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Sporadic photos and notes from a Psyche-midwife, cheerleader, anthropologist--aka clinical social worker in therapy practice. Photos are usually mine except for those of historical events/famous people. Music relevant to the daily topic is often included in a web video embedded below the blog. Click on highlighted links in the copy to get to source or supplemental material. For contact information, see my website @ janasvoboda.com or click on the button to the right below. Join in the conversation.

Thursday, March 10, 2011

From the Advice Column: My Therapist Doesn't Understand

 I received a note from a reader this week:
"As someone who suffers from anxiety/panic and the resultant depression that goes along with those, I find it very frustrating that therapists, and even psychiatrists, really don't understand what this is like. I mean, yeah, they understand it academically, but not from having the actual experience. What do you think about this?"

What I think is that it can be very frustrating to feel your experience of reality is being questioned by someone else who doesn't get it.  But I'd add that if I had been through everything all my clients have been through-- cancer, horrific abuse, war trauma, loss of a limb or ability to walk or everything I owned in a house fire for just a few-- I don't know that I would be able to practice.  On the other hand, I've been through some things.  And I think most people with some compassion and insight know what it feels like to be scared, hopeless, furious, or any of those other intense emotions.  They might not know exactly what it feels like to have a panic attack, just like your physician may not know what it feels like to have a heart attack.  But they've seen plenty.  They should still be able to treat you effectively.  I don't mean that to sound snarky.  I think it helps a lot to talk to someone who has been through your particular experience, just to know more certainly that you're not alone in what you are experiencing.  That's why I often refer clients to peer support groups or give them articles from people who've been there.

The best practitioners I know fall somewhere in the range of "the wounded healer", as Jung calls it.  They've been through enough hardship to understand that life isn't all roses.  They've seen and felt suffering on a level to take it seriously. They can relate, if not to your specific dilemma, to the suffering it causes. Suffering is inevitable if you live long enough. I don't think they need to have directly experienced a particular symptom to understand the effects it can have on you or how to help you address it.

That aside, I remember with big chagrin being a young, childless family therapist and telling people with authority how to handle their kids or marriages.  I remember at 25 becoming frustrated with a patient addicted to anxiolytics (medication for relief of anxiety) and telling him he really didn't have a thing to be anxious about, beings as he was not doing diddly squat with his life.  For me, getting some more life experience was humbling and helpful.  The older I get, the less black and white my thinking becomes-- and thank goodness.  I still think I was helpful, most of the time.  I also think at times I was a more than a little clueless.   I appreciate the clients who called me out, saying, "I don't think you are really getting this."  I appreciate the varieties of human experience, and the gift my practice gives me of having more of them vicariously than any one life could hold.  Each year I feel my heart expanding in compassion, and "that little aluminum tube through which we all look at the world, thinking all others are seeing the same scene through their tube", enlarging.

Bottom line:  if you don't think your therapist gets you, tell them.  Be ready to own your own shist, so to speak.  We are, in other wise words of Jung, "dirty little projectors", often unconsciously foisting our own shame and defensiveness onto the other.  Look clearly at that first.  Be curious and open to information as well as clear as you can be of your experience and your interpretations of it.  Be willing to let go of your assumptions if they really aren't in line with your caregiver's intention.  Give it a little time to see if maybe you are just dealing with vestiges of resistance.  Even bad habits are afraid of dying. 

If after honest conversation, reflection, deep listening for understanding and curious compassion you feel unheard, disrespected or just plain mis-matched, remember this is your nickle.  You can vote with your feet.  You can and should discuss your reasoning and even ask for a referral to someone that could be a better fit.
Nobody can be everybody's everything (and if say they are, run).  I don't make it with all my clients.  Earlier in my career I saw this as a big failure.  But then I read a passage in a book on the Zen of Falling in Love that shifted things for me.  It was something along the line of, "you may have chosen a perfectly outstanding apple, with stellar apple qualities.  But if you want a pear, you're not going get what you what."  Now you have to choose-- learn to deal with pear-ness, or go out and find an apple.  There are deficits, benefits and chances for growth both ways.

But if you feel humiliated, harassed, dismissed-- and you've discussed this to no positive outcome-- ask for a referral or ask others you trust.  Finding a good therapist isn't much different from finding a perfect pair of jeans or shoes. You might have to shop around and try a few before you find what really works for you.

Like most therapists, I have been in therapy.  Sometimes for a few short sessions for a tune-up or problem solving, and sometimes for longer when I needed to dig to get at some perspective or to process something heavy.  I have met with perfectly delightful clinicians who frankly were not what I needed at the time.  Sometimes I needed a handholder and got an asskicker; sometimes the opposite.  I like very active therapy, and the smile-nod-how-does-that-make-you-feel sessions make me feel crazy.  Maybe that would have been a good thing if I'd stuck around longer to find out, but at my age I have some clear ideas of what helps and what doesn't, and I can get close to that level of feedback from my cat.  We all have our preferences.

On the other side of the couch, I may move way too fast and feel aggressive to a client who wants much slower, gentler and contemplative experience.  It's not a bad way to work; but it isn't the way I work.  In such circumstance, I may suggest they'd  find the therapy experience more comfortable and valuable with someone who practices in a different way.  When I refer out like that, it isn't a rejection of the client.  I am truly hoping to find a better match so progress can be made.  I have to get my ego out the door and do what's best for a unique individual.

The take home, as they say, is "know thyself."  This includes knowing your strengths and preferences and warts and defensiveness.  Bring your whole self into the office.  Ask for what you need .  You still may not get it, but it sure as heck improves the chances.  And speaking only for myself, I love it when clients throw me a little education about their diagnosis, recent research on it, and area resources.  I do my best to keep up, but as a generalist, there's no way I'm going to know everything.

Thanks for the thought-provoking comment.  Hope to see more of these inquires as we continue muddling through the middle path. 

Related readings:
How to Do Therapy Part One:  Finding a Therapist
How to Do Therapy Part Two: Bang for the Buck

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