Monday, November 17, 2008
Some Thoughts on Therapy
One of my oldest and dearest friends is in therapy, an endeavor I would never have thought he would undertake. But times change and losses happen. He called me last week to have a conversation about his therapy and after we were done, he suggested that I should put what I told him in my blog. I thought about that for awhile and since I am not actually giving anyone specific clinical advice, I guess I will share my thoughts on therapy.
As a professional disclosure, I do have a degree in psychology and while I am not in an established clinical practice, I do have several clients, most of whom are professional poker players. If any of my clients read this, I am confident what I say here is consistent with my therapeutic style.
Let's call my friend, Jeff. Of course, not his real name. Let's not call his ex-wife anything. I never really liked her but she is not the source of Jeff's problem; as always, life is the problem. Jeff went into therapy about a year and a half ago with a specific issue to resolve and is currently a bit unsatisfied with the course of the therapy. This is what prompted the phone call to me.
I should say to those who are not familiar with psychology in general, that there are dozens, perhaps hundreds of different forms of therapy; practiced by individuals across a wide spectrum of clinical modalities and belief systems. Meaning--it ain't all the same. But in Jeff's case, we are talking about a fairly standard form of "talk therapy", where the client sees the therapist once a week for a 50 minute hour and talks about their life, the situation and/or the problem.
The goal of such therapy is to uncover the various aspects of the client's problem or issue or whatever we, he or she wants to label it and to provide the client with tools to solve, resolve, move past or "fix" it. This form of therapy is essentially a dialog between the therapist and the client. Here is where Jeff's therapy got off track, in my not so humble opinion.
Intelligent people who enter therapy often need a period of time to simply vent. Usually followed by details of the issue and a good deal of background about how and why they got to the place they are now unsatisfied with. This process of getting it out and mulling it all over out loud can and should take some time. Let's arbitrarily say this process might take three months; sometimes longer, sometimes shorter but let's go with three months. Several issues now arise, not the least of which is that you or your insurance company are paying the therapist to sit there for these sessions. Quite frankly, a therapist is not motivated financially move the process along because once you get what you need, you stop coming to therapy and you must be replaced with a new client. Sorry, but money is a factor in what should be a completely caring, healing process. Yes, life sucks or at least someone gets a bill for it.
Now the therapist has some kind of training, usually at least a Masters degree in clinical psychology and probably, depending on local laws, some training in actually conducting therapy sessions. They also will have some frame of reference, some philosophy for his or her work. All too often that therapeutic frame is simply a continuation of the talk process. I do not believe this is helpful to the client in most circumstances and, in fact, it creates a dependency in many clients that does not lead to resolution of their issue. Very quickly the weekly visits can become very comforting. You get to go to a safe place and talk to someone about your life and they are completely and uncritically willing to listen. All nice and warm and fuzzy.
Now, if you treated your job like this you would soon be unemployed. You don't deeply ponder an issue for an indeterminate period of time, not if you want to keep collecting that paycheck. Action is called for and at some point in the therapy process, there needs to be a call to action. It is the therapist's responsibility to make that completely clear to the client. Once you have gotten your issue or issues on the table and once you have explored the depths and shallows of that issue; well, then it is time to do something about it.
You see we come to therapy because of some discomfort in our life. If you went to see your doctor, you would not be surprised if the conversation turned to the subject of disease. Well, that should happen in psychological therapy as well. Just take the word apart. Dis-ease. Not at ease. Something is wrong, is that not why you went looking for some help? The therapist should be always working towards the goal of the elimination or transformation of dis-ease.
Unfortunately, talk therapy can become very, very comfortable. Those weekly sessions become something you look forward to and they should not be. You are attempting, I hope, to resolve some issue in your life and to move on; to get back on course; to solve or resolve the issue. But instead you get stuck in the cycle of talking about it. That is the failure of the therapist. At some point, there needs to be a goal oriented conversation initiated by the professional in the therapeutic relationship. What is it that you are hoping to accomplish and what skills or tasks can the trained professional present to you to accomplish those goals?
At this point, therapy should not be comfortable. You probably will not look forward to those weekly sessions and you won't be doing all the talking. There will be questions, there may be assignments, there should be progress and in most cases there will be discomfort, anxiety and often tears.
If this type of interaction is not happening in the therapy setting, then you are simply paying someone to listen to you. Get a dog or better yet talk with an honest, caring friend; someone who knows something about life, which is precisely what a trained therapist should be in the first place.