From One Therapist to Another: Do No Harm
Potential Hazards in Individual Psychotherapy Part 1
Having been trained as a family therapist, I like to think from a systems perspective even when doing individual therapy. Some of you may have attended a workshop that I do titled Conducting Individual Therapy from a Systems Perspective: Being on Your Client's Side Without Taking a Side where I talk about some potential hazards inherent in individual therapy.
The subtitle of this workshop came to me as I was supervising staff and students who were so focused on listening to and validating their client (seemingly helpful endeavors) that they naturally wanted to believe everything they were told (potentially harmful endeavor). They often sided with the patient, even when the patient’s perspective was distorted or was a projection of false narratives. Such an endeavor, though well meaning, may leave clients stuck in personal narratives or beliefs that may be ruining their lives. I propose that we try not to take a side in sessions and minimize the time we spend validating our clients. I've written before about how therapists can mistakenly use validation in a way that's not helpful. We don't have to believe or disbelief what we're being told, that's not really our job or even within our power. But there are so many more powerful things we can do!
Walking into our staff room, I would often hear comments made from one therapist to another such as "I can't believe her mother said that to her!" or "His dad doesn't believe in psychotherapy." The person speaking was unintentionally taking a side against a someone in the cient's interpersonal realm. I found myself jokingly asking if they actually had heard the comment or even met the person to whom the patient was referring. At team meetings, I often interjected, “allegedly” when staff would share stories about the patient or his past that involved another person. No person's perspective is completely accurate and if the clients’ perspectives were always accurate, they probably wouldn’t need to be in therapy. Supervision often became primarily about teaching staff and students how to be on their client’s side without taking a side. When we validate a perspective, even subtlely which is not fully accurate:
Valuable therapy time can be wasted chasing the client
down well-worn paths, possibly even ingraining them further,
rather than empowering the client to
shift their thinking or perspective to be more effective.
This topic is difficult for many therapists to acknowledge, and is even more difficult to recognize when it is happening. So what do we do instead? The next few blog posts i write will focus on various tenets of systems theory to talk about how to reduce the possibility of negative consequences when doing individual therapy.
The first tenet to keep in mind is that people live in interpersonal systems and no one in the system has a completely accurate perspective of the whole. I was working with a woman recently where I forgot the importance of this. Mandy was married and was working on finding balance in her life as she tended to feel like she had to be accomplishing something at all times. She made a goal to take about 30 minutes for down time each day when she got home from work rather than jumping straight into other tasks which needed completing. She was pleased with herself as she told me that she had been doing this most days for the past couple of weeks.
However, a couple of days later, I received a call from her husband who was very alarmed, telling me that she was depressed and that therapy was not helping, it was making her worse! His evidence of this was that she was coming home from work, going straight to the couch and turning on the TV, a behavior that he had never witnessed in their marriage. He also wanted her to speak with a psychiatrist about antidepressant medication. When he mentioned these things to her she heard it as a complaints and criticism that she was taking some time for herself.
Although his perspective fit the facts both current and past, they were not the full perspective. He and his wife had very different perspectives on what was occurring when she was sitting on the couch after work. Plus she was projecting her ambivalence about relaxing onto him when he expressed concern assuming that it was criticism. Had he not reached out to me, no telling what misconceptions could have continued to fester. I had not taken into consideration a couple of tenets from systems theory that I actually pride myself on knowing and even teach to others some of which are:
- offers a way of looking at the world in which objects are interrelated
- focuses attention on the connections between relationships
- holds that change in one part of the system affects other parts
Fortunately, he did reach out to me and we had a few conjoint sessions where Mandy shared her goals in treatment. He was then able to express support for her goals as opposed to how Mandy had first interpreted his reaction to spending more time relaxing. I sometimes wonder if there have been other times where I unknowingly participated in helping one part of an interpersonal system change without considering the consequences which then strained the relationship. Keeping tenets of family systems in mind will minimize the likelihood of this happening.
My book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side can teach you how to avoid taking sides when working with your clients by developing skills to work directly on resolving ambivalence and rewriting old narratives. I would love to hear from you. Please scroll down to the bottom of this page (past the banner of recent posts) to leave a comment.