What are the Limits of Telling Your Patients Something Uncomfortable?

I wrote an October post offering suggestions to make oneself more interesting: Are You Boring? Words You Should and Shouldn’t Say.

Today I’ll take this another step: what should a counselor do if the patient complains of inexplicable, endless rejection and the healer believes the explanation is that the solitary creature is boring?

Not the kind of training we get in graduate school.

Most counselors first establish the therapeutic relationship, of course. They sidestep the dullness problem. But, when the uncomfortable complication remains untouched and the individual continues to experience exclusion, what then?

The “Are You Boring” article offers both dos and don’ts. Some of those remain unmentioned in the course of a routine psychological consultation.

A UK therapist, Emma Cameron, tweeted this in response to the notion of raising the issue:

But to me this seems like a recipe for increasing social anxiety, self-judgement and shame, which many therapy clients already struggle with…

I answered,

As noted within the essay, this is a risk. On the other hand, some might benefit from recognizing and improving their interpersonal skills, of which speech is a part.

Ms. Cameron is wise, but where do her point and my counterpoint leave us?

My approach in treatment was to engage in a Socratic dialogue: use questions to lead my fellow man into the light of self-knowledge. People skills, anxiety, depression, and self-image issues were addressed, as necessary. I’d evaluate whether my patient’s present relational distress caused him to offer only the safest conversation; as if he were “hiding his light under a bushel basket.”

Indirect suggestions of routes out of his tediousness might be offered. Something like, “Have you ever thought of reading this, or studying that; visiting museum X or watching movie Y? Perhaps you might enjoy trying something new.”

But what if the forlorn fellow doesn’t have much wit or wisdom worth sharing in a relationship, yet I believe him capable of striking sparks with some guidance?

Counselors and advisors ask themselves how much information is enough, how much too great? Whether the other is open to unsettling opinion and what will happen if the fraught communication is attempted? The cause of Ms. Cameron’s hesitation is to be found here.

No challenging tidings should be offered for the sake of the truth alone. Daily choices about what to say and how to say it are made by everyone.

We are now in the domain of the unmentioned and the unmentionable. Who will tell the other he has bad breath or a failed deodorant? Does your new female acquaintance mention your comb-over looks preposterous or you bore her to desperation? No, she just takes flight.

I’ve not met a single soul who needs to know everything about himself. One minute of complete self-awareness is a scorching, lazer-like invasion of insight. Inflicting pain in honesty’s name is cruelty disguised as moral superiority. The Hippocratic oath reminds us, “First do no harm.”

Let me put this another way. What does a psychologist give you and what does he take away? Therapy involves a transaction or exchange, as in all well-functioning relationships. What do you present or withhold and at what cost? How far do you go providing anyone painful knowledge?

One must not to take something useful away (including the foundation of self-esteem) without inserting a superior substitute. Mental and emotional defenses cannot be deconstructed without peril. They serve, perhaps imperfectly, but they do serve.

Some kind and decent people gain more by learning to deal with inevitable rejection than by heightened awareness of their lack of incandescence. Not a few profit from ways of enriching their lives without the degree of friendship or intimacy desired.

Do you see the problem with what I just said? The counselor who is swift to conclude his client unable to triumph over his limitations could sell him short.

Perhaps to protect the comforter from discomfort in delivering a harrowing message, he refrains from nudging the sufferer to exceed himself and improve his life.

A therapist is like a magical juggler. Before he walks off stage, he must do his best to provide as much or little of what the patient requires to stay aloft.

And understand how much weight the client’s reinforced wings can now bear.

Thanks to Emma Cameron for allowing me to quote her tweet.

The top photo is a Security Guard Sleeping on Duty, posted by Brad & Sabrina. The second image is Prince Florimund Finds Sleeping Beauty from Child’s Favorites and Fairy Stories. Both come from Wikimedia Commons.