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Re: How therapists think or feel (trigger) daisym

Posted by alexandra_k on October 8, 2005, at 20:55:17

In reply to How therapists think or feel (trigger), posted by daisym on October 8, 2005, at 20:26:17

> I've been researching again -- I do this when I'm lost and looking for answers.

me too :-)

> I wish someone would tell me where they are hidden.

yes, oh yes.
what i found...
well... i found psychodynamic theorists first. that was useful to me because the first thing i wanted to know was: why the hell are clinicians so damned judgemental? and so i found the answer right there. because of the theory. the intentions they attribute to the client. the 'real reasons' they attribute to the clients words / behaviours.

i'm sure that not all psychodynamic theory is like this but i do have to say that based on what i have read... a fair chunk of it is.

i was reading books mostly. and journal articles, yeah, but i wasn't database searching and thus i had to search the stacks manually to find journal articles. what that meant... was that i found books mostly. and they tended to be older... and same goes for the journal articles, i guess.

i hope that current theory isn't as judgemental as i found past theory to be...


truth be told, there is still a lot of judgement and assumptions out there...

with respect to suicide...
i'd say that linehan is a pretty good source.
because she started out being interested in suicide and parasuicidal behaviour (si) and from there became interested in borderline personality disorder because that was the clincial population that seemed to have most of the chronic suicidal ideators.

it is my personal belief that she is revolutionary... because she refrains from negative judgement and assumption of malevolent (or otherwise perverted) intent.

and so you might find some answers there...

at least... i did.

> What strikes me is that a lot of the literature talked about how therapist can grow to resent this aspect of their job and the individual patients who pose a risk of attempt or completion... There was one article that talked about how a therapist might go over board to prove caring because they really feel angry and are masking that.

I think that is reaction formation? When people have the opposite emotion to what they are 'really' having?

> So, how do we (the patients) know which is true?

hmm. how does the therapist know which is true?

>How do you know how honest to really be?

well... i would say that if the therapist felt angry with me for being honest then i would pick up on that and i wouldn't feel safe disclosing. if i had the option... i guess i'd find myself another therapist.
i would say that if the therapist seemed very caring etc but really felt angry with me... well... i guess how i'd describe that is to say that they feel angry because they feel POWERLESS. that that is where the anger is really coming from. and that they know that it is inappropriate (and ultimately unhelpful to the client) to express that (and they probably feel a little guilty about feeling that way anyways) and thus they try and help the patient the best way they know how. ie. by caring for them.

i had a t once who told me fairly upfront that she was terrified that one of her patients would kill themself. that she was really very worried that i was going to do that. i think i said something like 'well, you should have thought of that before you became a t'. we didn't get on so well... but anyway... she said that she rationally knew that she could only do the best she could do and ultimately she had to accept that it would be the patients decision whether to do it or not - and all she could do was help them and care for them as best she could.

and i guess...
thats all they can do.
i mean... it is hard. when people are distressed. and when people need to talk abotu that distress. and yeah, it must be hard for the t. but that is the t's job. and it is a necessary part of the job. and so... despite how they feel about it the burden is on them to explore their own responses and reactions and to behave in a manner that is most likely to help the client. that is what makes a good t.

and you have to be honest...
or there isn't any point in doing therapy.

> The other thing was that there are lots of theories about what suicide and suicidal ideation represents to the patient. Things like "acting out against the therapist" or "trying to gain the upper hand in the power differential" or "getting and keeping the therapist's attention."

okay... so imagine you are a t and you are reading that interpretation of what suicidal clients are really up to. now... how are you going to feel? i know that i would feel pretty mad at them for trying to play such games with me. and thus the theory ENCOURAGES therapists to feel angry at their clients and then CHASTISES then for that. Crazy crazy crazy and i do wonder just who are the crazy ones?????

I think that is crap.
in the words of linehan 'intention must be assessed and not assumed'.
and linehan reckons...
and yeah so maybe this smacks of behaviourism or cognitive behaviour therapy a bit
(but they do have some decent stuff to say and best not throw it all out because of some of the crazy sh*t)
but linehan says that maybe we should listen to what the client says as to her reasons.
and believe her.
and believe her.
instead of theorising that the 'real' reasons have just been repressed and are thus inaccessible to the client.


>Is it not possible that sometimes the world is just too hard to live in? That wanting to die might really be about wanting to escape all the bad things -- internally and externally? Why does there have to be some other unconscious motivation?

yes yes yes
i agree 100%
and i dare say that that is what clients think it is about
it is just psychodynamic theory that would have the 'real' reasons inaccessible to the client.

>Honestly, it made me feel like I should never admit these thoughts or feelings unless I was in a very dangerous place. I found it very upsetting and I didn't find the answers or cures or whatever I was looking for.

i understand your response.
that is something that i struggled with for many many years...
and my way out...
was linehan.
even though apparantly the dx of bpd was a mis-dx...
its her theory
the lack of judgement
that is so very refreshing.

best have a theory that both patients and clinicians can live with ;-)




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