You can't just cancel therapy during allergy season

The education, training and development for young therapists is changing rapidly. They are receiving more training in how to address and monitor issues related to psychiatric medications, in coordinating with medical providers, and far more training in evidence based services.

But, young therapists today lack any knowledge or confidence in what to do if their client farts during therapy! Therapists today don’t even seem willing to consider the therapeutic implications of this very important issue. They seem to think that bodily functions, fort both them and their patient turn off at the therapy room door.

Some of these things are “gross,” and unprofessional! We’re not supposed to talk about them. We’re therapists man, we deal with the mind! It’s even rather impolite, improper, edgy and challenging that I’m writing about this.

But, these things happen. Our patients are human, and we therapists, well, we are even more human sometimes. Yoga therapists talk about farting during classes - why don't therapists? When we don’t talk about these things, we perpetuate the myth that therapists are infallible, and that the things that aren’t discussed, don’t need to be discussed. I disagree. I think in fact that the things we don’t talk about, are exactly the things we need to explore.

  • Stomachs rumble. Especially the therapist’s stomach, when it’s been a long day, packed sessions and meetings, and you couldn’t squeeze in time for lunch.
  • Sinuses get clogged, even when no tears are falling. Sneezes and colds happen, on both sides of the couch.
  • Sometimes, somebody’s gotta make a pit stop to the rest room, even in the middle of therapy.
  • Sadly, some of the things in our noses don’t always stay hidden where they should be. It’s hard to carry on therapy, when you’re focused on a booger in your patient’s nose, or worried that one is dangling from your own.

These are terribly amusing, but painfully funny situations. A friend told me a story once, of seeing a therapist who insisted on having her dog (a pseudo-therapy dog – don’t get me started on that debacle) in the therapy room. Unfortunately, the dog had a stomach condition, and tremendously odiferous emanations, to which the therapist was apparently immune. Sadly, my friend, the patient, was not.

These are silly situations, but I’ll be honest, I believe they are the test of therapeutic skills. They are opportunities to engage with patients, at a human level. I recall reading once, where a famous psychologist recalled with horror when he once urinated a stall, next to one of his mentors. The writer was stunned and shocked at the realization that his idol was human, with human conditions and needs. But that writer, Maslow, I think, used that opportunity to examine and consider his view of the world, and his place in it.

So, here you go. Based on many years of real-world experiences, this is what you consider in these situations:

Interrupting therapy to go to the bathroom?

When you have to go to the bathroom

  • If you can’t hold it easily, it’s better to excuse yourself to the restroom. Your therapeutic focus needs to be on your patient, not your bladder and bowels.
  • But, then you have to ask yourself if it’s safe to leave the patient in your office? Any protected health information in there? Can an adolescent patient get on your computer and look at porn that you will have to explain to your IT department and boss?

When your patient has to go to the bathroom

  • Let them go to the bathroom. Extend the session to compensate for it. Be glad that they had the ability to let you know they needed to go, and didn’t sit there agonizing, unable to concentrate on the therapy.
  • But if it happens more than once, you’ve gotta start to wondering what’s going on? Is the therapy too intense? Are they using the bathroom as an escape?
  • If you’re an attractive female therapist, and you’ve noticed an adolescent male goes to the bathroom during or after therapy, it’s probably time to have a therapeutic discussion about attraction. Seriously. Can’t count the number of times I’ve seen this in therapists I supervise.

When your body, or theirs, is a distraction during therapy

  • Who is it distracting? If it’s you that it is distracted, then you the therapist need to examine what’s going on here. Are you having countertransference towards this patient? Could you ignore that booger in another patient’s nose?
  • Do daily living skills and hygiene need to become part of this patient’s treatment? Are they aware of how the world sees them and reacts to them? Will they give you permission to start working with them on these issues, and can you do so in a therapeutic way?
  • Do you need to start seeing this patient in a special room, rather than your regular office? I’ve had homeless and psychotic patients, whose body odor lingered so much, that we had to do therapy in a different room, or even outside. Can you do that, schedule or arrange it, in a therapeutic, empathic, but respectful and responsible way?
  • If it’s your body that is doing the distracting, then it might be time to have that discussion with your patient, about how human you the therapist are, and that their belief in your infallibility could actually get in the way of good therapy.

"You and I both know there ain't a thing I can do about it (passing gas)"

When somebody passes gas in therapy

  • Is it more empathic to ignore it, or comment on it?
  • Should you pretend it doesn’t bother you?
  • Should you the therapist claim it or pretend it didn’t happen?
  • Flatulence can be connected to gastric distress, to some medications, and to nervousness. Don’t just “pass this off” too lightly.
  • Is the patient aware of it, present enough in their own body that they noticed it?
  • Are they sitting there laughing, or are they horrified? Are they paralyzed with shame, or dying of the giggles? In either case, this can be a therapeutic opportunity, a time and a place to join with your patient, to understand their emotional internal world, and help them express and manage it.

We therapists are human, as are our patients. It is through our shared humanity that we are able to facilitate healing. We help people, through empathy, self-awareness, acceptance, and the courage to observe and comment on things that others do not. Our society treats many bodily experiences with shame, disgust and feigned ignorance. It is truly a therapeutic gift, when we are able to help a patient to break free of those suppressive social messages.

Got stories of your own, of humanity intruding into the therapy session? Share them in the comments! You can follow Dr. Ley's musings on therapy, sex, and the business of mental health on Twitter @DrDavidLey

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