Feeling Our Way

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A Simple Test of Therapy

Complain about something annoying and see what happens.

I used to ask groups of graduate students a couple of questions about their own therapies, the answers to which left me so disheartened that lately I’ve just skipped the exercise. They went like this: Can you think of something your therapist did that annoyed you? (Everyone answers yes.) Did you tell your therapist about it? Exceedingly few students ever answered yes to the second question. So I rarely got to ask how the therapist managed the complaint.

Two people cannot be in the same room for more than a few minutes without experiencing some conflict (incompatible goals). (Freud would say the same of one person.) They certainly cannot spend much time together in a power differential like therapy without encountering the problem of whether the patient is going to be marginalized or disqualified for having an agenda different from the therapist’s party line. In therapy, the duty of the person in power with respect to the marginalized voice is paramount. This is because so many therapy patients are in therapy because they were marginalized by others and now marginalize themselves; one way or another, therapy patients are constantly telling some part of themselves to shut up and go to its room (or worse). The cure for this way of treating the self is a welcoming attitude toward all that is human in us. The cure is accomplished by developing a therapeutic relationship in which all aspects of the self (if represented verbally and emotionally) are welcome. This leads the patient to developing a welcoming attitude toward herself when she is on her own, because she learns in exposing these marginalized identity elements that they are not so aversive after all. (The attitude of acceptance will transfer only if the therapist is ambiguous enough; otherwise, the patient concludes that the therapist is especially saintly and not that the patient is acceptable.)

This is the second major frame element in psychotherapy, a welcoming attitude. It’s what Frieda Fromm-Reichmann meant when she said, apocryphally, “Wear old clothes,” after a trainee asked her what to do when the patient wants to smear feces on you. As noted, the kind of therapy I am writing about is one that requires patients to stay in their chair and use words and minor frame deviations to express themselves. So “wear old clothes” stands as a metaphor to describe an attitude, not literal advice.

Good therapists communicate that the patient’s complaints are important—not by asking for complaints, which usually garners assurances that everything is fine or attempts at obedience by reporting very minor annoyances. Good therapists inhabit a welcoming posture, and they detect complaints even without being told, through empathy and the interpretation of metaphors. They use the content of complaints to explore the meaning for the patient, partly to reflect on the patient’s problematic patterns and partly to understand exactly and specifically how the patient experienced the annoyance, so that any ensuing remedies are specific to what needs remedying. Then, the therapist changes the things that ought to be changed (in the direction of fostering a therapeutic frame), helps the patient reconcile herself to the things that constitute a therapeutic frame, or helps the patient reconcile herself to the deviations in the frame that cannot be remedied.

So if you want to know if you are in a real therapy, or a real relationship for that matter, complain about something annoying and see what happens. The same goes for democracy, by the way, which is why the right to complain is in the First Amendment, along with freedoms of speech and religion and assembly. You never know if you are in a democracy until you complain and discover whether you will be listened to or silenced.

Michael Karson, Ph.D., is a professor of psychology at the University of Denver.

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