When meeting new clients (and others), I
encounter a variety of comments that reflect common misconceptions about
psychotherapy. One is that the focus of
therapy is for me to evaluate the client and tell them what to do. Many people start their therapy a bit defensive
because they are fearful of my judgment or correction. Some people have mocked the process of
therapy by saying that therapists never tell you what to do and only “Listen”. Others have said to me, “Why am I paying you
to listen to me when I could just be talking to a friend or family member?” The difficulty with all of these assessments
is that they assume over-activity or inactivity on the part of therapist. With the distortions of the therapeutic
process portrayed in film and television, I cannot really blame people for
these misconceptions. Unfortunately,
there are also a number of people in the world practicing some type of
counseling who contribute to these stereotypes by their methods of
practice. The very terms we use for this
type of care are also confusing – counseling, therapy, psychotherapy,
psychoanalysis, etc. In a previous post, I commented on the technical differences in these various terms. However, what makes the process of
psychotherapy different from talking with a friend or other type of helper is
the attention to the process of therapy.
Because this part of the relationship is often managed in subtle ways,
people often perceive that the therapist is not doing much, but the reality
that is that the process is rich with reflection.
Fundamentally, what makes any type of
counseling or psychotherapy beneficial is the quality of the established
relationship. However, in the process of
psychoanalysis, psychotherapy, and Pastoral Psychotherapy, the therapist is
mindful of the dynamics of the relationship, monitors these things, and uses
them (hopefully) for the client’s benefit.
These types of dynamics can exist in other relationships with friends, etc,
but it is rare. Psychotherapy is, by
definition, a relationship between two (or more in the case of couple or family
therapy) people for the benefit of one of them.
Everything the therapist does or says should be for the benefit of the
client. In order to do this, the
therapist must be aware of many dynamics that are simultaneously at work in the
counseling office.
When a person comes to therapy, the
issues they wish to discuss and the struggles they have with these issues constitute
the “content” of the session. However, the forces that motivate a person’s
behavior are also important. The
therapist should be reflecting on the selection of material presented and the
content of the material. After a
particularly painful session of dealing with something like grief, a client may
come in the next session and talk about more mundane or superficial issues. The therapist’s job is to note the shift in
tone and help bring to awareness the change.
When a client presents a memory of events, the therapist is focusing on
how the person was affected and how they behaved in the events presented, but he
or she is also focused on how the person seems to be feeling as they are
presenting the material. The therapist
should not make assumptions about what the client felt, how they are feeling,
or why they behaved in a certain way. The
job of therapist is to note that such feelings and motivations exist and to ask
questions to raise the client’s awareness.
This is why it has become cliché for a therapist to ask questions like “How
did you feel when that happened?”
Completely out of the awareness of the
client (at least it should be) is the therapists’ reflections on another set of
dynamics in the room – his or her own. As
the client is sharing, the therapist is also monitoring his or her own feelings
about what is being shared. He or she is
monitoring the experience of the person and noting what they observe and
hear. The therapist is monitoring how
his or her own story is connected to the client’s story. The goal for the therapist is to be able to
separate his or her own experiences from the experiences of the client. In order to do this effectively, the therapist
should have done sufficient therapy for their own personal issues and to
receive adequate supervision and/or consultation on their work. The therapist becomes less effective when he
or she assumes what the client will or should feel instead of allowing the
client to discover what they actually feel.
While the therapist may provide some
education on common dynamics of interaction or personal development, their
primary goal is to allow the client to discover how he or she plays out these
dynamics in their own life. Any
intervention or action on the part of the therapist should be in the service of
this self-discovery or to help provide an environment that contrasts the
clients’ previous hurtful experiences.
By observing the clients actions, monitoring feelings, and dealing with
the dynamics of the client’s relationship with the therapist, the therapist
creates the opportunity for growth and healing.
The client’s experience of the resulting relationship between therapist
and client can then grow beyond the walls of the therapy office to the other
parts of the client’s life. The goal for
the therapist is to create independence for the client and not to foster
dependence. Advice-giving and such
activities, while helpful, only keep the client dependent on the
counselor. When the therapist helps the
client discover his or her own ways of dealing with things, then they are able
to apply that understanding to novel situations. The experience of this growth within a
therapeutic relationship is generally experienced by client and therapist as
deeply meaningful. In pastoral psychotherapy,
this growth and self-reflection will often include reflections on faith, God,
and spiritual development and the process of the therapy itself can be
experienced as quite spiritual or holy.
So, far from doing nothing or doing
everything for a client, the therapist works with the content of the client’s
issues while monitoring the internal and relational process of therapy. The therapist should maintain a calm
exterior, but should always be actively reflecting internally. I have found this process personally, professionally,
and spiritually enriching. I know that
the quality of a good friendship can accomplish similar purposes, but for me,
there is no substitute for a meaningful therapeutic relationship.
