Book Review: Gift of Therapy (Part 2)
A page in the diary "Accept, Adapt and Appreciate: How?"
Written by nw4m Jan 10 2008 10:50 AM
If patients make an important and courageous therapeutic step, compliment them on it. If I’ve been deeply engaged in the hour and regret that it’s come to an end, I say that I hate to bring this hour to an end. And (a confession – every therapist has a store of small secret transgressions!) I do not hesitate to express this nonverbally by running over the hour a few minutes.
Often the therapist is the only audience viewing great dramas and acts of courage. Such privilege demands a response to the actor. Though patients may have other confidants, none is likely to have the therapist’s comprehensive appreciation of certain momentous acts.
For example, years ago a patient, Michael, a novelist, informed me one day that he had just closed his secret post office box. For years this mailbox had been his method of communication in a long series of clandestine extramarital affairs. Hence, closing the box was a momentous act, and I considered it my responsibility to appreciate the great courage of his act and made a point of expressing to him my admiration for his action.
A few months later he was still tormented by recurring images and cravings for his last lover. I offered support.
“You know, Michael, the type of passion you experienced doesn’t ever evaporate quickly. Of course you’re going to be revisited with longings. It’s inevitable – that’s part of your humanity.”
“Part of my weakness, you mean. I wish I were a man of steel and could put her aside for good.”
“We have a name for such men of steel: robots. And a robot, thank God, is what you are not. We’ve talked often about your sensitivity and your creativity – these are your richest assets – that’s why your writing is so powerful and that’s why others are drawn to you. But these very traits have a dark side – anxiety – they make it impossible for you to live through such circumstances with equanimity.”
All therapists will discover their own way of supporting patients.
..Support may include comments about appearance: some article of clothing, a well-rested, suntanned countenance, a new hairstyle. If a patient obsesses about physical unattractiveness I believe the human thing to do is to comment (if one feels this way) that you consider him/her to be attractive and to wonder about the origins of the myth of his/her unattractiveness.
In a story about psychotherapy in Momma and the Meaning of Life, my protagonist, Dr Ernest Lash, is cornered by an exceptionally attractive female patient, who presses him with explicit questions: “Am I appealing to men? To you? If you weren’t my therapist would you respond sexually to me?” These are the ultimate nightmarish questions - the questions therapists dread above all others.
It is the fear of such questions that causes many therapists to give too little of themselves. But I believe the fear is unwarranted. If you deem it in the patient’s best interests, why not simply say, as my fictional character did, “If everything were different, we met in another world, I were single, I weren’t your therapist, then yes, I would find you very attractive and sure would make an effort to know you better.”
What’s the risk? In my view such candour simply increases the patient’s trust in you and in the process of therapy. Of course, this does not preclude other types of inquiry about the question – about, for example, the patient’s motivation or timing (the standard “Why now?” question) or inordinate preoccupation with physicality or seduction, which may be obscuring even more significant questions.