therapist mistakes

January 16, 2022

When a Therapist Changes His Mind

Some people consider changing their minds as a sign of weakness. It provokes the fear of being criticized, looking stupid, and needing to apologize or ask forgiveness.

Yet every therapist and non-therapist needs modification of himself and his outlook. We must try to learn what we don’t know of the human world and reform our previous beliefs. Bullet-proof ideas, unchangeable in every detail, lead to unchanging actions. As the old saying goes, “If you always do what you’ve always done, you always get what you’ve always gotten.“*

More than a few times during my career, I realized my patient and I were stuck. My part included a failed treatment plan and a misunderstanding of my client’s essential qualities, how he thought or felt, and the universe of his suffering.

I established a way of approaching this situation. Of course, researching and discussing the dilemma with experienced and wise clinicians was the first step.

If that failed, however, the fix required more.

I tried for a new conceptualization of my patient.

Imagine a blackboard full of every word or picture available to describe you. Now visualize your counselor. He is responsible for all you see before you, everything he chalked on the white-on-black wall.

He included the way you dress, move, and express yourself. Your history is recorded in the way he heard it. Your own self-reflections and self-knowledge are present, too, as you described them in the office.

The hard surface before you hides the contribution of an invisible sense, as well. The words and pictures sprang from the lens of the healer.

The counselor’s professional and personal life colored his attempt to recognize you for who you are. Add any psychological test results or elements from your medical history. The representation in front of you, no matter how close to capturing the whole of you, is imperfect and incomplete.

I have been this imaginary clinical psychologist. Looking at the blackboard, I thought about the product of my work and erased everything so I might begin the therapeutic project again.

This approach didn’t help everyone, but the piece I missed revealed itself in many cases where I tried to reimagine what I’d overlooked.

Abraham Lincoln said it better during the Civil War when he applied similar thoughts to the job of saving the broken union of individual states:

The occasion is piled high with difficulty, and we must rise — with the occasion. As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.

This way of approaching the world extends elsewhere on a much-reduced scale.

Take reading. Assume you are poring over the pages casually. Instead, engage in a conversation in your head with the book’s author.

Most of us reflexively respond to the characters or ideas we like and the ones we don’t. This manner of proceeding demands little thought. We judge the people, their behavior, and views from the perspective of beliefs we held before we began.

Here is an alternative, the one that grew from my professional frustrations. Begin by wiping your mind free of ingrained opinions and trying to figure out what the author wishes to express. No, you needn’t read his biography to discover this. Understand his message through his words without a leap to judgment.

When done regularly, the practice becomes automatic. Moreover, you will become less prone to immediate acceptance or rejection emerging from the deep freeze of your prior convictions. Perhaps reading will come to enlighten you through a growing capacity to read “closely,” with active searching and questioning as you dig into the material.

Little of this is easy, nor is it the work of a few days. None of us can make himself a whitewashed blank slate or scrape the blackboard of our every thought and feeling. Yet, to my way of thinking, we must try to be open, not constrained by comforting ourselves with unwarranted certainty.

We travel a road to stagnation when we insist our rightness is godlike and beyond reconsideration. To the extent we accept assertions based on questionable evidence handed down from a single person or group of like-minded people, we walk into invisible imprisonment by the false gods of our choosing. The more we convince ourselves of our rationality, closing our minds along the way, the farther we throw off our intellectual apparatus.

Doing so may make us feel wise or justify our anger but at the price of misunderstanding the world as it is.

As Ludwig Wittgenstein said in the preface to his Philosophical Investigations:

I should not like my writing to spare other people the trouble of thinking. But if possible, to stimulate someone to thoughts of his own.

A few of the most delightful and provocative books I’ve encountered so fascinate me, I return to rereadings. The new thoughts they spur sometimes modify my conceptions over time. This approach continues to transform me. I am humbled by recognizing I must change my ideas, redefine the unstable world, and modify what is in my control. That includes changing myself while recognizing what is unchangeable about me.

I know there will never be enough time to learn all that is worth remembering, do all that is worth doing, and repair more than a few bits of our planetary life together.

Still, I must try to hold my arms wide and embrace as much of the world as I can — with love.

==========

All of the photographs come from History Daily. The first University of Pennsylvania Football Player Frank Yablonski Wearing a New Style Helmet in 1932. Next is an image of Bedouin Tents in Morocco. The card game following includes Billy the Kid  (the Young Man in the Top Hat) with His Accomplices in 1877. Finally, Broadway and 53rd Street in New York City in 1928.

October 8, 2017

When Being a Therapist Means Saying You are Sorry

We all try to understand people. Counselors and personality experts use formal systems for the job. The therapist begins with lists of human characteristics, a bit like a Chinese menu – beef, chicken, pork. If you fall into one column or another, you are given the name at the top. Not fish or fowl, but introvert, extrovert, narcissist, schizophrenic, etc.

These systems all tend to put people into a box they fit imperfectly. We therefore add other words as qualifiers to make the label more precise. Kind of like saying a person is not merely “tall,” but “muscular,” or “slender” or also has “a winning smile.” Still, they are all generalizations and even the one with the dazzling teeth isn’t grinning all the time.

Our boxes are not made of corrugated cardboard or wood. They come from knowledge and experience, imagination and instinct. Without using them to “place” every person we meet, we’d be like small children, unable to make sense of people, neither responsive to their needs nor capable of securing our own.

On occasion the categorization strategies don’t come close to making the human world comprehensible. Not all labeled people and their motives are well-captured by name tags. They are more complex. Those individuals don’t quite think the way we do or feel the way we do, making our comprehension of their nature harder to achieve. Our effort at understanding another, too often based on how our own minds work (or we think they work) can fail. Therapists share this experience of failure with everyone else. Less often, we hope.

I’ve met only a few unique people in my life despite having more in-depth human encounters than most. These few burst any categories in which we place them. Usually, however, the boxes work well-enough or better. Indeed, many times they are spot-on.

Everyone outside the doctor’s office, however, is at risk of resorting to stereotypical, pejorative labels, condemning those who are different because they don’t understand them. The labeled crate becomes a confinement of accusation and punishment. Look around: nationalists of all countries transforming races and religions and different national groups into imagined monsters.

It makes the world less scary to do this. Life is simplified into one pile of good people and one pile of evil people. The individual doing the sorting is never in the evil stack.

Being a therapist means you must be humble and open to those who can be difficult to categorize and sometimes, just plain difficult. If you are over-matched by the task of grasping and managing the therapeutic relationship, maybe you should make a referral from the start. Usually, however, you don’t realize your understanding is flawed for a while. By then a referral will not be simple. No matter the desire to do good by the patient, your rejection is likely to sting or devastate. The client came to you for repair and you made him worse.

Some counselors will keep the same box and keep using their failed understanding to treat the person. Some try to jam the client’s body into a differently labeled container and still treat him, even when box #2 doesn’t work either. Most will try to learn more, be humble, and look for a right-sized carton or no box at all until things are clearer. None of these tacks is sure-fire, but I favored the last one when I was in practice, often with the help of a personality test.

The therapist in all such situations confronts his own limitations. He needs modesty before he can achieve mastery. He needs to acknowledge his errors. He needs to figure out what is best for the patient while keeping his brain from exploding a little from the frustration and the fear he won’t be able to handle things.

Not all of us can do this in therapy or in life, and no one does it all the time with those for whom we care and those we care about.

If you’ve read the black on white scribblings I seem to endlessly produce (to my own astonishment) you know I don’t offer too many simple answers. Like you, I keep trying to understand this thing called life that appears so simple on the surface and no one ever fully gets right.

Life is a squirmy creature. You believe she is in your grasp and one second later she wriggles away. You think you are the master of yourself until your lack of mastery can’t be ignored. People don’t fit into a carton, and life – of all things – oozes and leaps and bumps against any enclosure we attempt to put it in.

Our boxes, as essential as they are, can injure people around us and limit our own understanding: understanding of the complexities of our fellow-man and our ability to be understanding, comforting, and kind.

The irony is that our use of boxes puts us in a box, too.

The moral of this story is to acknowledge the artificiality of labeled cartons and know they are also needed to get through the day. And then, perhaps, drink a glass of wine and accept the universe as it is.

No wonder religious faith is so appealing. The idea of “giving control over” to a benign, all-powerful, all-knowing being is consoling for those who can. For others, myself included, the wine will have to do. And tomorrow you will find me, not at a wine bar again, but back at repairing and enlarging my boxes, fashioning some new ones perhaps, trying to make them work as well as they can.

To be our own best selves, therapists or not, at some point we awaken to the guidance so easy for every one of us to forget.

Each box should be labeled “Handle with Care.”

—

The top photo is called Box Loading and is the work of Surya Prekash, S.A. The second image features U.S. Troops Surrounded by Holiday Mail during World War II, ca 1944. It comes from the Smithsonian Institution. Both are sourced from Wikimedia Commons.