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Gift of therapy. An Open Letter to Beginning Therapists By Dr. Raja Roy Choudhury. An Idiosyncratic Mélange of Ideas and Techniques. Remove the obstacle to growth.
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Gift of therapy An Open Letter to Beginning Therapists By Dr. Raja Roy Choudhury
Remove the obstacle to growth I do not have to do the whole job: Not to inspirit the patient with desire to grow, with curiosity, with zest for life, caring, loyalty or any of the myriad of characteristics that make us fully human. No, what I have to do is to identify and remove obstacles.
Avoid diagnosis A Diagnosis Limits vision: it diminishes ability to relate to the other as a person.
Therapist and patient as“fellow travelers” We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence. “Have Patience in everything unresolved and try to love the questions themselves: Try to love the questioners as well”
Engage the patient Therapist: How are You and I doing today?
Be supportive Therapists have great power that stems from the knowledge of their patient’s intimate life events. Acceptance and Support from one who knows them so intimately is enormously affirming.
Empathy: looking out the patient’s window We valued very different parts of the session: My elegant and brilliant interpretations? She never even heard them. Instead, she valued the small personal acts I barely noticed: complimenting her clothes, awkward apologies for arriving late, teasing her when we role- played. -Therapist.
Teach empathy Help patients experience empathy with You, and they will automatically make the necessary explorations to other important figures in their lives.
Let the patient matter to you It is sad to think of being together with others for so long and yet never to have let them matter enough to be influenced and changed by them.
Acknowledge your errors The difference between a good and a bad therapist is not the commission of errors but what you do with them.
Create a new therapy for each patient Appreciation of the uniqueness of each patient’s inner world and language, a uniqueness that requires the therapist to invent a new therapy language for each patient.
The therapeutic act, not the therapeutic word The patient’s view of helpful events in therapy are generally relational, often involving some act of the therapist that stretched outside the frame of therapy or some graphic example of the therapist’s consistency and presence.
Engage in personal therapy Q: What is the therapist’s most valuable instrument? A: The therapist’s own self. A therapist should enter therapy at many different stages of life.
The therapist has many patients;the patient, one therapist Do you ever think about me between sessions or do I just drop out of your life for the rest of the week? - Patient
The Here-and-Now. Immediate events of the therapeutic hour: What is happening here in the relationship- Space between you and me. And now in the immediate hour.
Why use the Here-and-Now The interpersonal problems and Maladaptive patterns will soon be displayed in living color in the here-and now of the therapy hour.
Using Here-and Now: Grow rabbit’s ears Each individual has a different internal world and the stimulus has a different meaning to each.
Search for Here-and-Now equivalents When there is a then-and-there Dysfunctional interaction: The strategy is to find a here-and-now equivalent of the Dysfunctional interaction.
The Here-and-Now energizes therapy Therapy is invariably energized when it focuses on the relationship between therapist and patient.
Use your own feelings as data If in the session you feel bored or irritated, confused, sexually aroused, or shut out by your patient, then regard that as valuable information.
Frame Here-and-Now comments carefully Talk about how you feel, not about what the patient is doing.
What lies have you told me? There is always some concealment, some information withheld because of shame, because of some particular way they wish to be regarded.
Blank screen? Forget it! Be real Forget the Blank Screen: Therapist disclosure begets client disclosure.
Three kinds therapist self-disclosure Therapist self-disclosure is not a single entity but a cluster of behaviors: Some invariably facilitate therapy and Some are problematic and potentially counterproductive.
The mechanism of therapy-be transparent Suggest total disclosure about the mechanism of therapy.
Revealing Here-and-Now feelings-use discretion All comments must pass one test: Is this disclosure in the best interests of the patient?
Revealing the therapist’s personal life- Use caution The personal life of the therapist, there swirls the controversy. But how can one have a genuine encounter with another person while remaining so opaque?
Revealing your personal life-Caveats Though patients have confidentiality, therapists do not.
Therapist transparency and universality Disclosure of similar thoughts and feelings is comforting and provides a “ welcome to the human race”
Patients will resist your disclosure Those who desire magic, mystery and authority are loath to look beneath the trappings of the therapist.
Avoid the Crooked Cure At times the therapist must provide “magic, mystery and authority”. Keep it brief and help the patient quickly make the transition into genuine therapeutic relationship.
On taking patients further than you have gone Some cannot loosen their own chains yet can nonetheless redeem their friends
On being helped by your patient Wounded healers are effective because they empathize with the wounds of the patients; perhaps because they participate more deeply and personally in the healing process.
Encourage patient self-disclosure Anytime you feel like saying, “Dammit, all these wasted hours, why didn’t you tell me this before”, is just the time to bite your tongue and appreciate the fact that the patient did finally develop trust to reveal this information.
Provide feedback effectively and gently Here-and-Now feedback: Sticking to observations of the behavior and what the behavior makes one feel.
Increase receptiveness to feedback by using “parts” “I understand that at times you feel like giving up, that right now you even feel like taking your life. But some part of you has bought the rest of you into my office. Now, please, I want to talk to that part of you-the part that wants to live”.
Feedback: strike when the iron is cold One principle that proves useful time and again is to strike when the iron is cold- that is to give the feedback when they are behaving differently.
Talk about death From the beginning of written thought humans have realized that everything fades, that we fear fading, and that we must find a way to live despite the fear and the fading. Learning to live well is to learn to die well.
Death and life enhancement Boundary experiences- Urgent experiences that jolt us out of “everydayness” and rivet our attention upon “being” itself. The most powerful boundary experience is confrontation with one’s own death.
How to talk about death A calm, matter-of-fact dissection of the anxiety about death is often reassuring.
Talk about life meaning What we must do is to plunge into one of many possible meanings, particularly one with a self-transcendent basis. The question of meaning in life is not edifying. One must immerse oneself into the river of life and let the question drift away.
Freedom The chasm, the abyss of freedom. And with the realization of the nothingness at the heart of being comes deep anxiety.
Helping patients assume responsibility “Even if 99% of the bad things that happen to you is someone else’s fault, I want to look at the 1% - the part that is your responsibility. We have to look at your role, even if it’s very limited, because that’s where I can be of most help”
Never (almost never) make decisions for the patient Beware of leaping into make decisions for the patient. It is always a bad idea. Not only do we lack a crystal ball, but we work with unreliable data.
Decisions: A via regia into existential bedrock Decisions are a royal road into a rich existential domain- the realm of freedom, responsibility, choice, regret, wishing, and willing.
Focus on resistance to decision. Everything fades and alternatives exclude.
Facilitating awareness by advice giving Offering advice or prescribing certain behaviors not as a way of usurping the patient’s decision, but in order to shake up an entrenched thought or behavior pattern. More often than not it is the process of giving advice that helps rather than the advice itself.
Facilitating decisions-other devices “I’m not going to change, Mother, till you treat me differently when I was eight years old” “The hardest thing for a man to give up is that which he really doesn’t want”
Conduct therapy as a continuous session Psychotherapy – Cyclotherapy We open up new themes, work on them for a while, move to other issues, but regularly and repetitively return to the same themes. Each time deepening the inquiry.
