Voicelessness and Emotional Survival Message Board
Voicelessness and Emotional Survival => Voicelessness and Emotional Survival Message Board => Topic started by: Dr. Richard Grossman on July 07, 2011, 11:39:44 AM
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Hi everybody,
Here's an article about Marsha Linehan, Ph.D., the well-known creator of Dialectic Behavior Therapy (DBT) which is used to treat Borderline Personality Disorder (BPD). She recently disclosed her own personal struggles with Borderline Personality Disorder in a New York Times article (6/23/2011): "Expert on Mental Illness Reveals Her Own Fight" by Benedict Carey.
http://www.nytimes.com/2011/06/23/health/23lives.html?_r=2&scp=1&sq=Marsha%20Linehan&st=cse
The article raises the issue of self-disclosure by therapists to their patients. A quote from the article:
“So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward,” said Marsha M. Linehan, a psychologist at the University of Washington.
And here's a response by a New York psychiatrist, Maureen R. Goldman, M.D., in Clinical Psychiatry News (7/6/2011): "Editorial: Thoughts on Self-Disclosure for Psychiatrists"
http://www.clinicalpsychiatrynews.com/views/commentaries/blogview40731/editorial-thoughts-on-self-disclosure-for-psychiatrists/36388f6a86.html
This is a topic I have thought a lot about over the years, and one that I have strong feelings about--which I'll share.
But, as usual, I'd like to hear your comments first...
Richard
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Hi Richard,
I didn't see the links so haven't read the articles.
My first gut response is "Yes." For me, simply knowing my therapist is a human being with life issues and feet of clay is comforting.
The old model of rigid boundaries may be important in some cases; for me, it was not helpful.
At times when I was so self-absorbed I couldn't have cared less whether my T was alive or dead or a propped-up rent-an-ear,
so desperate was I to vent...this wouldn't have been so important. I cared only about feeling safe and being heard.
But in later life, I've found it very reassuring to know a few facts that remind me that a therapist is a person too. In one instance,
the T-relationship got boundary-blurred, as much through my lack of boundaries as his own. It wound up dying an appropriate death
with no hard feelings and perhaps relief on both sides. When I gradually learned some things about the hardships of his childhood, I had explanations for things I'd wondered about. I recognize the mistakes he (and I) made, but do not blame him or myself. Compassion and gratitude are how I think back.
Currently, when I was anguishing over my daughter, my now-T let me know that he has a daughter with a severe eating disorder.
It helped me recognized that not only was he being professionally compassionate, but that as a human being, he happened
to truly understand what it's like to have a troubled child in jeopardy. I occasionally ask him how she's doing, and I let him
know I'm not digging for detail. We seem to have a comfortable mutual recognition that boundaries aren't going to dissolve.
But he'll tell me something like--she's in a hospital program. Or, she's home with us now. And, he also mentioned once that
he is Quaker, which for me was also a positive thing to know about him. My trust was stronger and has remained so.
Once, he mentioned a prior marriage. And he often references insights from his work with couples. Those facts too are very
comforting, because I'm divorced. With an earlier T (who turned out to be fundamentalist and had NOT disclosed
to me how much that affected his view of me...even to the point that he pressed me to marry quickly when I'd mentioned
my inner voice was telling me to wait--which turned out to be a disaster for me)...the lack of knowing much (or enough)
about who he was as a human being as well as as a professional and what his values were, both hamstrung the therapeutic
relationship and also wound up causing me considerable personal harm.
If I had a therapist who was bipolar and clearly taking responsibility for being in treatment or on Rx and was behaving effectively
I would be grateful to know this. Maybe not the first session, but the first or second. Again, it would encourage me to see a T
as a human being as well as healer. It would then be my choice to decide whether that issue of theirs was triggering or an obstacle
for me in some way. I would be appreciative of the disclosure. Nothing shame-based about it, just an important factoid, perhaps.
My D and I went to see a counselor who is paralysed and severely disabled and wheelchair-bound. She didn't have to disclose
verbally. But we knew this key thing about her life.
I don't know why a counselor with a condition that required a bite of protein every 30 minutes wouldn't say, I have XX, so you'll see
that I pause to eat something during our session. Or someone with a hearing problem wouldn't say, I need for you to sit
in that chair because I'm deaf in one ear. Or, I have macular degeneration so I need to keep the office quite dark. Or, I am bipolar
and in treatment, it's well controlled, but I prefer to let clients know this in case that would be troubling for you. Etc.
Now, I view a careful and considerate amount of personal disclosure on the part of a therapist as a gift of respect to me.
I do understand that one would have to be very careful with how much to disclose, and when and how. I don't think there's
a blanket rule. But from my own experience, I am both encouraged and humbled by seeing those clay feet. It encourages me to take
fuller responsibility for my own healing, and discourages utter dependence on the therapist for learning about self, other, boundaries, etc.
Very interested in hearing your thoughts on this, and will look forward to the thread.
Thanks for posting this, Richard. (And I hope you and your wife are well...?)
best,
Hops
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Hi Hops,
Ooops! Sorry. I inserted the links...
Richard
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Yes. Of course they should not keep self referring but sharing their experience helps the connection deepen.
Sea storm
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These are all very interesting questions. I think the answer probably lies somewhere in the middle. What to disclose and when? When is it relevant? When would it be helpful and how would it help? That said, disclosure as part of small talk about getting to know someone maybe not so much.
In my case, my T had written a book where he disclosures his issue with his mother in a small section of one chapter. This was helpful to me, because he said he was co-dependent and had to avoid getting over-enmeshed with needs of patients. Then later in T, he also told me that his own kids were in T, in response to his divorce. As I remember, I think it was relevant to my feeling that good parents turn out good kids who are not in T. He wanted me to feel less of the stigma of T when I was feeling very wounded.
I do think if I knew someone had a similar problem, as in "i know just how you feel", it can help one feel validated, heard and understood at the same time.
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I'm too tired and lazy to read the articles right now. Is there some kind of evidence that shows there is a tangible improvement in the patient's outcome as the result of the therapist's disclosure?
I think if there is evidence that the outcome for the patient is increased positively (not just perception of validation) after therapists disclosure then YES therapists should consider doing this. If there is no real positive outcome improvement for the patients when the therapist self discloses then I think NO it should not be added into the therapeutic model.
I wonder how much the benefits of disclosure are related to the specific therapy goals. Maybe disclosure helps some goals but not others.
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"Officially" and publicly, as in the media? That seems to be the issue here, rather than in the T-client relationship. On the one hand, it could be positive marketing "branding" of the doc as having personal experience (and this implies additional expertise) in the subject problem. But, in T... it's the working methods and personal relationship between the "partners" that's most important. I find the idea that a therapist is an all-knowing, all-powerful Oz who has all the answers and the magic ability to "fix" me... well, it's off-putting. Yet, I think we all start the process with that stereotype in our minds.
It could also work in a negative branding fashion -- as in physician, heal thyself FIRST. Before trying to help others. Many folks would have trust issues with someone who flat out admitted they were human and fallible and had their own issues.
Personally, I don't think a T's personal history is relevant to being able to guide a client through the process of learning a new balance within themselves. You reach out, steady them, help them find their balance... then slowly, give them the room to realize they can move around just fine, without wobbling and falling again. That doesn't require the T to have experienced vertigo, you know?
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I'm going to respond from the standpoint of being on "both sides of the fence", so to speak, regarding the question: "Should therapists self-disclose?"
From my point of view....it depends. I've dealt with one therapeutic professional who basically wasted my time talking about himself, his culture, his views, his values, his beliefs, and how I SHOULD do "blah-and-so" simply because I'm female! That gives me reason to suspect he's a Narcissist! (Didn't understand NPD back then.) He also attempted to force me to relinquish going to 12-Step Support groups because: (a) it made him jealous and (b) HE would control my addiction FOR me! (While he's pressuring me to start taking benzodiazepines again KNOWING FULL WELL MY HISTORY OF ADDICTION TO THEM!) All of the above factors led me to my decision to terminate him as a therapist as he was clearly NOT hearing me! (Why pay the expense of seeing a mental health therapist if they continuously REFUSE to LISTEN and HEAR what you have to say in therapy sessions?)
On the other hand....
When I worked, for a short time, in a substance abuse treatment facility, I did not disclose that I am also in recovery. I felt I was not there to talk about myself or to focus the spotlight on me. Eventually, my clients figured it out and asked me point-blank: "Are you in recovery from alcohol and/or drugs?" I would smile and inquire: "Why do you ask?" The response would almost always be: "Because you recognize my bullsh*t and call me on it! I can't bullsh*t you like I bullsh*t my friends and family! You get it!" Then we will BRIEFLY discuss my history while emphasizing, we are here to talk about YOU and WHY you are in treatment, I am NOT here to talk about ME! Your time is more valuable than that!.
Just my two-cents.
Bones
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"Should therapists self-disclose?"
If nothing else, open information about a T prior to therapy might help weed out the real people from the charlatans/Ns/exploitative dickheads/children acting as Gods/plain nutters etc etc.
Yes, some personal life information upfront can't hurt. But therapy can be like trying to fix a problem in a Microsoft program - you have to know the general answer to the question before you start otherwise you don't know what to search for in the 'help' section.
As for disclosing during therapy - that's a different matter.
I didn't read the articles.
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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
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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
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“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.
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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
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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
Thanks, Dr. G!
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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
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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Well, I'm glad you have self disclosed on this board, glad that the board exists.
Glad because knowing that there are other people who have similarly confusing and grief inducing family relationships, probably does reduce my own emotional confusion and strain a little bit.
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Now if only we can find more therapists who GET what being a survivor of a Narcissist is all about. Unfortunately, Dr. G. is unable to clone himself and be everywhere.
Bones
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Hops,
You have seen all types (in terms of therapist self-disclosure and boundaries), and I appreciated your perspective and where you have ended up. You’re right. In and of itself, self-disclosure does not make for great therapy—the text and subtext of that self-disclosure are critical. But I think, as you do, that “feet of clay” are usually damaging.
CB,
Personality disorders including Borderline Personality Disorder present a whole different challenge for a therapist. My “kind of therapy”, I found, largely failed with patients with BPD. DBT (a mixture of cognitive therapy and mindfulness training) is not relationship based, but largely technique based. (Couple’s therapy, too, is largely advice-based, and not relationship based—so I’m not surprised self-disclosure didn’t help.) So, I’m not sure that Marsha Linehan’s acknowledgement would have helped her patients had she offered it in real time. Still, like you, I admire her admission—and I believe her having had the disorder was crucial to her finding something that worked for others.
Ales2,
I think your therapist telling you that his children were in therapy, in order to reduce your stigma/guilt was a fine thing to do…
Boat that Rocks
Here’s some evidence of the value of therapist self-disclosure:
Therapists Redraw Line on Self-Disclosure
By ERICA GOODE
Published: January 01, 2002
http://www.nytimes.com/2002/01/01/health/therapists-redraw-line-on-self-disclosure.html
PR,
“I find the idea that a therapist is an all-knowing, all-powerful Oz who has all the answers and the magic ability to "fix" me... well, it's off-putting. Yet, I think we all start the process with that stereotype in our minds.”
I agree. In the psychoanalytic heyday at the major teaching hospitals and institutes, this is what, in my experience, therapists wanted people to believe. Many people were either not helped or damaged as a result.
“Personally, I don't think a T's personal history is relevant to being able to guide a client through the process of learning a new balance within themselves. You reach out, steady them, help them find their balance... then slowly, give them the room to realize they can move around just fine, without wobbling and falling again. That doesn't require the T to have experienced vertigo, you know?”
In my experience, both as a patient and supervising other therapists, those who had experienced “vertigo” (metaphorically speaking) or some other disorder that allowed them to know something of what it was like from more than an intellectual perspective, were much better at helping those with the disorder. But there are many variables here, including whether the treatment was technique based (e.g. cognitive therapy), how severe the problem was, how broad or narrow the problem was, etc.
Bones,
If the therapist is narcissistic, self-disclosure is of no use at all…
Guest,
Yes, it definitely helps to know something about the therapist’s specialties before you start. The internet has been a wonderful help in that regard.
TT,
“It's kind of like a piano tuner knows how to tune a piano, but not necessarily know how to play a piano in the strict sense (if that makes any sense).”
For some problems, technique based solutions work fine. But for other’s, IMO, a relationship is required—and the better the relationship, the better the outcome.
Bones,
“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!”
That’s a very sad situation.
Thanks to all for your responses,
Richard
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Hi Richard,
No big deal but what I meant to convey actually is that perceiving "feet of clay" has mostly been the opposite of damaging, in my view...
from my own experience, I am both encouraged and humbled by seeing those clay feet. It encourages me to take fuller responsibility for my own healing
...sensitive/thoughtful self-disclosure by a T, done with care (as opposed to self-indulgence) is, for me, is a positive.
Hops
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Got it, Hops. Sorry, I didn't read closely enough the second time around...
Richard
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Hops,
You have seen all types (in terms of therapist self-disclosure and boundaries), and I appreciated your perspective and where you have ended up. You’re right. In and of itself, self-disclosure does not make for great therapy—the text and subtext of that self-disclosure are critical. But I think, as you do, that “feet of clay” are usually damaging.
CB,
Personality disorders including Borderline Personality Disorder present a whole different challenge for a therapist. My “kind of therapy”, I found, largely failed with patients with BPD. DBT (a mixture of cognitive therapy and mindfulness training) is not relationship based, but largely technique based. (Couple’s therapy, too, is largely advice-based, and not relationship based—so I’m not surprised self-disclosure didn’t help.) So, I’m not sure that Marsha Linehan’s acknowledgement would have helped her patients had she offered it in real time. Still, like you, I admire her admission—and I believe her having had the disorder was crucial to her finding something that worked for others.
Ales2,
I think your therapist telling you that his children were in therapy, in order to reduce your stigma/guilt was a fine thing to do…
Boat that Rocks
Here’s some evidence of the value of therapist self-disclosure:
Therapists Redraw Line on Self-Disclosure
By ERICA GOODE
Published: January 01, 2002
http://www.nytimes.com/2002/01/01/health/therapists-redraw-line-on-self-disclosure.html
PR,
“I find the idea that a therapist is an all-knowing, all-powerful Oz who has all the answers and the magic ability to "fix" me... well, it's off-putting. Yet, I think we all start the process with that stereotype in our minds.”
I agree. In the psychoanalytic heyday at the major teaching hospitals and institutes, this is what, in my experience, therapists wanted people to believe. Many people were either not helped or damaged as a result.
“Personally, I don't think a T's personal history is relevant to being able to guide a client through the process of learning a new balance within themselves. You reach out, steady them, help them find their balance... then slowly, give them the room to realize they can move around just fine, without wobbling and falling again. That doesn't require the T to have experienced vertigo, you know?”
In my experience, both as a patient and supervising other therapists, those who had experienced “vertigo” (metaphorically speaking) or some other disorder that allowed them to know something of what it was like from more than an intellectual perspective, were much better at helping those with the disorder. But there are many variables here, including whether the treatment was technique based (e.g. cognitive therapy), how severe the problem was, how broad or narrow the problem was, etc.
Bones,
If the therapist is narcissistic, self-disclosure is of no use at all…
Guest,
Yes, it definitely helps to know something about the therapist’s specialties before you start. The internet has been a wonderful help in that regard.
TT,
“It's kind of like a piano tuner knows how to tune a piano, but not necessarily know how to play a piano in the strict sense (if that makes any sense).”
For some problems, technique based solutions work fine. But for other’s, IMO, a relationship is required—and the better the relationship, the better the outcome.
Bones,
“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!”
That’s a very sad situation.
Thanks to all for your responses,
Richard
You're welcome, Dr. G., and thanks!
Regarding therapies that are "technique based", one thing that bothers me with that approach is the "one-size-fits-all" mode of thinking. When I worked for three months, at a prison facility, they had recently changed from a client-centered approach to one of the technique-based approaches....cognitive behavioral therapy...and was attempting to force ALL the prison residents there to "fit the mold" so to speak. I was NOT comfortable using that technique-based approach, (plus I had NO prior training in that method) and I was seeing too many instances where CBT was just simply NOT appropriate! It made it difficult, if not impossible, to design an Individualized Treatment Plan while being pressured to write that plan from a "cookie cutter" standpoint. If a client could NOT "fit the mold", (e.g. suffering from schizophrenia and taking psychotropic medications), he was shipped to a different prison and he basically got NO help at all in spite of the fact that he was CLEARLY DUALLY-DIAGNOSED! In the end, I just could NOT condone that and stay there. (The powers that be were also violating several state regulations which also compelled me to quit after such a short time of employment.) The experience left me in a lose-lose situation....quit and be unable to become certified, stay and attempt to work while vehemently disagreeing with the way the clients were being treated....wait for the ax to fall on me as the now-identified "whistle blower" because I contacted the state to question what I was seeing and the state authorities used my name when they contacted my then-supervisor. I felt I had no choice but to leave considering the circumstances. That one experience left me with the impression that the powers that were in control was simply looking at the money going into their pockets and didn't care about the front-line staff nor the clients that they were supposed to be helping. They seemed to have forgotten WHY the clients needed help in the first place! I find it so sad when someone in a therapeutic professional position looks at a human being and sees ONLY DOLLARS, CENTS, AND PROFIT. Am I making sense?
Bones
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I agree that T's that share their own experiences, and struggles, helps me bond and feel safer.
I also feel that the trust goes both ways, and that's truly a gift, IME.
Lighter
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I didn’t publicly answer Hops’ question about my wife’s health. Hildy recently got the results of her latest CT scan, and all is well. As many of you know, she was diagnosed with lung cancer 4 ½ years ago. The non-profit she founded three years ago, Upstage Lung Cancer (http://www.upstagelungcancer.org/), is about to make a $100,000 donation (in conjunction with Lungevity-- http://events.lungevity.org/site/PageServer) to support research in early detection of lung cancer. Hildy is the most determined person I know. She, too, tries to turn bad “stuff” into good “stuff”...
Richard
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Hi Bones,
"They seemed to have forgotten WHY the clients needed help in the first place! I find it so sad when someone in a therapeutic professional position looks at a human being and sees ONLY DOLLARS, CENTS, AND PROFIT. Am I making sense?"
Perfect sense...and, unfortunately, things are only getting worse because of the financial crunch.
Richard
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Hi Bones,
"They seemed to have forgotten WHY the clients needed help in the first place! I find it so sad when someone in a therapeutic professional position looks at a human being and sees ONLY DOLLARS, CENTS, AND PROFIT. Am I making sense?"
Perfect sense...and, unfortunately, things are only getting worse because of the financial crunch.
Richard
Thanks, Richard! I wish I had the power to change things for the better.
Bones
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One last thought on this topic (from me). If you have experienced “voicelessness”, finding a good therapist in my experience, is very difficult. When people ask me how to do it, I do not have any easy answers. Training/experience is important, smarts are important, and “kind of human being” is important. For me, the third factor is the most difficult to assess quickly—particularly in an era of supposed neutrality. Professional or friend’s recommendations are not enough—one has to make the assessment oneself. And one has to use every bit of information available. In a sense, one has to be excellent at reading people quickly—but often in therapy relationships, just as in non-therapy relationships, we are drawn to what we know. And what we know is/was damaging. So we have to be careful. If a therapist is willing to self-disclose and trust, IMO, that is a positive measure of the third criterion. But clearly, on its own, self-disclosure is not enough. When auditioning therapists, we have to listen to every word the therapist says, and we have to ask ourselves the same question the therapist asks: “Who is this person.” Every therapist will be different and every therapy will be different. Finding the right match is, in my view, critical.
Richard
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Glad to hear your wife is doing well Doctor G. No sure thing by any means with lung cancer.
I've never been through therapy myself but have known a few therapists.
I'm sure, or at least hopeful, that this is merely anecdotal, but the few I have known seem to me to have been considerably more in need of intense therapy themselves rather than dispensing it to others.
Are the disturbed inordinately attracted to the field of psychology the same way, just as an example, smart, handsome, rugged dudes are attracted to the timber industry? Heh.
mud
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Hi Mud,
Thanks. Sadly, only 15% of people diagnosed with lung cancer survive 5 years—which is why early detection is so important. If it is caught early (before symptoms appear) approx. 75% survive--my wife was lucky enough to fit into this category. I hope your wife continues to do well…
I've never been through therapy myself but have known a few therapists.
I'm sure, or at least hopeful, that this is merely anecdotal, but the few I have known seem to me to have been considerably more in need of intense therapy themselves rather than dispensing it to others.
Are the disturbed inordinately attracted to the field of psychology the same way, just as an example, smart, handsome, rugged dudes are attracted to the timber industry? Heh.
Yup. If I were a smart, handsome, rugged dude, you never would’ve heard from me……...or maybe you would have:
http://www.youtube.com/watch?v=5zey8567bcg
Richard
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Richard,
You made my morning! I woke up and "tuned in" to VESMB with a cup of coffee and found your youtube link.
Oh my goodness. Big smile!
CB
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Uh-oh.
Poor Mrs. Mud.
We don't even know if Mud can carry a tuuuuuuuuuuune...
and now she's going to have to listen to this!
(At least let her help pick out your outfit, okay, Mud?
She does have good taste in lumberjacks, so that bodes well...)
:lol:
Hops
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First saw The Lumberjack song in the 70's.
It's what inspired me to become one. :oops:
mud
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Hi Mud,
Thanks. Sadly, only 15% of people diagnosed with lung cancer survive 5 years—which is why early detection is so important. If it is caught early (before symptoms appear) approx. 75% survive--my wife was lucky enough to fit into this category. I hope your wife continues to do well…
I've never been through therapy myself but have known a few therapists.
I'm sure, or at least hopeful, that this is merely anecdotal, but the few I have known seem to me to have been considerably more in need of intense therapy themselves rather than dispensing it to others.
Are the disturbed inordinately attracted to the field of psychology the same way, just as an example, smart, handsome, rugged dudes are attracted to the timber industry? Heh.
Yup. If I were a smart, handsome, rugged dude, you never would’ve heard from me……...or maybe you would have:
http://www.youtube.com/watch?v=5zey8567bcg
Richard
YAY, Monty Python!!!! LOL!!!!!
Bones
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One last thought on this topic (from me). If you have experienced “voicelessness”, finding a good therapist in my experience, is very difficult. When people ask me how to do it, I do not have any easy answers. Training/experience is important, smarts are important, and “kind of human being” is important. For me, the third factor is the most difficult to assess quickly—particularly in an era of supposed neutrality. Professional or friend’s recommendations are not enough—one has to make the assessment oneself. And one has to use every bit of information available. In a sense, one has to be excellent at reading people quickly—but often in therapy relationships, just as in non-therapy relationships, we are drawn to what we know. And what we know is/was damaging. So we have to be careful. If a therapist is willing to self-disclose and trust, IMO, that is a positive measure of the third criterion. But clearly, on its own, self-disclosure is not enough. When auditioning therapists, we have to listen to every word the therapist says, and we have to ask ourselves the same question the therapist asks: “Who is this person.” Every therapist will be different and every therapy will be different. Finding the right match is, in my view, critical.
Richard
Hi Richard, I see this was your last thought on this, but I do have one observation - if a potential client is able to see their own problems clearly enough to be able to ask themselves those questions about a potential therapist.....do they need therapy? By the time we reach that kind of understanding, at least with me, half the battle (if not more) would have been done. It's a bit chicken and egg I guess. Not that I know.
Mud,
Are the disturbed inordinately attracted to the field of psychology
yes! but the more disturbed they are, the more they'll be attracted to psychiatry first. I reckon psychiatrists feel the rest of the world is wrong, so they want to fix the world to fit their view. Psychologists feel they may help themselves as much as their clients/patients so it's more of a mutual undertaking. And that's just my non-informed opinionating based on nothing more than meeting some of the buggers.
On the other hand, we've explored an awful lot of the planet. The really unchartered territory is still inside our heads. What profession could be so interesting? What other profession, if we could really change minds, if we could ....has the ingredients to ...well.....
make a better world.
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This is a really valid issue when it comes to therapy. I wholeheartedly agree with most here who suggest, that therapists who share similar experiences with their patients can immeasurably add to demonstrating empathy which is so important to building a trusting therapist-patient relationship.
But for me there is a huge caveat. This sharing of personal experiences must not be selfishly motivated. Like any other interaction or methodology the therapist chooses to employ, sharing his/her personal experiences must done with an eye to serving the patient and their personal growth.
I, too, have had experiences where 1) it would have been immeasurably beneficial to be validated through the sharing of personal experiences from my therapist and 2) where the therapist shared personal experiences, but not effectively. In this latter scenario, it also served the opposite effect. I shared some painful experiences and rather than empathize or validate them, the therapist spent a good amount of time sharing his personal experiences that included the inherent message, "my pain was far greater than yours so you have no right to dwell on your pain because it can't compare with mine." This happened a number of times.
Now, I'm a very empathetic person and so I became invested in the therapist's pain but ultimately, it just added to be mine. Not only did I share personal experiences for which I was not validated but I was also made to feel these experiences were irrelvant in comparison to those of others....including my therapist's. It was "my pain trumps yours."
So, provided the therapist can share painful and personal experiences with the intent of HELPING the patient, it's a very beneficial thing to do. But the therapist has to have a very good handle on his/her own issues before doing so. If their own pain has not bee fully addressed, it becomes difficult to share it with a patient without turning the patient into the therapist.
To all therapists, by all means, share! But be sure the sharing is about helping the patient...not obtaining attention from the patient for your own issues, resolved or not.
I think it's especially important for victims of Narcissists who already have a higher than average level of empathy for others.
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Thanks, Mud and SunBlue! Hear, hear!!!!
Bones
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Sunblue:
Amen!
Guest:
"Hi Richard, I see this was your last thought on this, but I do have one observation - if a potential client is able to see their own problems clearly enough to be able to ask themselves those questions about a potential therapist.....do they need therapy? By the time we reach that kind of understanding, at least with me, half the battle (if not more) would have been done. It's a bit chicken and egg I guess. Not that I know."
IMO, identifying the problem is part of the "battle"--then comes the harder parts: shedding destructive relationships and literally learning to live in a world where your needs are heard and taken seriously. Significant brain re-wiring has to take place to do the latter comfortably. After a lifetime (for many) of not being heard, the brain has adapted to this painful situation. It takes a new experience (therapy) over time to lay down these new "tracks".
Richard
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I hear you Richard. Thanks for that.
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I think they should. One reason why rehabs are even partially successful is because they are staffed with ex users and patients know this. It builds trust, confidence and a knowing that the therapist can/could really help me if they understand what I am going through. Maybe it's this thing I expressed the other day about intellectual and emotional understanding.
I understand your question is not about similar experiences but disclosing them but I guess it would help me for instance if I would go the a therapist who understood emotionally and not just intellectually what I went through and if she told me so she had similar upbringing for instance, I would be certain that the person across really knows what I am talking about. It would make it safer for me to open up and trust, especially if she would seem a person that 'has it together' which would mean that there is hope for me too in becoming exactly that.
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This thread just seemed to emerge from the past and I found it interesting.
I am so surprised that anyone would want to go to therapist's who weren't able to self disclose or who thought it counter-productive.
I like the idea of checking in with the client and asking "And how are we doing?" You know, how is our relationship. If the therapist is in a top dog position this is not good. One has to know deeply that the therapist really knows.
Having gone through training for counseling at the Master's level I saw many counselor's who couldn't really connect with anyone let alone clients. They chose modes of working that guaranteed no deep or probing work would happen and they seemed unable to have deep empathy. It was too high a cost personally for them. It was not something they could develop and they just reinforced who they were rather than growing with each client. If they are working with the worried well then they can't do too much harm but if they are working with the really wounded it is scarey to think of them out there. They would not be disclosing because they didn't have the understanding of multiple layers of meaning and boundaries. Or they might disclose all over the place and be unhelpful that way.
I notice that Dr Grossman is seen as a parental figure here on Voicelessness and that it seems a great comfort to many. If he weren't the complexity would be amped up exponentially.
As for lumber jacks being handsome and not needing therapy. Oh baloney. They just go drinking and exercise a lot climbing hillsides and having near death experiences.
I'm a lumberjack and I don't care.
SEa
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Personally I prefer not to know anything about the therapist I'm seeing other than their professional qualifications and whether they have experience in whatever it is I'm trying to deal with. I find I clam up if the relationships starts to feel intimate in any way and I find chit chat or knowing stuff about them does that for me. I also find (and I think it's because of my massive codependcy issues) that if/when I know 'something bad happened to them' I find myself worrying about them and monitoring what I say for fear of triggering them.
I do agree with Sea that checking in with how things are going is vital and very useful for both sides, but personally I find someone asking me 'how are we doing' makes me say 'fine' (people pleaser and I don't want you to think you're doing a bad job plus I'm not really even sure I know what I want from this, I just want to stop feeling crappy about myself all the time). I've had an initial assessment now with a rape crisis centre and as part of their preliminary assessment they gave me a tick sheet that just lists all sorts of thoughts/feelings, negative and positive, and asks you to rate where you are on a scale that ranges from 'constantly' through to 'never'. Then they give you the same questions again at stages to see if what they're doing is helping or making you feel worse. Of course, sometimes you do feel worse when you're working through something so there's that to manage as well. I prefer that sort of more impersonal approach, it sort of felt more clinical and that's what I feel I need now.
I felt that I got to know my last therapist too well to talk about the sexual abuse with her. I felt embarassed and I worried that she knew me too well and would suspect I was lying. I think that came from so many people who knew me well calling me a liar when I first told them what he did. So for this particular situation, I feel like I need someone I don't know at all, know nothing about and who doesn't live too near me so there's little chance of bumping into her in the street. Equally, I found that knowing a lot could really trigger me. My last T had to cancel some appointments because her dog was having pups and there were some problems near the end and she was rushing backwards and forwards to the vet a lot with her. My mum has always been far more interested in her dogs than in her kids - completely different situation, obviously, but enormously triggering for me, no fault of the therapist, she was behaving like a responsible dog owner and was being honest with me about her reasons for cancelling but from my point of view it triggered me and I couldn't go and talk about it to the person involved which made it more difficult! It's all a bit of a minefield, isn't it?!
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Oy, yes.
Tupp, sounds like that to really let someone "in" -- you'd have to risk being disappointed.
Because I think for some Nsurvivors, when people let us down, it's disproportionate disappointment we feel.
Well, I should speak for myself...that's healthier.
I think I react badly to being let down sometimes because:
1) I was raised to be judgmental so that reflex kicks in when I'm hurt, instead of "I am feeling hurt"--it's protection
2) When someone I'm investing with so much authority/competence (as compared to my own) shows insensitivity or less competence/commitment--it's like, on some level I'm not conscious about, a reminder of how my own earliest "protectors" let me down--and that feels like disaster, like a confirmation that there is no safety in the world
3) So I'd best not start trusting or allowing others to be imperfect or...I'll be the hurt child, without protection, all over again
And I can't take it.
I can work through all this. When I tap into my own strength, then I recover my baseline empathy and compassion, which includes for therapists.
I think it's key to not be ABOVE others, when you feel compassion. It's not because we're more sensitive and compassionate than anybody else. It might be, sometimes, that we feel even that so intensely, that it's disabling. We can hold it out but need to clamp onto the dock intentionally. While others might be able to extend and retrieve, with more naturalness.
Sea said something so helpful to me on my other thread, about "drowning in empathy not being helpful." It was "drowning" that made me think. Or a word to that effect.
Empathy isn't supposed to drain us, but I think Nsurvivors build all sorts of brittle walls, or shell layers. Because as intense as our fear and pain was, equally intense is the empathy we can experience as adults...and that can be just as overwhelming as the original hurts.
So if my T is dealing with something personal, it's a test of my healing. Can I allow this person to move in and out of roles a bit? Can I contemplate their humanness and ordinary life, including failings, and still trust?
For me, when 90% of the time a T is solidly there for me, if the 10% appears, I now see it as a welcome reminder that I am not just AT an appointment to get that service performed (the paid-for listening)...but I am also WITH A PERSON. And if they need some time to just be that person...it is better for me than if I keep them in a rigid "professional" box to keep me safe.
I have to risk the unsafe feeling of trusting, for it to eventually become a safe one. I have to experience, over and over, that I can take these risks with others. That my brother is never coming back into my life. Nor are my childhood bullies.
So I hope, in whatever way you can work it out, that you find you are not a helpless victim merely-patient in your role as client, but also as a co-human being. You are a surviving and healing adult. And it took you great courage to seek help for your troubles.
As it took them courage to take on that career.
You are not "lesser than" your therapist, so you don't have to protect them from you, or protect yourself from them. Bad ones are rare, and you DO have the capacity to intuit who is safe for you.
love
Hops
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Oy, yes.
Tupp, sounds like that to really let someone "in" -- you'd have to risk being disappointed.
Because I think for some Nsurvivors, when people let us down, it's disproportionate disappointment we feel.
Well, I should speak for myself...that's healthier.
I think I react badly to being let down sometimes because:
1) I was raised to be judgmental so that reflex kicks in when I'm hurt, instead of "I am feeling hurt"--it's protection
2) When someone I'm investing with so much authority/competence (as compared to my own) shows insensitivity or less competence/commitment--it's like, on some level I'm not conscious about, a reminder of how my own earliest "protectors" let me down--and that feels like disaster, like a confirmation that there is no safety in the world
3) So I'd best not start trusting or allowing others to be imperfect or...I'll be the hurt child, without protection, all over again
And I can't take it.
I can work through all this. When I tap into my own strength, then I recover my baseline empathy and compassion, which includes for therapists.
I think it's key to not be ABOVE others, when you feel compassion. It's not because we're more sensitive and compassionate than anybody else. It might be, sometimes, that we feel even that so intensely, that it's disabling. We can hold it out but need to clamp onto the dock intentionally. While others might be able to extend and retrieve, with more naturalness.
Sea said something so helpful to me on my other thread, about "drowning in empathy not being helpful." It was "drowning" that made me think. Or a word to that effect.
Empathy isn't supposed to drain us, but I think Nsurvivors build all sorts of brittle walls, or shell layers. Because as intense as our fear and pain was, equally intense is the empathy we can experience as adults...and that can be just as overwhelming as the original hurts.
So if my T is dealing with something personal, it's a test of my healing. Can I allow this person to move in and out of roles a bit? Can I contemplate their humanness and ordinary life, including failings, and still trust?
For me, when 90% of the time a T is solidly there for me, if the 10% appears, I now see it as a welcome reminder that I am not just AT an appointment to get that service performed (the paid-for listening)...but I am also WITH A PERSON. And if they need some time to just be that person...it is better for me than if I keep them in a rigid "professional" box to keep me safe.
I have to risk the unsafe feeling of trusting, for it to eventually become a safe one. I have to experience, over and over, that I can take these risks with others. That my brother is never coming back into my life. Nor are my childhood bullies.
So I hope, in whatever way you can work it out, that you find you are not a helpless victim merely-patient in your role as client, but also as a co-human being. You are a surviving and healing adult. And it took you great courage to seek help for your troubles.
As it took them courage to take on that career.
You are not "lesser than" your therapist, so you don't have to protect them from you, or protect yourself from them. Bad ones are rare, and you DO have the capacity to intuit who is safe for you.
love
Hops
I think I'm the opposite, Hops, because I'm paying for them to listen that's what I want them to do! I don't really want to see them as a person, I want to be able to spill and either recieve some good advice or tips for coping/managing etc or just be able to work it out myself (the way you do sometimes when you say things out loud and for some reason the solutions are clearer than when they're in your head). To me it's like any other service I'm paying for, I want them to do what I'm paying them to do, particulalrly as it's so expensive and the time you have in there is so limited. I don't want to spend any of it listening to them talk about themselves. I don't think I'm as compassionate as you are! xx
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Well, I've experienced you as very compassionate, Tupp.
I'm sure you know your own needs and what works best for you better than anybody else could, especially including me.
I hope you find the right new T soon, because you deserve excellent listening.
love
Hops
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Well, I've experienced you as very compassionate, Tupp.
I'm sure you know your own needs and what works best for you better than anybody else could, especially including me.
I hope you find the right new T soon, because you deserve excellent listening.
love
Hops
That's very kind of you to say so, Hops, I don't feel compassionate, I feel like a grumpy old bat most of the time. But it's nice to know it doesn't come across like that always. It's a really interesting thread, I'd never thought about it before. I've had two really good therapists who've helped me enormously and I did end up knowing bits and pieces about them. Listening is an amazing skill, isn't it? Sounds very passive but is actually very empowering for the other person. Did your doggie door get installed the other day, is your pooch loving it? xx
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Aww, feel free (to be a cranky old bat).
I have been irritable lately too, offshoot of a week of depression.
It's clearing up now, some walks in bright sunshine and a good
session with my own T.
And yes! Dog door's in and pooch seems so much more relaxed
when I get home. Clearly not in distress. I would love to know
how much time she spends outdoors. I don't think a lot but
it's great to see how much more comfortable she is when I
have a long workday. (Three days/week I'm gone for 10 hours,
which is rough on her.) But this morning we walked a couple
miles with my friend before I went to work, since Mondays
are my "late day". Fridays, too. So it all evens out.
Have a happy Monday, Tupp.
xo
Hops
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Aww, feel free (to be a cranky old bat).
I have been irritable lately too, offshoot of a week of depression.
It's clearing up now, some walks in bright sunshine and a good
session with my own T.
And yes! Dog door's in and pooch seems so much more relaxed
when I get home. Clearly not in distress. I would love to know
how much time she spends outdoors. I don't think a lot but
it's great to see how much more comfortable she is when I
have a long workday. (Three days/week I'm gone for 10 hours,
which is rough on her.) But this morning we walked a couple
miles with my friend before I went to work, since Mondays
are my "late day". Fridays, too. So it all evens out.
Have a happy Monday, Tupp.
xo
Hops
Ah, that's great, I bet she loves it! Even if she's not outside much it's good to know she can get out when she wants to. I expect the change of scenery does her good. I've always had this little story with my boy that our cat gets all her friends round when we're out and has a party. It started after a trip to the vets when she was a kitten. I took her to get her neutered but knew telling my son that she was having an operation would really upset him, so I told him she was going to a party with her kitten friends there. For some reason I assumed they went in underneath the cat to do the op, so he wouldn't see the scar. But they go in on the side, so when we picked her up she had a shaved patch and some stitches - I told him she fell off the bouncy castle! Bless him, he told everyone that story for ages, and since then the party theme has continued :)
I hope you've carried on having a better week. Sunshine really does help, I find. Monday was good, thanks! You have a Happy one, too xx
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Thank you, Tupp.
I swear, I have a strong suspicion that she's outside at dawn and rather than chasing off the deer, I think she's wagging her tail and wandering the yard with them, pointing out the most succulent plants.
:lol:
Hops
(Sorry for the digression from the thread topic, Doc G!)