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Should therapists self-disclose?
Dr. Richard Grossman:
Hi everybody,
I want to respond to everyone’s comments, but first I want to post about my own experiences first from the patient side of the room—and then from the therapist’s.
I have written elsewhere on this site about my two experiences as a patient in psychotherapy:
"Dreams, Imagined Dreams--Failed Therapy" http://voicelessness.com/dreams,_imagined_dreams.html
"Bad Dream" http://www.voicelessness.com/disc3//index.php?topic=9607.msg153248#msg153248
Both therapists mentioned in these essays were highly recommended, well-trained psychiatrists—the first, well-respected in the field of trauma, and the second, a highly regarded member of the Boston Psychoanalytic Institute and Society. Sadly, both did more harm than good. And both, after 2 ½ years and 7 months, respectively, knew me no better from my perspective, than they did the moment I first stepped into their offices. (Of course, I’m sure they would both disagree with this assessment—and the second did say when I left that I was a “nice guy”--which I suppose is true.)
Why could neither hear me? My belief is that both ultimately lacked the vulnerability to sit in the room with another person and simply listen. They had to be smart, wise, have answers, have all their problems worked out—or at least have it appear that way. They were the experts. And sitting with their expertise and their knowledge, I felt all alone. This was not about creating an attachment (patient—therapist, therapist—patient), and discovering the best that life has to offer: a relationship where one is actually heard, including the suffering and the joy and everything in between. It was that I had a problem (or multiple problems), and they knew the best way to fix them.
Which brings me to the topic at hand: self-disclosure. If just once, either psychiatrist had ever said to me: “Yes, I’ve experienced that, and I know how painful it is,” I might have been theirs forever. Or they would have been mine forever, even when therapy was no longer necessary. But, of course, for this to happen, the therapists would either have had to be different people, or have different training (one that did not value neutrality and the use of patient projection as a therapeutic medium), or both.
If I were to look for a therapist again, following the first session in which they learned about me, I would ask the therapist:
How have you suffered in life? What helped? What didn’t?
And if they wouldn’t answer—or answer in a genuine way, I would move on.
Next: from the therapist’s chair…
Richard
Guest:
“Yes, I’ve experienced that, and I know how painful it is,”
that would be amazingly good to hear. I'd like to hear that. I'd like to be believed. Oh, when I stop and think about it, I reckon I am believed, the facts tell me I must be, and more than the facts tell me that. But that's all the thinking logical side. I know that I was not believed once. And I can see why. Knowing that, understanding why I wasn't believed - didn't stop it hurting at the time. How ridiculous is that? How unbelievable. Ha, it really hurt; I wonder why. Probably some deep running rut from the prime-evil muds. The logical side knows, but the heart/amygdala doesn't trust logic. It trusts very little. A difficult combination.
ANYWAY That's a great line Richard. It packs some emotional punch. Which is what people need, rather than some detached analyser reading you to fit a 'diagnosis', ready for prescribing.
Dr. Richard Grossman:
A few decades ago when I was working at Mass. General Hospital, I remember once sitting in on a therapy observation seminar. A seasoned, well-known therapist conducted psychoanalytic therapy behind a one way mirror, and then after the session, the therapist would discuss the session with the observers/residents. In this particular session, the patient, a woman in her early 30’s spoke about how painful it was being overweight in our culture. Sometimes she would stop and look at the therapist—an overweight woman herself, of about 40.
But this was the psychoanalytic era, and the therapist simply nodded. During the session, the patient never expressed her disappointment at the therapist’s silence. (Perhaps she did in a later session. And if she did, the therapist would likely have asked her about her associations to being disappointed in this way.)
After the session in the discussion period, I waited for someone to ask the obvious questions. What is it like when topics painful to the therapist are raised by patients? What did it feel like at that moment? Did you want to answer, but stopped yourself for theoretical reasons? Aren’t there times when pain is just pain, and it’s best to respond simply and empathically—or as Freud said “a cigar is just a cigar”?
But no one asked these questions or anything like them. These questions were verboten for two reasons. They questioned the very nature of psychoanalytic psychotherapy on which this therapist and a generation of therapists had based their careers. And secondly, the questions were potentially humiliating to the therapist as a human being.
But the questions should have been asked. And situations like this radically changed my opinion of the prevailing therapy paradigm. My view, some 30 years later is this: an excellent therapist is someone who effectively uses their own suffering, past and present to facilitate an attachment with another person. Self-disclosure by the therapist can be extremely important in fostering this attachment. Neutrality (and certainly, I never considered the therapist’s nodding in the situation described above as even approaching “neutral”) is, for the most part, damaging. There are two words the therapist should have said that would have stayed with this patient for a lifetime (particularly in the context of the group observation):
“I know.”
Richard
BonesMS:
--- Quote from: Dr. Richard Grossman on July 08, 2011, 12:09:45 PM ---In my view, the single most important “basis” of therapy (for non-personality disordered people) is that the therapist “gets it”, i.e. understands the patient’s suffering (both at a knowing and feeling level), and conveys this understanding convincingly back to the patient.
Why is this important? Because it is difficult and not very helpful to form a genuine attachment to a therapist who doesn’t “get it”. And, in my experience, it is this unique two-way attachment that reduces suffering and ultimately leads to healing.
Is therapist self-disclosure useful in this process? Self-disclosure of a particular painful common (to both parties) life event/situation can sometimes be exceptionally reassuring to a patient that he or she truly “gets it.”
(As Bones says above, however, sometimes because the therapist “gets it” so well, patients already know…)
More to follow…
Richard
--- End quote ---
Thanks, Dr. G!
BonesMS:
--- Quote from: Dr. Richard Grossman on July 09, 2011, 01:21:08 PM ---A few decades ago when I was working at Mass. General Hospital, I remember once sitting in on a therapy observation seminar. A seasoned, well-known therapist conducted psychoanalytic therapy behind a one way mirror, and then after the session, the therapist would discuss the session with the observers/residents. In this particular session, the patient, a woman in her early 30’s spoke about how painful it was being overweight in our culture. Sometimes she would stop and look at the therapist—an overweight woman herself, of about 40.
But this was the psychoanalytic era, and the therapist simply nodded. During the session, the patient never expressed her disappointment at the therapist’s silence. (Perhaps she did in a later session. And if she did, the therapist would likely have asked her about her associations to being disappointed in this way.)
After the session in the discussion period, I waited for someone to ask the obvious questions. What is it like when topics painful to the therapist are raised by patients? What did it feel like at that moment? Did you want to answer, but stopped yourself for theoretical reasons? Aren’t there times when pain is just pain, and it’s best to respond simply and empathically—or as Freud said “a cigar is just a cigar”?
But no one asked these questions or anything like them. These questions were verboten for two reasons. They questioned the very nature of psychoanalytic psychotherapy on which this therapist and a generation of therapists had based their careers. And secondly, the questions were potentially humiliating to the therapist as a human being.
But the questions should have been asked. And situations like this radically changed my opinion of the prevailing therapy paradigm. My view, some 30 years later is this: an excellent therapist is someone who effectively uses their own suffering, past and present to facilitate an attachment with another person. Self-disclosure by the therapist can be extremely important in fostering this attachment. Neutrality (and certainly, I never considered the therapist’s nodding in the situation described above as even approaching “neutral”) is, for the most part, damaging. There are two words the therapist should have said that would have stayed with this patient for a lifetime (particularly in the context of the group observation):
“I know.”
Richard
--- End quote ---
I agree!
On the other hand, I had the unfortunate experience of a therapist abandoning her patients in group therapy because an issue that came up with us triggered her PTSD. NOT fun!
Bones
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