Friday, January 11, 2019

Misunderstandings in Therapy:


Recently, I prescribed a systems/cybernetic theory type intervention to a patient whom I had met with several times.  Later that night, the patient e-mailed me and accused me of treating him like Pavlov’s Dog and ended our therapy.  I was really saddened by this.  This, of course, was not my intention.  I felt bad because the patient read it that way and worse that he ended our therapeutic work because of this misapprehension.  I felt that we could have made some real progress with his situation if he had just taken the intervention as prescribed.

This is part of the problem with the cybernetic way of working in therapy, and with the modern (or is it post-post-modern?) world where the patient is now quite “educated” from reading things on the internet.  I have no problem with an educated patient or with people reading things on the internet.  But if you come to me, as a professional who has been doing this work for a long time, you need to relax a bit and know that I am working in your best interest.  Otherwise, you can read things on the internet and do self-therapy, or see another therapist who will take your money and keep quiet. 

I told the patient that this psychotherapeutic intervention might seem strange, but that its efficacy relied upon not questioning and just doing it (This is the way with much of psychotherapy.  It’s just that it usually passes without notice.).  He seemed enthusiastic when leaving the consulting room and I had the expectation that things would go very well.  The same patient, recently in Mexico from our burly, yet lacking, cousin to the north, was taking a shopping list of Big Pharma drugs to dull his senses.  The same patient had no problem when I gave him instructions for Vipassana meditation written by a Burmese monk in the 1940s.  What is the difference?

This is a point that has been troubling me.  It actually seems that there are people who contact me seemingly wanting to do therapy, but they don’t really want anything to change in their lives.  Wow!  Despite the old psychoanalytic literature I’ve read about “malingering” and “secondary gain,” this has all just come home to me!  There are people who seek therapy, not to be helped, but to have a conversation, to be with someone, to feel validated in their current state, and to validate and perpetuate their current state from which they say they want to be free.  Wow!  That’s a lot to take in.

Maybe it is my nature to accept people as they are, without judgment, and to not be cynical.  Because cynicism is very easy and very understandable.  But this is a revelation to me.

I am a psychotherapist, I am a scientist, but I have never simply, blindly practiced theory on others before first realizing the efficacy of an intervention on myself.  I, unlike most doctors, have never prescribed drugs to a patient that I have not taken myself, and the same goes with therapeutic interventions.  I see too many uncaring missteps in that area on a daily basis.  No, I would never do that.

The reason that I am a psychotherapist is that I want to understand myself, how I and my mind/body work.  I wanted to understand how to live, and to live well with others and with the world which we all inhabit.  Of course, this is an ongoing process.  I won’t bullshit you.  I have made a lot of progress, but I am not at the end of the search.  It is this practice that informs everything I do, in the consulting room or outside of it.  I want to be transparent.  I don’t want to be the typical psychotherapist of old that just listens and nods and lives their own depressing life in isolation.  No!  I am with you in this process! 

You are not Pavlov’s Dogs to me.  You are all brothers and sisters that I meet on the street every day.  And I want you all to be well, to feel the happiness and contentment that is the right of each and all of us.       


 I am a Scientist by Guided By Voices


I am a scientist - I seek to understand me
All of my impurities and evils yet unknown
I am a journalist - I write to you to show you
I am an incurable
And nothing else behaves like me
and I know what's right
But I'm losing sight
Of the clues for which I search and choose
To abuse
To just unlock my mind
Yeah, and just unlock my mind
I am a pharmacist
Prescriptions I will fill you
Potions, pills and medicines
To ease your painful lives
I am a lost soul
I shoot myself with rock & roll
The hole I dig is bottomless
But nothing else can set me free
and I know what's right
But I'm losing sight
Of the clues for which I search and choose
To abuse
To just unlock my mind
Yeah, and just unlock my mind
I am a scientist - I seek to understand me
I am an incurable and nothing else behaves like me
Everything is right
Everything works out right
Everything fades from sight
Because that's alright with me
--R. Pollard