Respecting patients in therapy means enouraging their interpretations -- not mine


You typically have a breathtakingly honest approach to sensitive issues but I feel this week (8/19) you held back. Why would you pose such a perfectly blunt question then skate around the issue by providing an out for her to not face the answer? You asked L., "Why would anyone hold on so tight for so long to nothing?"

L. reminds me of a time in my life where I was incapable of expecting and demanding more. What I've learned is that when you don't know and value your own worth, you quickly settle for silently begging for the love and respect that should be freely given.
 
She already knows the type of man her husband is. She can't change him, she can only change herself ... love and respect herself more. She must find out why she believes she isn't worthy of real love and turn it around to where she does not settle until she gets it. T., Las Vegas

For you, T., sounds like blunt would sound more like this: "L, love and respect yourself more because the reason you're stuck and won't let go of nothing is because you lack sufficient love and self-respect!"
 
Never once in my career as a therapist have I told someone to get married. Or to not get married. Or to stay married. Never once have I told someone to get a divorce. Or not to get one. Not even in drastic cases, like, domestic violence.

Here's the deal ...

It's disrespectful. Such discourse inflates the role of therapist and diminishes the expectations we should rightly have for our patients.
 
Even if I'm certain my patient's behavior is a pathology, I'm reminded that everyone attaches themselves sooner or later to behavioral pathology. Including me. Unless it's an eminent danger to self or others, my job is to invite the patient to examine the behavior. It is not my job to advise, cajole, or scold the patient via my own prejudices of what constitutes behavioral health. Same goes for interjecting unsolicited interpretations of behavior.

This restraint on my part is a fundamental way I RESPECT my patient.

So, I thought I was pretty blunt just saying out loud what she already knew: She was holding on to nothing.

T., you say that "L. reminds me of a time in my life where I was incapable of expecting and demanding more. What I've learned is that when you don't know and value your own worth, you quickly settle for silently begging for the love and respect that should be freely given."

If you were a first semester practicum student and I was your supervisor, here's what I would say to you:

Good for you! You have the acumen to be aware of your own countertransference. That's the word we use to describe what happens when a therapist begins to notice their own life reflected in the content of the patient. Nothing wrong with that. Deployed skillfully, it can actually be a helpful part of the therapy.

But, do you have sufficient data to KNOW THAT YOU KNOW the central issue is the L's "incapability?" See, I don't think so. It could be just as likely that the ugly dilemma is fueled by something more positive. To wit: Betrayal, inconstancy, and ambivalence can, for a while, completely paralyze even people with terrific self-esteem and self-respect. These relationships are "crazy-making" but that doesn't necessarily mean WE'RE crazy.

Living and loving in such insanity, our very character and values start to work against us. It is precisely our depth of commitment overriding the deeper voice that screams: "You're mate is a schmuck/loser! Run like hell!"

Betrayal is like a sudden death. Ever hung around people who have lost a loved one to sudden death? Takes them sometimes a couple of months just to believe it. But their slowness to grasp reality is not evidence of lack of self-esteem. So it is with betrayal. Our slowness to grasp the reality of the betrayal and its implications are, ironically, a function of just how much we trusted.

Now, again T., you could be right. Maybe L is a woman without sufficient self-respect and self-esteem. But still, I'm not going to mess with her future or her destiny ... and certainly not her right to autonomy.

In the meantime, she's free to hold on to nothing as long as she chooses. And THAT'S the blunt message I AM willing to deliver. She is choosing.