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Weekly Report vs. Psychotherapy

Outside, Inside & Between in Therapy

Jane gets started:

"Ok, well, I saw you last Wednesday, and that night Sally and I went to a restaurant near her house. She knows the bartender there and he seemed pretty nice. Anyway, that was Wednesday. On Thursday morning they sent a memo around work saying......

(Jane continues reporting her week for the next 45 minutes) then this morning I emailed her and said I wasn't coming to the party, but she hasn't written back. And that's my week. Oh no, time's up! We didn't get to work on anything!"

Jane spent the whole session rehashing her week. I know a lot about what happened to her, but very little about what's going on inside. Many therapists would interrupt Jane to push deeper into a certain event or ask if there's anything in particular she'd like to work on. Others would let her keep talking, assuming she will eventually come to the most pressing point. Sometimes that point never comes.

As I've said before, the session is yours and you can use it however you'd like. For some people, reporting the week is all they want. Therapy is purely their sounding board. They check in with the therapist, let her know what's happening and repeat next session. It's a verbal rehash of their iCal. The therapist is like an expensive breathing journal that says "uh huh" and "mmmm."

While rehashing is certainly allowed, clients who only report shouldn't expect to see a significant change in their thoughts, feelings or behaviors as a result of therapy. They may feel the satisfaction of being heard and might solve some external conflicts while thinking aloud, but there's nothing inherently transformative about checking in. In fact, it may be a way to resist the deeper material. If she talked about her feelings regarding the bartender or the work memo or how she felt about coming today, Jane could discover some painful memories or truths about herself deep inside, so she skipped along the surface, all headlines and no articles.

In order to go deeper the discussion needs to move from outside to inside or between. I'll define my terms:

Outside: Events outside the session that impact your life directly or indirectly. This includes world news, situations at work, interactions with friends and family, what you've seen in books, movies, TV shows, what happened on the way to the session or something your mother said. It's what's going on in your environment.

Inside: Everything you're noticing, discovering or understanding about yourself. It includes your own thoughts, feelings, concerns, attitudes, wounds, strengths, memories, dreams, wants, needs, beliefs and opinions. While the inside is influenced by the outside, these realizations are uniquely your own.

Between: The relationship you have with your therapist, including all the feelings, beliefs, history, conversations, conflicts, assumptions, rituals and customs you share.

In order for significant change to happen, we need to pop the hood and look inside. Talking about the outside (the stupid thing your jerk brother did yesterday) has the least amount of personal disclosure or vulnerability, and therefore less capacity to provide deeper understanding of yourself. Talking about what's going on inside (how you feel about your brother's behavior, how you can be a jerk sometimes, too) is more personal and can give insight into who you are. Discussing the relationship between you and your therapist (how it feels talking about your family here, how you experience your therapist as a jerk like your brother) is the most vulnerable and intimate, giving valuable information not only about you, but how you relate. It's what's called talking about the "here and now." It's when therapy becomes a laboratory where you're addressing thoughts and feelings with another person in the moment.

Most of the time, therapy sessions start with outside talk and move inside. For example, a client first reports being overlooked for a promotion and then moves to discussing the hurt and rejection he felt, maybe even memories of similar rejections in the past. This could become a between discussion too: talking about how the therapist's two week vacation also left the client feeling hurt and rejected. There's no formula here, clients can dive straight into inside or between talk from the beginning. I find talking about outside issues is only useful to the degree that it provides material for inside or between work.

If you think your therapy has reached a plateau or you're feeling stuck, take a look at the content of your conversation. Are you sharing what's going on inside, or are you rehashing your weekly calendar? This is not the only cause of stuckness, but it is a common one. I once suggested coming to therapy 10 minutes early and reflecting on the question "what am I noticing about myself this week?" This takes the session directly to inside discussion, bypassing the stories of the outside altogether. Or you can start with a between question like "how do I feel about therapy today?"

I like making progress so I'm biased toward inside and between work. Save the rehash for friends and family. Tell your therapist what's really going on.

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