I am very grateful to Dysthymia Bree for writing this excellent review of an excellent book, which I can heartily recommend to anyone interested in the process and nature of psychotherapy. I read it a couple of months ago, and it was one of the few books which I wanted to pick up straight away and re-read, the moment I had finished it.
It was an interesting, informative and thought-provoking read, and for me, it played a crucial role in helping me to overcome some big obstacles I had been struggling with in my own therapy. Before starting with my current therapist, I had spent five months working with a psychodynamic psychotherapist to whom I formed a very deep and idealised attachment, despite the fact that I knew from the beginning, that our work was time-limited. For me, she came to define ‘the perfect therapist’, and the way in which she conducted therapy became the model I looked for in my subsequent experience. In consequence, my commitment to, and my relationship with my current therapist suffered, due to constant comparisons and very particular expectations on my part. I did not feel cared for or understood, and that fact led me to seriously consider leaving therapy (or at least therapy with her) on a number of occasions.
Reading ‘Psychodynamic Counselling in a nutshell’ had a profound impact on me, in that it really brought home to me, two key points about therapy.
Firstly, when my therapist withholds reassurance, she is not doing it because she is evil, difficult, controlling, or because she does not understand or care for me. She is not rejecting me or abandoning me, however much I may not understand the reasons for her withholding. Withholding reassurance can be immensely difficult for therapists, who may long to provide what they know is being sought from them, and who know that the implications of not providing it, may be that the client (temporarily) hates them or withdraws from them. Sometimes, providing reassurance may be the easy path, but not the one which has the longest-term therapeutic benefits. In those situations, far from acting uncaringly, the therapist is acting more like a loving parent, ‘holding’ the client in their distress while at the same time acting for their long-term benefit in order to try and teach them how to trust and to reassure themselves. Realising that not always rushing in with reassurance may sometimes be as difficult for my therapist, as it is for me when I don’t receive that reassurance, helped me to have a much more ‘human’ view of her, when I might otherwise be tempted to view her as callous and uncaring.
Secondly, the nature of short-term therapy is very different to the nature of long-term psychotherapy, and therapists use different strategies in each case. Some of the things I remembered and valued most about my ex-therapist, were the statements that she made which ‘bound us’ and ‘bonded us’ together (for example, talking about how we both recognised that we worked well together), and the things she said that made me feel cared for (for example, worrying about whether she had hurt me with something she had said, or offering me a ‘metaphorical hug’). I remembered the statements, and criticised my current therapist for the absence of similar statements, but what I never considered was WHEN those statements were made and WHY.
How quickly and successfully a therapeutic alliance can be made, is key to the success of short-term psychotherapy. My current therapist had the freedom to allow an alliance to develop gradually (which was particularly difficult given my attachment to my ex-therapist), whereas previously, a relationship had to be forged quickly, and my ex-therapist had to lead that process. As for the statements I treasured because they made me feel cared for – they may have occurred ‘only’ fourteen sessions in, but my fourteenth session was also my penultimate session. So although those statements felt as though they happened ‘early’ or ‘quickly’, it’s not the time elapsed that is significant, but the fact that they happened at the very end of our therapy together. The time-scales in long-term work are very different, and things unfold and develop at a very different pace and in a very different way. Direct comparisons between the two can be very unhelpful, and they certainly held me back for a long time, in terms of trusting and committing to my current therapist.
I am grateful that I came across this book recommendation when I did, as it contributed to changing the course of my therapy, and the view of my therapist. I hope that it may be similarly helpful for you!
October 23, 2014 at 7:15 pm
That book sounds interesting. I’ll have a look out. I remember my first encounters with therapy were not very successful. I think it helps to have a basic understanding of the therapeutic process, but a lot more depends on whether we are ready.
It’s easy to become judgemental and critical of the Therapist without realising that the unease originates within.
The first Therapist I tried was a devoted Christian. She let it slip out once that, in her opinion, maybe Jesus and faith can cure homosexuality. My second attempt was with a Therapist who barely spoke a word, even when I (metaphorically) reached out, he still sat there like a cold piece of meat. My current T is the exact opposite and it has helped me trust in him more. I’m not sure if I would want him to step in with any kind of comfort or opinion because I’d rather not know what kind of thoughts he has.
What would you class as short or long-term therapy? How long is your current?
October 29, 2014 at 9:54 pm
Completely agree Cat – a lot depends both on whether we’re ready for therapy, but also, once in therapy, whether we’re ready to hear particular things at particular times. I’ve been thinking a lot about this recently – about the power (or otherwise) of words, and what determines whether or not they have an effect. There may be a post in there somewhere, but I think it needs to simmer for a while longer! 🙂 But it’s true to say that when I posted the extract of the T. S. Eliot poem, ‘Waiting’, I loved the words, but didn’t really connect with what they (and my therapist) were trying to tell me. A few months down the line, with a bit more knowledge of therapy, and more trust in the therapeutic relationship, I think I understand the words a whole lot better. And yes YES, what a wonderful phrase: “It’s easy to become judgemental and critical of the Therapist without realising that the unease originates within” – such a hard hard lesson to learn and to keep learning, time and time again, but so important to remember….it’s interesting to hear that you’d rather not know what kind of thoughts your therapist has – only because I find myself constantly wondering what my therapist is thinking, and wanting to know. Although having said that, I am simultaneously terrified of knowing, and duck out of asking her all sorts of questions because I couldn’t bear to get an answer I wouldn’t like….As for silence, I’m still finding it hard to deal with, but at least when I reach out and say I’m struggling, my therapist does (usually) then say something. Peter Lomas, somewhat controversial British psychotherapist who died a few years ago, had ‘seven golden rules of therapy’, one of which concerns silence. The rules are somewhat tongue-in-cheek (deliberately funny but oh so true), meant mainly for other therapists, and they were read out at his funeral. I have wanted to put them in their entirety in a blog post, but I don’t think the laws of copyright would be on my side! If you want to look them up, they can be found on page 14, here: http://cambridge-psychotherapy.org.uk/wp/wp-content/uploads/2012/11/Vol-10.pdf . I’ve realised, after your question about short or long term therapy, that I probably used the wrong word, and should have said ‘short term’ versus ‘open-ended’. My current therapy is open-ended – my therapist has made a committment to me (life events permitting!) until I no longer need her – but to be honest, I’m petrified she will retire before that happens! With regards to short-term….I saw Jane for 15 sessions, and I guess I would think of that sort of length of time as short-term…is that what you were thinking? Is your therapy open-ended?
November 2, 2014 at 2:31 pm
Sorry for the delay in getting back to you. The reason why I don’t want to know what the Therapist is thinking is because it would then leave me privy to their opinion and might even sway the things I feel comfortable talking about. I think a good Therapist will have this in mind.
My therapy is for 18 month. Its Mentalization Based Therapy and we attend one individual session and one group each week. The programme is specifically for people ‘living with’ a Personality Disorder. So far so good.
November 3, 2014 at 9:47 pm
I’ve heard of MBT – it would be interesting to know how it compares to DBT. Having said that, I don’t have access to either, but am happy with pursuing psychoanalytic psychotherapy at the moment. I have huge admiration for those who undertake group therapy – I find the whole idea really scary! I can understand why you don’t want to know what your therapist is thinking – it makes sense that this would lead to worry about what they might think of things you might mention in future….thank you again for replying!