Psychotherapy

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Would a Therapist Ever Give Up on a Client?

That’s a very important question – in that it could be devastating to a client to be “fired” by his/her therapist. It’s tantamount to having your parent dis-own you, because of the transference.

After close to 40 years of doing therapy in private practice I think I have told a client I couldn’t keep working with them 3 times: once, the client was refusing to engage with therapy and only wanted to “use me “ much the way he used prostitutes – to feel better emotionally – and refused to have even have an area he wanted to improve himself about and ‘work on’. Another time it was very similar with a woman, and a third time I was seeing a man for the first time and intuitively felt in danger being alone with him in my office. I later heard he had attacked a female nurse in a hospital situation. In the first two examples I considered what I was doing to be therapeutic – in that the impact of having me refuse to continue seeing these people was my *final* BIG statement to them about the importance of dealing with their behavior.

All of which is to say – if you take someone on as a patient and you are not legitimately over your head with them – you have a moral obligation to them to work with them. It’s really OK to admit to a client that you don’t know how to help them and refer them to someone you think can help them. So yes, I think some therapists probably do give up on clients. Hopefully not often. It’s important for therapists to learn how to “size up” clients who show up at their door and decide if they want to work with this person or not.

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How Can I Overcome My Fear of Being Vulnerable in Therapy/

You are absolutely right, you are vulnerable in therapy. Even when your therapist works to gain your trust, as she / he should, you can only know then that the therapist will do all they can to protect you from unnecessary hurt, and help you recover when you are hurting. You can get hurt during therapy in many ways, not only by mistakes the therapist could make with you, but by remembering things you forgot or never knew, or learning to see things that happened to you in a new light that is hurtful to you to realize. You may learn and grow from these new insights and understandings but initially they may hurt. So even the best therapist taking the best care of you can not shield you entirely from being vulnerable and experiencing hurt.

Maybe the only real answer to your question is to encourage you to be brave and deal with your vulnerability head on. Definitely don’t work with a therapist unless you can trust them to be both competent and caring. Know that things that are difficult and painful initially may be the very things that set you free from old alliances that aren’t worth keeping so steadfastly. Know that learning the deeper truths of your life will make it better, and that coming upon wounds that need healing is worth the work and the time. Pick your guide carefully and then take yourself, fears and all, into the fray. How wise of you to realize your vulnerability! Keep that wisdom with you and watch for all the other things you will learn as your wisdom grows. My best to you.

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Re-parenting in Psychotherapy

I think therapists are re-parenting all the time they are in session with a client, and being keenly aware of that is part of using transference. Recognizing that transference is going on all the time in therapy allows the better therapists to be most effective. This is what is meant by “ It’s the relationship that heals,” not the particular therapeutic approach utilized.

It’s the therapists respect, interest, affection, effort put out to help; all of this and more is apparent to the client consciously or unconsciously. And all of this is saying “you are worthy, you are of great value as a person.” Your thoughts are interesting, your feelings matter, etc. etc. These messages are the ones the person should have gotten as a child are now being expressed by the therapist, overtly and not so overtly, verbally and non-verbally. That’s re- parenting. Knowing how to do this genuinely is an important therapeutic skill.

When I am meeting a client for the first time, I look to see what I label to myself as the “beauty” of this person. If I don’t see it right away, I consciously wait, because I know I will see it soon. If I can tell I am never going to like a person, for what ever reason, I don’t work with them. It happens very rarely. I know each person deserves to have their therapist like them and find them worthy.

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The Therapist / Client Relationship

Snakes live in the forest. Every day they travel over rough ground – pebbles, rocks, fallen trees with uneven bark. Every Spring they get a new skin, and it happens this way:  the old skin stretches and loosens. It eventually detaches, over time, from the snakes body, and  the new skin  shows up underneath.

The old skin never falls off until the new skin has had the time to toughen up and manage the rough terrain the snake goes through. When It first appears, the new skin is delicate and pink, but by the time it is ready to protect the snake from it’s daily environment, it has become brown and strong.

It’s never the therapist’s job to pull he skin off a snake.

 

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The “Not Good Enough” Therapist

I have answered a number of questions on Quora; many from people asking specifically for my response.  A large percentage of them speak of  variations on the same theme. They are either blaming or at least doubting themselves about their discomfort with their  therapist or the  lack of success of the treatment.  In each situation, I saw reasons to believe the therapist was either inadequate or downright unscrupulous and unethical.

This is such a set up:  People go to therapy  because they feel uncertain about themselves  or their life in some way, and that in itself makes the them vulnerable and not confident in their ability to critique the therapist. Plus, everyone really wants the therapist to be wonderful and help, even to be a really trustworthy parent figure.  Unscrupulous therapists can turn this to their own advantage in a myriad of ways: from seeing the client longer than needed to make more money, having sex with their client, to using the client to be  their friend. Poor therapy can be very harmful or at a minimum waste the client’s time and money, and it may turn them off to therapy altogether.

Some people automatically give the therapist credence just because they have an office and are in business. Please don’t! Question the therapist and trust your intuition as much as possible. You are not supposed to trust this professional just because they have a degree. The therapist has to earn the client’s trust and you can let that take as long as it takes. It some situations, that trust isn’t fully felt until the end of a long bout of therapy. And that’s just fine.

If you are uncertain if your therapist is useful  to you, it’s fine to bring this up and evaluate the therapist’s response. It can also be helpful to ask another therapist about your situation.  The ‘second opinion’ therapist may want you to try and work the  out your dissatisfaction  with your current therapist – considering the possibility of negative transference – but if you have given that your best shot, it’s really OK to find someone who works well with you. If you repeatedly have the same dissatisfaction, then it may indeed be negative transference and you need to pick your best choice  of a competent therapist and hang in for the long haul.

I have other blog entries and short articles about How to Choose The Right Therapist, what you should get from a good therapist and how to decide if and when you should leave as well, as well  as blogs about transference. Check them out if it would be helpful to you. You  can also write and ask me for my opinion.

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Fall Depression – Seasonal Affective Disorder

We are moving into winter, and daylight  savings time has come and gone. If you are sensitive to light, you may well  be having less energy, have a low mood, trouble with mental acuity, and many  other symptoms of depression. If you realize that this is true for you every  fall and winter, you most likely have Seasonal Affective Disorder, or SAD. Although some people find they feel worse in the summer and need to wear sun glasses, most of us effected by light changes and shorter days  experience it more in fall and winter.  Some of the symptoms that are easily noticed in our selves are craving carbohydrates and not wanting to be social.

The good news is that this is all pretty easy to fix: use a light box. Figure out a routine in your daily life so that you can be in front of a light box for whatever period of time you need. You can be working at a desk or walking on a treadmill; there are different sizes of light boxes that suit all these activities. There are even light box visors that allow you to move around doing whatever you like while you get your light.

Your medical doctor or a psychotherapist can put you in touch with reputable companies that sell light boxes.  Learn how they work and get started. Most people get results in 1 to 3 days. Good Luck!

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Evaluate Your Therapist

Are you dissatisfied with your therapy? Is it you or is it your therapist? Let’s evaluate and find out.

First I will tell you what is reasonable to expect from a competent, experienced therapist. In the next post I will explain the notion of transference, positive and negative, and then how to work with your current therapist to see if negative transference is the problem.

Here are some fair expectations you should have of your therapy process and your therapist:

  1. You should make progress. If you don’t think you are, ask your therapist why they think you are or aren’t making progress. Don’t automatically discount your your own instincts. Listen but don’t assume the therapist knows more than you do just because they are “the professional” if what they say doesn’t make sense to you.
  2. You should get something new out of every session. If you are not, ask yourself if your therapist is:
    • not really working when you are in session – they should be.
    • just being “someone to talk to”: therapists should have a lot more than this to offer.
    • not clearly showing you how to get engaged in your sessions: You have to if you want to grow.
    • just giving advice: you should be learning how to answer your own questions and make your own decision.
  3. You should be learning from your therapist. Your therapist should know more than you do about the general kinds of issues you are dealing with. They should be able to clearly relate this understanding to your specific situation.
  4. You shouldn’t feel worried about your therapist’s feelings – it’s the therapist’s job to take care of themselves. The therapist should call you on doing this and reassure you they don’t need or want this from you.
  5. You should feel your therapist likes and cares about you. If your therapist doesn’t accept who you are and like things about you, you deserve more.
  6. Your therapist should have several ways to approach you and your problem. You should never feel like you are supposed to fit into their way of doing therapy.

If these expectations are not being met, talk to your therapist about them. It is also reasonable to look for another therapist. Remember, just because this therapist is set up in an office or clinic doesn’t mean they are good at their trade.

On the other hand, if you find yourself repeatedly switching therapists I would recommend you stick with your current therapist and make a sincere effort to work out your dissatisfaction.

If you fire a therapist, it may rid you of the problem at hand, but another version of that same problem will likely show up with your next therapist. You need to give your current therapist 3 to 5 more sessions while you focus on working out your relationship. This may well be about transference which is the unconscious phenomena of transferring feelings from one person to another; in this case unconsciously transferring your feelings for some one else in your life to your therapist.

Transference is one of the reasons therapy can work so well and it is also a reason why it can fail. More about that next in “Transference in Therapy“.

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More Common Questions

I’m afraid of not liking my parents if I find out they hurt me when I was little.  I want to be able to love them and be close to them.  Maybe it isn’t worth finding out what happened to me, or is it?

That is a real and serious question.  Would you rather live with the truth or with your hoped for fantasy? Would you rather have your whole self, or your relationship with your parents?  I suggest you look at what troubles you in life and decide how much you want that to be different.

 

So what in me probably has to do with past childhood abuse? No one is perfect, what can I assume about myself is attributable to childhood abuse? 

Low self esteem, relationship dissatisfaction, trust issues, lack of self actualization, unnecessary fears and anxiety,  problems with your sexuality, to list only the most obvious.  I have never known a person who has worked on their childhood abuse be sorry they did.

 

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The Bottom Line on Therapy

So what is the purpose of therapy, anyway? What is it supposed to do for you?

Therapy gives you choice. It allows you to have choices instead of  automatically thinking/feeling /acting  from what your history taught you  – about yourself, other people and the world.

Your history, in this case, means your childhood.  During those early years you learned by experience what the world is like, what  to expect from other people,  and who you are.  For an example: for the child who was expected to mommy’s little helper and take care of her younger siblings learned that to be a good person was to figure out what someone else needed and do it for them. Maybe she learned to put her own preferences  and needs in the background, to never complain or think of herself first,  to think of herself as valuable only  in the ways she  could serve others.
So she grows up to be a what we all call a caretaker, giving “selflessly”, and  depressive without knowing why.  After all, everyone she knows says she is wonderful!  She finally decides to get her own career, and, you guessed it, she becomes a nurse. More depression.

She comes to therapy and discovers what she thought were her own choices where based on what she learned as a child  and decides to throw it all off.  Her kids do more chores around the house. Her husband comes into therapy with her because she is fed up of his self centered ways and expectations that she be his maid, lover on demand, and the one who takes care of the kids. She gets a new hair cut, loses weight,  quits the subservient good girl role at work and becomes an administrator…..you get the picture.

Therapy teaches you how your childhood effected you and gives you choices about what you want to do, who you want to be.  How does it do that? Look around at other blog entries, and if you have specific questions, leave a comment and I’ll do my best to explain.

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The Therapist’s Commitment

Lately I’ve been thinking about this work, and what the therapist owes her/ his clients.  Therapists often say that they don’t want to be doing all the work, (meaning that the client must apply him or herself) or nothing useful will really happen.  Very true.

However, the therapist must also be working, and working hard, so that when the client leaves every session they take with them something new to ‘chew on’, a new awareness or an insight  they didn’t have before. Perhaps  they have gone through an emotional experience that has created a self-understanding. This is often more useful than then the intellectual putting together of a new concept. For example, crying teaches how significant something is (or was) in a deeper way than thinking about it.

The therapist  needs to connect things that their client said in a previous session to what they are saying today, or show them things about themselves they hadn’t recognized.  Good therapists pick up on things that other people  wouldn’t notice.  Then there is the timing and  presenting of things, so that the client can take in what the therapist is saying.   Skill, experience and intuition come in here. Therapists have to stay on top of their own reactions to things, so they know when something from their own life is influencing the way they feel and react to their client. Having different therapeutic approaches to the same issue is needed – the therapist needs to adopt to their client, not the other way around!

I guess I’m saying some people are more talented about this work than others — and  don’t settle.