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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 50 to 74 of 84. Go back in thread:
Posted by Susan47 on December 5, 2004, at 22:06:26
In reply to Re: simcha, posted by messadivoce on December 5, 2004, at 17:15:26
I agree with the last poster that it would've helped me to know what was going on in therapy. As people, we are *not* all the same and there are many many ways of thinking and approaching things, also many ways of interpreting and living through feeling.
I disagree with the theory, used in therapy as discussed above, that it's in the patient's best interest to hide disclosure of psychodynamic dynamics (Heeheehee, Susan you're a nut....
Posted by simcha on December 5, 2004, at 23:46:41
In reply to Re: simcha, posted by Susan47 on December 5, 2004, at 22:06:26
Yes,
And consider this... When you go in for surgery (and the analogy is apt for therapy for those of us who have walked the path) the surgeon explains what they are going to do and what you might expect. Yet, in the end, each person is different and the effects in recovery vary greatly. They can't predict it. Neither can therapists.
Some things must be held by the therapist until the client's ego structure has grown enough to be able to handle what is actually happening.
Like denial: It is not my job to pop someone's denial. It is my job to explore all of the detrimental debris of the tornado that is really in the room that the client can't see. It is a lack of respect for the client for me to point at the tornado and tell them that that is the monster that they MUST deal with to get better. It's much better and it honors the client's own ability to heal to hold certain things.
Those of you who have gone on-line and investigated are brilliant. That is precisely what the therapist is looking for. You find your way to wellness. We are guides. Guides on quests do not reveal the goal and the place where the querant is going. That would be arrogant. The guide may be wrong in their own judgments.
I honor my clients' abilities to heal themselves and walk their paths with them. I might point out a stone or a tree or a bramble along the way, but it is not my job to blow away coping techniques that have allowed many clients to cope most of their lives just fine without me.
The coping mechanisms have become maladaptive. It is up to the client to see that and to develop the new more adaptive mechanisms with the therapist's guidance.
We walk on a knife's edge in the room with clients. And yes, we make mistakes. I do in every session. And I point them out to the client. That way they can see that I am human too and I'm not some guru with all the answers coming from an infallible theory.
I never know the way therapy will turn out. If I did know, I would be arrogant and a terrible therapist.
Just my 2 cents....
I hope I have not offended anyone.
I've been in the client chair for ten years. Now that I'm on the other side and I've had almost three years of grad-school I can see why my therapists did not point out certain things to me at certain times. There were times I was not ready to let go of a coping mechanism. I was surviving using that maladaptive coping mechanism. If the therapist were to make me aware of it and take it away from me too soon without helping me find a new coping mechanism I don't know that I'd be writing these sentences....
So, I hope that I have not come across as some "know it all." After all, I've been at this only three-ish years. It takes at least a decade to become more sophisticated. And the good therapists I know tell me that they still have doubts about their abilities.
Simcha
Posted by messadivoce on December 6, 2004, at 0:16:37
In reply to Re: simcha, posted by simcha on December 5, 2004, at 23:46:41
Hi Simcha,
I liked your reply. However, I'm not sure all T's like it when clients research on the internet. I know that I did a bunch of internet research and when I told my T, he rolled his eyes (because he was afraid of all the wacky info I might find). I found his response kind of annoying b/c I felt like he had put me in the position of ignorance and I had to fend for myself.
I know that I had a bunch of maladaptive coping mechanisms, and when my T pointed some of them out, it was really rough. But I was glad he did so...it helped jolt me out of the mediocrity I was in. But that's just me, I know that a lot of people handle things differently.
Honestly, I've always been a huge advocate for consumer's rights, so that's kind of where I'm coming from. I guess I figure if I'm thoughtful enough to want true, deep answers about my treatment, I should get them. But again, I admit that may not be right for everyone in their treatment situations.
It's interesting to hear someone's point of view who is a T. And I liked what you said about the discipline being in adolesence. I had never thought of that.
Posted by dawnfawn on December 6, 2004, at 6:36:30
In reply to Re: simcha, posted by messadivoce on December 6, 2004, at 0:16:37
I have been following this thread and I would like to say just a few words: Let's look at mental illness the way all the Ts currently say we should. It is an illness not something to be ashamed of but something to work out with medicine or talk therapy. Ok, everyone, got it. It is not like in the dark early days a secret only attended to by shaman like people who hold the solution to secrets in their own brains and methods. Well now if that is true---why should any of us as clients, patients, etc. have to undergo arcane approaches that further generate fear and misunderstanding? Put another way would you consistently wait and wait for a dentist (or any other type of doctor)? Would you wait while the doctor went over notes for ten or fifteen minutes to see what he/she was doing. Would you undergo a procedure that you were told nothing about to clean your teeth? Better yet would you not even know that you were having your teeth cleaned? Would you take medication without knowing its true effects or if it even worked? There are further analogies here but we all get the picture. The day of the mystical all-knowing father figure (Freud, Jung, etc)are long gone. Some of the stranger elements in therapy really need revision and patient input. Unless the patient has no grip on reality (psychotic) then input into treatment and methodology should really be taking place.
Posted by littleone on December 6, 2004, at 14:13:16
In reply to Re: simcha, posted by messadivoce on December 6, 2004, at 0:16:37
> I know that I had a bunch of maladaptive coping mechanisms, and when my T pointed some of them out, it was really rough. But I was glad he did so...it helped jolt me out of the mediocrity I was in.
This may be true, but I think part of what you're missing in simcha's message is that timing is everything. It's possible that your T identified these maladaptive coping mechanisms very early on in the piece. But it is unlikely that he pointed them out to you in the first session. I bet he waited until you got to a stage where you were ready to be jolted. You may not have been consciously aware of this readiness, but he would pick it up from things you said/did.
If this is the case, then this is like one of the stones or trees that simcha's pointing out along the away.
Thanks for your message simcha. You articulate yourself so well.
Posted by Susan47 on December 6, 2004, at 17:41:40
In reply to Re: simcha, posted by simcha on December 5, 2004, at 23:46:41
I got as far as a therapist holding, and can't read any longer. Shite. Okay, I hurt and have to say that, don't care if I'm vilified.
Posted by Dinah on December 6, 2004, at 19:28:05
In reply to Re: simcha, posted by simcha on December 5, 2004, at 23:46:41
I think a wise therapist should probably judge disclosure on a case by case basis. My therapist could have probably saved us both a bit of grief by demystifying things a bit. He didn't respond to my tentative questions, and I was too embarassed to go further until I did tons of research. Now mind you, I probably would have done the research anyway because I don't like the idea of someone mucking about in my brain without my knowing how. :) But I picked up a lot in my internet research that still causes me shame. If my therapist had been a bit more open, perhaps some of that stuff wouldn't have found such a foothold.
I think he regrets that now. He's way more open now than he was, and he still gets irritated when I quote the anti-whatever sites.
Posted by Dinah on December 6, 2004, at 19:30:34
In reply to Re: simcha, posted by Dinah on December 6, 2004, at 19:28:05
I kept my research my biggest darkest secret of all. It was somehow way more embarassing to admit than anything in my personal life or history.
Posted by Dinah on December 6, 2004, at 19:32:34
In reply to Re: But of course, posted by Dinah on December 6, 2004, at 19:30:34
It might be a good idea for a therapist to put out feelers every once in a while to gently inquire about outside research. I'm sure I'm not the only one embarassed that my psych libary is probably bigger than my therapist's or that I subscribe to professional magazines. (He STILL doesn't know that!)
Posted by messadivoce on December 6, 2004, at 20:33:56
In reply to Oooh, that leads to a DO, posted by Dinah on December 6, 2004, at 19:32:34
Posted by simcha on December 6, 2004, at 23:32:33
In reply to Re: simcha, posted by messadivoce on December 6, 2004, at 0:16:37
Thanks for your thoughtful reply.
I actually love an educated client. When a client is searching out answers I know that they are getting better.
I think that some therapists are insecure about their expertise and think that therapy should be some sort of secret. I don't like that. Then again I come from a Holistic perspective. I'm kind of a radical in my field.
Also, seeing how some clients look up information and apply it to their own situations is very diagnostic. Hypochondriacs are easier to spot this way. Sometimes a client may diagnose themselves improperly. I tend to err on the side of client education. When I was starting therapy ten years ago I read everything I could about what I was experiencing. This helped me and my therapy.
I've had many a psychiatrist roll their eyes when I give them information about medication that they would rather that I don't know about.
Also, there are some pretty crappy sites out there about psychiatry and psychology. Generally these are infiltrated by scientologists who hate psychiatry and psychology. They call it quackery.
So, this site is actually very excellent as a source for reliable information. WebMD is another good source. NIMH has a great site too. Be careful out there. Not all that is written anywhere is true.
Also, I'm humble enough to know that I can be wrong too. So, I do make mistakes with clients and I acknowledge them. There are limits to what we know about psychology and I acknowledge this with clients. Sometimes when I don't know the therapy is about sitting in the "I don't know."
Simcha
Posted by simcha on December 6, 2004, at 23:39:48
In reply to Re: simcha, posted by Susan47 on December 6, 2004, at 17:41:40
Susan,
I'm so sorry you are hurting. I hope that I'm not offending you. I'm just trying to tell you my experience.
I'm more than willing to be wrong. I'm a trainee. I hope I never lose the willingness to be wrong. A little humility is a great therapeutic tool and a sign of a good human being, in my humble opinion.
So, please hang in there.
Also there are a lot of very bad therapists out there unfortunately. They make it more difficult for the profession to really advance. Unacknowledged mistakes fester and give us no chance to really make the profession better.
I'm sorry if I'm no comfort to you here.
Blessings,
Simcha
Posted by simcha on December 6, 2004, at 23:46:55
In reply to Oooh, that leads to a DO, posted by Dinah on December 6, 2004, at 19:32:34
Dinah,
All I say is go! Read, watch, and learn. Many of us who are becoming therapists started in the client's chair. I truly believe that those of us who have walked through fire and know what it is like and have made progress make the best therapists.
Who knows? Maybe you might be starting an MA degree in the near future. I say, go for it! We need educated consumers in this field. Heck, doctors try to educate people about their physical syndroms. It only makes sense that we therapists should expect that our clients educate themselves.
I know that some therapists find an educated client a threat. That shows me that the therapist has some work to do on him or herself, in my humble opinion.
I go to therapy every week. I take my meds. I will never stop going to therapy so long as I see clients. My clients are like mirrors sometimes showing me parts of my psyche that I did not know needed work. I think that a therapist who is not willing to do self work is not a very good therapist. There would be too much projective identification in the room if I did not sort things out with my therapists and collaborate with other professionals.
Blessings,
Simcha
Posted by Dinah on December 8, 2004, at 11:52:38
In reply to Re: Oooh, that leads to a DO » Dinah, posted by simcha on December 6, 2004, at 23:46:55
My son's new play therapist has a great opening handout that, among other things, discusses the therapeutic relationship.
It explains that therapy feels like an intimate personal relationship but that it is a professional one confined to the hours that she is paid to be there. That contact should be confined to that time and that clients shouldn't try to contact her in extratherapeutic ways through inviting her to personal events or giving her gifts or a few other examples.
It was clear, yet nicely worded, and given at the beginning of the therapeutic relationship when no attachment had been formed.
I liked that.
Of course, on the other hand, my therapist may have given me something similar nearly ten years ago and I blew it off. :))
Posted by Dinah on December 8, 2004, at 11:53:05
In reply to I've just experienced a do » simcha, posted by Dinah on December 8, 2004, at 11:52:38
Posted by Daisym on December 8, 2004, at 12:29:50
In reply to I've just experienced a do » simcha, posted by Dinah on December 8, 2004, at 11:52:38
hmmm...I just sort of shivered reading those words.
I like the way she was straight up about gifts, ect. but I think the "confined to the hours I work" would give me pause. It would reinforce my "don't bother anyone" sensibilities. And I'm pretty sure that if I read something like that at the beginnning I would have simply thought, "well sure, of course." But having been "bowled over" (someone else's phrase) by therapy feelings in a way I never expected, that piece of paper would stand in conflict with what I was being told (call me).
*sigh* I guess I want my cake and to eat it too.
Posted by simcha on December 8, 2004, at 17:26:48
In reply to Re: I've just experienced a do, posted by Daisym on December 8, 2004, at 12:29:50
Here is my policy:
I let my clients know that I check my phone messages 4-6 times per day. I can get back to them within a couple of hours usually. Or if it's late at night, the next morning.
I will talk to them for 5 minutes if it is not an emergency. If it's an emergency we talk for 10 minutes. If the emergency cannot be resolved in 10 minutes over the phone we schedule an extra appointment hopefully within 24 hours...
I have been taught to remain available to my clients and to keep boundaries professional. It's kind of like being a willow bending in the wind as opposed to an oak that will snap in a nasty gail.
Simcha
Posted by pinkeye on December 8, 2004, at 17:50:34
In reply to Re: I've just experienced a do » Daisym, posted by simcha on December 8, 2004, at 17:26:48
Simcha,
this is a general question. What do you feel about clients who need you too much or become emotionally dependant on you and want to contact you a lot ? Do you feel they are a nuisance? Also do you respect them or think they are a nuisance? Do you like your clients?
Pinkeye
> Here is my policy:
>
> I let my clients know that I check my phone messages 4-6 times per day. I can get back to them within a couple of hours usually. Or if it's late at night, the next morning.
>
> I will talk to them for 5 minutes if it is not an emergency. If it's an emergency we talk for 10 minutes. If the emergency cannot be resolved in 10 minutes over the phone we schedule an extra appointment hopefully within 24 hours...
>
> I have been taught to remain available to my clients and to keep boundaries professional. It's kind of like being a willow bending in the wind as opposed to an oak that will snap in a nasty gail.
>
> Simcha
Posted by Dinah on December 8, 2004, at 19:21:09
In reply to Re: I've just experienced a do, posted by Daisym on December 8, 2004, at 12:29:50
Hmmm. I think I worded that wrong. There was a separate session about phone contact. She does make herself available, but says that if it's an emergency she can't promise to always be available and to go to an ER.
This was in a separate sessions, and she means nonprofessional contact. Inviting her to parties or weddings, going out to coffee, stuff like that I think.
Posted by simcha on December 8, 2004, at 23:31:46
In reply to Re: I've just experienced a do » simcha, posted by pinkeye on December 8, 2004, at 17:50:34
So far I like all my clients.
If a client insisted on daily contact, it would have to be an emergency. Then if it could not be resolved over the phone in 10 minutes I would let them know that we need to meet 2-4 times per week for sessions if they need that much support. When the crisis is over we could cut back on sessions.
With Borderline PD clients this is an issue. Firm therapeutic boundaries are part of the treatment. I really like working with BPD clients. Most therapists don't I like the energy, the challenge, and I can meet the energy. Some therapists get overwhelmed with that much work on a client. I welcome it. I try to do whatever the client actually needs to get better. Sometimes people who insist on daily contact really need more than one session a week. I have to keep that boundary for their own treatment plan. I would let them know that it's a boundary and explain the parameters in a compassionate manner.
Simcha
Posted by simcha on December 8, 2004, at 23:34:33
In reply to Re: I've just experienced a do » Daisym, posted by Dinah on December 8, 2004, at 19:21:09
Sometimes a therapist must refer a client to 911. Personally I like my Ethics and The Law teacher's way of dealing with such a situation. She tries to get the client to come to the office and they call 911 together. The police come and make a determination whether or not the client needs to go to the hospital.
Of course, clients are always welcome to call 911 or go to the ER and admit themselves. In that case I would want them to call me so I could visit them.
Simcha
Posted by daisym on December 8, 2004, at 23:35:38
In reply to Re: I've just experienced a do » Daisym, posted by simcha on December 8, 2004, at 17:26:48
I don't want to come across as challenging, Simka, but I don't know if you have that willow thing down yet.
I think if you've already set a time limit for things, 5 minutes, 10 minutes, etc. you've already limited your flexibility. I know the basic idea is to offer support over the phone and do therapy during sessions. But sometime clients need more than 5 minutes of support.
I am a competent, well-educated 40-something woman who works in human services. When I finally started talking to my therapist about the abuse that happened in my childhood, I was shocked at how absolutely overwhelmed and suicidal I felt. I remember the first time I called after a session. I think it was a couple of hours later and I said something like, "I don't know what is happening to me. I can't stop crying and I hurt so bad I can't function." It wasn't an emergency - I wasn't planning on hurting myself - but I NEEDED to have someone normalize the pain for me and just be there. He said all the right things and let me cry on the phone until I was calm. It probably took 15 minutes. If he had cut me off after 5 minutes, I probably would not have continued on this immensely hard road trying to heal. Since then, we have lots of phone contact. Much of this includes loosely scheduled phone check ins (like "let's touch base Friday afternoon") if I'm going through a rough patch. I worry a lot that I'm that "pain in the a**" client that made all the rules necessary. My therapist tells me that he wants me to reach out to him as much as I need to. I believe he means this. If you've read any of my posts you will notice that I swing wildly about accepting this attachment and fighting it.
I think I read in one of your other posts (forgive me if I'm wrong) that "most" people in therapy have boundary issues. I would argue that it is just as likely for you to have a client who won't want to bother you AT ALL as it is to have one bother you too much. That would have been me if my therapist wasn't so proactive in encouraging me to use him for support.
By the way, I do pay for phone calls. We agreed that this would help me get past my reluctance of bothering him.
Lastly, I think you will encounter clients who can't afford extra sessions, can't take the time off work, etc. etc. In these cases, longer phone calls might be just the answer.
I should admit to being sensitive about this subject tonight. I'm trying to add a perspective, not lecture.
Posted by simcha on December 9, 2004, at 0:05:05
In reply to Re: I've just experienced a do » simcha, posted by daisym on December 8, 2004, at 23:35:38
Daisy,
I completely respect your perspective. BPD clients are very different from survivors of childhood sexual, physical, and emotional abuse, and neglect. These clients do need more phone time.
Currently I am a trainee I work under someone else's license. I have to consult with her and respect her wisdom in setting limits and boundaries. Right now she wants me to be conservative. So, I have to tow the party line in order to finish my traineeship.
Also, I will be an Intern for about 4-5 years. I will have a different supervisor then. They might have different limits and boundaries and a different clinical orientation.
When I get my own MFT license I will be free to explore boundaries and limits on my own. In your case, I would have spent at least ten minutes almost every day with you on the phone when you were having your existential crisis. This is crisis counseling and it comes with the fee you pay for the one hour per week session.
In my current situation I have asked my supervisor about having clients pay for more phone time if they need it. It would be at a reduced rate. The Agency and the Supervisor have to agree on this. At the moment they won't let me do this. They want me to experience the conservative approach.
As part of this I do have two clients who need to be seen twice per week and we are negociating the fee to be lowered per session to make it affordable to these clients. My supervisor is for this. She does not want me to get burned out as a trainee who works 30 hours a week at a Group home for pay, works 30 hours per week at a trainee center that pays me $50 per month, and goes to school full time spending 20-30 hours per week on class time and homework.
So, as an MFT Trainee, my availability must be more structured so that I can really be there for my clients. I don't want to burn out and become ineffective in the therapy room. My supervisor wants me to avoid this too. Currently I'm limited to six clients for this reason at this time. I do eight hours of therapy per week. Phone calls take up another hour or two. Don't even ask about the paperwork that goes with this, it's deadly....
So, my orientation is different from my current supervisor's. I see her point and I'll do it her way now in order to learn. She acknowledges that I will be doing things differently when I have my own practice. So, I will grow as a therapist. This is my first quarter as a trainee and I don't have ton's of experience with one on one therapy.
I have been a counselor for four years. This is a very different form of therapy and less taxing than psychotherapy. As a counselor, I could be more of a peer and do more self-disclosure. I could also do more behavior modeling and CBT techniques.
So, that is my history.
I respect your story and your experience and it sounds like you have a very good therapist. I hope to match his skills someday.
Respectfully Yours,
Simcha> I don't want to come across as challenging, Simka, but I don't know if you have that willow thing down yet.
>
> I think if you've already set a time limit for things, 5 minutes, 10 minutes, etc. you've already limited your flexibility. I know the basic idea is to offer support over the phone and do therapy during sessions. But sometime clients need more than 5 minutes of support.
>
> I am a competent, well-educated 40-something woman who works in human services. When I finally started talking to my therapist about the abuse that happened in my childhood, I was shocked at how absolutely overwhelmed and suicidal I felt. I remember the first time I called after a session. I think it was a couple of hours later and I said something like, "I don't know what is happening to me. I can't stop crying and I hurt so bad I can't function." It wasn't an emergency - I wasn't planning on hurting myself - but I NEEDED to have someone normalize the pain for me and just be there. He said all the right things and let me cry on the phone until I was calm. It probably took 15 minutes. If he had cut me off after 5 minutes, I probably would not have continued on this immensely hard road trying to heal. Since then, we have lots of phone contact. Much of this includes loosely scheduled phone check ins (like "let's touch base Friday afternoon") if I'm going through a rough patch. I worry a lot that I'm that "pain in the a**" client that made all the rules necessary. My therapist tells me that he wants me to reach out to him as much as I need to. I believe he means this. If you've read any of my posts you will notice that I swing wildly about accepting this attachment and fighting it.
>
> I think I read in one of your other posts (forgive me if I'm wrong) that "most" people in therapy have boundary issues. I would argue that it is just as likely for you to have a client who won't want to bother you AT ALL as it is to have one bother you too much. That would have been me if my therapist wasn't so proactive in encouraging me to use him for support.
>
> By the way, I do pay for phone calls. We agreed that this would help me get past my reluctance of bothering him.
>
> Lastly, I think you will encounter clients who can't afford extra sessions, can't take the time off work, etc. etc. In these cases, longer phone calls might be just the answer.
>
> I should admit to being sensitive about this subject tonight. I'm trying to add a perspective, not lecture.
>
Posted by simcha on December 9, 2004, at 0:11:29
In reply to Re: I've just experienced a do » simcha, posted by daisym on December 8, 2004, at 23:35:38
Oh, and from the very beginning I tell my clients to call me at any time. I check my messages 4-6 times a day lately due to my client load. It's important for me to get back to clients promptly.
I make sure that they should call me if they are having extreme difficulty that they cannot handle. Idle chat is for friends. Crisis is for therapists and good friends who can be really supportive. Most of my clients don't have these kind of friends so I really stress, every session in fact, that they SHOULD call me if something comes up...
Simcha
> I don't want to come across as challenging, Simka, but I don't know if you have that willow thing down yet.
>
> I think if you've already set a time limit for things, 5 minutes, 10 minutes, etc. you've already limited your flexibility. I know the basic idea is to offer support over the phone and do therapy during sessions. But sometime clients need more than 5 minutes of support.
>
> I am a competent, well-educated 40-something woman who works in human services. When I finally started talking to my therapist about the abuse that happened in my childhood, I was shocked at how absolutely overwhelmed and suicidal I felt. I remember the first time I called after a session. I think it was a couple of hours later and I said something like, "I don't know what is happening to me. I can't stop crying and I hurt so bad I can't function." It wasn't an emergency - I wasn't planning on hurting myself - but I NEEDED to have someone normalize the pain for me and just be there. He said all the right things and let me cry on the phone until I was calm. It probably took 15 minutes. If he had cut me off after 5 minutes, I probably would not have continued on this immensely hard road trying to heal. Since then, we have lots of phone contact. Much of this includes loosely scheduled phone check ins (like "let's touch base Friday afternoon") if I'm going through a rough patch. I worry a lot that I'm that "pain in the a**" client that made all the rules necessary. My therapist tells me that he wants me to reach out to him as much as I need to. I believe he means this. If you've read any of my posts you will notice that I swing wildly about accepting this attachment and fighting it.
>
> I think I read in one of your other posts (forgive me if I'm wrong) that "most" people in therapy have boundary issues. I would argue that it is just as likely for you to have a client who won't want to bother you AT ALL as it is to have one bother you too much. That would have been me if my therapist wasn't so proactive in encouraging me to use him for support.
>
> By the way, I do pay for phone calls. We agreed that this would help me get past my reluctance of bothering him.
>
> Lastly, I think you will encounter clients who can't afford extra sessions, can't take the time off work, etc. etc. In these cases, longer phone calls might be just the answer.
>
> I should admit to being sensitive about this subject tonight. I'm trying to add a perspective, not lecture.
>
Posted by daisym on December 9, 2004, at 0:32:58
In reply to Re: I've just experienced a do » daisym, posted by simcha on December 9, 2004, at 0:11:29
Sounds like you've thought about this a lot. It must be very hard to be a trainee. Negotiating not only your clients but your supervisor's needs is a balancing act. Good thing you have your own therapist!
I remember what it was like having small children, working on my thesis and working too. I taught classes at the hospital at night and I was always worried I'd nod off during the movies. :)
Take your vit. C and eat right. And keep your Starbucks card handy!
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