From One Therapist to Another: To Return or Not to Return
Updated: Aug 23, 2021
Feeling ambivalent about returning to seeing clients in your office? You may be feeling even more pull to return (if you haven't already) with the recent tragic events that have triggered pain for so many. There are therapists I greatly admire who have never stopped going to the office and others who I admire just as much who are not even considering going back until September.
How can the opinions vary so widely among very thoughtful, caring and intelligent people?
I believe because there is so much wisdom on both sides of the coin and so many individual factors to consider. This is generally the case when ambivalence rules. I’ve read on list-serves a huge debate, sometimes a little heated, about what therapists should do. My supervisees have also expressed ambivalence about how to know what’s the right thing to do. I know I’m feeling very ambivalent myself. I mean I wrote the book on ambivalence! Actually I did write a book for clinicians on dealing with client's ambivalence but I've also struggled with it my entire life.
In this post, I won’t be offering an opinion on whether you should go back to the office but I might be able to offer a couple of suggestions on how to move through your ambivalence to enable you to make the best decision for you.
It is part of human nature to experience ambivalence due to the complexity of our personality. Just consider all the phrases we have for it:
Of two minds, I’m torn, It’s a dilemma, the jury’s still out, waffling, it’s debatable,
vacillating, wavering, having a foot in both camps, hem and haw, it’s a quandary,
sitting on the fence, in limbo, wishy washy
I love the scenes from Fiddler on the Roofwhere Tevye expresses his ambivalence while talking with God by saying “on the one hand … but on the other hand…”In one famous scene he says it about six times (of course we don’t have that many hands) and in frustration he finally exclaims, “No! There is no other hand!” Ever felt like that? I sure have!
In one of my group consultation meetings, ambivalence about returning to the office came up for discussion. A particular therapist was considering her options and volunteered to participate in an Empty Chair Exercise to help her understand why she was stuck. This is my very favorite exercise for working with clients who have ambivalence, and it is also an amazingly powerful exercise for us when we feel torn as well, and can often be done in just a few minutes.
I suggested that she have the part of her that wanted to return to the office talk with the part that didn't yet want to. As the part of her that wanted to return to the office spoke (imagining the other part across from her in the empty chair), she recognized reasons related to
1) an adventurous spirit that enabled her to act in spite of fear which she greatly appreciated,
2) a desire to help others and
3) a need to please people.
The part of her that did not want to return to the office expressed
1) the concern of potential consequences of hurting herself, her clients or her children and
2) feeling like she was being pushed by the other side to do something that she didn't want to do.
In participating in a conversation with herself, she increased insight into the layers behind her ambivalence. She was able to see that the thoughts and feelings on both sides were understandable. In the group discussion that followed, it was noticed that one of her motivations was from an old script from childhood which stated "I need to please others". When she considered this from an adult perspective and was able to clear that part of the motivation aside, she was able to come up with a reentry plan and time line that honored both sides of her dilemma. In about 20 minutes she was able to move forward on an issue that she had been struggling with for days if not weeks.
When feeling ambivalent, the first thing to do is determine which thoughts are related to false narratives or scripts from childhood (we all have them, right?). Validate them as understandable and then consider the dilemma if you put the old scripts aside for the moment. You will then be accessing your wisdom without the old scripts interfering.
When introducing the Empty Chair technique I ask, “Would you be willing to try an experiment with me? It’s a little odd but it can be very revealing.” I structure the exercise by reviewing the concept of parts or ego states, if needed, and by normalizing the experience of ambivalence. The goal, then, is to take the conversation out of their head and into the room in order to help them see it more clearly and understand why they are stuck.
Next, the participant is asked to describe the ambivalence in terms of “one part of me wants or thinks… while another part wants or thinks…” The participant will choose which part they want to have speak first and when that part is finished, they will then move to the other chair to allow the other side to speak. I am very active as a “coach” during this exercise, helping the person to avoid unintentionally switching sides and providing sentence stems as needed to facilitate a thorough expression of both sides. I recommend starting with whatever they’d like to say and then providing sentence stems when they pause. The sentence stems which I most commonly use are:
What you don’t understand …
When you tell me _______, I feel …
What I wish you’d do differently …
When you say/do that, it reminds me of (what or whom?) …
If I listen to you, I’m afraid that …
I understand that you feel …
Although empty chair is a very powerful exercise, often leading to new a deeper awareness, another strategy that I most often use with myself when I am ambivalent is compromise because it takes about two seconds.
I used to try to figure our which was the best option when I was ambivalent. This often just kept me stuck because I couldn't decide. If I tried to take one side, the other side just seemed to speak louder. It was like playing a game of ping pong in my head.
I have grown to trust myself that if I'm ambivalent there is wisdom on both sides and instead of wasting energy trying to decide, it often works best for me to look for the compromise in the middle. For instance, my husband and I generally walk our dog every evening. If I am tired and feeling ambivalent about the walk, i can quickly decide to just take a shorter walk, thereby honoring both sides of me. This strategy has saved me so much mental energy.
My hope is that you find the answer about your practice that is right for you and that these strategies might help you get to your answer with less anxiety. I have recently completed a workbook on Dealing with Ambivalence which can be used as a companion to the Clinician's Guide to Pathological Ambivalence. Please check them out!
Blessings for peace and health, Linda
*(unless otherwise noted, images licensed for use by shutterstock.com)