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For my own benefit, I am looking for stories of two types of therapy moments:
1. Things a therapist did right.
2. Things a therapist did wrong.
In both cases, I'm looking for things that weren't obvious.
For "wrong things," I'm not thinking of clearly, extremely terrible things that I would never do in a million years, like having sex with a client, telling a client their abuse was their own fault, telling a client not to be gay, etc. I'm looking for mistakes that were more subtle than that - things a well-meaning but inexperienced therapist might do. For example, it was not beneficial to me (as a client) to let me sit there and recount lengthy abuse stories, and then have the therapist immediately start delving deeper into the abuse. But that's not an obvious mistake on the level of "It was all your fault it happened."
For right things, also, I'm looking for moments that went beyond the obvious "She was very empathetic," "He told me it wasn't my fault," or "She helped me see the connections between my childhood and my adult relationships." I am particularly interested in any times in which a therapist managed to do a good job with identity issues (gender, culture, etc), whether or not the therapist had the same identity as the client.
I realize that everyone is different, and what's right for one person may be wrong for another. I'm not looking for a rule book, but rather for inspiration and food for thought.
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1. Things a therapist did right.
2. Things a therapist did wrong.
In both cases, I'm looking for things that weren't obvious.
For "wrong things," I'm not thinking of clearly, extremely terrible things that I would never do in a million years, like having sex with a client, telling a client their abuse was their own fault, telling a client not to be gay, etc. I'm looking for mistakes that were more subtle than that - things a well-meaning but inexperienced therapist might do. For example, it was not beneficial to me (as a client) to let me sit there and recount lengthy abuse stories, and then have the therapist immediately start delving deeper into the abuse. But that's not an obvious mistake on the level of "It was all your fault it happened."
For right things, also, I'm looking for moments that went beyond the obvious "She was very empathetic," "He told me it wasn't my fault," or "She helped me see the connections between my childhood and my adult relationships." I am particularly interested in any times in which a therapist managed to do a good job with identity issues (gender, culture, etc), whether or not the therapist had the same identity as the client.
I realize that everyone is different, and what's right for one person may be wrong for another. I'm not looking for a rule book, but rather for inspiration and food for thought.
Anonymous comments are enabled but screened. If you comment anonymously, please let me know whether or not you'd like me to unscreen.
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From: (Anonymous)
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. . .. uh. Unless its sheer LENGTH makes you think otherwise. Jaysus, self. -.-
First, things that various psych professionals have done wrong, because I've had more experience with them; some of them are super-personal, and I fully admit I am a hard patient/client/whatever to deal with. However:
- inform me that I cannot be $thing, because they have never seen me do $thing. I am unbelievably adept at behaving as if nothing is wrong and I am a totally normal and functional human being. The less comfortable I am, the more I will force myself to do this. I do not show, for example, autistic traits in front of people I don't feel safe around; I will flat and outright lie to people I don't feel comfortable around about how I am feeling and what's happened lately; and I will repress PTSD reactions to the point where four hours later I will quietly go be painfully and violently sick, because it comes out in my body. I am capable of doing all of this, but it's not healthy, it has a very limited timeplay before I have a screaming meltdown even I can't repress (although I will probably run away and hide/claim a physical illness/channel it through a physical illness before I show it to anyone). I feel exposed breaking down and crying in the living-room of my own house when there's nobody around: I will probably go hide in the shower with a locked bathroom door instead (again: the house is EMPTY, the door is already locked, etc, but I still need a smaller, more controlled environment).
This means that unless I have become super-comfortable in your presence, I will not SHOW YOU, willingly, any symptoms of my various Issues. I will happily tell you all about them at great length, but I will not display them. If I do get pushed to breaking down before I'm comfortable, you have just classed yourself as the enemy, and I will be even LESS comfortable around you than I was before I started crying in your office.
As a result of this, I went all the way to a suicide attempt without anyone noticing I was depressed, and then went another five years coping with depression, undiagnosed autism and burgeoning PTSD before anyone said anything about it. The tentative steps I made in that period to get these things identified were shut down by professionals informing me that since I was performing at high levels at uni, holding a job, had friend, etc, etc, etc, I was a totally functioning adult who had no problems and should stop self-sabotaging by thinking I did.
If it were not for the dedicated efforts and help of my totally untrained but rather more psychologically useful friends, I would be dead right now. And it sounds rather stupid insisting "but she couldn't've been depressed, she was so functional!" after someone's cut their own throat.
- push talk/cognitive therapy at me before medicating me. This is a very individual one, I know, but at the time it was being pushed at me "instead of" medication, talking/thinking things thru/etc ACTIVELY MADE THINGS WORSE. I would go away after having done the exercises/talk session/whatever feeling more self-loathing and suicidal than I had beforehand. I couldn't do it, it didn't work, and it became something else to fail at. What made the difference at that point was finding a med that worked so that I was physically capable of, you know, reading more than a paragraph through my brianfog, and being able to write coherently, and being able to even think about emotions without dissolving into a pile of wet tissue.
-ignore/challenge boundaries I had explicitly set. This is another personal quirk one, but it arises from the fact that I spent years of my life having my boundaries - especially emotional, but also physical ones, thank you interrupted attempted sexual assault and following helplessness - ignored, or told I was a selfish cow for having them, or that I was wrong about where they were/where they needed to be. The proper response to me saying "and if X happens, I will do X" is, in this case, at the most, "I hope you will someday feel comfortable enough to talk about X". It is not, in fact, "well this won't work if you're not willing to deal with X, because the entire point of this is dealing with X and if you won't deal with X you are just going to fail at this." This relates back to my first point about "I will not display these things to people I do not trust". My boundaries exist because beyond them I am harmed. I will enforce them. If how I enforce them is "fire you as my therapist", so be it. (If for some reason I was unable to, I . . . well, it would depend on how angry I was, but I have it on good authority I could be a nightmare patient if I set my mind to it.)
- probably THE most personal of the lot, but: present me with a blank, unreadable aspect. Firstly, I get super anxious if I cannot read people's reactions to me. Being unable to read people's intents or decipher their thoughts about me has invariably led to the most horrible and traumatic experiences of my life. I understand that for some people, this is actually a technique that works? this idea of not having a personal reaction of any kind to anything the patient says, and presenting this smooth mirror front of emotionless listening? I could even see how it might work, theoretically. For me IT'S A BIG SCREAMING TRIGGER.
Not only that, the culture/class/whatever you want to call it I grew up in? That's how women express disgust and anger for someone to whom, for some reason, they cannot say "you disgust and enrage me". You get very calm, polite, reserved and unreadable. It means "for professional/life reasons I must cooperate with you, and together we will agree not to make a big deal about this, but secretly I would be happier if I never had to look at you again."
Thus, when presented with it, I get a double trigger: firstly, I have no idea what someone is really thinking, and secondly, WHAT THEY'RE THINKING IS ALMOST CERTAINLY AWFUL. (I realize that logically, these two things sort of contradict each other. Believe me when I say that the part of my brain that's panicking doesn't care about logic other than its own special defensive brand.)
This was only reemphasized by the fact that the few times I threw her a serious curveball, I DID manage to see a very clear sense of " . . . . . . . " from the lady in question.
Then there are things various professionals have done right. MOST of these are my current psych, which is why she continues as my current psych, but others are spread around:
- be a human being. The professional boundaries are quite well-observed, but still, I have a sense that current!psych has a life outside her practice, and what kind of person she is in it, and how she relates to the world. This makes her a human being I can figure out how to communicate with. She was able to establish this with a tiny amount of small-talk on our first appointment which allowed me to relax and SHOW a number of the behaviours that actually demonstrate my issues, rather than having to present a pure public face. (This was also totally a test: I managed to relax enough, and then I was watching to see if she would pick things up/how she would interpret them. I am UNBELIEVABLY socially paranoid, and not easy to work with because of this, and I acknowledge that).
- assume that I am being as honest as I possibly can, that I have no intention of deceiving you, and that I am here because I want to get better. I realize this is not the case for all clients, and that some of them are better at self-deception than I am, but I am not them. I am here because I am fucked up. I would like to become less fucked up. I am, if anything, brutally honest - as long as I don't feel that honesty is going to be used as a tool to harm me. If I'm hiding something, it's not from me: it's from you, because I think you're going to hurt me with it.
- assume that I am a freaking grownup, and that I have lived in my head for quite a long time, and know more about my head than you do, even if you have the shiny degree and I don't. I might not know the WORDS, I might not know the REASONS, but if I say "when X happens, Y results" or "Q means V", it's because I have experiential reasons to say it, not because I'm making it up. I realize that there's stuff I don't know, and that I need help with, or I wouldn't be here, but I am not an empty-headed disciple for you to fix.
- listen to what I say, not what you want to hear/what you think would make more sense.
- interact with me as a complicated human individual, rather than a textbook case. I have a weird and twisted up conjunction of ASD, MDD, PTSD and Giftedness combined with a specific and rather unusual family background and all the lovely priming shit that was my childhood interaction with my peers. I won't look like what you learned in the classroom, or what you read about in this month's magazine. (I'd imagine few of your patients would - I don't think I'm that unusual in being Bloody Weird and Unexpected, so I think this one applies pretty broadly.)
- have spontaneous reactions to things I say. This one might be super-just-me, I don't know, but I genuinely feel more comfortable with my psych when she has a clearly-unscripted reaction to something I say. (the last best example was the expression of " . . . .wtfBWAH" and laughter at the point where I solemnly explained that I cannot use logic to talk MYSELF out of self-hatred spirals no matter HOW ridiculous and extreme and outright laughable, because I am always certain that I am lying to myself to make myself feel better.) It reassures my screaming paranoia that she is not carefully lying to/manipulating me to some unseen end.
(the thought "well maybe she's just THAT GOOD" has, in fact, arisen. It is countered by two things: one, I am really quite good at seeing that in people these days, and two, if she is that good, I'm fucked anyway, so I might as well just ignore that thought, it's not useful.)
- dealt with my weirdness. I tend, for example, to speak of the way that all my stuff interacts into a lump that can't readily be disentangled as "dragon-brain", because of . . . reasons. *waves hand* There is a way in which my brain interacts with the world that is totally internally consistent and predictable and does not match up with human norms. I explained this to current!psych and she took it in stride and it is now a useful bit of shorthand. Similarly, when I explained that I think in a combination of texture-colour-temperature-sound that amounts to an internal language that is only with DIFFICULTY translated into English, and thus sometimes I would flounder around with words or resort to "it's not sadness, it's a scratcy-electric-crazy-chaotic-blue-and-silver ball of STEEL WOOL in my HEAD", she took this in stride and moved on. (In contrast, last!psych kept insisting that I secretly meant "sadness" or "anger" or something that could be expressed in useful words, and I very nearly screamed at her.)
- accept and respect my boundaries when I declare them. Doing that is passing a test. If you're not willing to do that, no questions asked, then you are not a safe person and I cannot trust you. If you do, then I can start thinking about moving the boundaries around and opening myself up to things on the edge of "need to talk about this/this is going to hurt." My body, my brain, my rules.
. . . that incredible pile of word-spew is all I can think about right now. I have no idea if any of it is useful, but if it is, woo. :)