A few weeks ago I had a session with a patient I've been working with off and on for over a year. He's the kind of patient therapists love; he's introspective and insightful, he listens to feedback, he thinks about things in between sessions, and he attempts to use every technique we discuss at least once to see how it works for him. He was a bit guarded when we first started working together. Over time, however, he became more comfortable and talked more openly about things that bothered him. I was surprised when he revealed to me a few weeks ago that he has been intentionally holding things back during our sessions. When I asked him why he replied, "To protect you." He explained that some of the things he's been through were so horrific that he did not want to subject anyone else to them. He's tormented by memories of these events but has not shared his recollections because he fears they might be damaging to others.
His consideration for my feelings was touching and I told him so. On the other hand, I wanted him to feel free to talk to me about anything. I assured him I am capable of hearing his stories. I explained that it is my job as a therapist to take care of myself emotionally so that I am able to listen to people's stories without becoming overwhelmed. I told him I am diligent about self care. I said some other things I can't recall. Basically, I tried to persuade him that I can handle anything he decides to tell me. I don't know whether or not I convinced him.
As a result of this incident, I realized I'd been taking for granted that most of my patients feel comfortable telling me anything. Of course I know there are those who hold back but often these patients are upfront about that fact. I've had plenty of patients tell me they don't know me well enough to tell me certain things.
The thing that struck me most was the reason my patient had for holding back: he was afraid of damaging me with his thoughts, feelings, and memories. This in one way reveals something about the patient's character; he is genuinely concerned for the well being of others. (Ironically, he claims to not like people very much). Maybe that's the only thing it reveals. I wonder though, if there's something about me that led my patient to decide to hold things back. Is there something I said or did that drew him to his conclusion?
I've searched my memory but can think of nothing. If there is something I'm doing then it is something I am not aware of. I am, however, paying more attention now. Last week a different patient talked about how hard it is to cope with the horrible memories she has of her time in Afghanistan. She doesn't talk to anyone about her memories because, in her words, "nobody wants to hear about this stuff. Even I don't want to think about it and they're my memories!" She went on to explain that the memories are her burden to bear. I replied that hearing her memories is my burden to bear. "That's why I'm here," I said.
I'm not sure if spelling it out for people makes any difference. I guess I'll have to wait and see.
Showing posts with label psychotherapy. Show all posts
Showing posts with label psychotherapy. Show all posts
Wednesday, October 16, 2013
Wednesday, August 21, 2013
Can a therapist with problems still be a good therapist?
I sometimes wonder why, in my personal life, I am not more competent interpersonally than I am. In fact, for someone who spends a significant amount of time helping people learn to interact with one another I often find my own lack of skill in such matters embarassing. I wonder if it is possible to be a good psychotherapist when I sometimes struggle with issues similar to those facing my patients. Can I really help people learn to overcome problems I myself have not successfully mastered? Can I teach others to do things I myself am not able to do? And if not, does that mean I am not a good psychotherapist? Am I doing my patients a disservice? Do my personal limitations prevent me from providing adequate care?
Then again, I know I am not the only psychotherapist facing this problem. I thinks about other therapists I know, colleagues both former and current. Many of them have struggled in their personal lives. Ironically, one of the best marriage therapists I've ever encountered has been married and divorced at least twice. And yet, I refer my patients to him again and again, confidently touting his skill and expertise. When I talk to patients who have seen him with their spouse for ocunseling, they always give positive feedback about the experience. As good as he is at marriage therapy, however, he is apparently not that good at marriage.
If a skilled marriage therapist can be terrible at marriage, it stands to reason that a competent psychotherapist can have unresolved personal problems.
Of course I decided to do some research. In doing so, I stumbled upon an article written by an historic icon in the field of psychotherapy, Carl Rogers. There was something in particular he said in the article that brought me peace of mind. In the article, he proposes a theory in which he identifies the conditions necessarry for positive therapeutic change to occur. One of six identified conditions is that the therapist be "a congruent, genuine, integrated person" within the context of his relationship with the patient. He goes on to say that it is neither necessarry nor possible for the therapist to be "a paragon who exhibits this degree of integration, of wholeness, in every aspect of his life. It is sufficient that he is accurately himself in this hour of this relationship..."
What a relief. I don't have to have it all together all the time to be a good therapist. I just need to bring my healthiest self each time I interact with a patient.
Then again, I know I am not the only psychotherapist facing this problem. I thinks about other therapists I know, colleagues both former and current. Many of them have struggled in their personal lives. Ironically, one of the best marriage therapists I've ever encountered has been married and divorced at least twice. And yet, I refer my patients to him again and again, confidently touting his skill and expertise. When I talk to patients who have seen him with their spouse for ocunseling, they always give positive feedback about the experience. As good as he is at marriage therapy, however, he is apparently not that good at marriage.
If a skilled marriage therapist can be terrible at marriage, it stands to reason that a competent psychotherapist can have unresolved personal problems.
Of course I decided to do some research. In doing so, I stumbled upon an article written by an historic icon in the field of psychotherapy, Carl Rogers. There was something in particular he said in the article that brought me peace of mind. In the article, he proposes a theory in which he identifies the conditions necessarry for positive therapeutic change to occur. One of six identified conditions is that the therapist be "a congruent, genuine, integrated person" within the context of his relationship with the patient. He goes on to say that it is neither necessarry nor possible for the therapist to be "a paragon who exhibits this degree of integration, of wholeness, in every aspect of his life. It is sufficient that he is accurately himself in this hour of this relationship..."
What a relief. I don't have to have it all together all the time to be a good therapist. I just need to bring my healthiest self each time I interact with a patient.
Thursday, April 26, 2012
Self and No Self: Psychology and Buddhism
I was asked by a fellow blogger to write about Buddhist views on the self. Since my interest in Buddhist teachings originated in my desire to integrate these ideas into my psychotherapy practice, I decided to compare and constrast how the self is conceptualized in Western psychology and in the Buddhist tradition. This is a rather big undertaking, and one that I will not attempt to complete in one blog post. "Self and No Self: Psychology and Buddhism" will therefore be my first "series" of posts on a single subject.
Over the past twenty years, Western psychology has become increasingly interested in ancient Eastern practices and traditions. Among the first to advocate the usefulness of Eastern precepts to Western mental health practice was Dr. Marsha Linehan, the well known pioneer of Dialectical Behavior Therapy (DBT). DBT is built around the Buddhist practice of mindfulness. Since the original publication of Linehan's DBT treatment manuals in 1993, mindfulness and other Eastern ideas and practices have gained widespread use among Western mental health practitioners.
Since the days when Freud fathered psychoanlysis -- the first form of modern psychotherapy -- the self has been among the primary foci of psychotherapy practice. As the number of psychological theories have grown, so have the ways in which the self is conceptualized. Almost every psychological theory has its own unique conception of the self. Thus, it is impossible to make any overarching statement to summarize how the self is perceived in the field of psychology. What can be said is that virtually every school of psychology has some conception of the self that influences its ideas about the causes and treatment of mental illness.
This seems to be completely at odds with Buddhist teachings. Fundamental to the Buddhist worldview is the concept of anatman (roughly translated as "no soul," "no self," or "egolessness"), which asserts that there is no such thing as an immortal soul or core self. The Buddha taught that nothing exists that is permanent. Things come into being and things disintegrate. Humans, like everything else in existence, are made of impermanent substances. Human beings have no separate soul or self that exists apart from our material bodies.
Buddhism asserts that the self, which is of central importance to the field of psychology, does not exist. Just as the concept of self is integral to the understanding and practice of psychology the idea of "no self" is fundamental to the understanding and practice of Buddhism. How is it, then, that psychology has embraced Buddhist teachings when the two fields are built around opposing fundamental tenets?
Despite differences in their basic beliefs, Buddhism and Western psychology share a common goal: they both seek to alleviate suffering. Each field approaches this goal in a manner consistent with its own belief system. The Buddha taught that "the self" is an illusion and that this illusion is the source of all suffering. Consequently, Buddhism asserts that the way to relieve suffering is by seeing through the illusion of self, thereby bringing the self to an end. In contrast, Western psychology tends to view the absence of a stable, integrated sense of self as among the most significant causes of suffering. Thus, many psychotherapists believe that building or restoring a strong sense of self is an important part of the treatment process (the primary goal of which is to alleviate suffering). In short, Buddhist practice aims to alleviate suffering through losing the self; psychotherapy seeks to alleviate suffering by helping to build, rebuild, find, strengthen, or define the self.
These are the ideas I will be exploring over the next few weeks. Next week, I will explore in more detail Buddhist views of the self (or no self). The following week, I will try to provide an overview of the major theories about the self in Western psychology. Finally, I will attempt to tie it all together by addressing questions like, "Are the ideas of Buddhist and Western psychotherapy practitioners about the self fundamentally at odds with one another?" "Is there any overlap betwen how Buddhists and Western psychotherapists think about the self?" and "What aspects of Buddhist practice have Western mental health practitioners embraced and what, if any, impact does this have on their ideas about the self?" This is an ambitious undertaking on my part so I ask that you please bear with me. I am also open to feedback throughout this process.
Over the past twenty years, Western psychology has become increasingly interested in ancient Eastern practices and traditions. Among the first to advocate the usefulness of Eastern precepts to Western mental health practice was Dr. Marsha Linehan, the well known pioneer of Dialectical Behavior Therapy (DBT). DBT is built around the Buddhist practice of mindfulness. Since the original publication of Linehan's DBT treatment manuals in 1993, mindfulness and other Eastern ideas and practices have gained widespread use among Western mental health practitioners.
Since the days when Freud fathered psychoanlysis -- the first form of modern psychotherapy -- the self has been among the primary foci of psychotherapy practice. As the number of psychological theories have grown, so have the ways in which the self is conceptualized. Almost every psychological theory has its own unique conception of the self. Thus, it is impossible to make any overarching statement to summarize how the self is perceived in the field of psychology. What can be said is that virtually every school of psychology has some conception of the self that influences its ideas about the causes and treatment of mental illness.
This seems to be completely at odds with Buddhist teachings. Fundamental to the Buddhist worldview is the concept of anatman (roughly translated as "no soul," "no self," or "egolessness"), which asserts that there is no such thing as an immortal soul or core self. The Buddha taught that nothing exists that is permanent. Things come into being and things disintegrate. Humans, like everything else in existence, are made of impermanent substances. Human beings have no separate soul or self that exists apart from our material bodies.
Buddhism asserts that the self, which is of central importance to the field of psychology, does not exist. Just as the concept of self is integral to the understanding and practice of psychology the idea of "no self" is fundamental to the understanding and practice of Buddhism. How is it, then, that psychology has embraced Buddhist teachings when the two fields are built around opposing fundamental tenets?
Despite differences in their basic beliefs, Buddhism and Western psychology share a common goal: they both seek to alleviate suffering. Each field approaches this goal in a manner consistent with its own belief system. The Buddha taught that "the self" is an illusion and that this illusion is the source of all suffering. Consequently, Buddhism asserts that the way to relieve suffering is by seeing through the illusion of self, thereby bringing the self to an end. In contrast, Western psychology tends to view the absence of a stable, integrated sense of self as among the most significant causes of suffering. Thus, many psychotherapists believe that building or restoring a strong sense of self is an important part of the treatment process (the primary goal of which is to alleviate suffering). In short, Buddhist practice aims to alleviate suffering through losing the self; psychotherapy seeks to alleviate suffering by helping to build, rebuild, find, strengthen, or define the self.
These are the ideas I will be exploring over the next few weeks. Next week, I will explore in more detail Buddhist views of the self (or no self). The following week, I will try to provide an overview of the major theories about the self in Western psychology. Finally, I will attempt to tie it all together by addressing questions like, "Are the ideas of Buddhist and Western psychotherapy practitioners about the self fundamentally at odds with one another?" "Is there any overlap betwen how Buddhists and Western psychotherapists think about the self?" and "What aspects of Buddhist practice have Western mental health practitioners embraced and what, if any, impact does this have on their ideas about the self?" This is an ambitious undertaking on my part so I ask that you please bear with me. I am also open to feedback throughout this process.
Sunday, March 18, 2012
Do therapists practice what they preach?
Most people probably assume that their therapist is mentally and emotionally healthy. After all, the therapist seems to have it all together: a good job, nice office, nice clothes, and a consistently calm demeanor that is both comforting and reassuring. It certainly makes sense that a therapist should have good mental and emotional health; she has all the necessary tools and she knows how to use them. But do therapists practice what they preach?
I can't speak for all therapists; I can only speak for myself. Am I the picture of perfect mental and emotional functioning? Absolutely not. I do, however, practice what I preach. One of the reasons I am able to "sell" certain strategies to my patients is because I know from personal experience that they work. I'm a walking testimonial. I'm quite proud of this. I started out insecure and emotionally unstable. Learning to "do" therapy is an ongoing process that for me started when I got my first job out of college. From day one I started using what I learned to help myself. I've come a long way since then and I'm proud of myself.
Imagine my chagrin, then, when six months into my marriage my mother suggested that my husband and I needed marriage counseling. I resisted. "We don't need a therapist," I thought. "I am the therapist." (I've since reconsidered my position). Then I started thinking about all of the therapists I've worked with over the years; A LOT of them are divorced. Even some of the therapists I know who are trained specifically in marriage and family therapy are divorced! Apparently, when it comes to relationships there are a lot of us who have a hard time practicing what we preach.
I recently stumbled upon a research study that looked into this. (The article is entitled "Do psychotherapists have better marriages than nonpsychotherapists?" and is found in the journal Psychotherapy: Theory Research, Practice, Training, Vol. 41, No. 3. The authors are Murstein and Mink). The study measured marital adjustment in couples where neither spouse was a therapist, where one spouse was a therapist, and where both spouses were therapists. Overall, they found no difference in levels of marital adjustment between couples where neither spouse was a therapist and couples with one or more therapist spouse. In other words, couples with one or more therapist spouse did not have better marital adjustment than couples with no therapist.
They broke the results down into categories and found some very interesting results. The couples with the highest indicators of marital adjustment in both partners were those composed of a therapist husband and a non-therapist wife. The lowest ratings of marital adjustment came from husbands (both therapists and non-therapists) married to therapist wives.
This is, of course, extremely relevant to me, given that my husband is married to a therapist wife. I started thinking about our "marital adjustment" and how me being a therapist affects our relationship...
Early in our marriage, my husband had a terrible habit of not telling me when I did something to upset him. Instead, he'd accumulate these instances in his mind and then throw them at me one by one whenever we had an argument. This meant that if I complained about something he did that was really upsetting me, he would respond by going through a long list of examples of things I'd done to make him angry. As a therapist, I knew he was breaking one of the cardinal rules of fair fighting: stick to the subject and stay in the present (don't bring up issues from the past). I'd tell him, "Look, you're not supposed to do that when we're arguing." The thing is, he didn't know anything about the fair fighting rules and he hadn't agreed to abide by them. I know that at times he seemed to resent me telling him how we were "supposed" to communicate with each other (especially when I didn't always follow my own "rules").
I suppose my husband might have some theories of his own. I plan to ask him. I'll let you know if he has any interesting insights.
I can't speak for all therapists; I can only speak for myself. Am I the picture of perfect mental and emotional functioning? Absolutely not. I do, however, practice what I preach. One of the reasons I am able to "sell" certain strategies to my patients is because I know from personal experience that they work. I'm a walking testimonial. I'm quite proud of this. I started out insecure and emotionally unstable. Learning to "do" therapy is an ongoing process that for me started when I got my first job out of college. From day one I started using what I learned to help myself. I've come a long way since then and I'm proud of myself.
Imagine my chagrin, then, when six months into my marriage my mother suggested that my husband and I needed marriage counseling. I resisted. "We don't need a therapist," I thought. "I am the therapist." (I've since reconsidered my position). Then I started thinking about all of the therapists I've worked with over the years; A LOT of them are divorced. Even some of the therapists I know who are trained specifically in marriage and family therapy are divorced! Apparently, when it comes to relationships there are a lot of us who have a hard time practicing what we preach.
I recently stumbled upon a research study that looked into this. (The article is entitled "Do psychotherapists have better marriages than nonpsychotherapists?" and is found in the journal Psychotherapy: Theory Research, Practice, Training, Vol. 41, No. 3. The authors are Murstein and Mink). The study measured marital adjustment in couples where neither spouse was a therapist, where one spouse was a therapist, and where both spouses were therapists. Overall, they found no difference in levels of marital adjustment between couples where neither spouse was a therapist and couples with one or more therapist spouse. In other words, couples with one or more therapist spouse did not have better marital adjustment than couples with no therapist.
They broke the results down into categories and found some very interesting results. The couples with the highest indicators of marital adjustment in both partners were those composed of a therapist husband and a non-therapist wife. The lowest ratings of marital adjustment came from husbands (both therapists and non-therapists) married to therapist wives.
This is, of course, extremely relevant to me, given that my husband is married to a therapist wife. I started thinking about our "marital adjustment" and how me being a therapist affects our relationship...
Early in our marriage, my husband had a terrible habit of not telling me when I did something to upset him. Instead, he'd accumulate these instances in his mind and then throw them at me one by one whenever we had an argument. This meant that if I complained about something he did that was really upsetting me, he would respond by going through a long list of examples of things I'd done to make him angry. As a therapist, I knew he was breaking one of the cardinal rules of fair fighting: stick to the subject and stay in the present (don't bring up issues from the past). I'd tell him, "Look, you're not supposed to do that when we're arguing." The thing is, he didn't know anything about the fair fighting rules and he hadn't agreed to abide by them. I know that at times he seemed to resent me telling him how we were "supposed" to communicate with each other (especially when I didn't always follow my own "rules").
I suppose my husband might have some theories of his own. I plan to ask him. I'll let you know if he has any interesting insights.
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