Sunday, April 29, 2012
Psychotherapy as a Model for Positive Relationships
One of our regular readers wrote in a comment that she's read how the psychotherapeutic relationship is supposed to model a healthy relationship for the patient. I hope I got this right, I can't seem to find the comment.
So I think I missed that lecture in residency. It seems to me that while psychotherapy is about having an honest, trusting relationship (and that is usually a good thing), it is very different from the relationships we have in our real lives.
Psychotherapy is about the patient's life. In some ways, it's a rather narcissistic endeavor (and I don't mean that in a pejorative way, but it just is). Mostly it goes one way, and aside from the patient asking "How are you?" and perhaps a polite exchange about the therapist's life if the relationship lends itself to that, the session focuses on the problems and concerns of one person, without the expectation that the patient listen patiently or provide support, kindness, insights, or interpretation to the other party.
Healthy real-life relationships are two-way streets. And real life people have issues, demands, and problems. The psychotherapist is a little bit actor, who doesn't generally volunteer his own distress, and who may certainly have his own very screwed up life!
Oh, but you want to say that the therapist, by listening attentively and being supportive is modeling good listening skills, empathy, and kindness. Ideally, that's true. But the therapist is modifying his reactions based on the fact that he's learned a particular style of listening, understands that being non-judgmental is part of the deal, and responds in a way that is therapeutic for the patient. So he doesn't argue about politics, doesn't get indignant if the patient makes a degrading remark about something the therapist values, and when he confronts the patient with behaviors or thought patterns that need to be changed, he does it from a place that is gentle, respectful, and he backs down if the patient gets upset and can't hear it. In other words, the therapist sometimes quashes his own emotions and reactions for the sake of the patient. Real life people in two-way relationships just aren't wired to be 'all about you' all of the time. While a friend may see that you are upset and let you go off ranting (and thank you to my friends who do this for me) and listen nicely and therapeutically for a bit, this is too much to ask from anyone all of the time in a long-term relationship. People disagree, they argue, they have their own opinions, and they show it when they get offended or angry. One should not expect the people in their lives to react as their therapists do, in measure ways. Nor should they hold themselves to that standard when engaged in a relationship with others. It's nice if you can do it for a little while for a friend/spouse/relative in distress who needs a comforting ear. But don't go home and try to be your shrink. It's hard and you won't have any friends.
Ideally, a psychotherapist is very responsive and reliable. There are exceptions (oh for the shrink with ADD, or who runs overtime with an emergency, or who is just a bit disorganized), but generally, the doctor shows up. Probably a good thing to expect in one's important relationships, but it doesn't always work out that way, and there is some motivation for the shrink in that this is "Work" (and many people who are irresponsible in their private lives do prioritize "work") and the shrink gets paid.
On the positive side, in real life intimate relationships, you get to be together for more than an hour, it doesn't cost you big bucks to talk, there's some possibility that you aren't being pushed to talk about things you'd rather not, a hug or a kiss or a reciprocal statement of love can be very wonderful things, as can a card or a gift (chocolate is often good) or an offer to go out for coffee or a drink or a walk, when you're feeling distressed.
Therapists generally don't throw plates against the wall when they get upset with a patient, so if you need that type of adaptive behavior and restraint to be modeled for you, then I agree, the therapeutic relationship does show some healthier ways of responding.
Tell me what you think? What have your patients said they've learned from you, and what have you learned from your therapist?