Tuesday, November 2, 2010

Your Beliefs versus a Therapist's Beliefs

As some know, one of my pet peeves is the fact that so many people have unquestioningly accepted the various beliefs and theories put forth by a century of therapists.

James Hillman and Michael Ventura authored a book some years ago – “We’ve Had a Hundred Years of Psychotherapy – and the World’s Getting Worse".

I’m not sure their assertion is accurate but I don’t think the influence on the culture is always benign or helpful. Psychotherapy is in the company of other “healing arts” – they too are not always benign. Who has not heard frightening stories of surgeries gone awry or adverse reactions to medicine; and these are usually the result of well-meaning practitioners using approved treatments. Add to these the quacks using untested methods or phony treatments.

Many, if not most, naively present themselves for treatment, assuming that the treatment provided will help. I am a bit surprised that many of my own patients scheduled preliminary appointments with me without interviewing me first. It is worrisome that some will accept the referral of AN INSURANCE COMPANY employee whom they’ve never met. When I’m on the phone with a potential patient scheduling a first appointment, I’ll usually ask, “Is there anything you’d like to ask me about – my therapeutic approach, how long I’ve practiced, my credentials, what my thoughts are about specific concerns." Some just want to schedule the appointment (I hope if they find me unhelpful they won’t continue seeing me.) A recent patient was candid enough to tell me she just wanted to talk with me for a while to see if I sounded crazy.

Allow me to mention a few of the ideas and practices that I believe are unhelpful. (In previous columns, I’ve discussed what I think IS helpful.)

Talking more is always helpful.

This commonly held belief has prevailed in the Western culture for probably the last 50 years. Rooted in the heyday of anything-goes sensitivity groups (originally, “T-groups”) unedited stream-of consciousness talking was thought to be “healthy”, it theoretically was an expression of an uninhibited mind.

The truth is that more talking is SOMETIMES helpful and it is sometimes unhelpful. Perhaps you’re familiar with the axiom: “You cannot unring the bell.” It is also true that what is said CANNOT be taken back regardless of some people who strongly assert that they take back a comment. Once said, it will exist forever in the mind of the one hearing it.

I have told many patients that when I speak to my boss, I am careful (i.e., full of care). It seems to me that when I speak to someone I care about, my words should reflect my care. If I spoke carelessly to my boss, I imagine I would not have remained employed for more than 20 years. Presumably, I care more about my mate than my boss – I believe my words should reflect that I care. Context is an important (though not sole) determinant of our tone of voice and our words. Some believe that they are not responsible for their words and tone of voice. I assume the most people are (for the most-part) neurologically intact. That leads me to believe that most (99.5%?) do have control of their behavior – despite the insistence by some that they don’t. A gross example would be the battering spouse who would have us believe they were not in control of the hands that strangled their spouse.

A variant of this idea, that we must “say what is on our mind” is an apparent belief that we must express our thoughts and feelings (particularly if they are negative) because if not expressed, we will somehow build-up psychic pressure (as if people are pressure cookers or steam engines) and explode. This belief has no foundation in fact. It does bear striking resemblance to the old but still used ploy told to women (forgive me for the following vulgarity) that unless men can have sexual release with women that the man will develop “blue balls” (an entirely fictional condition). Just as men will not explode without sexual release – people will not explode if they don’t express to ones they care about, complaints or other hurtful comments. (If this principle were true, wouldn't there be a pandemic people - particularly teenage boys, spontaneously exploding?)

It’s OK to say (if it’s true.)
Another falsehood – again I suggest the guiding principle should be “Is this the most caring thing to say and way to say it.” Using the rationalization that “it’s true so it’s OK” is an excuse to be uncaring and hurtful in our communicating.

Most of us have heard the cliché: A woman asks her mate, “Honey, do these jeans make my butt look big?” One can very lamely try to hide behind the rationalization that the jeans are unflattering to say, “Yes, they make your butt look really big.” With just a little thought, one can answer in a more caring way, “Those jeans are OK but I really like the way you look in the other outfit.” The guiding principle is caring.

You should use communication the way I do.
For me, it’s annoying when people seem to believe that others should communicate in a way that essentially is similar to their own. Previously, I reported a saying from my old mentor: “The fact that we both speak English only augments the delusion that we are speaking the same language.” Clearly each of us uses language differently, some more effectively - others… not so much.

Problems develop proportionally to how much we expect others to believe and communicate as we do. I can personally attest to this. Not everyone appreciates my sense of humor. In the not-too-distant past, I was careless about my sense of humor. In recent years, I have become more careful. I used to believe that everyone could, with only brief notice, express how they think and feel (copiously) about almost anything. I’ve learned that others are not like me – some people prefer to be more deliberate (i.e., think before they speak). I’m unaware of any word that has a unitary definition and if there were, we would still moderate the word by the tone and inflection we use. Others will not (ever) communicate the same way we do. You might wonder, “How then do we ever communicate?” The answer is the same as the punch-line to the old joke: “How do two porcupines mate?” The answer is, “Very CAREfully.” Effective communication acknowledges that we are all different and so we communicate most effectively when we try as much as we can to avoid assumptions that the other has understood what we intended with our comments – we intermittently confirm that we have communicated effectively - when we detect miscommunication, we correct it.

I was perfectly clear in my statement – YOU misinterpreted.
An axiom of communication theory states: “The meaning of a communication is its effect.” (not its intent) This is a very difficult notion to understand. I too have trouble accepting it, particularly if I’m the one that feels that I was totally clear about what I’ve said. If I am trying to communicate a thought or idea to another, it is my responsibility to express it in a manner in which it is most likely to be understood by the other party. If their reaction to my communication suggests they may have misunderstood, it is my responsibility to restate the communication more effectively. It is not the receiving party’s responsibility to understand me (particularly if I am using expressions that are not commonly understood). Believing that “I communicated clearly” is very similar to the delusion “I am right and you are wrong.” (see my earlier post.) Anyone who does public speaking will appreciate that choosing the right words and tone is their obligation. Again, in homage to my teacher, Carl, “If during a play of a comedy, the audience doesn’t laugh, it’s not the fault of the audience.”

Feelings reign supreme.
Psychotherapy has encouraged the idea that feelings and emotions are more important that thoughts and behavior. Truthfully, all are important but the relative importance of each merits greater reflection because they each are differing categories of experience.
Feelings are emotional facts like the doctrine of The Trinity is a religious fact. It is a disservice to try to justify these as concrete facts – this doesn’t however diminish their importance. Feelings can be very ephemeral; I may experience an emotion for a moment and then it fades. An emotion is not bound by appropriateness or consistency. I’ve often heard a patient say of their mate, “I love him but at times I could just strangle him.” Emotions don’t have to be reasoned, they just are. Emotions can shift from one moment to the next. Thinking is more deliberative; we have considered a variety of factors and have come to a tentative position.

Think of behavior as sign-language. I remember that for years, I expected my father to express himself the way I do. For years, I believed that because he didn’t communicate and believe as I do, he was in “denial”. When I became a bit more open-minded, I saw that his behavior communicated what he couldn’t verbally express. Too often, behavior is under-appreciated. When a man changes the oil in his wife’s car, it is an act of caring. When a wife makes dinner (please excuse my sexism), it is an act of caring.
At least twice monthly a patient tells me, “I love my mate, but I’m not “in love” with him/her.” To me, this reflects that my patient is expecting the exhilarating feeling of infatuation that is often experienced in the first stage of a relationship. Some of my patients have told me love is a verb. Love is what you do or what another does for you. Being “in love” is an experience – the experience is not a constant; it is a variable phenomena that ebbs and flows. Reflect on other feelings such as fear, joy, anger or suspense. These are not constant, they come and go depending on context.

Feelings are not more important – they are feelings, nothing more and nothing less.

My last comments before ending this rant; please consider carefully anything a therapist says. Remember, unlike physicians who have x-rays and lab tests all we have is beliefs. A therapist's job is to help you be more clear about what you think and feel – not to indoctrinate you into what they think and feel.

1 comment:

  1. Are you friends with any colleagues?


As always, your comments are helpful.