Dr. Rob,
My girlfriend recently convinced me that I should start seeing a therapist to deal with some unresolved issues that she feels hurt me and our relationship. I'm not sure how I feel about therapy, I'm not sure I need it, but if I'm going to put the time in and fork money over every week I don't want this to just be something I do to please her. I want to get something out of it. Who knows, maybe she's right. Anyway, without going into my issues, what's the best way to be a good patient? I don't really care if my therapist likes me per se, but how do I get the most out of therapy.
-Jim
I'm glad to hear you're taking this step and at least considering therapy. It's also good that you would be doing this for you as opposed to your girlfriend, and bonus points for not worrying about whether your soon-to-be therapist likes you. Too many of us care about what other people think of them. The late, great Albert Ellis, Ph.D. said that those who focus on being liked by others or who seek others' approval are doomed to a life of misery and neurosis. I've adopted his way of thinking for myself. The only side effect is that I'll probably die old, alone and childless.
Your question can be difficult to answer, however, due to the different schools of thought regarding how therapy should be conducted. At the most basic and hopefully obvious level you will maximize your treatment if you are attending sessions with at least some regularity, arrive on time, call within the required time frame if you need to cancel or reschedule, and pay your fees appropriately. These points are particularly important because failure to do them will invariably result in conversations about why you are not following an agreed upon therapy protocol (i.e., why you are being difficult). Some therapists will argue that these behaviors are "grist for the mill" and shouldn't be discouraged and instead discussed and analyzed ad nauseum, but we'll just ignore those people right now.
To a degree, your therapy success is going to vary on the type of therapy in which you are involved. For example, if you are in a cognitive-behavioral therapy (CBT) you will get the most out of your sessions if you can follow a semi-structured, goal-oriented approach. Therapists who practice CBT will ask you to put into practice what you discuss during sessions (i.e., "homework"). Most CBT practitioners report that people who complete homework get better results than those who do not.
I had only one semester of training in Freudian-based psychoanalysis and related approaches, but it is well-known that this type of treatment is much more open-ended and unstructured. To maximize its effects, I was taught to give the following instructions right at the start:
"Your task is to say whatever it is that goes through your mind. When I have something to contribute I will say it. You may have questions, which I may or may not answer. This might be frustrating for you. But the more you are able to say whatever comes to mind the more progress we will make."
While I agreed that speaking your mind was probably a cornerstone of the treatment, I was always skittish at the idea of truly "analyzing" someone. At 25 with little to no life experience, a naïve view of the world, and bad hair, who was I to know the inner workings of the human mind? To compensate for my shortcomings, I spent the entire night before my first Freudian session trying to memorize the simple instructions so that I could recite them verbatim, likely lacking any compassion or empathy. I also wore a lot of hats.
My first "Freudian" client was a 22-year old woman who had come to the university clinic for relationship troubles with her boyfriend. This was leading to irritability and poor sleep. Having unsuccessfully memorized the above-mentioned paragraph I stumbled through something that sounded a bit like the above and, after listening to my prattling, she spoke.
"Okay, sounds good. Hmmm, what's on my mind today?" she said, and then began cogitating. "Hmmm..."
"Um, no," I said. "I don't mean to ask what's on your mind, I'm asking you to say what comes to your mind. There's a difference, albeit a subtle one."
"Oh, I see. Actually I don't think I get what you mean."
"It's important to understand that during the time you are pondering what to say, you are actually having all sorts of thoughts and images and ideas going through your mind. Our natural tendency is to filter what we say to others or to suppress thoughts that might be unpleasant or uncomfortable, but ideally you'll simply say everything."
"Are you saying that I'm thinking things when I'm thinking about what's on my mind?" she asked.
"Exactly."
"Is this true for all types of therapy or just this one?"
"Well, articulating your thoughts and feelings is important in any therapy, but the way we are discussing it here is unique to this approach."
"I don't know if I want to say just anything that pops into my head."
"Of course. That is completely understandable. It is more of an ideal to strive for to get the most out of the treatment. But the more you can say the better off you will be."
"Okay."
Pause.
"It seems clear that you are not saying what is on your mind."
"I'm just thinking about what I want to say!"
"Okay, that's not a bad start, but maybe you can...think aloud a bit?"
"Hmmm..."
"Just try not to..."
"God just shut up! You're breaking my concentration."
"I'm sorry, it's just that there's a certain way..."
"My dad and my boyfriend are always interrupting me and forcing to me to do things their way. You are annoying me. Men are annoying!"
Pearl of Wisdom (POW!): This is known as "transference," or the redirecting of feelings for a person (especially from childhood, such as a father) toward another person (often the therapist).
"Men are idiots!"
"Um...right. They are. Idiots that is." There was something important going on here (transference), but I was too stupid to recognize what it was in the heat of the moment. And then it hit me. POW!
"Well now we're getting somewhere!" I said.
I began to explain transference to her and how it was applicable here, but she was so steamed to the point of almost hyperventilating that I decided to deviate from protocol and do some basic relaxation training (very un-Freud-like). After she calmed down we discussed her transference reaction and eventually things began to click for her. She saw me as being oppressive and controlling which generated feelings of irritability and resentment. Although she wasn't accurate in her perception of me, discussing these thoughts and feelings as they were arising allowed her to step back and take stock. It allowed her to see her father and boyfriend's behavior more objectively as well as her role in choosing partners who were similar to her father. A few months later she told off her dad, broke up with her boyfriend and thanked me for making that possible. This made me a therapeutic hero. Or possibly a home wrecker.
While most therapists would say that it's important for you to share as much as possible, there clearly are no hard and fast rules on how to be a good patient (given that this woman's silence unpredictably led to an insightful moment). That being said, the more you can articulate what comes to mind the greater the likelihood for success. While your therapist may not always demonstrate complete competence (see above), if you say enough about what you are thinking, he or she will probably figure out something useful to say sooner or later...POW!
Posted by Rob Dobrenski at 11:58 PM