Why Therapists (and Others) Don’t Always Understand

How often we hear someone say, “I understand.” How often we think, “I only wish it were so.” Beyond the imprecision of language, I want to consider 10 reasons why true comprehension – recognizing the other person as he is and in depth – is difficult.

  • The fog of appearances: We instantly react to the individual in front of us, even before he makes a sound. Beauty (including a lovely voice) or its absence rose with the dawn of man. Sometimes revealing, sometimes obscuring; sometimes enhancing, sometimes diminishing. Sometimes all of the above.
  • Stereotypes: Beyond what we take from the person’s facial symmetry, shape, and size, other factors can cloud deeper comprehension. Gender, age, race, religion, and nationality interfere with vision beneath the surface.
  • Secrets and history: Polite conversation sets boundaries around self-revelation. Many of us believe we have been misunderstood – judged to the point of harm – and hesitate to reveal much. Even in therapy this is an issue, though with time and growing trust, significant secrets are often divulged. Without exposure, the job of comprehending you is far harder.
  • Our limited access to important data: Think about what information you might need to understand someone else. No one can access to all three sources below:
  1. The individual is the only person who perceives his life from the inside. He does not, however, see himself from the outside and will be shocked the first time he hears a recording of his voice. His grasp of his own motivations cannot be assumed accurate and may not reflect the work of the unconscious. Similarly, he interprets his life without the benefit of external perspective; except whatever is received, understood, and accepted of the other’s body language, tone of voice, praise or criticism. Most of us would be unsettled to know what others say about us in private.
  2. Friends and acquaintances hear what the same individual says about himself, what he reports of life apart from the observer, as well as experiencing his behavior in real time. Even his intimates must contend with the fact that “a mask of him roams in his place through the hearts and heads of his friends.” (Nietzsche, Beyond Good and Evil).
  3. Finally, the therapist has the most limited exposure to the client in real life. Ideally, however, the patient is more open to the therapist than perhaps he has even been to himself. The counselor has the training to “figure out” who is facing him, and the opportunity to ask the most essential questions with some expectation of penetrating to answers not offered in the public world. He sees not from the inside and not only from the outside, but,  from closeup, below, and through.

  • How remarkable are you? Though I evaluated and/or treated well over 3000 people, I encountered only a handful who were unique. Such individuals represent an enormous challenge to one’s understanding.
  • Countertransference: We can have reactions to our patients that grow out of our own unfinished issues with persons of consequence who they resemble in appearance or personality. This is called countertransference. Objectivity and unbiased analysis flees the evaluator under those conditions.
  • The limits of our experience. One who hopes to grasp the essence of another will not have encountered the whole of humanity. If, for example, most of his contact is with like-minded people (let’s say small town residents of one religion) he will be at a disadvantage with those whose backgrounds are different. On the other hand, therapist and non-therapist alike can meet an individual with whom he is “in sync.” In that event, both might find friendship and sympathetic intuition effortless and uncanny.
  • The listener who wants to be right. Insecure counselors can be troubled, sometimes unconsciously, by their own uncertainty. They tend to find it more comforting to put people in a box than to recognize when someone doesn’t fit. The job of evaluator (not a judge) calls for two qualities not often mentioned. First, enough confidence to say to yourself, “I don’t understand yet.” Secondly, “I can do better and I’ll work until I get this right.” Therein they offer an odd combination of humility and security. From time to time the therapist must clean the slate and start over.
  • The observer’s own emotional wounds and defenses: Our personal wounds (we all have them) place a limit on the ability to absorb, accept, and seek the truth of all humanity. Indeed, who is to say there are not many truths. The best of us never fathom all we encounter.
  • The listener’s capacity and willingness to endure the other’s pain: Hearing personal stories, even with the therapeutic distance healers work hard to achieve, still creates vulnerability to the most poignant encounters. Too many such episodes close in time risk either overwhelming the counselor or making him callous. To understand the human condition one must recognize his limits.

Final thoughts. Treatment by someone who opened-wide your self-understanding can make you believe no one on the planet will ever know you so well. I’ve long believed that if you then allow yourself to take more real-life personal risks, other satisfying and close relationships are achievable. Nonetheless, the special nature of a therapy relationship may include a hard-to-duplicate quality of perception and acceptance “as you really are.” You then will want a friend or lover who is psychologically-minded, a patient and dedicated listener, and one who makes the effort to approximate what an expert analyst can manage. This might be a tall order.

Do remember this: you and the therapist might not have much in common beyond his comprehension and kindness. Interests, compatible temperaments, and world view count for a lot. He exists, as well, in a fantasy world of your creation: literally, too good to be true. Were the light-reflecting cellophane of illusion to come off the package, you’d find his unshaven, distracted, and ill-tempered alter-ego – occasionally.

Another thought. A psychologically profound understanding of your inner workings isn’t always essential for a happy relationship outside of the office. Love and acceptance, even without full knowledge of all your moving parts, can go a long way. Not even your counselor has a total grasp of himself or anyone else. That said, his success at his work doesn’t require perfection.

Anyone close is “out of this world.”

The first image is called Rorschach-like Inkblot by Irion. It is sourced from Wikimedia Commons. The painting that follows is Vassily Kandinsky’s Composition VI, 1913. Finally, just above, is Honore Daumier’s Couples Singers, as sourced from Wikiart.org/

19 thoughts on “Why Therapists (and Others) Don’t Always Understand

  1. I’m going to reply in sections (about 3 or 4). Here’s the first. Wow, Dr. S – you’ve evaluated over 3,000 people! That’s amazing!

    Overall, I really like what you posted. It helped me to understand more about the therapist’s perspective, especially when I (a client) can be really judgmental or picky.

    As a person who wants to go to grad school, however, I’m scared about whether or not I’d make it through the clinical training (even if I plan on doing primarily research as a job). I secretly wanted to learn to be a therapist though, in addition to research. However, I honestly don’t know if I can do either. I’m still working through my own issues, and I definitely don’t want to be unethical or ineffective. Research, in comparison, seems easier, but I like to challenge myself to do something meaningful. I’ve tried to ask my therapist about it (and I’ve only done this with three therapists so far – the first I couldn’t afford anymore, the second said I’m too old, and I’m barely getting acclimated to the third/my current therapist). Meanwhile, they weren’t able to answer a question I didn’t know how to ask. Without knowing, you answered a lot of it here.

    It’s amazing how well you understand people, Dr. S. I read it in your posts, responses, and kindness. Your knowledge and ability (at least from what I know online) is amazing. Your writing is awesome, too!

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    • Thanks, PP. Generally people choose clinical practice or research, rather than both. I was a researcher at Rutgers and Princeton for a short while, then moved into hospital work that ultimately led to a private practice. Sometimes the door to choose, if a choice is necessary, just sort of turns up. Good luck!

      Liked by 1 person

      • Peace Penguin

        Thank you! Wow, those are amazing institutions you’ve worked for! I’m pretty much open to anything these days. I love research, so that is my first goal. I’m terrified of clinical training. As a former dissociator, the movie “Breaking Dawn” (http://www.imdb.com/title/tt0366518/) – which isn’t the vampire movie, but rather a psychological thriller staged in a psych ward – is what I pictured “clinical training” would be for me in grad school. I could probably do well with the research and stats training, but the clinical is where I know I’d struggle in for many reasons. However, I’m not giving up on that just yet (though I have contemplated giving up many times so far, but in my heart I haven’t). Thanks for the luck. I’ll need it! But for now, I’m focused on my own healing that will help me to prepare (or to be open to alternative possibilities).

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      • I’ve been very lucky and smart enough to walk through a few of the right doors when I realized they were open. Thanks, too, for the movie recommendation, PP.

        Liked by 1 person

  2. My 2nd reply re: “The listener’s capacity and willingness to endure the other’s pain”:

    In criminology and victimology undergraduate courses, as well as in other types of courses, the professors tend to “desensitize” us for the very field or topics we’re interested in. For example, in victimology, we were prompted to watch testimonies about a girl who graphically described her abuse (she was under the age of 7, probably 5 or 6) she had experienced and had done to her brother and adoptive parents. Our assignment was to reflect on that, with subtopics related to child psychopathy (antisocial, callous-unemotional traits) and victim-offender theories. In that same course, we had to watch the victims and vicarious victims testify about the pain they experienced when a serial killer (adult) raped and murdered their children or family members’ children. Hearing the pain was horrendous enough, but then we had to write a letter to a friend, where we “pretended” that we were a victim of rape, and where we tried to disclose that information and request for our friend’s understanding and help in that letter. We also watched a short film about a person who had been raped, who did the victim impact statement thing. For me, that assignment was both painful and liberating. In other courses, we had to watch clips of how women were being victims of porn films, which was also very graphic.

    Overall, I learned to have compassion for others who have struggled in their lives – some that held similar struggles as me, and some who had entirely different struggles. I learned that I often compared my struggles to theirs, I often minimized my own struggles, and I often got teary-eyed. Over time, however, those kinds of courses got easier, and so I was able to truly focus on the pain of the person being represented and not that of my own pain. I still haven’t worked out everything in my life, but the courses themselves helped me because they exposed us to graphic testimonies and video.

    I’m wondering if one way for therapists to increase their capacity to actively listen and endure someone else’s pain, as well as to reduce secondary traumatic stress (especially those who want to specialize in trauma), is to be exposed to film, vignettes, and interactive coursework during their grad and clinical training sessions (similar to the examples I’ve experienced above)?

    As a trauma survivor myself, my hope is that my therapists can “handle” me. I’ve had some therapists ball their eyes out to the point where I wanted to offer them comfort and “therapy,” LOL. However, I do appreciate when someone can cry with me. What makes it challenging for me is when a therapist has this “disgusted” look on their face, or when they coldly tell me to stop crying and focus on something else, especially when I just wanted to express my emotions and my story to them. I couldn’t help but wondering if those therapists would have been better with me if they were exposed to graphic things in their training.

    And here’s a funny thought I had on that (just pretending here): If I were a “trainer,” I’d totally be sensitive to every students’ needs, but I’d also treat it like “boot camp.” I know, that’s totally wrong perhaps, but still, it’s a fantasy of mine. I’d imagine saying something along the lines of, “Now you’re about to enter the most rigorous and challenging training phase. For those who can gut it out, you are well on your way to becoming successful trauma therapists. But for those who cannot, you might want to reconsider whether or not trauma is your forte. Trauma-informed practices and treatments are not easy to master, and ethically, when someone is not well-equipped to handling a particular practice area, they should refer out. However, if you’re truly interested in this line of work, so as not to discourage you, I’d recommend that everyone who remains in this program seek outside therapy while you are in this particular phase of training.” My fantasy came after I realized that I have a long way to go before I’m ready for grad school, but it’s also something I’m passionate about researching and learning. It’s a wish-fulfilling fantasy I thought about as I reflected on my strengths before my traumas, and my courage while in boot camp. I miss the military, and I miss the challenges of police training before that. I thought I could handle anything, but I was young. And, for a while, I was able to handle a lot of things. Desensitization really helped me at that time, and in many ways, it still does. Perhaps it could help others, too.

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    • Sounds like a superbly well-thought-out course. Nothing like that was common when I was in grad school, let alone as an undergrad. Certainly habituation or adaptation or desensitization play an important part in developing a therapeutic distance. You sound very well equipped through your training and reflection on your own traumatic experience to come to a good decision about your future, whenever the time comes for that. Therapists who break-down with their clients really do need to ask the “what am I doing here” question. I had moist eyes many times and was struck almost dumb for about 15 minutes on one occasion, but never lost control. When I felt the emotional toll (not in tears) was too great, I retired.

      Liked by 1 person

      • Peace Penguin

        Dr. S, Thank you so much for your reply! I can’t imagine what the toll must feel like, yet I see therapists like soldiers – both are heroes, both willingly risk secondary (and sometimes even primary) traumatic experiences, and both are part of the search and rescue team (only, there is different training involved). Thank you for your service in practice and out! And, I hope you’re having a great retirement. My hope is to at least put in some years before I retire, but I’m not there yet. I still am healing from lots of lingering issues, but I’m more focused this time (and more motivated). I never heard the term “habituation” or the context for which you use “adaptation,” so those are areas I’d be interested in learning about in the future.

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      • Thanks, PP. I’m no hero, but appreciate all you’ve said.

        Liked by 1 person

  3. Final reply #3: When you said the following, it totally resonated with me: “You then will want a friend or lover who is psychologically-minded, a patient and dedicated listener, and one who makes the effort to approximate what an expert analyst can manage. This might be a tall order.”

    After many experiences with kind-hearted and helpful therapists (and even mentors or professors), I’ve completely changed my choices in friends and significant others. I’ve also changed how I’ve interacted with others in the world (though I’ve rebounded or regressed to a strange place today, but I can remember when I was stronger before). I started seeing the “red flags” in other people, and I couldn’t help but compare my real-life friends, families, and lover to the therapist. I couldn’t help but ask myself outside of the therapist’s office, “What with my therapist suggest?”

    Sometimes I hated my therapist for that (no, I didn’t hate my therapist, but I did begin to up the ante with my own personal boundaries and standards for tolerance). I still have difficulties in life and with myself, but there’s something about a therapist, when the therapist connects and bonds with you, that is irreplaceable and different from any relationship you’ll ever have. I’ve only felt this way toward two therapists in my string of over 20 “try-outs.” And my life has forever changed because of them. I’ve felt this way with maybe one or two other therapists, but that wound up really painful when I had to leave them due to their unethical behaviors toward me (e.g., having me sleep over at their house).

    Since then, my experience with therapists has been tough because I’m still learning to trust therapists. I haven’t been able to process with any therapist the “therapy abuse” I had encountered. Every therapist wants to go back to my childhood or to the rape. I’ve been so desensitized from the rape that it’s not really what is bothering me anymore. My childhood will still come up, for sure, and will probably always intrude on me, but I miss having a good therapist who can bond with me (ethically, of course). I want to say everything, but I’m afraid. And then I think back to a time when I remember two really great therapists I had the privilege of getting healing from, and I wonder today, “What would they suggest?” Honestly, when I read your blog, Dr. Stein, I sometimes wonder also (in real life) what you would say, or what insights you would have.

    It’s easy for me to judge because I don’t know much, and the little I’ve learned in my undergrad years mean nothing compared to the knowledge all the professionals hold. Lately, I’ve projected my past pains and current fears about grad school onto my poor mentor (a psychologist PI). I know it isn’t his job to be my therapist, and I know I have to try to trust my new therapist. But at least now I know where I’ve fallen short by understanding how judgmental I can be. I truly don’t want to idealize anyone, but rather accept people as they truly are. I truly want to also be accepted as I truly am, and I love the moments where I can just be goofy and “myself.” But I try so hard that I behave the very way I don’t want to behave. I just want to trust again, internalize praise and criticism again, be tough again, and dream again. I can’t do grad school until I can at least do that – trust in those who are there to help me in whatever capacity they are able to. Anyway, your posts make me think, and they’re a blessing to me.

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    • The fact that you have reflected on the kind of people who are best to be with, and went so far as to change your social contacts, is quite striking. Too few people do, in or out of therapy. I am genuinely pleased that you find my writing helpful, PP. Take care.

      Liked by 1 person

  4. Great article Dr Stein. We humans are so complex, and therefore it’s impossible to know ourselves (and others) completely. It’s a lifetime pursuit without an end.

    Liked by 1 person

  5. What complex creatures we-humans are, Dr. Stein! Without forms of social order, I doubt that we would have survived this long as a species.

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    • They say the cockroaches will be around long after we are gone. Place your bets, Rosaliene! Of course, I can think of a few cockroaches in high places who walk upright on two legs.

      Liked by 1 person

  6. Joseph Patrick Lori

    It has been quite some time since I have first heard it said that, “You can’t judge a book by its cover.”
    Unfortunately, that brings into play another old saying:
    “Easier said than done.”

    Like

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