Walking in Both Shoes
A therapist learns from her therapist and from her patients.
Posted Dec 19, 2011
Several months ago, my therapist arrived three minutes late for our 8:00 AM Friday session two weeks in a row which was unusual for her. The thought entered my mind that she was late because she didn't want to see me, because our sessions had become boring of late, because she no longer cared about me. I have been seeing Dr. Adena* for just over six years. When we were deep in the throes of some intense issues I used to imagine that she took a deep breath before she opened the door to the waiting room because she so dreaded our sessions.
At almost five years in, my therapy had been stalled for several months. I was not making progress, I was slipping and sliding in and out of the anorexia, and frequently going to the emergency room for symptoms that seemed real to me, but most of the time turned out to be nothing. I sat in Dr. Adena's office sobbing because nothing in my life was going right. Through my tears I remarked "You must be so frustrated with me." I didn't expect her response as she nodded her head confirming one of my worst fears.
I was shocked and devastated, but it was one of the turning points in our therapeutic relationship; one that I would always remember. I was amazed that a therapist could have these feelings about a patient, much less acknowledge them aloud. Her admission of these feelings provided me with a new awareness of the importance of countertransferance and how valuable it can be in the relationship between therapist and patient.
I didn't start telling my patients that they frustrated me. I simply became more aware of my own feelings towards them and I began to examine why I was having these reactions. This process helped me to develop a deeper knowledge of myself and eliminate some of the blind spots. I was able to see if I felt bored or frustrated, how much of it was mine and how much of it was generated by the patient.
When I am several minutes late in going out to pick up a patient from the waiting room in our clinic, I need to ask myself why. I am aware that when Dr. Adena opens the door late even if it is just a few minutes, I feel cheated out of some of our time together. Conversely, I am aware my feelings of annoyance and frustration when as a therapist, I tell my patients, that we need to stop, that the session is over, but they stay seated in their chair and continue to speak.
After this happens several times, I address the situation as a matter of respect for the next patient. I tell them that I am sure they appreciate it when I am on time for them and that the next patient would appreciate it if I was on time as well. The majority of patients understand and change their behavior though it may take several gentle reminders.
I have learned to tell my patients when they inspire me. Offering the example of single mothers, I have been extraordinarily moved by their courageous stories all of which are different. I have never had children, a decision which I don't regret, but I do know that that parenting is the hardest job in the world, which I constantly reinforce with my patients. One Christmas season, I had a patient who was pregnant with her first child and in a tough financial situation, so I gave her a copy of "What to Expect When You're Expecting." Perhaps this goes against the convention of traditional therapy, but my decision was a practical one. I suggested she pass along the book to another woman who could benefit from it when she was done.
I have also learned to acknowledge my errors. This goes a long way toward building the therapeutic alliance. I had been in a bad car accident in which I totaled my car and suffered whiplash and a concussion, yet I went to work the next day. A patient of mine, a young man was talking about his friend Jacob.* During the next exchange, I called my patient Jacob. He became very angry and left the session prematurely. In our next session, we explored his anger and I told him the reason for my confusion. It was a tricky situation. His eyes filled with tears as I told him I had been in a car accident and suffered a concussion (I omitted some of the worst details). "Are you afraid that I might have died?" I asked and he nodded. We were then able to look at his fear of being abandoned by me and who else in his life had abandoned him.
Each patient is an individual and as I begin working with him or her I generate a new therapy for each patient. Therapy is not recyclable or repeatable. It needs to spring out of spontaneity. I believe in letting the patient lead, going where the patient goes. Tailoring the therapy to the patient, making it distinct to the person and unique is essential. This is how my therapists have always worked with me, this has been my role model and this is how I have always and will always work with my patients. I can't imagine working any other way.
For me the irony is in the inequality of the traditional psychotherapy situation. As a clinician I have many patients, but they have only one therapist. As a patient, I am one of many that Dr. Adena treats. I walk in both shoes and by far the more difficult to be in is one of many.
I take what I learn from each therapeutic encounter and consistently apply it to the other. The learning goes both ways. It's difficult to walk with only one shoe.
* Names have been changed