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.