Two People Agree

Last week, a childhood friend of mine who writes a wonderful blog posted something about an article she'd read about therapy; the next day I found a copy of this same article in my box at work and figured I needed to read it. The article, called "My Life in Therapy," chronicles the experiences of a chronically depressed woman who seeks the services of many, many psychoanalysts over the course of her life. I read it with great interest and increasing distress: her experiences were just so awful, so invalidating, so...so...common.

The author states from the outset that:

To this day, I’m not sure that I am in possession of substantially greater self-knowledge than someone who has never been inside a therapist’s office. What I do know, aside from the fact that the unconscious plays strange tricks and that the past stalks the present in ways we can’t begin to imagine, is a certain language, a certain style of thinking that, in its capacity for reframing your life story, becomes — how should I put this? — addictive.

This is probably my greatest professional concern: that I will not actually help anyone, but only serve to perpetuate the therapeutic tropes that run rampant in our culture. Come see me, go watch Dr. Phil, go read a book by Dr. Laura--whatever, it's all the same.

She goes on to write about an experience she had with one of her analysts wherein she found herself profoundly bothered by the rules and regulations of the relationship, but simultaneously found it necessary to keep her mouth shut:

Needless to say, I didn’t air any of these thoughts and instead went into my skittish, slightly apologetic, pre-emptively self-deprecating patient mode — intent on sounding like someone who was aware of the pathological currents that ran beneath a life that might be viewed as functional, even successful, if looked at from afar.

I guess you could look at this a couple of ways: as the unending spiral of an incurable neurotic--as most analysts would likely see it--or as the understandable need to portray oneself in a certain way so as not to be labeled prematurely. In my experience, the latter seems disturbingly reasonable: there are a whole lot of pathologizing clinicians out there, people who will diagnose every assertive woman with Borderline Personality Disorder, who start talking about "resistance" when patients start questioning the point of therapy. And speaking of questioning:

All of which raises the question: What exactly is the point? How can you be expected to know when being in therapy is the right choice, to know which treatments are actually helpful and which serve merely to give the false sense of reassurance that comes with being proactive, with doing all that we can? Does anyone, for example, really know what “character change” looks like?...Even to this day, I’m not sure I know anyone whose character has been genuinely transformed because of therapy. If anything, most people seem to emerge as more backed-up versions of themselves.

I felt truly heartened when I read this passage. In fact, this is the point in therapy when I frequently feel the most hopeful: when a client begins to question the usefulness of the whole endeavor. The whole idea of "character change" repulses me, frankly, and I use the moment of questioning as an opportunity to tell people precisely that. The job of the therapist, in my opinion at least, is not to change the character of a person, but to help that person become more fully themselves. Sure, it can be and often is about changing problem behaviors or habits, but the self of the person should remain not only intact but more solid, more whole, more robust. I have come to understand that people arrive at my office with the expectation that I will reveal to them all that is flawed within themselves, then give them the necessary tools to remedy the problems. This makes me immensely frustrated with the whole business of therapy, which is truly responsible for the idea that most people are flawed.

One of the most striking passages in the article dealt with the issue of the therapeutic relationship:

And for all the emphasis on therapy’s being a place of intimate disclosure — for all the times, in between shows of hostility, that I haltingly stated my feelings of great affection or even love for my therapists — none of them ever opened up about their feelings for me other than to convey a vague liking or appreciation for some facet of my personality.

I have to admit a certain fascination with this topic. Therapist transparency is a hotly contested topic, with some clinicians--mostly those of the psychoanalytic persuasion, but some plain old psychotherapists as well--maintaining that transparency or self-disclosure on the part of the therapist only serves the therapist's own needs and inevitably muddies the therapeutic waters, while others--myself, and most therapists of the existential persuasion--believe that transparency is essential to an authentic and intimate relationship. Let me be clear: I believe in strong and healthy boundaries, and while I keep photos of my kids on my office desk and respond geniunely to personal inquiries, while I invite frank discussions about the nature of the therapeutic relationship and frequently express my care and concern for the people I see--despite this belief in authenticity, I am also aware of the threat of self-indulgence, the TMI factor, the thin line that sometimes exists between transparency and non-productive self-disclosure. And I harbor the not-so-secret-anymore suspicion that those clinicians who denounce transparency are somehow uncomfortable with the between-ness of the therapeutic relationship; that they can't quite negotiate the kind of working relationship that's based on true human contact, not arbitrary heirarchies.

I was wary by this point of the alacrity with which I attached to shrinks, each and every one of them, as if I suspended my usual vigilant powers of critical judgment in their presence merely because they wore the badge of their profession. The truth of the matter was that in more than 40 years of therapy...I never developed a set of criteria by which to assess the skill of a given therapist, the way you would assess a dentist or a plumber. Other than a presentable degree of intelligence and an office that didn’t set off aesthetic alarms...I wasn’t sure what made for a good one.

And this, of course, is a major freaking problem. I have no problem stating for the record that there are a great number of very bad therapists out there--I've seen a couple of them myself--and the potential for these people to inflict serious harm makes me gasp for breath. The beauty and gift of the therapeutic relationship is, alas, it's Achilles heel: the subjectivity of the intimate relationship makes it difficult for many people to separate "their own issues" from true and real problems with the practitioner. But here's some real and objective truth:

A good therapist will encourage questioning--at the very least they will not try to make you believe that your questioning suggests a fundamental resistance towards self-reflection. Good therapists will project warmth; they will project caring; they will set a tone of safety and acceptance. A good therapist will have strong boundaries, but won't shame you for making personal inquiries. A good therapist will help you discover yourself and learn skills to help you function better, if that is what you are seeking. A good therapist will admit mistakes.
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I thoroughly enjoyed reading this article, and I wish the author well on her journey to find the "right" therapist. Of all the things that struck me in reading this, perhaps nothing resonated so completely as this line, attributed to the psychoanalyst Adam Phillips:

"Psychoanalysis is about what two people can say to each other if they agree not to have sex."

I don't know why I love this, but I do. I really do.