And later still Sonali finds herself wondering if perhaps she was a “mass murderer” in a previous life.  “I balk at the failure that I am – quite separate, this, from the more obvious agony of missing them.”


The remainder of the book is a chronicling of her torturous efforts, over the course of the next nine years, to manage the agony of her despair and the desolation of her spirit without her boys, without her husband, without her parents, wracked with obliterating shame and excoriating guilt, knowing that she had made choices that enabled her to live but contributed to the deaths of those she loved most dearly.


At first, Sonali refuses to remember and instead engages in all sorts of impulsive and destructive behaviors, contemplating suicide, drinking to oblivion, driving recklessly, berating herself mercilessly, stalking the people who move into her childhood home.  She does her best to keep herself as numb and dissociated as possible, desperately intent upon not remembering, not going back, not revisiting.


Daring to Remember the Horror of It All

But over the course of the years, Sonali finds herself beginning to remember not just the horrific details of the trauma itself but also the bittersweet details of the life she had once shared with her family.  And as, bit by bit, she dares to remember, she is startled to discover that her life begins to “cohere a little.”  When she pretends not to remember, she loses track of herself, becomes “hazy” about her identity, as if she were somebody else or in a “witness protection program.”


But as Sonali comes increasingly to a place of remembrance, she writes:  “I have learned that I can only recover myself when I keep [my family] near.  If I distance myself from them…I am fractured.  I am left feeling I’ve blundered into a stranger’s life.”  But when she allows her mind slowly to “unclench” and “allow in” glimpses of the beauty that used to be, she rediscovers a "brightness" and an aliveness in herself that she had feared were gone forever.


Redemption and Absolution

What shines through, in Sonali’s unflinchingly honest chronicling of her journey back, is the courage it takes for her, over time, to begin to dare to face her haunting guilt and her intense shame – to relive, moment by moment, the horror of it all – ultimately realizing that, under the circumstances, she had indeed done the best that she could.  And, by the end of the book, the reader as well, with compassion and without judgment, understands that truly Sonali had done the very best that she possibly could.


At the end of the day, Sonali’s journey back is a story about redemption, absolution, forgiveness, acceptance, and humility.


In the acknowledgements, Sonali offers heartfelt thanks to Dr. Mark Epstein, the "extraordinary therapist" with whom she felt "safe enough" that she could try to "grasp the unfathomable" and "dare to remember," ultimately arriving at a place of sober acceptance and inner calm.





I wanted to say a few more words about the actual process of grieving.


We all grieve in our own way.  But however we do it and however long it takes, ultimately, we must revisit, remember, relive – before we can let go and move on.


What that means is that we must be able to immerse ourselves in the pain of our grief – feel it to the depths of our soul and all the way into every cell in our body, the heartbreak, the devastation, the sadness, the anger, the rage, the outrage, the regret, the remorse, the if onlys, the shame, the guilt, the horror of it all – that the world, that our lives, that the people we love, that we ourselves are so not the way we would have wanted them to be – that horrific things can happen to the people we love, horrific things can happen to us – that tragic loss and heartbreak are inevitable aspects of life – all the bad things that do happen and the good things that don’t – all of which must continuously be confronted, grieved, and ultimately accepted.


Only more recently have I come to appreciate that genuine grieving requires of us that we be able, at least for moments, to stay present with the pain of our grief and that we not absent ourselves from it – that we be able to enter into the grief without running from it – that we be able to enter into the grief and, even, embrace it without dissociating.  We can’t grieve when we are missing in action, running away, or dissociated.  We need to be present, engaged, in the moment, mindful of all that is going on inside of us, grounded, focused, in the here and now.  If, instead, we are “not present” or “in denial” or “unwilling to confront” or “closed” or “shut down” or “numb” or “not engaged” or “retreating” or “refusing to accept,” then no real grieving can be done.


Grieving, which can certainly be done in bits and pieces between the spasms of pain and outrage that will periodically overtake us, is an ongoing process of raging against the world, screaming out our pain, railing against our fate – but ultimately forgiving, relenting, accepting, letting go, separating, and moving on – it is what it is – it was what it was – and, at the end of the day, there’s nothing we can do about it – at the end of the day, we are powerless in the face of it.


In a beautiful article entitled "The Refusal to Mourn," Sheldon Kopp (1969) has written:  "Genuine grief is the sobbing and wailing <that> express the acceptance of our helplessness to do anything about <our> losses.  If instead, we whine and complain, insist that this cannot be, or demand to be compensated for our pain, then we are forever stuck with trying to redeem the past." 





In conclusion:  I have come to realize that being able to experience the self as good enough is actually a story about not only relenting, grieving, and accepting but also forgiving.  "Learn to forgive yourself again and again and again and again."  The healing power of forgiveness – of others and of the self.


In the words of the theologian Lewis B. Smedes, "To forgive is to set a prisoner free and discover that the prisoner was you" (1996).





Deraniyagala S (2013). Wave. New York, NY: Vintage.


Kopp S (1969). The Refusal to Mourn. Voices, Spring, 30-35.


Smedes LB (1996). Forgive and Forget: Healing the Hurts We Don’t Deserve. San Francisco, CA: HarperOne.