Well, they have not gone far. Not all of them anyway, but a few therapists are noticing that some clients have strayed away over the holidays and not come back. And we are talking about this here at Good Practice.
Some questions we've been studying are:
What disrupts treatment?
What gets in the way of clients telling us directly if they have a bad feeling about us, or about the work?
What if we are more interested in doing the work then the client is?
What is subjective countertransference and what is objective countertransference, and how do they affect our work?
What can we learn about ourselves to help clients to stay and do good meaningful work?
And really...when someone is coming on a regular basis and then they don't want to schedule again, or they say..."I'll call you..." What do therapists do? How do therapists decide when to help a client to stay and when to let go. And how do we do this?
What exactly is the balance between rejection and intrusion? Between holding onto the work and going deeper, and following the contact, the surface presentation that a client makes?
First things first. And case by case we think. We must know our own intentions. And we must know our fears. Many therapists I know are ruled, in some way, by their own fear. They fear being too forceful. They fear being solicitous. Or being rejected. In an effort to not act on their own fears, they sometimes do the opposite of what might really be called for.
We do filter things through our own lenses and experiences. One therapist in our groups terminated treatment with her own therapist, who then called her every few months to see if she wanted to return. This gave our colleague the idea that her therapist was pursuing her for money, or because she was bored, or needy. "It gave me the feeling I was just a paycheck to her," she told the group, "and I don't want to do that to my clients."
So how do we know what's really going on when clients disappear? Look back, we think. Look back and see if possibly we've hit the wrong note. If we may have implied that they have to talk about their father when they don't want to or are not ready. Or perhaps they thought that we were sick of hearing about that relationship that ended three years ago, and they should not talk about it anymore. Perhaps they don't even know the source of their discomfort. Of course clients project their feelings onto us, but we have to be good catchers. It helps to study the feelings, and see who is tired of what and why.
Are we understanding of client's narcissism? That they are not trained to notice us, to know that we exist. Our existence may be frightening to them. The connection may be too strange, the relationship not understood. We may have to tend to this. To help them talk about it, about us.
Do they feel too cared for, or not cared for enough. We never really know the effect we have.
Sometimes, not pursuing a client who leaves can feel rejecting to the client. While clients need to be able to say everything to us, sometimes they need to go at their own pace. We may be going too fast. One client I know recently said to me, "If you keep helping me, I will stop coming." So we talked about how I was helping her, what I should stop doing and what might be a better way to talk.
Talking is, after all, what we are here to do. It is still curative, still productive, still life giving and relieving.
Its hard to know which resistances are treatment destructive and which are not. And when to join such resistances and when not to. Its hard to know who is feeling bad and about what. But we study. We ask. We can even prevent. We can ask sometimes, about how the work seems to be going. We can remind clients about the the five topics, which includes the treatment itself, that can be discussed in treatment, so that we can create a space to talk about everything, including everything about the treatment.
There is an ebb and flow to private practice. Things shift; They are fluid. Life is fluid. We have to talk. We have to take good care of ourselves. We have to take note of our fear of being abandoned. Our fear of being disrupted. Of being bumped around. We are supposed to be trained to study and tolerate our own feelings. To use them to advance our good work. We cannot always call it right. There is so much ambiguity in our business. But we can let people know they can tell us whats on their mind. We can build our resiliency and our own knowledge and we can stick together and advocate for our work, on its own merits, and for its own sake. We can hold the hope and the value of what we do, and not let go of what we know to be true: that its worth it.
Tuesday, January 26, 2010
Tuesday, November 17, 2009
Say It Here
"If I can't bring it up here, where can I?" P.L. , psychotherapist, Illinois, about our groups
True and yes. Our groups are where to bring it up. Its amazing how much we wish we could say but keep to ourselves. And how useful it always turns out to be. To talk, for sure. But also the exchange of ideas, the practice studying cases and feelings, transferences and doubts all adds up to better practice.
What's been on everyone's minds here? Fees, always and still, a hot topic. Missed sessions, insurance issues, and erotic transference. And appreciation for the continuum of following cases over a longer period of time and getting to know ourselves and the dynamics of treatment in new and deeper ways.
It feels good to work together, to connect and to talk.
True and yes. Our groups are where to bring it up. Its amazing how much we wish we could say but keep to ourselves. And how useful it always turns out to be. To talk, for sure. But also the exchange of ideas, the practice studying cases and feelings, transferences and doubts all adds up to better practice.
What's been on everyone's minds here? Fees, always and still, a hot topic. Missed sessions, insurance issues, and erotic transference. And appreciation for the continuum of following cases over a longer period of time and getting to know ourselves and the dynamics of treatment in new and deeper ways.
It feels good to work together, to connect and to talk.
Tuesday, October 20, 2009
Group Success, Practice Success and What If it Feels Like Selling? ..... Resisting Resistance
No doubt about it, group works. I am just reflecting back on the last few months in some of our professional peer supervision and consultation groups. We have indeed been busy. Connecting, talking, analyzing, laughing, schmoozing. Presenting issues, cases and new ideas. And we have been progressing. Somehow, someway, group works.
What we have been doing: We have been talking about everything. And we have been studying what we want, professionally, personally, sometimes, and what's in the way of getting it. We have been talking about cases, and about what feelings come up, and what to do with them.
We help each other talk. Together we worry. We find relief. We wonder if feelings are contagious. Is ambivalence solvable. What are we afraid of and why. Can we, do we, how do we, know what feelings are in the room, whose are they, and what do we do with them? We are never out of things to talk about. We are awake, interested and engaged. Okay, sometimes we are not, but then we talk about that too.
Some participants have doubled their practice. Some have started groups of their own, for sufferers of chronic illness, for women in midlife transitions, for women considering divorce, for parents of special needs children. And more.
We have moved forward through ambivalence, resistance, fear, edgy feelings, and even good ones, that might get in the way of us connecting and growing.
What happens if we ourselves don't know if we should stay or go, in our groups? Or join one? Or start our own therapy or supervision. And how does this translate into our work?
So this is what's come up recently: If we help a client to stay with us, are we selling? And by the way, if we were, what are we selling, and what would be wrong with that? Why do some of us feel like we should not "sell" therapy? And why do some go so far as to readily agree with clients or group members who want to leave? To defend against their own wish that the client stay?
What's the problem really? One therapist I work with tells me that she is so fearful that if one person leaves her practice, everyone will leave. That leaving is contagious. She says that the moment a client talks about leaving, she feels panic. First, she feels that she needs the money, and then she feels guilty for that feeling. Then she feels that she must not being doing a good job, and she feels bad about that. And then she feels that she should take care of the client and ignore her feelings. And she thinks she should be supportive of the client. So she goes along with the client's statement about leaving and the therapy ends.
Too bad, really. Maybe, of course, it was time to end. But we don't know. We don't know what was really bothering the client. We don't know if the client really wanted to feel wanted, and wanted to be helped to stay. We don't know if the client leaves other situations abruptly, without warning or discussion. We don't know if there is something amiss with the treatment that talking about would benefit the client enormously, helping the client to express discomfort safely and honestly, and be well received. And even to effect change and feel effective.
If we agree readily with resistance and go along with it too quickly because we don't know enough about our feelings and thoughts, we all miss out. We are selling, I suppose. We are selling life, and progress, recovery, maybe even intimacy, self knowledge, resiliency and substance.
But not everyone wants this, or is ready for it. Some folks need to stay where they are, for a while, maybe a long while. And then we can study that too. But we don't have to go along with the ending. We can hold out, even against our own feelings, or theirs, of wanting to bolt. We can check in about it.
And we can take ourselves to group, to therapy, to supervision and let ourselves be sold.
For your reading enjoyment, on treatment destructive resistance, and other good words, check out this blog by Jim.
What we have been doing: We have been talking about everything. And we have been studying what we want, professionally, personally, sometimes, and what's in the way of getting it. We have been talking about cases, and about what feelings come up, and what to do with them.
We help each other talk. Together we worry. We find relief. We wonder if feelings are contagious. Is ambivalence solvable. What are we afraid of and why. Can we, do we, how do we, know what feelings are in the room, whose are they, and what do we do with them? We are never out of things to talk about. We are awake, interested and engaged. Okay, sometimes we are not, but then we talk about that too.
Some participants have doubled their practice. Some have started groups of their own, for sufferers of chronic illness, for women in midlife transitions, for women considering divorce, for parents of special needs children. And more.
We have moved forward through ambivalence, resistance, fear, edgy feelings, and even good ones, that might get in the way of us connecting and growing.
What happens if we ourselves don't know if we should stay or go, in our groups? Or join one? Or start our own therapy or supervision. And how does this translate into our work?
So this is what's come up recently: If we help a client to stay with us, are we selling? And by the way, if we were, what are we selling, and what would be wrong with that? Why do some of us feel like we should not "sell" therapy? And why do some go so far as to readily agree with clients or group members who want to leave? To defend against their own wish that the client stay?
What's the problem really? One therapist I work with tells me that she is so fearful that if one person leaves her practice, everyone will leave. That leaving is contagious. She says that the moment a client talks about leaving, she feels panic. First, she feels that she needs the money, and then she feels guilty for that feeling. Then she feels that she must not being doing a good job, and she feels bad about that. And then she feels that she should take care of the client and ignore her feelings. And she thinks she should be supportive of the client. So she goes along with the client's statement about leaving and the therapy ends.
Too bad, really. Maybe, of course, it was time to end. But we don't know. We don't know what was really bothering the client. We don't know if the client really wanted to feel wanted, and wanted to be helped to stay. We don't know if the client leaves other situations abruptly, without warning or discussion. We don't know if there is something amiss with the treatment that talking about would benefit the client enormously, helping the client to express discomfort safely and honestly, and be well received. And even to effect change and feel effective.
If we agree readily with resistance and go along with it too quickly because we don't know enough about our feelings and thoughts, we all miss out. We are selling, I suppose. We are selling life, and progress, recovery, maybe even intimacy, self knowledge, resiliency and substance.
But not everyone wants this, or is ready for it. Some folks need to stay where they are, for a while, maybe a long while. And then we can study that too. But we don't have to go along with the ending. We can hold out, even against our own feelings, or theirs, of wanting to bolt. We can check in about it.
And we can take ourselves to group, to therapy, to supervision and let ourselves be sold.
For your reading enjoyment, on treatment destructive resistance, and other good words, check out this blog by Jim.
Sunday, September 13, 2009
Late
In one of our supervision groups this past week we were discussing lateness. Of course we were discussing this because someone came in late. By about half an hour. What happens when this happens?
Well, different groups handle it in different ways of course. This group was silent for a few moments after our late-comer arrived. The person who was speaking stopped speaking, and then felt derailed (which we learned later). So we turned our attention to what kept our colleague from arriving on time. It was after all the elephant in the room.
Like all elephants, it appreciated being discussed. A few good things came out of it. First, our late comer fessed up that he was late a lot, for a lot of things. And that he was late for his own therapy and late starting sessions with his clients. And we got to unpack a bit what this might mean to him, to others.
Lateness, we decided, is a resistance. It has many meanings. Each individual, but many universal, and all human. On the possibilities list: perhaps lateness is a signal of protest of some kind, an unconscious communication from the self to the self about desire, or lack of it to be somewhere, or with some one. Or perhaps its a communication to others, that there is something they are missing or paying too much attention to. In one case I have worked with, a group member arrived late because she felt, after we discussed it, that she would otherwise not get any attention at all. She did not know how to ask for it. We of course have helped her to ask for what she needs more directly now. In another instance, a member was late because he feared being criticized by another member of the group whom he thought to be on the attack at times. He had to wrestle with himself to come to group at all, and could not find the words to articulate it, even to himself. But when his late entries were analyzed, we were able to understand this, and help him out.
One woman I know fesses up that she is often late as a way of drawing out pleasure or anticipation. She feels very stimulated by group and looks forward to it. In fact, she finds herself attracted so much so to another member, that she loves to draw out the waiting, To heighten the thrill, and rev up the feeling. All of this is only partially intentional, but bringing it to light expands our knowledge of ourselves, others, and our work. It gives us a deep appreciation for the unconscious, for humanity and humanness.
Lateness, while simplistically may signal ambivalence or conflict, is something we can really put to use in session as well as group. But there is some suffering. Late comers do not want to be late, really. One late comer shared with me that he knows much about his lateness, but he can't seem to stop. Its like an addiction. With him, in group, after studying for several months the possibilities, the group decided to embrace his lateness, to allow it, expect it and even love him for it. For some reason, he stopped coming late after that.
Not to be forgotten, the person who was talking when the late comer walked in, and got upstaged by the late comer, learned a few things too, about herself. She noted to the group that she easily gives up her time, to men especially. She stopped what she was saying about herself, and what she needed, and turned her attention to the late comer, as did the group, only noting it with very little time to spare at group's end. I wondered why she did not just keep talking. In fact, she was thoughtful about this and said that believes that she has to do a lot of listening and deferring to men while hoping that she will get a little back at some point. She is afraid to put her needs first, for fear of seeming selfish or depriving. She recalls getting all kinds of good feelings by catering to men and their needs, and giving them the good feeling of being heard and admired, attended to and important. Something she would like to learn more about, and perhaps use to work better with herself, her colleagues, her patients.
Much to ponder. And all toward our good work together. And a good reminder that all things can be studied gently, unpacked, talked about and incorporated into our practices and lives for the better.
Well, different groups handle it in different ways of course. This group was silent for a few moments after our late-comer arrived. The person who was speaking stopped speaking, and then felt derailed (which we learned later). So we turned our attention to what kept our colleague from arriving on time. It was after all the elephant in the room.
Like all elephants, it appreciated being discussed. A few good things came out of it. First, our late comer fessed up that he was late a lot, for a lot of things. And that he was late for his own therapy and late starting sessions with his clients. And we got to unpack a bit what this might mean to him, to others.
Lateness, we decided, is a resistance. It has many meanings. Each individual, but many universal, and all human. On the possibilities list: perhaps lateness is a signal of protest of some kind, an unconscious communication from the self to the self about desire, or lack of it to be somewhere, or with some one. Or perhaps its a communication to others, that there is something they are missing or paying too much attention to. In one case I have worked with, a group member arrived late because she felt, after we discussed it, that she would otherwise not get any attention at all. She did not know how to ask for it. We of course have helped her to ask for what she needs more directly now. In another instance, a member was late because he feared being criticized by another member of the group whom he thought to be on the attack at times. He had to wrestle with himself to come to group at all, and could not find the words to articulate it, even to himself. But when his late entries were analyzed, we were able to understand this, and help him out.
One woman I know fesses up that she is often late as a way of drawing out pleasure or anticipation. She feels very stimulated by group and looks forward to it. In fact, she finds herself attracted so much so to another member, that she loves to draw out the waiting, To heighten the thrill, and rev up the feeling. All of this is only partially intentional, but bringing it to light expands our knowledge of ourselves, others, and our work. It gives us a deep appreciation for the unconscious, for humanity and humanness.
Lateness, while simplistically may signal ambivalence or conflict, is something we can really put to use in session as well as group. But there is some suffering. Late comers do not want to be late, really. One late comer shared with me that he knows much about his lateness, but he can't seem to stop. Its like an addiction. With him, in group, after studying for several months the possibilities, the group decided to embrace his lateness, to allow it, expect it and even love him for it. For some reason, he stopped coming late after that.
Not to be forgotten, the person who was talking when the late comer walked in, and got upstaged by the late comer, learned a few things too, about herself. She noted to the group that she easily gives up her time, to men especially. She stopped what she was saying about herself, and what she needed, and turned her attention to the late comer, as did the group, only noting it with very little time to spare at group's end. I wondered why she did not just keep talking. In fact, she was thoughtful about this and said that believes that she has to do a lot of listening and deferring to men while hoping that she will get a little back at some point. She is afraid to put her needs first, for fear of seeming selfish or depriving. She recalls getting all kinds of good feelings by catering to men and their needs, and giving them the good feeling of being heard and admired, attended to and important. Something she would like to learn more about, and perhaps use to work better with herself, her colleagues, her patients.
Much to ponder. And all toward our good work together. And a good reminder that all things can be studied gently, unpacked, talked about and incorporated into our practices and lives for the better.
Monday, June 8, 2009
Necessary Conversations in Therapy (Effectiveness, Outcomes and Research))
I had the pleasure this evening of tuning into a teleconference call with Bill O'Hanlon. Bill interviewed Bob Bertilino on effectiveness (the research supporting it) in psychotherapy. A subject near and dear to my heart, and one which is very much on the minds of the therapists I work with.
Some great ideas, and CEU's to boot (alas, we all need them!), the call was chock full of exactly what I had been hoping for...info and research on the importance of being open to evaluating what we do and what works for our clients. (And what helps them stay long enough to get something out of our work, and to really discover what that might be!)
Admittedly, I am a bit research adverse, it seems like a different language to me, but I must confess that I found the discussion lively and to the point...we do want to be effective, and there is research to help us understand what is effective and what is not. I also have to admit that there seem to be many variables in our work, and lots of dynamics to figure in....but:
The bottom line: feedback from clients is essential. And so is the therapeutic relationship. And, my own take, feedback helps move the therapeutic relationship along. Bob's got a new book coming out on the topic and there are other good reads out there as well, and check out http://www.talkingcure.com/ for some more stuff on effectiveness.
The research, according to Bill and Bob, supports the value and effectiveness of therapy. (good news!) And interestingly enough, effectiveness is more about how we are in the room than what approach we use. Helping clients to be with us requires an openness to what their agenda is, how they perceive the treatment, and what they consider useful and important in their sessions.
Though the call offered up several good ideas, and a few (buy-able) tools to help therapists along in the evaluation process, there was not enough time to delve into all the reasons that therapists hedge the issue of feedback in sessions. (Hint to Bill for another call on the topic).
My thoughts: I think we tend to be a self conscious bunch (surprise surprise), hardworking and interested in good outcomes for our clients, and subject to the many feelings that abound in the treatment room, but many therapists are uncertain about how to introduce the topic of feedback to clients, and even more unclear about what to do with it. Some therapists wait for some kind of acting out or resistance to show up (lateness, not paying, not coming to a session, problems with fees), to address the issue of how the therapy is going for the client. Until some behavioral communication happens, a discussion of the therapy itself rarely happens.
Some therapists I know ask for feedback all the time. And they do it in object neutral language that creates a safe way for the client to talk about the therapy without thinking s/he will offend the therapist ("How are the sessions going?" "What are your thoughts about our work so far?" "Are you getting what you had hoped for from therapy?") . Others prefer to give written questionnaires, but the key is to have the conversation or do the evaluation early on and ongoing and in a way that fits nicely into the session.
It requires, I think, some bravery and commitment on the part of the therapist to really use feedback as a tool for information gathering and rapport building, or as we say in analytic circles, establishing a narcissistic transference. But we can use it to help us tailor our work. I would even say that we should study the effect that asking for and getting feedback has on the client and on the treatment.
And, as always, to help the client say everything to us, including everything about the therapy itself, to allow ourselves to be open to their experiences and to learn about them and what they need is not only key to building good therapeutic relationships and doing good workbut evaluating effectiveness and getting client feedback is (point made by Bill and Bob) an ethical responsibliity.
Lots of good things to study. A big thank you to Bill for the great call, (and for taking my question!) You can check out the call on Bill's site if you are interested. Well worth it!
Some great ideas, and CEU's to boot (alas, we all need them!), the call was chock full of exactly what I had been hoping for...info and research on the importance of being open to evaluating what we do and what works for our clients. (And what helps them stay long enough to get something out of our work, and to really discover what that might be!)
Admittedly, I am a bit research adverse, it seems like a different language to me, but I must confess that I found the discussion lively and to the point...we do want to be effective, and there is research to help us understand what is effective and what is not. I also have to admit that there seem to be many variables in our work, and lots of dynamics to figure in....but:
The bottom line: feedback from clients is essential. And so is the therapeutic relationship. And, my own take, feedback helps move the therapeutic relationship along. Bob's got a new book coming out on the topic and there are other good reads out there as well, and check out http://www.talkingcure.com/ for some more stuff on effectiveness.
The research, according to Bill and Bob, supports the value and effectiveness of therapy. (good news!) And interestingly enough, effectiveness is more about how we are in the room than what approach we use. Helping clients to be with us requires an openness to what their agenda is, how they perceive the treatment, and what they consider useful and important in their sessions.
Though the call offered up several good ideas, and a few (buy-able) tools to help therapists along in the evaluation process, there was not enough time to delve into all the reasons that therapists hedge the issue of feedback in sessions. (Hint to Bill for another call on the topic).
My thoughts: I think we tend to be a self conscious bunch (surprise surprise), hardworking and interested in good outcomes for our clients, and subject to the many feelings that abound in the treatment room, but many therapists are uncertain about how to introduce the topic of feedback to clients, and even more unclear about what to do with it. Some therapists wait for some kind of acting out or resistance to show up (lateness, not paying, not coming to a session, problems with fees), to address the issue of how the therapy is going for the client. Until some behavioral communication happens, a discussion of the therapy itself rarely happens.
Some therapists I know ask for feedback all the time. And they do it in object neutral language that creates a safe way for the client to talk about the therapy without thinking s/he will offend the therapist ("How are the sessions going?" "What are your thoughts about our work so far?" "Are you getting what you had hoped for from therapy?") . Others prefer to give written questionnaires, but the key is to have the conversation or do the evaluation early on and ongoing and in a way that fits nicely into the session.
It requires, I think, some bravery and commitment on the part of the therapist to really use feedback as a tool for information gathering and rapport building, or as we say in analytic circles, establishing a narcissistic transference. But we can use it to help us tailor our work. I would even say that we should study the effect that asking for and getting feedback has on the client and on the treatment.
And, as always, to help the client say everything to us, including everything about the therapy itself, to allow ourselves to be open to their experiences and to learn about them and what they need is not only key to building good therapeutic relationships and doing good workbut evaluating effectiveness and getting client feedback is (point made by Bill and Bob) an ethical responsibliity.
Lots of good things to study. A big thank you to Bill for the great call, (and for taking my question!) You can check out the call on Bill's site if you are interested. Well worth it!
Wednesday, May 6, 2009
Are Interpretations a Sign of Annoyance? (or the Fine Line Between Understanding and Critisizing)
At lunch with a group of colleagues today, one of us was telling a very detailed story of some trouble he had gotten himself into, and his emotional pain over it. About ten minutes along in his tale of woe, the others, who appeared to be listening intently, began to interrupt him with interpretations. Now imagine how much fun this could be for a group of therapists, a few of whom are analytically trained, to want to jump in and interpret the problem for our troubled fellow. And each of us did have the idea that we understood something, more than something about this guy's problem, about his life circumstances, even his repetitions and defenses. We knew he had money troubles, and women troubles. A forceful, but slightly absent father. We knew he never felt very effective in business and struggled under the shadow of a talented and much accomplished brother.
We were sympathetic to him, though. We wanted to help. We wanted to be helpful. We wanted to help him understand something about himself, and about how he interacts with the world. And with us. And about how he may be inviting the world to interact with him. It was going to be, quite possibly, a good time for all.
Until one of us spoke up and ruined it. She put a big hand up and halted the help party just out of the start gate, and before it could reach a satisfying gallop. Before we could tell him things about himself, and the people he was in trouble with. The halt began with a question. "Is everyone transfixed by Sam's story?" We all nodded. "Is anyone feeling anything?" We stopped. We said no. We just want to help. And then....well, one of us said, yes. He was annoyed, a little, maybe. And another said, she was angry. And another said she was jealous. Sam seemed to have such colorful problems.
And so then, we departed from Sam's story a bit, and went to discuss why some therapists offer up analyses and other's don't. And what is helpful and what is not, and how to know.
One of us said that, come to think of it, when her own therapist gives her an interpretation, or an analysis, she feels criticized. She said that she thought she would feel understood, known, but that, in fact, the bulls eye evaluation of her defenses, her psyche, her emotional operations,was actually too keen, too accusatory, too unsettling. Instead of feeling understood, she felt undressed.
So, things to ponder. Sometimes telling someone something about themselves, or about who or how they are is akin to saying, "You know what your problem is, you...." And we would most likely not, with our therapist's hat on, do that. So we may have to be aware that sometimes interpretations to clients are simply a costumed way of delivering a punch. And the temptation to do so is a red flag that we, the therapist, may be experiencing a feeling that may seem intolerable to us.
True too of the impulse to be helpful. So what to do? We are suppose to be helpful right? So my friend who stopped us mid track admits that she does have her interpretive guesses about clients, but that she usually keeps them to herself. Or she wraps them into a question. That way the client can say yes or no. Or can consider it, and if it rings true, they can take to it, and if not, of its too unsettling and not supportive of needed defenses, they can reject it without shame or fear, or worry of hurting the analyst.
Sometimes, our job, I suppose, is to keep quiet. To study what's going on in the room. In ourselves. And not come forward with our ideas too fast. We may be missing out. Or having an impact that we are not aware of.
Our guy Sam, he was glad for the turn in conversation. He learned something about himself after all, and in a way that felt useful to him. Turns out that he learned something about how reality is not what it appears to be, and that when we slow down a bit, and ask questions, we can save ourselves a lot of heartache, and do much better work.
We were sympathetic to him, though. We wanted to help. We wanted to be helpful. We wanted to help him understand something about himself, and about how he interacts with the world. And with us. And about how he may be inviting the world to interact with him. It was going to be, quite possibly, a good time for all.
Until one of us spoke up and ruined it. She put a big hand up and halted the help party just out of the start gate, and before it could reach a satisfying gallop. Before we could tell him things about himself, and the people he was in trouble with. The halt began with a question. "Is everyone transfixed by Sam's story?" We all nodded. "Is anyone feeling anything?" We stopped. We said no. We just want to help. And then....well, one of us said, yes. He was annoyed, a little, maybe. And another said, she was angry. And another said she was jealous. Sam seemed to have such colorful problems.
And so then, we departed from Sam's story a bit, and went to discuss why some therapists offer up analyses and other's don't. And what is helpful and what is not, and how to know.
One of us said that, come to think of it, when her own therapist gives her an interpretation, or an analysis, she feels criticized. She said that she thought she would feel understood, known, but that, in fact, the bulls eye evaluation of her defenses, her psyche, her emotional operations,was actually too keen, too accusatory, too unsettling. Instead of feeling understood, she felt undressed.
So, things to ponder. Sometimes telling someone something about themselves, or about who or how they are is akin to saying, "You know what your problem is, you...." And we would most likely not, with our therapist's hat on, do that. So we may have to be aware that sometimes interpretations to clients are simply a costumed way of delivering a punch. And the temptation to do so is a red flag that we, the therapist, may be experiencing a feeling that may seem intolerable to us.
True too of the impulse to be helpful. So what to do? We are suppose to be helpful right? So my friend who stopped us mid track admits that she does have her interpretive guesses about clients, but that she usually keeps them to herself. Or she wraps them into a question. That way the client can say yes or no. Or can consider it, and if it rings true, they can take to it, and if not, of its too unsettling and not supportive of needed defenses, they can reject it without shame or fear, or worry of hurting the analyst.
Sometimes, our job, I suppose, is to keep quiet. To study what's going on in the room. In ourselves. And not come forward with our ideas too fast. We may be missing out. Or having an impact that we are not aware of.
Our guy Sam, he was glad for the turn in conversation. He learned something about himself after all, and in a way that felt useful to him. Turns out that he learned something about how reality is not what it appears to be, and that when we slow down a bit, and ask questions, we can save ourselves a lot of heartache, and do much better work.
Monday, April 27, 2009
Wish List (Do What You Love)
A psychologist friend of mine recently called to say that she was going on a professional wish binge. She has a solid practice, which she built many years ago by making good contacts, giving talks and teaching a few courses around her town. She does not take insurance, does not even give clients a statement to submit to insurance. She gives them a receipt and if they want a bill, they can make it themselves and she will sign it. She has not availed herself to the many good ideas of the practice building coaches or product development folks who are taking the practice of psychotherapy to new and broad based marketing levels, advocating multiple streams of income, selling e-books and audio downloads, phone coaching, etc. She happily practices straight forward psychotherapy, charges what she charges and makes fee adjustments rarely.
Already sounds good. So what's the wish binge. She now wants to work only with clients who are serious about working on their stuff. Who not only come on time, pay full fee and talk about their stuff, but and and who are thoroughly engaged, interested in their psyches and unconscious, and who are at least occasionally interested in her interpretations and analyses.
She does not want to absorb their bad feelings, or hear their complaints. If they want to vent, that's fine, but she does not want to have any hostile, angry, rebellious, demanding, frustrated, depressed people. And she wants progress. No chronic depression, unending anxiety or endlessly dissatisfied fighting couples.
She no longer wants to work with resistance. That's the wish binge. She wants the feeling of effective good work in each session. And if not, good bye. She does not want to have to broker all the feelings that come at her, that come up in more difficult cases. Or even in less difficult ones, where times are really tough.
Okay, I know. Maybe she is burnt out. Maybe she is dreaming. Maybe she's got too many clients. Maybe she is just a brat. Actually, at her own admission, she has said this is a possibility, but she has earned it. She has been working long and hard. And wants to be more selective, much much more selective about who she works with, and what kind of work she does.
I am always the first to say that we should not work with anyone we don't want to work with. We don't all have to work with anger or depression or fighting amygdalas. We can see if things are a good match when we meet someone initially. Only, the problem is, sometimes all the regression and progression doesn't show up so early on....
Its a freedom, though, I think. To be able to be choosy. To decide what degree of difficulty we want, and to say no when we would rather not encounter so much resistance. But resistance is unavoidable, largely, and I tell her this. To which she replied that while she appreciates my candor, she is going to do what she wants anyway. But she'll think about being more patient with the slow movers in her practice. And she will enjoy her wishes. She will even analyze them with her own therapist. Always a good idea.
Still and all, I like the topic. Going beyond all the "ideal client" marketing jargon and really giving ourselves permission to learn about what kind of work we really want to be doing. Not just what kind of client we want to work with or issues we want to hear about.
With so many options these days for how to practice and where to direct energy and spend time, I think it comes down to doing what you love. Really doing what you love. Really really. Figuring out what it is, even if it changes from time to time, and doing it. And weeding out the distractions and unnecessary tasks, and committing to pouring your heart into what you want to be doing and doing it. Brat and all.
P.S. On a slightly different note...Don't miss this article on Effectiveness at Psychotherapy.net
Already sounds good. So what's the wish binge. She now wants to work only with clients who are serious about working on their stuff. Who not only come on time, pay full fee and talk about their stuff, but and and who are thoroughly engaged, interested in their psyches and unconscious, and who are at least occasionally interested in her interpretations and analyses.
She does not want to absorb their bad feelings, or hear their complaints. If they want to vent, that's fine, but she does not want to have any hostile, angry, rebellious, demanding, frustrated, depressed people. And she wants progress. No chronic depression, unending anxiety or endlessly dissatisfied fighting couples.
She no longer wants to work with resistance. That's the wish binge. She wants the feeling of effective good work in each session. And if not, good bye. She does not want to have to broker all the feelings that come at her, that come up in more difficult cases. Or even in less difficult ones, where times are really tough.
Okay, I know. Maybe she is burnt out. Maybe she is dreaming. Maybe she's got too many clients. Maybe she is just a brat. Actually, at her own admission, she has said this is a possibility, but she has earned it. She has been working long and hard. And wants to be more selective, much much more selective about who she works with, and what kind of work she does.
I am always the first to say that we should not work with anyone we don't want to work with. We don't all have to work with anger or depression or fighting amygdalas. We can see if things are a good match when we meet someone initially. Only, the problem is, sometimes all the regression and progression doesn't show up so early on....
Its a freedom, though, I think. To be able to be choosy. To decide what degree of difficulty we want, and to say no when we would rather not encounter so much resistance. But resistance is unavoidable, largely, and I tell her this. To which she replied that while she appreciates my candor, she is going to do what she wants anyway. But she'll think about being more patient with the slow movers in her practice. And she will enjoy her wishes. She will even analyze them with her own therapist. Always a good idea.
Still and all, I like the topic. Going beyond all the "ideal client" marketing jargon and really giving ourselves permission to learn about what kind of work we really want to be doing. Not just what kind of client we want to work with or issues we want to hear about.
With so many options these days for how to practice and where to direct energy and spend time, I think it comes down to doing what you love. Really doing what you love. Really really. Figuring out what it is, even if it changes from time to time, and doing it. And weeding out the distractions and unnecessary tasks, and committing to pouring your heart into what you want to be doing and doing it. Brat and all.
P.S. On a slightly different note...Don't miss this article on Effectiveness at Psychotherapy.net
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