Whatever Comes To Mind

“The relation between doctor and patient remains a personal one within the impersonal framework of professional treatment. By no device can the treatment be anything but the product of mutual influence, in which the whole being of the doctor as well as that of his patient plays its part… Hence the personalities of doctor and patient are often infinitely more important for the outcome of the treatment than what the doctor says and thinks.”  C.G.Jung CW 16  

We ultimately behave with a therapist the way we do with most important people in our lives, with the same kinds of assumptions about the therapist and about ourselves. And we do so unquestioningly. Every week at least one patient tells me she “knows” what I think or feel, which she almost certainly does with others as well.

It is true that it is difficult for the therapist to respond to feelings and issues that the patient does not talk about. All rumors to the contrary, we are not mind readers! This underlies the basic therapeutic dictum that the patient should say whatever comes to mind.

Now of course, this is difficult for most of us, conditioned as we are by social norms, by rules we have learned from our parents. Remember Thumper in Bambi.”If you can’t say something nice, don’t say anything at all”? Most of us operate on some version of that in our relationships and avoid saying things to another person that we think might make them uncomfortable or angry with us. But therapy is a place where Thumper’s Rule needs to be suspended. So, if you don’t tell the therapist you don’t feel cared about, there isn’t much the therapist can do to help you with that. Similarly if you are angry with the therapist, have sexual feelings toward him or her, or any of the myriad of other feelings and thoughts about the therapist you might have. It all belongs in therapy. Putting those feelings into words is a key  part of what therapy is about, after all, because that opens the doorway to understanding where they come from and how to deal with them in ways that are helpful rather than destructive in life.

There is no magic in therapy. We meet. The patient talks. I listen and reflect what I see. Rinse and repeat.

Mistakes

“People do not grow in sterile containers with perfect analysts; they grow in messy human relationships with analysts who try their best to do right by their patients  but whose best must frequently consist of reparative efforts vis-á-vis the difficulties they have created.”

How do we recover from the mistakes that we make? We recover by recognizing that of course we make mistakes because we are human and it is how we learn. I have been in this work for 40 years and I still make mistakes — different ones, but mistakes nonetheless. 

 When things go awry because of something I say or do, initially I need to be able to simply accept that I made a mistake, be willing to own that mistake. Optimally the relationship is solid enough that my mistake does not end it and we have the opportunity to work through it, to look at what happened and why and how it came to be experienced painfully. 

Sometimes the therapist’s mistake breaks the relationship. What do we do then? Well, we have to sit with it, reflect on what happened to see what we can learn from it. Maybe got some supervision to see if looking at the situation with another pair of eyes illuminates it for us. We learn what we can from it and let the patient go. Pursuing trying to get her to hear the explanation starts to be its own problem.  

A wise supervisor once told me that we fail our patients in exactly the way they need to be failed and the trick is to be able to work through that. And he was right. Years ago I had a new patient come to me after having fired two previous therapists — one who fell asleep in a session with him and another he found unsympathetic. So I knew I started on thin ice, that he was looking for me to fail him also. One day he called and left me a message that he had to reschedule. I called back and left a message saying only my name and a time he could reach me. He got furious and said I had violated confidentiality by leaving the message so his roommate could hear. Now I knew I had left no indicator of who I was or why I was calling, but it didn’t matter because *for him* I failed. No amount of reasoning mattered. So we failed to work it through. I did learn to check with new patients about whether or not it was all right to leave a message if I had to get in touch by phone. And these days with the ubiquity of mobile phones, the chances that a message I might leave will be heard by someone other than the intended recipient is pretty small.

Sometimes with the best intentions, like Humpty Dumpty, all the king’s horses and all the king’s men cannot put the therapy back again.

It is hard to let go but what I want for a patient may not be what is best for her in her eyes — and those are the eyes that count. If she came back, I would be able to feel good, vindicated in some way — and sometimes patients do come back– but at the time, I have to live with the blow to my pride and my sense of my professional self. It is in these humbling experiences where we learn most.