Posted by deborah anne lott on July 28, 2005, at 20:38:46
In reply to Re: Lott, Obvious question, posted by daisym on July 28, 2005, at 10:35:17
Thanks for your question, Daisy. First off, I'm thrilled to be psych-babble's guest author. I think the bulletin board is terrific (I've been eavesdropping from time to time) and that clients sorting things out with other clients is often the best way to get information and support.
Since I'm going to be a bit inaccessible from August 1-2, and since you've already posted lots for me to respond to, I've suggested to Dr. Bob that I might stick around till maybe the 4th or 5th of August, if you'll have me.
Daisy, I don't find your question at all obvious,and if anyone else out there is hesitating to ask a question because you think it's "obvious," please take the leap of faith. I love what I call the "emperor has no clothes" kind of questions -- I think we all go around thinking everybody else knows something we don't and so don't ask some of the fundamental questions we need to keep asking. In the interviews with clinicians that I conducted for my book, I'm sure that a lot of clinicians thought I was being "dense" or "lame" because I questioned EVERYTHING. So ask away . . .
As for therapists' reactions to my book, I haven't actually been invited to address that many groups of therapists. That alone may tell us something about how therapists react to a non-clinician commenting on how they do their work. On a one-on-one basis, however,therapists have been very supportive of the book, and have thanked me for it. Some have advocated that all therapists should read it and it is being used in some clinical training programs. Whenever I get into a conversation with therapists about boundaries and transference issues, they agree wholeheartedly with the messages of the book. They all think that they are the "good therapists" and it's their colleagues who have bad boundaries or don't understand the transference. But then these same clinicians will sometimes say something to me that indicates an attitude more casual or cavalier about a boundary or transference issue that indicates to me maybe they don't totally "get it." Or that they still attribute intense feelings to the client's pathology. I would say overall that a lot of them still underestimate the extreme importance and delicacy of these issues to their clients, and how much a word or a look can matter.
In terms of learning from their own experiences as clients and extrapolating that to their experience in the room as therapists, I'm not sure what happens. I think it's possible that some don't have strong feelings or attachments for their own therapists -- not everyone does, and not everyone does for every therapist. Another possibility is that they never resolve their own feelings and so don't really know how to work through the feelings of their clients. Or perhaps they understand a particular kind of feeling, but are threatened by others. If you don't know how to handle something, sometimes it's easier to deny it or hope that it will just go away.
As to training in "bedside manner," the trend in psychotherapy is towards "manualized"(based on a how-to kind of book) cognitive behavioral therapies. These work to change the thought-feeling-belief-behavior connections in the here-and-now. They are not so concerned with the past,and generally they conceptualize the therapist-client relationship as one of teacher-student and don't put a lot of focus on the transference. As you probably know, the HMOs and insurance companies don't want to pay for long-term open ended therapy and are encouraging the adoption of these shorter, more results-oriented models.
From my perspective, something is lost in therapies that don't give more weight to childhood, and don't work with the transference potential of the therapist-client relationship. On the other hand, the cognitive-behavioral proponents argue that there is scientific evidence that these therapies are "effective" (of course, we can ask those emperor has no clothes kind of question about whether what they consider "effective" is what we consider effective, and if the "effects" last beyond the ten or twelve weeks when they measure them) and that clients are less likely to get bogged down in therapies that go on interminably. But what happens when the client develops strong feelings that arent' described in the manual? Do cognitive behaviorally oriented therapists know what to do? I'm not certain that they do at all.
I'd be curious to know what kind of therapy those of you who feel the transference has been handled badly were/are in? Was the model cognitive behavioral or more psychodynamic/psychoanalytic? I'm moving on to the next question.> Your book is recommended over and over again here, from client to client. I'm wondering if you've had opportunities to talk to groups of therapists and get feedback as to how they feel about the book. Especially therapists in training.
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> It seems that the medical profession is moving more towards training psycho/social skills (bedside manner and all that) -- do you think the mental health field is?
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> And I just can't figure out why therapists, who have to go through their own therapy as part of their training, don't know from experience how clients come to feel about their therapists. You'd think it would make them extra-sensitive to these attachment issues.
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> Thank you for considering my questions,
> Daisy
poster:deborah anne lott
thread:534691
URL: http://www.dr-bob.org/babble/psycho/20050725/msgs/535045.html