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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Dr. Bob on April 17, 2004, at 11:02:41
In reply to the inconsistent therapist, posted by paltiel on April 16, 2004, at 9:31:56
> Have you ever worried about your therapist being inconsistent - maybe having an off day, or in a bad mood, or with a sick kid? Me, too. I'm a therapist, and I'm planning a talk on this topic.
>
> I'm looking for references on this - books, articles, even printed first-person or fictional accounts. Is there anything out there? Let me know - thanks.
>
Posted by terrics on April 17, 2004, at 12:06:56
In reply to the inconsistent therapist « paltiel, posted by Dr. Bob on April 17, 2004, at 11:02:41
Some therapists are so good they are rarely inconsistent. I think it is the younger ones that don't have the discipline to separate work from their lives. Do you know the suits scientists put on to deal with deadly organisms?And On top of that they have to be so careful with their work that one mistake can cause them their lives? Their minds do not wander. In a way therapists have to be like that if they want to be good. It is a discipline that should be taught to therapists in school. terrics
Posted by DaisyM on April 17, 2004, at 15:06:18
In reply to Re: the inconsistent therapist » Dr. Bob, posted by terrics on April 17, 2004, at 12:06:56
I think honesty about being off is really important. I know Therapist don't want their clients having too much information, or even, worrying about them, but if a client senses distraction, they might think, "gee, I'm boring." OR, if clients sense distress, they might think they've caused it. I don't think you can underestimate the level of perception a client develops for their Therapist. Simply saying, "I'm sorry if I'm a little off today, I have a number of personal issues that are crowding our space" makes the Therapist more human.
Additionally, I think another inconsistent factor should be addressed. Most people go to therapy once a week. What happens at their session stays with them until the next session. They mull it over, think about the emotions, what was said, etc. Some sessions are especially intense, with either anger or frustration being expressed. Intellectually, we all know that our Therapists have other clients and their own lives. So it isn't reasonable to expect that the level of emotional intensity can be maintained into the next session. But I think that a Therapist should be very aware what the feelings were like at the end of the session, and at the very least, acknowledge those at the beginning of the next session. Otherwise, the client often feels like they were either over-reacting, misreading things, or both. That isn't to say that the client might not be overreacting. But to just "start fresh" in the next session can sometimes make the client feel like their Therapist doesn't remember what happened from week to week OR doesn't think about them or their sessions at all, except during the allotted time. This can make clients feel devalued and more or less like "just a paycheck".
Just my two cents...
Daisy
Posted by pegasus on April 17, 2004, at 17:48:57
In reply to the inconsistent therapist « paltiel, posted by Dr. Bob on April 17, 2004, at 11:02:41
The part of my own therapy experience that your request makes me think of are the tiny little inconsistencies that are inherent in therapy. For example, the therapist attempts to create an atmosphere of unconditional positive regard and caring, but then watches the clock, and requires payment. So, the caring and regard obviously are conditional at least with regard to time and money. In my experience this is rarely acknowledged, and rather confusing, although understandable from a practical point of view.
Or, here's another example: It's acknowledged by everyone involved in therapy that the relationship between therapist and client is critical, and building a sense of trust within that relationship is perhaps the most important job in therapy. But then, therapists move, they get sick, they change their practice, they cross boundaries, and clients move, lose faith in therapy, find other therapists, etc. So, in reality, none of us can be trusted to stick it out. And yet, we persist in seeing the development of client-therapist attachment and trust as a unquestionably positive thing.
Stuff like this is what gets to me.
pegasus
Posted by fallsfall on April 17, 2004, at 22:02:02
In reply to the inconsistent therapist « paltiel, posted by Dr. Bob on April 17, 2004, at 11:02:41
Your question makes me think of Kohut's phrase "optimal frustrations". Therapists are going to make mistakes, for any number of reasons. They are human, and humans make mistakes (except for me, of course). These mistakes and how they recover from them, and how we survive them are part of what makes therapy a learning experience. Parents make mistakes, too - and it is in learning to deal with our parents' mistakes that we learn to handle things on our own. Therapist's mistakes help us in the same way.
Now, the phrase does have the word "optimal" in it. If there are too many frustrations, then it can be too stressful. If there are too few, then you don't learn anything.
I think that it is important when a therapist makes a mistake that they ackowledge their mistake. I know that I am very perfectionistic, so it is important for my learning to see my therapist model making a mistake and surviving it.
You asked about "inconsistency", and I talked about mistakes. I pretty much see them as the same thing. If you see them differently, I would be interested to know how you think they are different.
Posted by deirdrehbrt on April 17, 2004, at 22:42:04
In reply to Re: the inconsistent therapist - paltiel, posted by fallsfall on April 17, 2004, at 22:02:02
I have worked with a number of therapists, at least six. I had one who was never inconsistent, but then again, she never said anything. She was mostly a parrot. There was no conversation except rephrasing my statement as a question. There was nothing in what she said to help me explore or understand. She was also quite young.
I have worked with two who I consider to be exceptional, and I'm currently with one of them. Both of these people have extensive experience with trauma and child abuse, both of which have influenced me greatly. Both of them have at least 30 years of experience, and one teaches at a fairly local college.
One of these I consider to be very consistent. I have only witnessed one mistake, and when she noticed it, she apologized. This mistake was that I first started seeing her for gender identity disorder, and during that time, I had to have at least one joke per session. I was always in a good mood when I saw her. I was always jovial. She never called me on the humor.
I left her for a time to see the other really good therapist. With her, there was a dual relationship starting, where she would make use of my typing skills, and programming skills in exchange for therapy. Still, I never noticed anything that seemed overtly inconsistent. I began though to have, or rather notice, some hallucinations. It affected my driving, and as she was some distance away with no transit busses available, I needed to see someone closer.
I went back to the previous therapist. This is where the inconsistency, or error became apparent to her. I had at this point been hospitalized for depression. She realized that my good mood and humor were defense mechanisms. Thinking, at first that the only issue was the gender identity problem, she didn't look very hard for more. I think though that had she, I would have still would have kept the other issues from her. Not because I wanted to, but because I wasn't supposed to be sick. She promised to not let me get away with anything this time. I love her.
Dee.
Posted by Pfinstegg on April 18, 2004, at 12:05:45
In reply to Re: the inconsistent therapist - paltiel, posted by deirdrehbrt on April 17, 2004, at 22:42:04
Even though my T is extremely experienced, steady and reliable, he does rarely make a "mistake". One time, I asked for a bit more support on something that was very painful, and he apparently felt criticized. I could feel him becoming a bit withdrawn, whereas he's usually so empathic and "there". I commented on that, and he agreed that I had hurt his feelings a little. We spent a LOT of time over this interaction, with him being very honest and owning up to his feelings, and me going through various stages of anxiety,self-condemnation, feelings that I had somehow *ruined* the therapy to eventual forgiveness, understanding and re-connection. Looking back, it's the tiniest thing, but while we were going through it, it seemed momentous. And I learned a lot-principally that part of his caring about me is that I can hurt him- and, because I care about him, he can hurt me, too. I think it is tiny incidents like this which help us learn, bit by bit, to really trust, even though things aren't (and can't be) perfect - they are real, though, and you always get another chance. And, nearly all of the time, the Ts' are *there* for us in ways in which no-one else can be
Posted by Racer on April 18, 2004, at 15:25:39
In reply to the inconsistent therapist « paltiel, posted by Dr. Bob on April 17, 2004, at 11:02:41
I don't know about inconsistency, but I can tell you that I'm having a hell of a time lately with therapists who just don't pay attention to what they say! With the sensitivity of the therapeutic relationship, patients can be devastated by offhand remarks, or hear something implied that is not necessarily the message the therapist is trying to send.
For example, one of my recent therapists mentioned that my pdoc said that I was "hypervigilant" about side effects of medication. Well, maybe I am. The problem is, once I heard that in increased my fear of discussing my medications with the doctor. Mind you, it was second hand -- I don't really know what he said, after all -- and it probably wasn't meant as a put down, but I experienced it as a way of saying that my experience of the medications wasn't relevant. Guess what? I'm too afraid to go back to the doctor now. I try to tell myself that -- hypervigilant or not -- what I feel is real, and deserves to be taken seriously, but I just can't make myself go back in there. I don't think the therapist meant to send that message, do you?
I guess what it comes down to is that there are three elements to communication:
1. What is meant by Party 1
2. The words said by Party 1 and heard by Party 2
3. The message received by Party 2These three things can all be different, and this dynamic does matter. It's all well and good to say that words don't matter, or that communication should be free and easy and not involve a lot of thought, but you know? The reality is that a lot of us hide how devastating what we receive is to us, and each of these little blows can build upon others until we just can't open up and trust in a therapeutic relationship anymore.
That's pretty much where I am at this point, and it's frustrating, it's frightening, and it didn't have to get to this point.
So, there's a little bit of a view from the other side of the couch.
Posted by Asya on April 18, 2004, at 19:50:21
In reply to Re: the inconsistent therapist, posted by Racer on April 18, 2004, at 15:25:39
Sometimes my T has off-days, and seems less focused on me than at other times, forgets certain details of things that are important to me, or just generally leaves me feeling hurt and dejected. This doesn't happen too often, and in the 9 or so months of therapy, I've come to learn to live with the ebb and flow of the therepeutic relationship.
I truly believe (and someone has said this on here before) that the therepeutic relationship is reflective of a microcosm of sorts of life. it is a safe way of explroing the phenomena that occur in real life and learning to deal with them. This exploration occurs most consciously through talking and less consciously through the development of a relationship with this other person.
I realize I have become quite attached to my therapist, am hurt when he seems disinterested, and perceive when he's having an off-day. So the therepeutic relationship is a great safe place to learn how to deal with the inevitable ebb and flow that is human interaction. It is precisely because therapists are human that they can help us, and what we have to accept is that because they are human, they can also hurt us. To erase inconsistency from the equation would deny the patient the richest experience of all.
Posted by deirdrehbrt on April 18, 2004, at 20:56:04
In reply to Re: the inconsistent therapist, posted by Asya on April 18, 2004, at 19:50:21
The way that therapists put things can really make a difference. Fallsfall has posted on this before, and maybe she can repost her thoughts.
I know that I internalize things and often don't tell people when they hurt me. I'm doing better at letting my T know about that, and usually I can do it before the next session.
My T doesn't taked notes unless I ask her to. She doesn't like to have alot of paperwork around; it keeps her from having to provide any records of a patient's sessions to police, etc. She offered to take notes for me because sometimes I don't remember the sessions.
I think it takes some time and struggles to create effective communications. If it's difficult for people who love each other to communicate, it can be for a patient and her T. If we are new to our T, or if we haven't been communicating as well as we should, this needs to be worked out or the sessions will be less effective. It took me over a year before I had a meltdown and she realized that what was going on in the sessions wasn't what was going on inside me. Then we worked like hell to get me to open up. It was hard, it was a long process and now things are better. It's easier for me to talk, and it's easier for her to know how I'm really doing.
This is the end of the thread.
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