Jung At Heart

7. What is one pearl of wisdom you would offer clients about therapy?

Many patients come to therapy and then hold on to their secrets, afraid to tell the therapist, afraid they will be judged or rejected. But secrets held keep us in their embrace and make moving forward all but impossible. As Jung put it:

The inferior and even the worthless belongs to me as my shadow and give me substance and mass. How can I be substantial without casting a shadow? I must have a dark side too if I am to be whole; and by becoming conscious of my shadow I remember once more that I am a human being like any other. At any rate, if this rediscovery of my own wholeness remains private,  it will only restore the earlier condition from which the neurosis, i.e., the split-off complex, sprang. Privacy prolongs my isolation and the damage is only partially mended. But through confession I throw myself into the arms of humanity again, freed at last from the burden of moral exile. The goal ... is not merely the intellectual recognition of the facts with the head, but their confirmation by the heart and the actual release of suppressed emotion (Jung, CW 16, p134)

I think this is hugely important, breaking the secrets. 

There are lots of other important things, like saying whatever comes to mind, even ugly things or angry things or silly things. But saying it all, giving up the secrets in the safety of the therapeutic space, seems to me the most important. 

Following on from a comment to Question 4, the following quote from Jung comes to mind:

... the principal aim of psychotherapy is not to transport the patient to an impossible state of happiness, but to help him acquire steadfastness and philosophic patience in face of suffering. Life demands for its completion and fulfillment a balance between joy and sorrow. (Collected Works, Vol. 16, p. 81)

I think this is a very difficult point to accept in our time which has seen the advent of the psychology of happiness and what seems like an expectation that if there is suffering, it must be bad. But Jung understood that suffering has meaning, brings depth to our lives, and is a necessary part of life.

Now to question 5:

5. What is the toughest part of being a therapist?

There are several aspects of being a therapist that are difficult:

-- the patient who comes and is someone you just know you would love to have as a friend and yet, you cannot because we take on an ethical responsibility to be in a very different kind of relationship, one which does not end for us when the treatment does, because often patients decide to return later, even years later.

-- letting someone you have worked with, sometimes for years, go knowing that you likely will never hear how things turn out for that person. We truly have to allow our patients to pass through our lives. Therapy is an intimate relationship yet we have to let it go when the patient leaves.

-- we can't casually talk about our work at the dinner table -- or anyplace else. We are charged with carrying other people's secrets and that can become a heavy load.

-- for those of us in private practice, there is the anxiety of being self-employed which must be held separate from our work with patients, so that we do not hold on to someone because we are afraid of losing the income.

-- the increasing turn to medicalizing emotional problems leads some patients to expect that change should not take work. 

Ryan Howes has posted the responses of the first of his notable psychotherapists on his blog -- this one from Donald Meichenbaum, one of the founders of CBT. An interesting contrast to my own responses as we work quite differently and with different thertical assumptions. Do take a look.

Now for question 3:

3. What mistakes do therapists make that hinder the therapeutic process?

A common mistake is not holding the therapeutic frame -- the elements of time, place, setting and fee which form the container for the work of therapy. How does this happen? By rescheduling appointments without charging for the one missed, by failing to note and address deviations from the frame like missed payments or sessions, lateness -- by patient or therapist -- starting and ending on time and the like. It doesn't sound like these would be serious issues but when the frame is reliably and firmly held, the container feels solid and trustworthy. 

Another is failing to listen carefully. In our eagerness to be liked and to be helpful, we can move to give advice or talk too much -- after all therapists inevitably carry their own issues with them. Or, as Meichenbaum observed, we can err on the side of fitting what the patient says into what we believe rather than listening to see if there really is a good fit.

I come back again and again to Bion's basic tenet: to approach each clinical hour without memory, desire, or understanding. In other words to allow each session to be itself. And not to impose my own desired goal or agenda on the hour. This is a big difference between depth psychotherapy and CBT. If I hold as best I can Bion's tenet, what I need to remember about the last session and sessions before that will come into memory as needed as this session unfolds. This requires patience and is a process that is never perfected.