therapist limitations

September 22, 2019

Are Therapists Ever Really Irreplaceable?

Counselors offer conventional wisdom to solitary, long term patients who are attached to them: “You have grown, and that growth will enable you to meet new and satisfying people. I’m merely the first person who understands and affirms you. I won’t be the last.”

I shared this with those whose attachment to me was substantial. Some doubted my words. Now, at a distance created by retirement, I’m less sure which of us was right.

For those who said I was wrong, I’m more than a little late in offering an affirming message in response to their concern. The belated acknowledgment is double-edged good news. The confirmation of your fear means you never found another person in your life who understood you enough, saw you clearly, and deemed you worthwhile.

Am I giving myself credit for insightful, redemptive compassion no one else duplicated? It is not as if I didn’t work hard to understand. It is not as if I didn’t recognize qualities that had gone long unseen and unappreciated. Many healers do this, however. I was not unique.

But, I was singular in several lives because I was their psychologist.

Clinician and patient encounter each other at a challenging juncture. The latter’s life is like a coin tossed above the crowd. Will it land heads or tails? If the therapist is a figurative fair wind, he tips the spinning silver for the better in an unrepeatable moment.

To the extent such an instant is a decisive one, perhaps the client will never meet another like him in a similar, poignant, and needful time. Whenever life is fraught after the treatment concludes, he might look back on past psychotherapy as an oasis worthy of an expensive return ticket.

Alternative paths exist. Not every person who enters counseling becomes so attached to the purported wise man sitting opposite him. Even among those who did bond before its conclusion, multiple people perhaps now provide more fulfillment than a therapist. Those relationships extend to meals together, bus rides, weekend evening plans, and physical intimacy. None of these occur in the patient/doctor range of interaction.

Nonetheless, the doc can be a hard act to follow for several reasons.

For a significant number, the healer made an indelible impact, perhaps an imprint. Remember what you learned about imprinting? Some birds and mammals will attach to another creature, not even of their species, who arrives during a critical, brief period: a moment fertile for bonding.

The right counselor at the right time with the right kind of intervention might be a bit like this.

Most patients — if they continue to work on themselves — will encounter new people who evoke as many positive emotions as the old psychotherapist. Still, these relationships are about both people, not so much about the client alone.

Trust develops in different ways inside and outside the clinic. Within the office, it is carefully orchestrated and permitted to be gradual. The room holds the possibility of becoming almost holy because faith (in another mortal, not a deity) enshrines the place.

In contrast, routine contact in the real world provides riskier opportunities to achieve confidence in another. The restaurant, workplace, and movie theater do not resemble sanctuaries. The ethical guardrails of the cloistered healing space are absent.

An impatient civilization puts down hurdles to closeness not everyone can overcome. Moreover, even best friends and mates do not hear all of the secrets some clients hide in the shadows.

Therapists do and, because they do, they double as confessors. They listen to the sins and inadequacies the client believes about himself. By bearing witness and accepting the reported frailties and flaws, the counselor frees him from the weight of the insecurity and doubt he carries.

Regardless of the wonders of a new friend or love, those companions cannot always be so focused on you as a person who gives professional guidance. This is true despite a weekly, clock-governed hour or two of purchased attention.

Indeed, the hour’s brevity and artificiality assists in creating the uniqueness and makes such focus possible. Where else in our busy, routinized adult experience does anyone get this?

There is a potential erotic quality present in the consulting room too, adding another level importance. Secrets are involved. Providers make appointments in advance, like a date.

The eager sufferer thinks ahead to these future engagements, considers what he wants to say, hopes to feel something soothing and enlivening.

Other competitors for the healer’s time exist (families, friends, spouses) as do additional “suitors” (other patients), and the troubled one worries about termination (aka getting dumped) just as we do in romance.

Experiences in the consulting room, as confined as they are by professional borders, remind us of impassioned events in our history. Perhaps the reminders come because we find ourselves talking about such past times and resurrecting dormant feelings. The memory of exposing one’s inner life to a psychologist lingers for many of those who allow this lowering of their defenses.

The ghost of the therapist might reside in the remembering mind as does a first love. Youthful friends, too, occupy a place in the heart to the end of many lifetimes. You passed with them through the same moment in history in the same place, experiencing like challenges and the same people in your shared world.

Wartime buddies, as well, understand things no one else fathoms. Nor should we forget the long-married, aged couples who are so molded to the other that they pass away close in time.

The sharing of something important, formative or reformative, is present in all these intimate contacts.

Intensity is a determinant in what can seem irreplaceable in such connections, whether with parents, childhood and adolescent friends, lovers, wartime comrades, and counselors. Similar ties are elusive.

I do not wish to understate the chance you will meet people who “get you” after you depart psychotherapy. Still, I now believe the possibility you may not is higher than I did before.

Each of us, no matter the losses we have had, must search to find new people who can become precious to us. Risks are required. The tightrope of homo sapien interaction offers no safety net, but we are a resilient species.

While many candidates for intimacy exist, if the task were comfortable, the patient would have been embraced by numerous such people before entering the mental health clinic.

Happiness is not a constant. Counselors do not erase the demands of living, including the filling of our social sphere. At their best, however, they empower you to identify and enhance the capabilities inside you to surmount them.

Even for those who profited from therapy and still lack fulfilling nearness, that satisfaction may yet occur. Our emotional lives never can be flash frozen. Children and grandchildren grow or move away and make their own families. Friends die or seek work elsewhere. Conflict with those we love is not always avoidable.

The cemetery is full of irreplaceable people who must be replaced.

Aristotle believed a person who did not require human connection was either a god or a beast. Thus, our quest for an essential other is a part of our nature.

You are not alone in your need to take on this challenge.

Many, many are looking.

They may be looking for you.

—–

The paintings reproduced above begin with Man with a Pipe by Joan Miró. It is followed by three works of Edvard Munch: Self-portrait in Bergen, Young Woman on the Beach, and Woman Looking in the Mirror. The final image is The Mask with the Little Flag by Paul Klee.

March 31, 2018

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/