Therapists sometimes reveal themselves despite their training not to. For example, in psychoanalytic treatment, Freud made himself a blank slate. He thought the patient’s troubles would become evident if he didn’t intrude upon the process. Remember, Freud sat behind the patient lying on the couch. Sigmund’s facial expressions and body language could not be observed. He said little, instead encouraging the analysand’s free association of thoughts. Then, if the client displayed positive or negative feelings about Herr Doktor Freud, the psychiatrist believed it due to underlying unresolved issues, usually about mom or dad. The heart of the problem having thus been uncovered, Dr. Freud could begin his “heart” surgery.
Still, patients wish to know “personal” things about the mysterious humanoid who treats them and will comment on the imbalance in unfolding that which is most intimate: the therapist gets to ask, the patient mostly does not. Spacefreedomlove, a provocative and prolific blogger, raised worthwhile queries in her post, Five Things You Always Want to Ask Your Therapist but are Afraid to Ask. I will try to answer, speaking only for myself. I encourage other therapists and clients to add or subtract by posting comments.
Question 1. “Do you ever wish you never met me or that you referred me out after the initial consult?”
A therapist works hard to find the best in the people he treats. This is a cliché, but it is true. You otherwise make both yourself and your patient miserable. I rarely if ever wished I had never met a patient, but occasionally thought later it would have been best to refer them. Careful readers will distinguish two questions here:
A. “Do you ever wish you never met me?” The reason I’m glad I came to know my entire clientele is because they enriched me in knowledge and experience. I grew because of them. Many are wonderful people with whom it was a privilege to work.
With respect only to my enrichment, however, I would even say I found value encountering some nasty folks outside of work. Of course, I didn’t love those who did me wrong at the moment of injury. Strong feelings of anger and dislike touch everyone, therapist or thespian, “butcher, baker or candlestick maker.” A psychologist realizes he learns from some lessons only pain offers. Thus, if you ask me, “Do you ever wish you never met me?” I can pretty much say no, because you taught me about life, work, and myself. Past your tutelage, however, I might say I’d rather not meet you twice! This last comment refers to only a few people I met in the office, however.
B. “Do you ever wish you referred me out after the initial consult?” The simple answer is yes, but read on before taking the statement to heart. First, a different therapist might have worked wonders I did not. I remember one intelligent and sweet young woman early in my career who I didn’t diagnose as Bipolar Disorder until she arrived at the clinic with a bunch of “gifts.” The package included a box of condoms for me! She was hospitalized soon after. Had I been quicker to make the proper diagnosis, she might well have avoided being temporarily institutionalized. The young lady had some bad feelings about me as a result and I deserved them.
Therapists don’t predict the future without error. Only in retrospect do we realize an earlier referral was required. That said, I think the real issue being raised by spacefreedomlove is found in her second question:
Question 2. “Am I too much? Do I wear you out?”
The answer is yes, counselors get worn out, but not necessarily because of you. Once the therapist realizes he is exhausted, two more queries should pop up: a) Am I trying to do too much instead of allowing the patient’s own energy to carry therapy forward? b) Do I have some countertransference issues? Countertransference refers to the feelings the therapist has about the client, negative or positive. These can go back to the therapist’s own unresolved emotional concerns, so I’ll address this in response to Question 4. “Do I remind you of anyone from your past?”
As a young psychologist, I was keen to heal the world. This delusion is common among new therapists. Experience informs you of your inability to save everyone and, indeed, perhaps you can’t save anyone! By that, I’m thinking of the lifeguard who tries to rescue someone trying to drown himself. In other words, you need a person who isn’t going to fight your efforts every session and who has the therapeutic integrity to endure the pain of treatment. He must do everything he can to wrest a good life from the wreckage of his previous existence.
Therapists can burn out if they don’t recognize and calm their own frustration when progress is stalled. A counselor might exhaust himself by meeting his patient too early or late in the day, discounting fees to the point of feeling ill-compensated, and by overworking. Phone availability is still another potential complication, especially in non-emergency situations. Private life stressors create a trip-wire, as do multiple late cancellations without strong reasons.
A wise doctor will discuss issues during appointments, but not before healing himself or seeking his own outside support if the problem is his, not the client’s. Psychologists need to set limits. Being “on call” day and night can feel like guard-duty in wartime, causing sleeplessness and fatigue to the point of being less good when it really counts, in session. Remedies might include talking about the patient’s level of determination; a change to the time, day, or frequency of sessions; renegotiating the fee or the cancellation and phone policy, etc. Without improvement, referral is another option.
Question 3. “What do I bring up for you? What do you struggle with in our sessions?”
As stated earlier, I only speak for myself. The best answer I can give is a long one, so I will refer you to a post called, What is Your Therapist Thinking? In addition to what is contained there, I struggled with how best to be helpful. Were a patient decompensating (getting worse) as the session progressed, I considered how to get the train of treatment on track to a safe place. The post I linked illustrates the manner in which your “doctor” head can be in a number of different places depending upon the flow of the therapeutic encounter as it happens. After the appointment, the counselor needs to reflect upon his efforts and whether they helped, were ineffective, or indeed caused the decompensation.
An inexperienced healer risks identifying with his patient’s pain so much that both he and the client are adrift at sea, and he is unable to offer a steady hand from the shore. Experienced therapists, on the other hand, risk becoming jaded to the point of equally worthless emotional distance. I believe I was eventually able to find solid ground in the middle.
Question 4. “Do I remind you of anyone from your past?”
Much like parents who are better suited to raising one child than another, counselors are not equally well-suited to each client. This can be a matter of skill, temperament, age, experience, or background. The question, however, seems to suggest you (the therapist) suffer issues from your past impinging upon your relationship with your patient in the present: your patient’s resemblance to someone else is the trigger. I remember a 16-year-old victim of sexual abuse. Her face reminded me of an old girlfriend, who I met when she (the girlfriend) was only a year older — 17. In the session during which the abuse surfaced, the client’s pain contributed to my own. While this was not a unique experience (my eyes can moisten hearing such stories), I was more than usually touched because of the invisible presence of tender feelings toward someone I’d not seen in many years. Nonetheless, my emotions settled and did not appear to derail treatment progress.
A few patients reminded me of my mother, with whom I had a “complicated” relationship. Please do note the euphemism! Once, however, I resolved my “mom” issues, I observed such similarities without undue emotion interfering in treatment. So, at least, I told myself.
Question 5. “What would you say to me if you were not my therapist?”
I am a pretty direct person. Not undiplomatic (most of the time), but direct. From childhood I found it almost impossible to be false. Should you care to know more, an amusing post on this congenital failure describes a kindergarten catastrophe: Gone in Sixty Seconds: How to Lose Three Girlfriends in a Minute. I don’t take full credit for my discomfort with being disingenuous (since I seem to have been born with it). Nonetheless, because of the trait, my client heard whatever I thought was most important to say. I tried to hold a mirror so that he might better recognize himself. If his vision was cloudy and it was essential that he perceive more (in my opinion), I often said more. I made good use of Socratic dialogue, asking questions designed to lead to self-awareness. Telling someone he is missing something is rarely helpful. A therapist says things like “What does that way of being cost you?” in the hope of allowing the patient (upon answering and thereby taking responsibility for his behavior) to grab the therapeutic initiative to change. The same comment in the form of a statement, by comparison, might cause him to feel scolded. It is easier to reject the therapist’s conclusion than your own.
No one gets to know every thought a therapist or a friend thinks about him. The truth of the previous statement does not mean, however, you would hear more from me as a friend than you would as your therapist.
In the end, as worthwhile as the above questions are, I believe it is most important a therapist know the truth of what Leo Tolstoy described in War and Peace — the role of medical doctors in early nineteenth century Russia:
“They satisfied that eternal human need for the hope of relief, the need for compassion and action, which a human being experiences in a time of suffering. They satisfied that eternal human need — noticeable in a child in its most primitive form — to rub the place that hurts.”
Dr. S, your essay reminds me of a funny story. At my first appointment with my psychologist — a very attractive woman who looks like Sandra Bullock — she told me I could ask her any question. Without missing a beat, I said: “How old are you and how much do you weigh?” From there on, she got my sense of humor. 🙂
What a terrific response! Yes, we all have our weak spots. If people knew every last skeleton in the closets of health care professionals, they’d still be consulting witch doctors!
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how can i view the spacefreedomlove blog?
A good question, Robin. She seems to have disappeared as of the last time I looked. You might search for an email address on her site. Some people who blog get tired of it or move on to other things of more value to them. If you find her, please do let me know.
So as someone who comes from serious family dysfunction, I’ve had a number of therapists along the way–since episodic depression was my thing, I’d pop into therapy in desperate moments and back out when I was feeling better. In all of those cases, the relationship felt very clinical and business-like, and I didn’t think much about these questions. I met my current therapist in couples counseling, when my current struggle had really strained my marriage to the point of wanting intervention. It’s hard to explain, but I do feel a unique trust and affinity with him (pretty immediate), which has been a balm since my unrelenting physical problem has really tested my coping skills. I’ll say that even my husband felt in our sessions together that I reminded my therapist of someone. With him, though he is extremely experienced and professional and incisive, I am curious about some of these questions. Once I had said to him, “Well, I’m not really that interesting” and he literally raised an eyebrow, so I’m possibly just a clinically interesting anomaly, a survivor who defies the pattern, along with some other personality contradictions he’s commented on. From my end, the connection feels dad-like, which is nice in a time when I feel like I need guidance and an even-keeled person to help me stay level. But your insights here, from the inside view, add an interesting perspective to the unspoken shadows of this doctor-patient relationship.
Thanks for your thoughtful comment. Reading your superb and intimate posts regularly, I know your physical problems are a very real test. I think a therapist’s reactions take lots of different forms. Some clients match up with us so well, we do indeed find them interesting in the same sense we’d use the term with anyone else. Some are, as you state, clinically interesting. Some (many) are very admirable as good, honest, hard working people. Some break your heart because of what they’ve been through. Some are psychologically minded and take to treatment with ease, others not. I’m glad you found my post useful. I am likely to write another one like it and answer some additional questions.
“Experience informs you of your inability to save everyone and, indeed, perhaps you can’t save anyone!”
Ahhh so true. I’ve had to come to terms with that statement in the last two years-in the end we have absolutely no control…we can only hope to be a guide for our clients. They’re the only ones who can save themselves. However, I wished more of them realized that. It’s difficult to not become more jaded then not.
I love how you opened up this post with Freud Doc. Perfect beginning! Although he was super kooky, he definitely earned his title as “The Father of Psychoanalysis.”
I would like to Add to “Do I remind you of anyone from your past?” …
…No. No you don’t. I may connect on a non-therapeutic level with some of your issues, but that’s also exactly when I tell myself to step back and readjust. However, sometimes I do find myself “lumping” patients into one category. This is a definite tell that I am a newer therapist. After you’ve seen one Bipolar individual you think you’ve seen them all. If you have one client who’s depressed with PTSD they remind you of another client you see who’s depressed and has PTSD. It’s a difficult trap to get out of once you’re in it and I am constantly reminding myself that every, individual is unique.
Yes, I think the need to remind oneself to take a fresh look at each person is very important. To me, it was useful for just the reason you described, but also another. If I wanted to bring my own intense focus to the client in front of me and the treatment process, I needed to be “in the moment” and alive to the moment. I didn’t want to “phone it in.” In that sense, I think, each therapist must “make” the hour unique, for both his own and his patient’s well being. Thanks for bringing up this point. I’d also say that each person evokes something a little different from the therapist. In a sense, you aren’t and can’t be the same counselor to Person A as to Person B, any more than you can be the same parent to each of your children.
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Reblogged this on Understanding Me and Her and commented:
This is just so brilliant. The questions are so true, the answers are so well thought out. A lovely read x
My thanks for your kind words and for reblogging my post.
Because my therapist of 7 years moved out of state, and the question did he care about me or any of his patients or were we just an insurance co-pay caused me pain (though I loved him and trusted him completely – this was the anger and grief at his leaving coming out), I wrote a book on Amazon “Real Life – Real Pain – Real Love – Insights into Therapy and Transference from a Patient’s Perspective” because I needed to understand and work through many of the questions you posed here. It is good to know therapists are “human” and have feelings. too. Mine seemed flawless and perfect. The inequality in the therapist-client relationship is very tough to accept, no matter what the Freudian reasoning behind it.
Indeed, as you say, the Freudian justification for the “blank slate” is a frustration to many clients. As I was not ever a Freudian psychoanalyst, I sometimes used personal examples from my own life in doing therapy. That said, there was still much they did not know. On the other hand, many patients who had previous therapists who were too revealing of personal material told me how troublesome those revelations were for their own treatment process. Thank you for the important points you make. Good luck with your book. It sounds worthwhile.
Thank you for writing this! I always wonder what my therapist is thinking or what he thinks about me during session.I’ve had both kinds of therapist, one who revealed too much and one who revealed very little about his life. I think the one who revealed too much caused a lot of harm. My current therapist doesn’t really talk much about himself, it just never comes up. Though I still have questions and want to know about him on a personal level, I feel he cares more about me than my former therapist.
You are welcome. I’m glad you found it useful (and that you have a therapist who cares). Best wishes.
Dr. Stein, my apologies for my delayed response. I am still a little flabbergasted that you valued my questions enough to write an entire post in response. I am hardly worthy of the attention, but am sincerely touched and grateful for your kind words about my blog and for writing a piece so meaningful to those of us in therapy.
Your answers made me laugh out loud as your posts often do and I feel I learned quite a lot about you and the therapeutic process. Your examples, especially to questions 4 and 5 helped confirm that the best therapists are born human and honest.
Thank you again for this honor and for crafting a pastiche title better than my own! I will be reblogging your post for my readers who will surely appreciate it as much as I have.
Your questions were good ones and served as a more than worthy springboard to my own thoughts. For all of that and for your reposting, I am grateful to you, as well. I’m glad you laughed, truly the best medicine. And, for what it is worth, my retirement allows me to disclose more of myself than I could do when I was practicing. No apologies necessary, just be well and keep writing. I will keep reading!
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Reblogged this on spacefreedomlove and commented:
I am honored to be featuring Dr. Gerald Stein’s response to my post “Five Things You Always Want to Ask Your Therapist but are Afraid to Ask.” It is a delightfully humorous and informative look into the mind of therapists.
Thank you for a wonderful post, which, like others have already done, I hope to reblog soon! It is incredibly helpful to know the sorts of things that therapists think or how they approach their clients – it has certainly helped me to keep in mind that my therapist is human and caring, even when, due to a particularly triggering session, I may temporarily have the opposite view of her! I think directness is very important, and am personally frustrated when I feel as though my therapist is ‘skirting around’ an issue (even though, intellectually I may know that she may simply be trying to get at why I’m asking a question in the first place). In terms of the therapist revealing more or less about themselves, I have found your own comments, and those of others, interesting. I see my current therapist in her own home, and so inevitably I ‘see more’ of her purely by virtue of that fact, than I did of my previous therapist, who revealed virtually nothing. In general, I really value anything she does share, as a sign of trust between us, and a growing relationship. At the same time, I can see the sorts of difficulties that too many revelations could bring about – for example, I suspect my therapist has a particular interest in early childhood development, and have sometimes interpreted her questioning in this area as ‘her focusing on her own interests’ rather than ‘her focusing on me’, which was upsetting at the time (less so, now, I think, as my trust in her has grown).
Thank you for the link to your ‘Gone in 60 seconds’ post which was absolutely hilarious 🙂 I am sorry to hear you ‘peaked so early’, but am pleased to hear of your subsequent relationships, marriage and children 🙂 Little girls can be very fickle – I remember asking to move desks at the age of 6 because a little boy who adored me made a comment about my pigtails which I found too sugary sweet (and his clinginess too off-putting). That was the end of that little love affair…..!
Thank you again for a wonderfully informative and helpful post….
You are welcome. Thank you in advance for reblogging my post. Yes, the matters of self-revelation and seeing someone in your home are complicated. You raise a good point about a therapist’s interests. Therapy is both an emotional and an intellectual process for each of the two people involved. I was lucky enough to have both of those interests fulfilled in the process of trying to understand and relate to some really neat people. The range of life experiences encountered second hand by counselors is something like reading a great book. It takes you places you will never actually see, both within the other and in the places which the other has visited. All the best.
Reblogged this on Life in a Bind – BPD and me and commented:
A couple of weeks ago I reblogged a post by ‘Spacefreedomlove’ called ‘Five things you always want to ask your therapist but are afraid to ask’. This post, by Dr Gerald Stein, gives a therapist’s perspective on those questions and some answers. As Dr Stein notes, therapists are trained not to reveal too much of themselves – this is true of my own therapist, as it is of so many others. I therefore often find therapists’ blogs useful, as they give me more of a sense of what my own therapist might be thinking or feeling, or the approaches she might be using. Dr Stein has the advantage of being able to ‘reveal’ a little more of himself as he is retired from practice, and his blog is full of a vast array of interesting, thought provoking and humorous material!
Reblogged this on SomewhereOverTheBPDRainbow.