What Your Therapist Didn’t Tell You

Many therapists spend most of a session without uttering a sound. The more they talk, the less they are heard. The more they speak, the less the patient does his own emotional processing.

The more they offer answers, the less the client claims ownership of his happiness, responsibility, and control.

When treatment works, the seeker isn’t passive but active. The new thought is taken, not given. He grasps the reins, a voluntary effort.

Clinicians should rarely propel the train, though they may clear some of the tracks. Persuasion and insistence have limits. A parental, authoritative position creates a struggle for power or dependency.

Repetition is tiresome. Some people won’t change. They sought a remedy with the wish for someone else to do something.

We are not surgeons who administer an anesthetic so you can be redesigned while unconscious. If we possessed a storeroom full of magical potions, we’d be drinking them ourselves.

The counselor asks questions, points in a direction, and monitors the strength of the resistant wind. He manages the temperature and allows hope to enter the room.

Who will reach for it? Not all do.

Like marriages and friendships, there are signs of trouble. The sessions drag, the medic becomes a debater, misunderstandings occur. The analyst drains his life force; perhaps he dreads the next appointment. The psychologist tries too hard, his counterpart too little.

Though the lesson is unwanted, the other’s life is not ours to reshape. The patient has the right to stay where he is, no matter the suffering.

The only adult we can alter is the one in the mirror. The man reflected in the silvered glass must reflect, claim his own agency, and act.

Mallets won’t hammer others to the shape desired. We are not sculptors or portrait painters. Sometimes the best we can do for another person is to give up on our capacity to do him good.

At least this permits him to take back his life.

Some people, including a few “helping professionals,” listen to be heard, to make pronouncements. They do better to listen to understand.

We all have limits. We all have goals and choices. Regarding the latter pair, here are mine for 2020:

To better understand myself and others. To discover an enlightening idea, an unexpected sight or sound.

I choose to search for these; and perhaps to change the world.

10 thoughts on “What Your Therapist Didn’t Tell You

  1. gb fragmented gumdrops

    Thank you, Dr. S., for another superb post!

    I like your explanations and your pursuits in better understanding yourself and others, and “to discover an enlightening iea, an unexpected sight or sound … and perhaps to change the world.” I’m sure that you’ve already had many epiphanies and enlightenments, and I’m sure that you’e already changed the world in many ways, including the improved changes in your past patients’ lives. 🙂 I hope your continued journey in life brings you all the possibilities of wonder, insight, enlightenment, and more. 🙂

    Years ago, I had learned about “active listening” in a counseling course, which entails the understanding of the “pretend patient’s” statements through reiterating what we thought we heard along with a minor interpretation predicated by the words, “It sounds like you….” The pretend patient could acknowledge such a statement and the “pretend therapist’s” understanding of that statement, or could refute it and better explain it in a following sentence, which gets reiterated yet again. –A sounding board, a mirror that reflects what others are saying, how they are saying it, how it is being interpreted, and how communication styles affect others’ interpretations and understanding of what has been said by the patient.

    But therapist bias coupled with assumptions (assume = making an “ass” out of “u” and “me”) can lead to ruptures, emotional distress for both parties, emotional abuse inflicted and received, misunderstandings, miscommunications, disempowerment of the patient, retraumatization of the patient, lack of empathy on the part of the therapist, frustration for both parties, premature terminations, continued traumatic stress based on systetmic stigmas and related structural violence infiltrating the healing room, secondary traumatic stress and wounding for both parties, and general life dissatisfaction for both parties – if not addressed appropriately.

    The power differential between therapist (in power) and patient (in a submissive position of subordination) complicates matters related to misunderstandings, therapist bias, transference, countertransference, lack of empathy, and lack of listening. Anyone can hear words, but do they actually listen and take the time to understand?

    Further, therapists’ narrow views on treating one mental illness/disorder at a time can harm patients when there remains a lack of understanding and research on the interactions between two or more disorders (including physiological, neurological, biological, and psychological disorders). For example, those who have experienced medical trauma (which encompasses health-related loss, identity loss, traumatic unconventional grief related to health loss) and subsequently have been diagnosed with depression, anxiety of some sort, and possibly obsessive-compulsive symptoms that are connected with the fear of being sickened with something worse, are often told to focus on desensitization and exposure elements to reduce obsessive-compulsive tendencies without also addressing the rational (not irrational) and realistic compromised immune system that encompasses medical trauma as a strong link to post-medical-trauma obsessive-compulsion. The treatment, if the symptoms were taken together as a coherent whole and fully understood, would not entail behavioral approaches to expose and desensitize (which could further retraumatize and/or traumatize the already suffering patient), but rather would entail cognitive behavioral treatments for trauma-specific incidences that could reduce emotional intensity and the self-destructive thought patterns that can worsen behavioral problems affiliated with obsessive-compulsive tendencies. Many people with so-called OCD tend to have experienced some form of medical trauma prior to their onset of OCD, yet medical trauma has rarely been addressed, actively listened to, researched, and acknowledged by biased therapists who focus solely on individual responsibility, which is, in fact, what patients with medical trauma have been doing (in a sense) when it comes to OCD or OCD-like symptoms to help patients (at least as they understand it in their own existential world) to prevent future medical trauma. The patient needs more education to realistically approach medical trauma/illness prevention, and to grieve and mourn the losses affiliated with past and potentially continuous medical trauma (i.e., continuous traumatic stress, not just post-traumatic stress), so that they can reduce their emotional distress, anxiety, depression, obsessive thinking, and compulsive behaviors – not eradicate the thoughts, but reduce the thoughts, since some level of their need to prevent future illness is, in fact, rational. This existential understanding through active listening and copartnership between therapist and patient could help the patient (1) heal from past and present medical traumas, (2) feel validated for having such trauma-related symptoms, (3) remember/address and mourn/grieve, and (4) improve their quality of life through informative resources that can balance illness prevention with the kind of freedom that is limited for such disabled persons. –And that is just one example of active listening and true understanding of the patient’s totality of symptoms. Many patients have complex, compound, and cumulative traumas that extend beyond what has been delineated above, and such complex, compound, and cumulative traumas often interact in such a way that the totality of those interactions, altogether, should be a singular (and person-centered) diagnosis for the individual with unique cultural experiences that requre treatments to look at all of those interactions and find a solution that does not cause retraumatization, iatrogenic effects, or harm (whether intential or unintentional).

    Regarding cultural differences, here’s another example. Let’s extend the above example by now adding on the patients ongoing, cultural behavior of removing shoes before entering a home. In Japanese and other Eastern traditions, removing shoes is both a cultural practice and a means toward health, cleanliness, and spirituality. To a biased therapist, however, removing shoes may be seen as a sign of OCD, even if the patient has OCD. If that biased therapist suggests that the patient should desensitze through wearing shoes, and even going a step beyond and inviting others into their home with their shoes on, which is based on the narrow-minded approach of looking solely at the OCD without also looking at cultural practices and beliefs, the therapist is now adding stress to the patient, possibly retraumatizing and iatrogenically worsening their condition. An alternative approach is to actively listen to the totality of the client and respect the client’s culture through non-Eurocentric lenses. The client doesn’t need to change a cultural practice in order to heal from the effects of medical trauma, including OCD. In fact, the client should be praised for the prevention efforts that have taken place, and acknowledged for having a different type of cultural practice that is sorely misunderstood by flagmatic Westernized individuals with Eurocentric biases. The client is possibly asking for a reduction in anxiety and depression symptoms related to OCD, not the eradication of cultural practices and the eradication of true prevention paradigms that medical doctors may suggest, even though therapists and patients fail to communicate (or ask with open-mindedness) about what prescriptions and information the patient received from the doctor, including risks for certain medications and illnesses, the doctor’s verbal prescription to reduce pathogens in the home that could exacerbate illnesses, etc. Such totality of factors should be taken into consideration, along with clients’ cultural beliefs and practices.

    My understanding of others comes from experiencing many things that others have experienced as well, but also from actively listening to others throughout my childhood and adulthood – even prior to my undergraduate teachings. Hearing many laments and stories and triumphs have taught me about cultural diversity and individual differences – in real life – the school of life. The best innovators of our time listened and expanded their narrowed worldviews; they were anything but traditional and conservative; they were open-minded, flexible, growth-minded, and hopeful for mankind – at least the “good-intentioned” innovators were.

    We all make mistakes and have our own limitations toward understanding others, but a lack of understanding others should not be blamed on any one thing or person. There are many complex factors in life that affect human minds, cultural practices, systemic traditions, our abilities to work with limitations, and our abilities to function in the world – even if simply surviving through it all. Not everyone has the mental and/or physiological capacity to “thrive,” but there are ways to help ourselves and each other reduce (not eliminate) the negatives involved in our limitations. It’s understanding different limitations of different people, places, and things that help us to reduce our own stress and make the world a more harmonious place to live – in my humble opinion.

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  2. Being open to the unexpected is so rewarding. I was at a holiday party. A young boy popped up next to me and said: “I love Tin Tin and Snowy.” I knew immediately what he was talking about. Tin Tin and his dog are the heroes of the marvelous books my son used to teach himself to read. Time disappears. The old is new.
    I’m sure you will notice and enjoy the unexpected in 2020. You are certainly the man for it!

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  3. Well, I was making a bit of a joke, as I imagine you know. The truth? I am he on my best days, though that leaves some room to fill on the calendar. Thanks, Brewdun.

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  4. gb fragmented gumdrops

    I met with my therapist for the third time today, and I really like her. She lets me go at my own pace, and she said that I can tell her if anything is too much for me. This is in stark contrast to everything I had experienced, since I felt forced, judged, and disempowered. I can at least feel like I am working with my therapist now, as opposed to being pressured. With only my statements about my past history and current and past symptoms, and how my symptoms have improved in some areas but drastically worsened in others, especially with brainspotting, EMDR, and exposure therapies, she concluded that I may have been retraumatized. I completely agreed with her. I would rather be interdependent than dependent or isolatingly independent. I also found my voice in therapy, or at least I am finding it again. She totally understood me when she said that it is okay for me to recall things in bits and pieces, and that if I want to work on stabilizing instead of trauma memories, I can. She also understood the unethical therapies I have had in the past without questioning my intelligence or insulting my integrity, which were huge reliefs and pluses.

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  5. Sounds like a great start!

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