Tuesday, March 23, 2010
...on being a therapist, part II...
Many great psychiatrists contend that "it is the relationship that heals". I would agree with that now. I did not realize this at first. You do the work of therapy, apply the concepts, make the interpretations, support the work of change - and as you do the relationship is what provides the healing.
At the end of a course of therapy (if appropriate) I like to ask the client, "What, if anything, made the difference for you in the work we have done together?" Rarely does anyone mention my 'amazingly insightful and astute interpretations', few mention any particular or timely interventions made, few seem consciously aware of a more adult point of view they now bring to their life ...
Most will say something to the effect of: "It was finally feeling understood." "It was how I was able to reveal anything and not feel judged." "It was how you accompanied me to hell and back." "It was seeing in your eyes that I had worth and that I mattered." Huh?, I would think. All those years of study and training, all the effort at understanding their inner dynamics and it was because I listened, sat there, looked at the person ... that was it?! Hmmmmm...... (I must admit that I had noticed that the less I said, the better I got!)
I used to be taken aback - after all the effort I had put into applying theories and concepts to their situation - after all the times I felt I had helped them develop more effective perspectives and behaviors to manage difficult situations - after all the times I had helped them come to terms with untenable situations - after all the support given while they effected change ... and it seemed to be the quality of my presence that helped them most.
Well, of course - Bonnie!!! As a student of Eastern philosophies how could you not have seen that?
(Buddhism and Taoism - many Eastern philosophies, are, in fact, very psychologically sophisticated.) So while you need to have acquired the concepts, the theories, the models, the protocols, the skills, the ability to understand, interpret and intervene ... what frequently matters most is the quality of presence you bring to the work. Your ability to be mindfully in the moment with the client - providing a safe 'holding' environment for the client. Simple attention and presence. Ready, able and willing to accompany them wherever they may need to go in their interior landscape.
Master psychiatrist Mark Epstein, M.D. (a Buddhist as well as a doctor) has written a few books on psychotherapy. His book, "Going On Being" is a little gem. He weaves the book around the work of child psychiatrist, D.W. Winnicott whose years of research were often whittled down to pithy statements about the relationship between mother (caretaker) and child. He encouraged caretakers of young children not to abandon and not to interfere. (There is so much to learn from those few words - but for today I want to share how they apply to the psychotherapeutic relationship.) "Don't abandon. Don't interfere." If the caretaker does either, according to Winnicott, it interferes with the child's "going on being" - the child's own private, precious process of learning, growing, developing, simply being. The caretaker needs to offer a reliable, predictable presence to the child. Presence. Mirroring. Accepting. This allows the child's innate nature to develop at its own pace, to not be cautionned at every turn, to not be interfered with by too much praise or too much instruction, to simply be.
Epstein rightly applied Winnicott's suggestions to the therapeutic relationship. Be there. Be in the moment with the client. Don't abandon. Don't interfere. Don't tell the client how to BE. Accompany them while they develop their own pattern of "going on being". In whatever field - when you get to the core principle - it is simple - it is pure - it is beautiful - and it works. Facilitate the client's 'going on being'.
You don't need to be a therapist to benefit from this insight. We can ask ourselves, what quality of presence do I bring to my relationships with my loved ones? One of the greatest acts of love is to simply pay attention. Full attention. Bringing our full, mindful presence to any exchange. Simple. Free. Doable. Loving.
Whether you talk to a painter, a photographer, a writer, an actor, a designer, a dancer - any kind of artist - they will all tell you that their work improves with the quality of attention and presence they bring not only to their art but to their life. Many clients have taught me that this is also true for the art of psychotherapy.